Board of Directors€¦ · 08/01/2013 · Board of Directors 8 January 2013 9.30am MIDRU Birmingham Heartlands Hospital HELD IN PUBLIC. Board of Directors anuary 2013 .2 Agenda.01

Agenda

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Apologies

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Part Two

Declarationof

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Apologies Minutes Matters Arising

Chairman'sReport

Chief Executive's

Report

External and

Strategic Review

Patient and Public

Feedback

Safety, Governance

and Risk

Council of

Governors

Any Other

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Board Commitee

Reports

Part Three

Financeand

Performance

Board of Directors 8 January 2013

9.30am

MIDRU Birmingham Heartlands Hospital

HELD IN PUBLIC

Board of Directors January 2013

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Agenda

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Apologies

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Chairman'sReport

Chief Executive's

Report

External and

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Patient and Public

Feedback

Safety, Governance

and Risk

Council of

Governors

Any Other

Business

Board Commitee

Reports

Part Three

Financeand

Performance

PART ONE:

1. APOLOGIES

2. DECLARATIONS OF INTEREST (Enclosure)

3. MINUTES:6 November 2012

(Enclosure)

4. MATTERS ARISING (Enclosure)

5. CHAIRMAN’S REPORT (Enclosure)

6. CHIEF EXECUTIVE’S REPORT (Enclosure)

7. EXTERNAL AND STRATEGIC REVIEW (SH) (Enclosure)

8. PATIENT AND PUBLIC FEEDBACK REPORT (LT) (Enclosure)

9. FINANCE AND PERFORMANCE 9.1 Finance and Performance Committee Report (LL, AS)9.2 Business Case Approval – Yardley Green Road (AS)9.3 Annual Business Plan Update (Q2) (SH)

(Enclosure)(Enclosure)(Enclosure)

10. SAFETY, GOVERNANCE AND RISK 10.1 Governance and Risk Committee Report

(inc Safety Sitrep Update & Board Assurance Framework) (AE, SW)10.2 Norovirus Update (MS)10.3 Hollier Team – TeamSTEPPS Training Update (SW, SH, JS)10.4 Organ Donation Annual Report (RH)

(Oral & Enclosure)

(Oral)(Enclosure)(Presentation)

11. BOARD COMMITTEE REPORTS11.1 Audit Committee (RH)11.2 Stakeholder and Community Engagement Committee (NH)

(Oral)(Minutes)

12. COUNCIL OF GOVERNORS Report from last meeting (PH) (Oral)

13. ANY OTHER BUSINESS

PART TWO:

14. IM&T UPDATE (AL) (Presentation)

15. GOOD HOPE HOSPITAL REPORT (SM) (Enclosure)

16. SOLIHULL HOSPITAL AND COMMUNITY SERVICES REPORT (CM) (Enclosure)

17. HEARTLANDS HOSPITAL REPORT (MN) (Enclosure)

PART ONE:

1. APOLOGIES



(Enclosure)










(Oral & Enclosure)



(Oral)(Minutes)



PART TWO:





PART ONE:

1. APOLOGIES



(Enclosure)










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EXCLUSION OF THE PRESS AND PUBLICThe Board will be asked to resolve “That representatives of the press and other members of the public be 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”.

PART THREE (PRIVATE)

18. 18.1 GROWTH STRATEGY REVIEW (MN/PH)

18.2 ASTON UNIVERSITY (MN)

18.3 UNIVERSITY of BIRMINGHAM – PRE-REGISTRATION NURSE EDUCATION (MS)

18.4 MR IP UPDATE (LT)

18.5 COMMUNITY PATHOLOGY TENDER (SH)

18.6 NOMINATIONS COMMITTEE (PH)

(Oral)

(Oral)

(Enclosure)

(Enclosure)

(Enclosure)

(Enclosure)

DATE AND VENUE OF NEXT MEETING – 5 March 2013, Education Centre, Heartlands Hospital

PRESS AND PUBLIC ARE WELCOME TO ATTEND THIS MEETING AS OBSERVERS ONLY

PART ONE:

1. APOLOGIES



(Enclosure)










(Oral & Enclosure)



(Oral)(Minutes)



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1. APOLOGIES



(Enclosure)










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Welcome

January 2013

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ApologiesApologies

January 2013

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Declaration of Interests


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REGISTER OF DIRECTORS and REGISTER OF DIRECTORS’ INTERESTS

VOTING TRUST BOARD MEMBERS

NAME DATE OF APPOINTMENT INTEREST (if any) DATE OF

NOTIFICATIONDATE OF

TERMINATION OF INTEREST

Dr Aresh Anwar 01.03.11 1. South Asian Health Foundation : Member of Diabetes Working Group

01.03.11

Ms Anna East 01.07.0501.05.10

01.09.1001.08.1201.04.12

1) Director of Dudley Building Society2) Non Executive Director Midland

Heart Housing Association3) Regional Panel CEAA4) Chair of Dudley Building Society5) Non Exec Director of Entrust

01.01.0825.10.10

25.10.1013.10.1113.10.11

Mr Simon Hackwell

01.03.07 1) Board Director for a 1 year term of office at MidTECH - one of a network of nine regional NHS innovation hubs, established by the Department of Health to identify, protect and commercialise innovative ideas from within the NHS.

2) Director on the interim board of the West Midlands Academic Health Science Network until April 2014.

09.10.09

10.10.12

26.06.2012

Ms Najma Hafeez 01.04.07 Chair of Postwatch 01.01.07 30.10.08

Mr Richard Harris 01.05.08

14.09.10

1) Brambles Limited Shareholder and Chair of UK Pension Fund

2) Trustee of Action for Children Superannuation Fund.

3) Birmingham Community Foundation Trustee

4) RSA Academy - Governor5) Flora Forster Students’ Fund

Trustee6) Director and Shareholder, Gorilla

Box Limited.7) President, Solihull School Parents

Association8) Richard Harris’ wife is a volunteer

WRVS worker at Solihull Hospital (half a day per week)

9) Non executive director of Simplyhealth Group Limited

10) Member of the Audit & Risk Committee of the RSA (Royal Society for the encouragement of Arts, Manufactures and Commerce).

11) Trustee of StartHerea charity based in West London engaged in developing information databases on health, social services, housing services and a range of other information, all targeted at people in need, and in particular accommodating people who do not have access to computers or who are not computer literate.

01.05.08

01.05.08

01.05.08

01.05.0801.05.0804.08.09

04.08.09

04.08.09

19.07.10

4.11.10

29.11.11


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Mr Paul Hensel 01.08.05 1) Paul Hensel’s wife has been appointed as a non executive director of the Royal Orthopedic Hospital. No conflict is foreseen but it is registered for the sake of good order.

2) Non Executive Director of Kplus Software Limited (small company involved in development and delivery of Mobile Data Solutions)

3) Non Executive Director of the John Taylor Hospice

30.01.07

22.02.07

08.02.12

01.08.07

Rt Hon Lord Philip Hunt PC OBE

01.10.10 1) Member and Deputy Leader of the Opposition, House of Lords

2) Self-Employed Consultant on NHS and wider health issues, t/a Phillip Hunt Consultancy

3) Trainer and Policy Analyst, Cumberlege Connections Ltd. (NHS leadership/awareness programmes)

4) Philip Hunt Consultancy consultant and trainer,

5) President, British Fluoridation Society

6) Trustee, Terrence Higgins Trust7) President, Royal Society of Public

Health8) President, Health Care Supply

Association9) Chair, Birmingham University

Policy Commission on Nuclear Energy

10) Member of the National Advisory Council of the Easy Care Foundation

11) Chamberlain Sixth Form College (where Lady Hunt is Vice Principal)has occasionally since 1993 utilised the services of HEFT OH Dept. There is no formal contact, neither Lord nor Lady Hunt are involved in the arrangement and the value is approx £1,500pa

12) Patron/Ambassador of Saving Lives

13) Lord Hunt’s wife, Selina Stewart,Vice Principle at Chamberlain Sixth Form College, is working with HEFT on a volunteer programme.

11.10.10

11.10.1011.10.10

26.04.11

June 2011

June 2011

01.10.2011

17 Oct 2011

Nov 2011

03.01.2012

17.08.11

03.07.2012

03.07.2012

Mr Les Lawrence 01.04.12 Nothing to declare

Dr Mark Newbold 01.08.10

01.08.12

Oct 2012

Nov 2012

Nov 2012

1) Member of Multidisciplinary Professional Advisory Panel of BabyLifeline (Charity)

2) Governor on the Council of Aston University

3) Chair of the NHS Confederation Hospital Forum

4) Member of the BMA Medical Manager Committee

5) Governor of Waverley School (November 2012

01.01.2012

01.08.2012


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Prof Edward Peck 01.04.12

Nov 2012

1) Pro-Vice Chancellor, Head of College of Social Science at the University of Birmingham

2) Wife is the chair designate of the proposed organisation to deliver community health services in Gloucestershire

3) Councillor for Birmingham Chambers of Commerce

Nov 2012

Prof LauraSerrant-Green

01.04.12 Nothing to declare

Mr Adrian Stokes 01.07.08 (as voting board

member)

1) Director of HECL2) Pfizer Virtual Customer programme

1) On app’t2) 20/6/2011

Ms Mandie Sunderland

01.12.08 Nothing to declare

Dr Sarah Woolley 07.05.07 Energy & Home Condition Surveys Ltd – Company Secretary

16.03.07 July 08

REGISTER OF INTERESTS

NON VOTING TRUST BOARD MEMBERS

NAME DATE OFAPPOINTMENT

INTEREST (if any) DATE OFNOTIFICATION

DATE OF TERMINATION OF INTEREST

Mr AndyLaverick

Nothing to declare 18.12.08

Mrs Claire Molloy

01.05.11 Nothing to declare 01.05.11

Ms Susan Moore

01.09.2011 Nothing to declare 01.09.11

Mr John Sellars 08.01.07 Nothing to declare 16.04.08

Ms Lisa Thomson

23.10.08 1) Non Executive Director of Multistory

2) Trustee of a charity ... Redditch United Football In the Community

22.12.08

07.11.11


January 2013

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Minutes


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Minutes 6 November 2012

Minutes of a meeting of theBOARD OF DIRECTORS

of Heart of England NHS Foundation Trust held at the St John’s Hotel, Solihull on 6 November 2012

PRESENT: Lord P HuntDr A Anwar Mrs A EastMr S HackwellMs N HafeezMr R HarrisMr P HenselMr L LawrenceDr M NewboldProf E Peck Prof L Serrant-GreenMr A Stokes Ms M SunderlandMrs L ThomsonDr S Woolley

IN ATTENDANCE: Ms C Jinks

Mrs A Hudson (Minutes)

Members of the Public

12.070 APOLOGIES and WELCOME

There were no apologies received.

12.071 DECLARATION OF INTEREST

The declaration of interests were received and the following items noted:

Dr Newbold:• Chair of the NHS Confederation Hospital Forum (October 2012)• Member of the BMA Medical Manager Committee (November 2012)• Governor of Waverley School (November 2012)

Professor Peck:• Council for Birmingham Chambers of Commerce

12.072 MINUTES OF PREVIOUS MEETINGS

4 September 2012

The minutes of the meeting held on 4 September 2012 were approved by the Board and signed by the Chairman.


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12.073 MATTERS ARISING

The Schedule of Matters Arising was reviewed and the following actions noted:

11.98.11 Harrop Inquest. Dr Newbold informed the meeting that all actions highlighted by the Coroner had been completed. Dr Woolley advised that she had made enquiries with the Coroner and no further action was being undertaken at the present time. It was agreed that this item could be discharged from the agenda.

12.020.9 Board Strategy Session to consider implications of Francis report on Mid-Staffs. It was noted that this report was now scheduled for publication inJanuary 2013 and a Board Strategy Session would be allocated to this.

12.050.05 Reshaping HEFT Update with related Workforce Plan. Mr Hackwell would present a discussion paper to the Board Strategy Session in December which will review the progress to date and look forward over the next 2-3 years.

12.050.05 Stroke Services Review update. Mr Hackwell advised that implementation was proving slightly more difficult than previously anticipated. It was agreed to postpone the update until the new year.

12.062.07 Hollier Simulation Centre. A report on progress made with cliniciantraining will be presented to the January meeting. Mr Hackwell advised that this was also on the agenda at the December Governance & Risk Committee meeting.

All other outstanding items would be picked up within the agenda.

12.074 CHAIRMAN’S REPORT

Lord Hunt presented a summary of his Chairman’s report and drew the Board’sattention to the following items:

The resignation of Mandy Coalter, Director of HR on 30th September 2012.

A meeting of the Appointments Committee had met earlier in the day and had agreed to Lisa Thomson becoming a voting member of the Board of Directors.

The Chairman formally thanked Roy Shields, former Governor, for his work in Chairing the Capital Planning and Procurement Group.

As part of the discussions at the recent Board Away Day, a number of changes were agreed including a new structure for Board Meetings as set out in today’s agenda (the new format will be subject to review in the new year in order to ensure that it is functioning effectively) and also a decision made to discontinue the HR Strategy Committee.

Congratulations on the success of the recent Safety September Campaign were extended to Dr Woolley and her team. Feedback from staff had seen high levels of engagement and was a signal to the wider NHS on how much importance the Trust placed on this area.


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The Chairman held a meeting with Sir Albert Bore to discuss the importance of closer working relationships with Birmingham City Council and a further meeting with Sir Albert, Dame Julie Moore, CEO of UHB, and Dr Mark Newbold, where the need for greater engagement and a more collaborative approach to solving healthcare issues across the region were discussed.

Richard Harris gave an oral report following his attendance at the Annual Foundation Trust Network Conference with Dr Mark Newbold and it was noted that:- The event had afforded an opportunity to meet with other organisations within

the wider NHS as well as act as a reminder of the key issues facing the NHS.- All Trusts were facing similar issues including delivering against targets including

CIP, finance, length waiting lists, focus on quality, A&E performance. - There were a number of Trusts facing a much more difficult future than HEFT.- Major changes in systems would be required if Safety and Quality was to be

improved. - Mr Harris had attended a session given by the Chief Executive of the NHSLA

where it was reported that there had been a large increase in the number of claims being made against Trusts with lawyers taking a much more aggressivestance. There had also been an interesting discussion on NHSLA versus commercial insurance.

- Dr Newbold had delivered a very interesting session on the role of Monitor. There was a general feeling that the patient voice would become increasinglymore important in guiding the ways in which Trusts behave especially in relation to feedback on the quality of care received.

Dr Newbold added that he felt the conference, the first the FT Network had held as a standalone organisation, had been a success and the overall feedback was that all other NHS organisations were grappling with similar issues.

The Chairman asked about the Trust’s position regarding its review of the NHSLA versus commercial insurers and when could the Board expect a briefing. Dr Woolley advised that detailed work was underway on the benefits and risks and a report would be available towards the end of March 2013.

The Annual Report for the Trust’s Volunteering Service was being finalised and would be presented to the Stakeholder and Community Engagement Board Committee. Overall the Trust had increased volunteer numbers by 50% replacing many short-term student volunteers with long term local resident volunteers. Levels of attrition had reduced from 60% to less than 5% improving continuity and enabling the service to focus on improving recruitment and training.

The Birmingham Bereavement Project had been highlighted as good practice in the Department of Health’s End of Life Care Strategy 4th Annual Review. The Trust’swork, as part of the Birmingham Bereavement Project, had been noted as an example of best practice and the Chairman formally thanked them for the amount of work undertaken with this project and for the excellent results that had been seen.

12.075 CHIEF EXECUTIVE’S REPORT

Dr Newbold asked that his pre-circulated written report be taken as read as he wished to highlight the following key points:


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The Department of Health had announced the commencement of the medical revalidation scheme in England from December 2012. The Trust is committed to the scheme which will provide additional assurances to patients by improving clinical governance and appraisal processes for doctors. The programme of work is being led by Dr Anwar, Medical Director, and included completion of the Organisational Readiness Self Assessment and widespread engagement with clinicians across the organisation. The Board discussed this topic and the following comments were noted:• The Chairman asked whether clinicians were engaged with the programme and

if it had been linked to job plans. Dr Anwar advised that the majority of clinicians in the Trust felt that this was a positive step and confirmed that job plans formed a critical part of the revalidation process.

• Mrs East asked whether the scheme fitted with the Trust’s appraisal system and whether a failure rate was anticipated with delivery of the programme. Dr Anwar advised that the organisation had a robust governance structure in place in order to facilitate delivery, however, he did anticipate a small failure rate. He advised that the first priority is assessment of fitness to practice followed by revalidation.The work on VITAL for Doctors would aid the programme.

• Dr Anwar advised that the Board would receive regular reports once the programme was up and running.

Adrian Phillips, Director of Public Health, Birmingham City Council, was now in post and Dr Newbold had met with him to share HEFT’s vision for improving public health across the region. He was keen to work collaboratively on this important agenda.

Dr Newbold referred to an item that had appeared in the national press that had criticised the Trust for not agreeing to fund a drug for the treatment of cystic fibrosis (CF). The article had contained some inaccuracies. The drug company concerned had offered to supply the drug free-of-charge on a case by case basis based on acompassionate need. However, this would only have been for a limited time after which the Trust would be required to fund the drug. The commissioners hadadvised the Trust that it would not agree to fund the drug at the present time. The drug was only effective for 5% of CF patients based on their clinical needs whichequated to twelve patients at the Trust.

The drug company had written to the Trust offering to fund four of the twelve eligible patients for a limited period of time. The Trust had considered but refused the offer based on ethical grounds. The drug company had since agreed to continue supplying the drug to four patients, which the Trust had accepted, with funding requests submitted for the remaining eight. The next steps in respect of funding this particular drug rests with the commissioners.

Mr Harris was pleased that the patients were receiving the drug and hoped that the Trust would have reached the same decision without the media pressures. Dr Newbold confirmed that he had received an email on Sunday regarding the situation and had already spoken to the clinician at the Trust on Monday who had confirmed that they had spoken with drug company and had already agreed to fund the treatment for four patients.


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12.076 EXTERNAL AND STRATEGIC REVIEW

12.076.1 External and Strategic Review

Mr Hackwell presented a summary of his pre-circulated report which was taken as read. The key items of note were:

The new oversight arrangements for NHS funded care. The Health and Social Care Act 2012 which makes significant changes to how NHS funded healthcare is commissioned and regulated comes into force on 1st April 2013. The changes include a new role for Monitor as the sector regulator for the healthcare system in England and the introduction of a licence for providers of NHS funded care.

Much of the detail of how Monitor’s new role and other arrangements will operate had yet to be finalised although a clearer picture was beginning to emerge. Monitor and the DoH were currently consulting on a number of areas:

a) Licensing arrangementsb) Pricing (tariff) methodologyc) Securing best value for NHS patientsd) Guidance for commissioners on ensuring continuity of health services

The Board discussed the new oversight arrangements for NHS funded care in depth. The Chairman felt that no difference would be seen until April 2013. Mr Hackwell agreed adding that no radical changes would be seen in the short term around the current procurement approach. Mr Stokes advised that the Trust was already in talks with commissioners and had not received indication of any changes. Mr Lawrence noted that the Commissioning Boards were seeking responsibility for community service strands and there were approximate forty areas of provision. Any Qualified Providers (AQP) would not be subject to oversight by CCGs. The Chairman felt that a discussion on how the organisation could become an AQP was required in order to undertake such services. Mr Hackwell advised that local PCTs would be given the opportunity to bid for which services they wished to take under AQP. The Trust is in process of becoming AQP for Audiology services.

Pricing. Mr Stokes advised that the delay in receiving the proposed national tariff was not unusual adding that the Operating Framework was eagerly awaited as this would give an indication of the proposed national tariff.

Mr Harris advised that this had been a topic at the recent FT Network Conference and it was felt that it would take several years to review tariff as it needed to incorporate costing information from Trusts within the NHS. Mr Stokes did not expect to see too much of a difference adding that Monitor would be careful not tocreate too much change in the current climate.

Academic Health Sciences Network. The tender from the proposed West Midlands AHSN was submitted and feedback was awaited with a decision on whether the bid would be invited for presentation. A website promoting the local AHSN was going to be launched soon.

Local Provider issues:• Mid-Staffordshire. Monitor had established an external team to examine the


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12.076.2

options for providing healthcare services in the Mid Staffordshire area. It was noted that this was the first time that Monitor had used the “protected service” rule in talking to other Trusts.

• Worcestershire. A major consultation was underway around the future provision of hospital services in Worcestershire. Although this was unlikely to have any direct impact on the Trust, it would be useful to follow and learn from the consultation exercise.

• George Eliot Hospital. A decision was still awaited on whether the Trust wouldpursue a tender exercise involving private sector bidders. The business case recommended a 10 year operating franchise be offered.

It was felt that the above would not have any major impact for the Trust. DrNewbold added that Monitor would be talking to neighbouring Trusts about the possible impacts around protecting services. He added that the large orthopaedic centre at Cannock may be an issue and that Monitor would be writing to us for information in relation to the current population and treatment demographics.

Local Economic Strategy. The Greater Birmingham and Solihull Local Enterprise Partnership had published a white paper entitled ‘Strategy for Growth’. This set out the priorities for economic growth across Birmingham, Solihull and the surrounding areas. The Trust had submitted a response to the White Paper highlighting theopportunity afforded by parts of the healthcare economy other than life sciences.

Research Committee - Terms of Reference

Mr Hackwell advised that at the recent Away Day the Board agreed to establish a new Research Committee under the Chairmanship of Professor Peck. The Board were asked to approve draft terms of reference and the establishment of the Research Committee.

Mr Harris asked whether any funding requirements would be presented to the Board for approval. Professor Peck advised that an outline research strategy with investment proposals would be undertaken which would then be presented to the Board in early Spring.

12.077 PATIENT AND PUBLIC FEEDBACK REPORT

Mrs Thomson presented the new format of the Patient and Public Feedback Report, as circulated, drawing the Board’s attention to the following items:

• The Trust was continuing to see a rise in patient information perceptions being provided and, for the first time, was able to capture the opinions of patients using its community services.

• The Friends and Family Test (NRI), which measures those patients who would recommend the services/hospitals to members of their family and friends, was continuing to show an upward trend The Trust had signed up to a national pilot of NRI which was being run until March 2013. The pilot wouldtie us into other NHS organisations findings. From April 2013 there would benew rules in place on how we can collect data these include no longer collecting data from patients ‘face to face’. As a consequence of these changes, the Trust was already looking at different ways to collect the data.


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The Chairman and Mrs Hafeez were concerned that ‘face to face’ patient feedback would no longer be an option and the impact this would have on getting patients to complete feedback cards within 48 hours of departure from hospital. Mrs Hafeez asked if the Trust could use volunteers instead of staff. Mrs Thomson responded that the Trust had already enquired and the response had been negative but it would continue to look at different options.

Mr Stokes asked whether the decision to avoid ‘face to face’ feedback was because it put patients in difficult position to answer honestly. Mrs Thomson reassured the Board that this was not the case at HEFT as staff did not physically sit with the patient whilst the feedback card was completed.

Mrs Hafeez noted the number of formal complaints in September and asked if the Board could have a breakdown on types of complaints received. Mrs Thomson agreed to bring to the next meeting. The Chairman advised that he would like the Board to have more involvement in complaints and requested a discussion at the next Board Seminar meeting.

• Looking ahead to the media for November 2012, the Trust had placed articles in the Guardian on Hospitals On The Edge and a HIV case study. In addition, the Body Squad were filming for its Channel 5 programme and the BBC filming project on elderly care at Heartlands had commenced.

12.078 FINANCE AND PERFORMANCE

12.078.1 Finance and Performance Committee Report

Mr Lawrence, Chair of Finance and Performance Committee, and Mr Stokes,presented the Finance Executive Summary and Key Performance Indicators Report from June to the end of September 2012. The Committee had met in October and discussed:

• The underlying position which continued to cause concern with no material change in the month of September 2012.

• The challenge of the underlying paybill and delivery of CIP remained with little improvement over the last quarter with 65% of CIPs under achieving. The Finance and Performance Committee had reviewed a series of rectification plans and in the majority of cases those plans had not delivered the improvement in September which sites had planned for.

• Specialised services income dropped in September as cardiology activity reduced. If this continued, our position would deteriorate further. Q1 activity over-performed by 156 spells but in Q2, over-performance fell to 34 spells.

• The escalation process continued to identify areas where recruitment can only be agreed at CEO level.

• Within year the key issues remain as;• Underlying pay controls• Delivery of full efficiency programme• Managing activity within funded capacity• Managing activity without recourse to waiting list initiatives or use of the

private sector• Creating a work force plan that is consistent with the scale of challenge the


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Trust faces• Creating a narrative that describes the organisation three years from now

that matches our work force plan.• Work on safety and quality continues including working with Dr Woolley and

colleagues to ensure that safety assurance is being developed and embedded.

PERFORMANCE:

• A&E. The Trust failed to meet the 95% A&E target in September (94.67%) with both BHH and GHH failing to meet their in-month trajectories. This is the first time the Trust had failed to meet the Q2 target since it changed to 95%, three years ago. A new combined Trust action plan was being developed and once finalised it would come to Trust Board for final sign off. Failure would mean that the Trust would receive a score of 1 for this indicator in the Monitor Q2 return.

• Cancer 62 day targets. The Trust failed to meet the national target for the 62 day indicator in August with a significant dip in performance from 86.35% in July. The most poorly performing directorate was urology. It was unlikely that we would be able to pull back the shortfall in September in order to meet the Q2 Monitor return requirement. This would result in a risk score of 1. The cancer lead general manager had been asked to provide an action plan which addressed all on-going concerns around the cancer indicator and present this to the Board Finance & Performance Committee. Delivery of cancer targets hadbecome a key area of risk for the Trust and if the Q2 target was missed it wasrecommended that this should be escalated to the Chief Executive.

• Diagnostic Waits. The Trust met the 99% target for 6 week diagnostic waits by achieving 99.01%. A revised combined trajectory had been developed and this would be used to monitor performance. It was proposed that this should bemanaged locally and only escalated if the trajectory was missed.Over 26 week waits. The Trust had failed to meet its agreed trajectory in relation to the number of patients waiting over 26 weeks for treatment. All directorates had been asked to review their position and take action to rectify any issues. Each site had produced an individual action plan and these would be reviewed at Operations Committee with a full report being presented to Finance and Performance Committee.

The following actions to secure the financial position for 2012/13 and mitigate the risk for 2013/14 have been put in place:

• Small Executive Group set up to oversee the escalation policy• Mutually Agreed Resignation Scheme agreed by Trust Board to be

progressed. This would be monitored by Finance and Performance Committee.

• Continued escalation for non performance• Rectification reporting to Finance and Performance Committee to continue• Cardiology activity plan to be developed• CIP board to continue

The Women and Children’s review was due to be completed and a report would be presented to the Board shortly.


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The Chairman asked how the Trust had responded to the failure to achieve its CIP.Mr Stokes advised that new initiatives were being introduced including the MARS scheme. Ms Sunderland and Dr Anwar were also working on reducing costs without affecting quality of care. The Vacancy Control panel had been in place for some time now and the Trust was starting to see results.

Mrs East noted that the Finance and Performance Committee were doing a good job in so far as was possible but was concerned about the rectification plans and asked how could the MARS Scheme improve responsibility and accountably. Mr Stokes responded that the MARS scheme was only one of the tools to manage skills and was mutually agreeable in order that the service quality would not be affected.

Dr Newbold added that the new site structure had taken time to embed in the organisation. However, he was confident that the seriousness of the financial situation was being communicated to the lower levels of the organisations and Mr Stokes ‘Finance Roadshows’ were generating high interest at all levels.

The Chairman was pleased to note the agreement to pay the Trust £1m over-performance payment. He noted the JMRA was designed to take demand out and asked whether the Trust had been able to reduce demand. Mr Stokes advised that the £1m over-performance payment was part of the £4m contingency set aside, which was the maximum the Trust could bid against. Had the Trust been under Payment by Results (PbR) in quarter 2 it would have been £2.5m better off.

Professor Peck questioned whether CIP schemes were achievable in the first place or whether the Trust is just not able to deliver against them and what would be the shortfall; was the Trust continuing to do more of same rather than looking at innovation and reconfiguration of services.

Mr Lawrence responded that root cause analysis of CIP looked into validity of schemes. Feedback had shown that the plans are robust and the programme amounts were achievable; however, lack of commitment to oversee the programmewas a problem. The escalation procedure was now more robust. There was understanding at all levels of the organisation of the need to meet and sustain budgets as well as achieving results through redesign of services eg treating elderly patients at home rather than being brought into hospital. It would take twelve to eighteen months to see an impact of the changes.

Dr Anwar felt that there were some issues around how we were communicating with the organisation. It was not just about taking costs out but organising the delivery of care.

The Chairman summed up the discussion by noting the current run rate was unsustainable and that the Board needed to see some progress by January 2013. It was agreed that an update report on CIP delivery and plans to move CIP forward would be brought to the next meeting.

12.078.1 JMRA Review & Recommendation

Mr Stokes presented a summary of his pre-circulated 6 month review of the JointlyManaged Risk Agreement (JMRA). The paper set out a summary of assessment of the JMRA against four success criteria;


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1. certainty of our income2. strength of our relationship with our commissioners 3. sustainability of our Health economy4. comparison against full PbR.

The JMRA had provided the expected level of certainty so far this year. The income volatility associated with previous years linked to the potential for large fines, hadbeen removed. Financial discussions with our commissioners had focussed on investment planning for demand management initiatives.

Meetings were now being held between HEFT’s contracting team and GP representatives in Solihull. The strength of our relationship with the Clinical Commissioning Groups was stronger under the JMRA. Financially, the difference between JMRA and full PbR is relatively immaterial.

The process to agree the contract for next year was already underway and wasexpected to be completed in February/March 2013. The 2012/13 JMRA value was £434m and a tariff deflator of 1.5% in 2013/14 was anticipated. If the commissioners make good the 2012/13 over performance of £7.2m, this would equate to £435m (allowing for the tariff deflator). If the offer was below £435m Mr Stokes recommended that the Trust reverted to full PbR.

If the commissioners’ offer included paying for 2012/13 over performance plus a realistic assessment of growth in 2013/14, equating to £445m, Mr Stokes would recommend accepting. He reiterated that JMRA was the right thing to do and should actively pursue this way forward.

Mr Hensel noted that the JMRA was a strong force for change with good transformational aspects but queried whether Monitor viewed this as anti-competitive. The Chairman responded that when the Trust had met with them to discuss the JMRA, Monitor had not expressed a specific view rather they were seeking assurance that the Board had ownership of the decision regarding the contract.

Mr Stokes added that Monitor were keen to get some semblance of where the Trustwould have been in relation to tariff and they were reassured with the Trust’sperformance.

Mr Hensel questioned whether they saw the advantages of the JMRA. Mr Stokes advised that they had not specifically expressed this, however, they did see the advantage of guaranteed income plus the good relationships being built.

Mr Stokes further advised that initial discussions with the CCGs indicated that they would want to continue with the JMRA although it was the Trusts decision to choosewhich system it wanted to pursue.

The Chairman summed up the discussion and noted that next year the Trust neededto be clear with CCGs about ensuring agreement around demand management.The Board agreed ‘in principle’ to the negotiation position with an update being brought to the next Board Meeting in January.


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12.078.2 Finance and Performance Committee Minutes

The draft minutes from the meeting held on 28th September 2012 were noted.

12.079 SAFETY, GOVERNANCE AND RISK

12.079.1 Governance and Risk Committee Report

Dr Woolley presented a summary of her pre-circulated report which summarised all key risks in the organisation.

Safety Situation Report:There were no current red operational risks. Healthcare and Governance werecurrently working with the sites to set up a scrutiny and review approach. New stronger measures would help prevent more serious problems occurring.

The Trust had had one new SUI which was a never event in T&O.

There were a number of cases with the Coroner that were all due for hearing in December and which might cause some adverse publicity for the Trust.

The Safety September Campaign had been very successful with much engagement with front line staff.

The Board discussed the two SUI in the papers both of which had failures in the use of equipment. There were wider lessons and staff training required for both medication and equipment.

Dr Newbold added that following the success of the September Safety campaign, a new programme of events which includes lessons learned from adverse events and SUIs had been organised.

With reference to the Medication Safety Update, Mrs Hafeez questioned whether the Trust had checking systems in place for medication. Dr Woolley confirmed that it did and that it was a case of human error. A work programme was underway to raise awareness of the levels of human error and how these could be avoided.

Board Assurance Framework

The Board reviewed and discussed the assurance framework and noted that Executive Management Board (EMB) had reviewed the document the previous month as a result of which two risks had been increased to a red rating: future tariff efficiency (SR1) score increased to 20; and patient flow (SR2) score increased to 16.

The meeting proceeded to discuss the risk presented by the Re-shaping HEFT programme which did not seem to link with the workforce transformation and CIP programmes. It had therefore retained its risk-rating in relation to financial risk. Itwas felt that there was a need to refresh and rethink the Reshaping HEFTprogramme to ensure its effectiveness.

Mr Hackwell advised that the Re-shaping HEFT programme was not about saving


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money, rather about supporting staff to make changes. However, he added that there were lots of transformation change schemes that needed short term investment to succeed.

Dr Woolley advised that the risk rating was appropriate based on the scoring criteria. She recognised that Re-shaping HEFT and CIP delivery needed a different approach.

Mrs East felt that the transformational agenda was not being addressed as well as it could be and was not sure that Mr Hackwell had the necessary support to deliver the project.

The Chairman asked if a further plan was required in order to deliver the savings required and what the next steps should be. Mr Hackwell reassured the Board that the programme was not lacking in commitment.

Governance and Risk Committee Report:

Dr Woolley and Mrs East advised that the Governance and Risk Committee had hadlengthy discussions around maternity and the labour wards and the further work that was required on improving outcomes and risks.

Discharges continued to be reflected in patient feedback with patients still not recognising they are receiving information on their discharges.

T&O is showing signs of improvement at Heartlands but less so than at Good Hope Hospital.

The Chairman agreed that maternity services were one of the top concerns for the Trust. There was huge pressure on the service and the CIP programme and therefore it needed close scrutiny.

12.079.2 INFECTION CONTROL REPORT

Ms Sunderland presented the Infection Control report for Quarter 2 which was taken as read with the following key points being noted:

• MRSA Bacteraemia (post 48 hour): there had been no cases in Q2. The total for Q1 and Q2 was 2 against annual target of 6.

• C difficile infections. There had been 15 cases of post 48-hour infections against quarterly objective of 31.

• Norovirus activity was low, with one ward closure in September at Good Hope Hospital confirmed as Norovirus.

• IPC Scorecard. This sets out the monthly data for key audits e.g. hand hygiene and commode, cleaning scores, patient experience and MRSA screening compliance. Audit scores had been consistently achieved for the infection control audits, overall cleaning scores had been achieved but action plans are in place to achieve them in the critical risk areas. MRSA screening compliance had decreased and plans were in place to improve compliance.

The Chairman noted the current performance and asked that the Board’s thanks bepassed onto staff for the achievements to date.


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12.080 REPORTS FROM BOARD COMMITTEES

12.080.1 Audit Committee Report

Mr Harris updated the Board on key items of note from the meeting held on 26 September:• Sue King had been invited to the meeting to report on the work being completed

within the clinical coding team to improve coding data. The request had beenmade in light of the Audit Commission report in which the Trust had been rated in the bottom 10 for worst performing Trusts in relation to errors in clinical coding. The Committee recognised that a considerable amount of work had been undertaken to address this issue including a restructure of the team. It was understood that some time would be needed to embed the new structure. It requested a further update in July 2013.

• The External Audit Plan 2012/13 was discussed and approved by the committee. PWC highlighted the additional risk and audit work that would be required as a consequence of the revaluation exercise

• KPMG provided a Progress Report on the current position of internal reviews being completed and suggestions for additional reviews. The Committee hadbeen satisfied that good progress was being made with the recommendations, in particular, in relation to those areas identified as ‘red risks’.

• The Committee had expressed some concern at the level of investigations listed in the Counter Fraud report. However, KMPG had assured the Committee that the numbers appeared high due to the good culture of reporting within the organisation.

• The Chairman confirmed that the Audit Committee meetings would now be held bi-monthly in order to allow the appropriate time necessary to perform the committee’s scrutiny role.

• The Committee was advised that PWC had completed a piece of consultancy work which had not followed the due procurement process. It was agreed that PWC and the Finance Director would review and ensure that the appropriate governance arrangements were in place and had been met. The Committee considered that this did not in any way adversely affect PWC’s impartiality as Auditors. However, PWC were requested to bring their internal policy to the next meeting and ensure that this matter is reported in the ISA260 Report.

• All NEDs had been invited to attend Audit Committee should they wish to. Lord Hunt advised that he would not attend all meetings but would endeavour toattend some.

• A progress report on the KPMG Bribery Act was due to be presented. Mr Stokes commented that it was important that the recommendations on actions were implemented. Ms Jinks confirmed that there were two reviews (the Bribery Act and Procurement Reviews) where many of the recommendations and actions were closely interlinked. She confirmed that there was a project plan was in place to for completion by the end of March 2013.

12.080.2 Donated Funds Committee Report

Mr Hensel updated the Board on key items of note from the meeting held on 12October 2012 as follows:

• Aggregated Annual Spending Plans. A review of aggregated Annual Spending


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Plans was being undertaken and fundholders were being requested to provide spending plans if their funds were over £5k in value. They were also being actively encouraged to spend the monies in their funds. It was noted that there were a number of funds with very significant balances and no spending plans. The Committee had decided to invite a couple of these fundholders to the next meeting in order to clarify their spending plan intentions.

• Donated Funds requests. It was noted that a number of requests for donations were being made from external charities. The Committee discussed this issue in some detail particularly in light of the three requests that had been submitted to the meeting which were all from separate charities. It was agreed that it was not appropriate to give monies donated to HEFT Charitable Fund to other charities. The Charitable Policy would be amended to this effect subject to the Board’s approval.

• Strategic Review of Investments. Marlborough Investments Management had presented a summary of their review on the charities current investment strategy. Their findings raised some concerns for the Committee in relation to the low return on current investments; the significantly high-level of investment in equities (against recommendations of the Investment Policy) and apparent investment in non-ethical trades (it was noted that both M&G and Schroder had breached the Ethical Investment instructions and invested in tobacco). In light of this, the Committee decided that there needed to be an urgent review of the Investment Policy. The Committee will report back to the Board in due course.

• Audited Accounts. In July, the Donated Funds Committee approved the Audited Accounts for the Heart of England NHS Foundation Trust General Charitable Funds. These accounts were then presented and approved at the Audit Committee held on 26th September 2012. The Board were asked to approve these Audited Accounts. The Board approved the Audited Accounts.

The Board discussed the Committee’s decision not to donate to external charities. Mr Hackwell asked if the new agreement regarding the refusal of charitable donations also included partnerships. Mrs Thomson responded that if it was a partnership for raising of funds for equipment this would be acceptable.

Mr Hafeez was in agreement that donations were for use by the Trust, however,asked if functions held for the benefit of the community could be funded from donated funds. Mr Hensel confirmed so.

Mr Stokes added that the decision not to donate to national charities was consideredin line with the original bequest of the donors. Mr Hensel confirmed that a paper outlining a number of changes in relation to the Committee’s work (as indicated earlier) would be bought to a future meeting for approval.

The Board agreed to the Committee’s recommendation that it was not appropriate to give monies donated to HEFT Charitable Fund to other charities and that the Charitable Policy be amended to this effect.

12.080.3 Donated Funds Committee Minutes

The draft minutes from the meeting held on 12 October 2012 were noted.


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12.080.4 HR Strategy Committee Report

The Chairman updated the Board on the items of note from the meeting held on the 10 September 2012. The main items of discussion were summarised:• Workforce Plans and Workforce Transformation. The Committee had been

advised that a number of projects were being considered by the executive team to take workforce transformation forward.

• Stress Audit Action Plan. A new Stress Management Policy was now in place which met NHSLA standards and requirements on stress management and prevention. Following an audit, the Trust had identified 10 hotspot areas. An action plan was being prepared and would be submitted to the Live Well/Work Well (LW/WW) group in October.

• Equality and Diversity. A discussion took place around equality and diversity issues and the importance of ensuring that the organisation addressed these.Laura Serrant-Green touched on the review that has been undertaken by the RCN and the possibility of the Trust liaising with them on this.

• Policies. Changes to three policies were notified: Sickness Absence (tighter timeframes introduced to help manage and reduce sickness absence); Disciplinary (updated to reflect ACAC Code of Practice and fast track for staff who admit responsibility); Policy on the Operation of Registration Authority (under the Connecting for Health Programme) – amalgamating the Solihull Community Services with the HEFT policy.

• Paybill. Hazel Gunter reported that a number of initiatives were being considered regionally but that the Trust needed to be mindful of the discussionsthat were taking place in Trusts in the South West. The Trust had decided to work within the boundaries of the Agenda for Change national agreement at this present time.

12.080.5 HR Strategic Committee Minutes


12.080.6 IM &T Committee Report

Mr Hensel updated the Board on key items of note from the meeting held on 15 June 2012 as follows:

• A demonstration of the new PMS2 , the new inpatient system, was presented.There was a need for continued momentum to achieve full electronic patient records.

• E-prescribing had lost some momentum due to the chair of the EP Tender Group having left the Trust.

• Medical Records. A new scanned records viewer has been introduced. Feedback on the speed of the viewer had ceased, however, there were still complaints around the way the content was filed in the notes and therefore scanned onto the system. There was a need to agree the standards for filing in the paper records.

Dr Anwar added that electronic patient records was a broad topic and clinicians needed to have the same understanding as to its purpose which was that it was anarchiving tool. The use of electronics records did create some risk in that records were not available as hard copies.


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The Chairman acknowledged that the area of electronic medical records was complex but there was a need to transform the Trust into a paperless organisation.The Chairman asked for a discussion paper to be brought to a future meeting.

12.080.7 IM &T Committee Minutes

The draft minutes from the meeting held on 15 June 2012 were noted.

12.080.8 Monitor Approval Committee Report


12.080.9 Stakeholder and Community Engagement Report

Mrs Hafeez updated the Board on key items of note from the meeting held on 21September 2012, as follows:

• The Committee received a discussion paper proposing amendments to the Trust’s membership including automatic enrolment, alignment of HEFT constituency areas with Council Counstituency boundaries, realignment of the number of Publicly Elected Governors to population numbers.

• The Trust had joined the Birmingham Chamber of Commerce. • A report would be bought to the next SCE meeting on Community and Equality.

12.081 COUNCIL OF GOVERNORS AND MEMBERSHIP

The Chairman advised that the Governors had met for the Annual General Meeting on 18 September 2012 where the main items discussed were as follows:

• PWC had presented the Annual Audited Accounts. They had welcomed the opportunity to meet with Governors ahead of the meeting to answer any queries in relation to the accounts. PWC confirmed that, in comparison to other Trust’s, HEFT was in a reasonably healthy financial position but looking ahead, the organisation needed to look at how it could continue to deliver services given the increased financial constraints that were being placed on the sector. The CIP, workforce planning and Re-shaping HEFT programme were key to this.

• A Stroke Services update was given and it was advised that Professor Mathew Cooke had completed his review of stroke services across HEFT sites whichconfirmed that Heartlands would be the most appropriate location for the basing of the hyper-acute service. The Board had given its ‘approval in principle’ to this decision and tasked the stroke team with developing an implementation plan should the Trust be commissioned to develop its services in line with regional review findings.

• A number of Governance areas were discussed including;o Feedback on the appraisals of the Non Executive Directors and Chairman

together with details of the key objectives they were set for the coming 12 months.

o Review of Director and Governor Attendance Recordso Update on Governors Governance Review in relation to committee

membership



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o Constitution changes required by Monitor. • Reports were received from the various Council of Governor Committee

meetings that had met during the preceding two months.

12.082 ANY OTHER BUSINESS

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12.083 PART TWO

12.083.01 Good Hope Hospital

Mrs Moore, Managing Director, gave a summary of her pre-circulated paper.

The operational team had had a challenging 5 months with Accident and Emergency department performance being central to all site activities.

The team had started to make positive steps with financial rectification delivering improvements in actual spend and efficiency savings, whilst acknowledging the enormous challenge which needed to be addressed with pace.

Successful implementation of the Recovery @ Home Service and planned closure of Ward 26, had been highlights, as well as the realignment of Stroke Services to a single ward. She also highlighted the consistency of nursing metrics and continued performance against HAI with both CDiff and MRSA.

The A&E performance continued to present a challenge and although Mrs Moore was confident that the site was working towards achieving the target. At every opportunity driving accountability for performance with good performance being rewarded and failure to deliver performance would be managed appropriately. The roles, responsibilities and expectations of the work force had been reset and reconfirmed and each ward now had a contract to deliver services whilst having a key focus on daily discharge.

Mrs Moore had had a successful and productive meeting with South Staffordshire PCT, which mirrored the work Mrs Molloy, Managing Director at Solihull Hospital, was undertaking with Solihull Community Birmingham City Council, looking at why people should not be in hospital.

The Chairman questioned if the Recovery @ Home programme was assisting the rest of the service and if Clinicians were visiting care homes. Mrs Moore advised that it was a replication of what we already had on the other two sites but Good Hope used a commercial provider. At the present time clinicians were not visiting care homes but this was being pursued.

The Chairman asked what the expectation was for A&E performance going forward into winter. Mrs Moore advised that the new A&E department would be operational by the end of November 2012. There were some concerns around the transferringof patients although plans were in place for moves during quieter periods. It was expected that there would be some teething issues but she was confident that the



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systems and processes in place would lead to improvements being seen.

Professor Peck asked what were the key factors for delivering the CIP for the year.Mrs Moore confirmed that she intended to deliver the plan, and confirmed that ‘challenge’ meetings were underway with directorates including intervention where required. The CIP, strategy and safety framework were all integrated and as such peer support and performance management were in place to deliver.

12.083.02 Solihull Hospital and Community Services

Mrs Molloy presented a summary of her pre-circulated report.

Quarter 2 had been a challenge with the operational team getting up to speed with the responsibilities inherited through the new structural alignment that had became effective in June. The team was now in place with the appointment of a new Associate Medical Director in October. Robust accountability and governance arrangements had been developed with a Divisional Board jointly chaired by the Managing Director and Associate Medical Director meeting for the first time this month. Sub Committees for Quality and Safety, Finance and Performance, and Operations had been established and were meeting regularly. Single committees to cover both the hospital and community services had been put in place from November.

A detailed work programme had been in operation for the last year, but had beenexpanded to reflect the additional responsibilities taken on by the site. In general, good progress had been made against the majority of the work streams. It was noted that the financial rectification plan had been signed off by the Board Finance and Performance Committee with focus on delivery. The in-month trajectory hadbeen achieved but there remained a high level of risk associated with the phasing of schemes, with the majority of cost reductions planned from month 7 onwards.

Significant focus was being placed on the scrutiny and governance of schemes at a level of granularity that provided sufficient assurance on delivery. Quality and Safetywas a high priority for the site ensuring up-to-date risk assessments were in place for all areas of responsibility with supporting improvement plans where relevant. The roll out of VITAL to community nursing is progressing well and the assessment phase will start at the beginning of December.

Mrs Molloy had been working closely with local partners including implementation of a shared narrative that will be finalised with the Health and Well-being Board and Joint Commissioning Board in November on the role of the Integrated Care Partnership. HEFT had joined the newly established Solihull Public Health Forum ensuring that we maximise our contribution to improving health and well–being. Incollaboration with the Chief Nurse, we had agreed arrangements for delivering safeguarding children functions within the local health and social care economy and use of collective resources. The Head Nurse for Solihull is the vice chair of the local Adults Safeguarding Board.

Work with local partners on a range of integrated care service redesign priorities included:• Working with the Local Authority over the last 6 months on 4 pathways of care to



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support the implementation of an agreed high level service offer. Work on the out of hospital pathway was being finalised and agreement had been reached on investment of re-ablement and local windfall monies to support implementation.

• A joint service improvement project for delayed transfers of care had beenestablished between the local authority and HEFT which was supporting the implementation of the JONAH approach in a number of targeted wards

• Solihull had been highlighted as an exemplar in the national Long Term Conditions QIPP programme for its work on virtual wards and out of hospital services, which have demonstrated reductions in admissions. Sir John Oldham was visiting Solihull on 13 November to talk to partners about our work. With the local CCG, we had recently appointed a fourth Elderly Care Geriatrician in Solihull who would work across hospital and community to support services for frail elderly and long term conditions

• A number of Re-shaping HEFT priorities were being supported which wereprogressing well, with the respiratory hub in Solihull planned to begin early in the new year; new models for diabetes and dermatology were being finalised with local GPs; and work on a new model for urgent care being developed (including redesign of the front end of Solihull Hospital) so that engagement and consultation could start from February.

Dr Newbold asked what the early signs were on the impact on activity. Mrs Molloy advised that long term conditions had seen some reductions in admissions which were down by 12%. Length of Stay had seen smaller reductions (2%) when comparing us to other schemes; however, we have asked to share data in order to reassure robustness and understand the data. Over 200 patients were being cared for through the ‘virtual ward with patients being put on a case management approach managed by community nurses.

The Chairman noted that we did not capture this in our performance report and as aresult did not highlight the achievements that were being made. The Trust wasdoing some excellent work and this should be showcased. It was agreed that a set of core metrics would be produced that each of the sites would report on.

Mrs Hafeez noted the 200 patients in the virtual ward and asked how Solihull compared with the other sites. Mrs Molloy advised that the virtual ward was based on admission avoidance and some of the 200 patients would include North Birmingham too. Good Hope Hospital had Care at Home that also supporteddischarge. In order to see more admission avoidance the Trust needed to work on a larger scale to have a bigger impact.

The Chairman was pleased to see some green shoots of transformation and wondered if the Trust needed to consider finding money to invest and grow these services. Mr Stokes advised that the Trust needed to ensure it did not ‘double count’ by investing in discharges.

12.083.03 Heartlands Hospital

Dr Newbold presented a summary of his pre-circulated paper, which was taken as read. The following was noted:• Planning was well advanced to extend the volunteer workforce at Heartlands, as

our ‘Olympic Legacy’ project. The aim was to achieve a better connection with



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local people through an extension of our current volunteer programme. Discussions had progressed to implement supported discharge service in conjunction with BCHC and BCC. The scheme would initially run as a Winter Pressures Pilot prior to a formal evaluation.

• The loss of the temporary car parking site on Yardley Green Road had createdincreased pressure on spaces. Most would be re-provided at our own Yardley Green site but in the meantime, we were progressing the multi-storey car parkquickly. Planning permission had been granted for the multi-storey car park on Yardley Green Road although permission was yet to be granted for the decked car park on the site of the current Bordesley House.

• Work would soon begin to replace the escalators in the Main Entrance and to create the new Patient Services facility (including the Chair and CEO offices). Completion was planned for December.

• The Pathology Laboratory extension was progressing to plan. The SHA wasprogressing the tender of community laboratory testing and our bid for this work is underway.

• The operational management team was now established and headed by Mark Houghton. Key issues would be to establish a Site Strategy and more robust ‘7-day’ service, reconfiguration of surgical services via a stepped approach, and re-examination of our current model of chronic disease management. From November, the General Medical Rota would be enhanced to include Consultant presence on AMU, 7 days a week.

• After a difficult month financially, the Associate Medical Director was meeting with all Clinical Directors to discuss progress and gain positive assurance over future delivery. Regarding performance, work was continuing on urgent care process with the site achieving 95% in the month to date. There was also asignificant piece of work underway to manage 62-day cancer waits more robustly.

• New measures taken to eliminate smoking outside the Princess of Wales unit were proving very effective. The same approach would now be used on our main entrances (on all sites).

• Filming had commenced for a BBC documentary, related to Frail Older People,highlighting the multi-agency challenges for frailty.

• The new Professor of Nursing, Rebecca Jester, took up her post in October and the search for a Professor of Infectious Diseases was progressing.

Professor Peck noted the three reports and asked for some symmetry in their presentation. The Solihull and Good Hope Hospital reports had covered the operational position and he felt that the Heartlands report would benefit from the same degree of insight and understanding. The Chairman and Dr Newbold took on board the comments and advised that these had been the first reports under the new Board meeting structure following the changes agreed at the recent Board Away Day. They assured the meeting that the reports would continue to develop going forward.

12.084 DATE OF FUTURE MEETING

8 January 2013, MIDRU, Heartlands Hospital.



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The Board was asked to resolve “That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest”.

12.085 Part THREE

12.085.01 Mr IP

Dr Ann Keogh, Director of Medical Safety, and Mrs Corinne Slingo, Partner, DAC Beachcroft Solicitors, joined the meeting for this discussion.

Mrs Thomson presented an Outline Proposal for an Independent Review of themanner and timeliness with which the Trust dealt with concerns raised by staff in relation to Mr IP’s surgical practice and the Trust’s management response to these concerns. The Trust had committed to patients and complainants that it will complete a reflection exercise to consider the actions taken by the Trust since concerns were first raised. In line with the Trust’s values of openness and transparency, it was recommended that this Review should be chaired by an Independent Chair, with direct input from patients and staff. It was also recommended that a recognised external lawyer may be the most appropriate person to hold the independent chair role and lead this review. It was further recommended that an independent patient/public group should be appointed to support the review and provide assurance that a full, open and transparent process was followed.

Whilst it was clear that the organisation had taken steps to investigate concerns regarding Mr IP’s surgical practice, concerns had been expressed by patients regarding the length of time taken to complete this investigation and take appropriate action. Whilst there may be valid reasons for this, the Board felt that, in the interest of providing high quality services, and its duty to safeguard both staff and patients, there may be lessons to be learned about how the organisation might improve its response to concerns raised by staff about clinical practice.

The principle objective of the review would be to provide a formal report to the Trust Board, which will provide an independent assessment of the organisation’s response to concerns, and capture the learning from the Trust’s response. The report would be published in full, and provide a comprehensive understanding of the organisational systems and processes which the Trust employed to discharge its duty of quality and safety to its staff and patients. This would need to incorporate the following:

• a detailed timeline of events and actions taken; • an independent assessment of the processes used to investigate concerns

that were raised and action taken to address those concerns, identifying both good practice and areas for improvement;

• identify clear recommendations which help to define the future direction and any changes to improve and enhance the Trust’s quality and safety culture;

• clear recommendations which can support the NHS in improving its response to concerns raised by clinicians into another clinician’s practice.

The costs associated with the review were estimated to be circa £250,000 although the exact cost was not known at the present time. The Board discussed the costs



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Matters Arising


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Matters Arising

BOARD OF DIRECTORSSchedule of Matters Brought Forward and Action Points

Date raised Minute No Detail Action Due Status Completed

5 July2011 11.98.11

Harrop Inquest Respond to Coroners letter when receivedBrief Governors

SWMNPH

Nov 2012

No letter yet received. SW to make discreet enquires with Coroners Officewho advised no further action

06/11/12

6 Mar 2012 12.020.9

Board Strategy session to consider implications of Francis report on Mid-Staffs

PHAwaiting publication of Francis Report in January 2013

6 Mar 2012 12.020.14 Update report on new JMRA contract

arrangements AS Nov 2012 06/11/12

3 July 2012 12.050.05 Reshaping HEFT update together

with related Workforce Plan SH / HG Nov 2012

Initial review to be discussed at Board Strategy Meeting –December 2012

04/12/12

3 July 2012

Reshaping HEFT - Stroke Services Review – update SH Jan

2013Update on decision of SHA

4 Sep2012 12.062.07 Report on the completion of clinician

training at Hollier Simulation Centre SW/SH Jan 2013

4 Sep 2012 12.062.09 Research Committee Strategy

Update SH March 2013

6 Nov 2012 12.074 NHSLA Review and Report SW March

2013

6 Nov 2012 12.075 Medical Revalidation Progress

Update AA March2013

6 Nov 2012 12.078.01 JMRA Contract Negotiations Update AS Jan

2013

6 Nov 2012 12.080.06 Electronic Medical Records Review AL/AA Mar

2013

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Chairman's Report

Q:\BOARD\BOARD PAPERS\2013\8 JANUARY 2013\WORD DOCS\ITEM 5 CHAIRMAN'S REPORT BOD 8 JAN 2013 MTG.DOCX

CHAIRMAN’S REPORT to the BOARD of DIRECTORS

Safety, Quality and the Cost Improvements Programme

I am pleased that the programme of safety walk-rounds continues and as we head into 2013 Iencourage all of my Board colleagues to take part in the safety walk-rounds to support this vital agenda.

In 2010, our Trust Values were launched with ‘safe and caring’ as a key priority. As we leave 2012 behind, the teams are focused on safe nursing care. From this month, the Trust is launching a harm free care project, aiming to use ward level information to reduce harm. Award leader toolkit has been developed by the corporate nursing team and to support this ambition.

We look forward to receiving an update on this important safety project.

Director of Workforce Appointment

I am delighted to advise you that following a competitive process, the Board’s Appointments Committee has now confirmed the appointment of Hazel Gunter as Director of Workforce with effect from 1 January 2013. Hazel’s is a strong appointment in this crucial role for the Trust and I am sure you will all join me in congratulating her and welcoming her as a substantive Director.

Hazel will focus, with her team, on the workforce issues that are critical for us in the coming months and years. The Organisational Development function will move to Sarah Woolley so that our OD effort is based around our first priority of developing a strong safety culture in the Trust. In turn, some of the compliance functions will move from Sarah to Lisa Thomson.

Non Executive Director Appointments

Regrettably both Anna East and Paul Hensel reach the end of their final term of office during the first half of 2013. It is important that the non-executive team has a balance of skills, knowledge and experience; life skills as well as academic and business skills to enhance the experience of the Board. We are now seeking up to three influential senior professionals to further build on our already substantial achievements. We are looking for additional Board members who have at least one of the following sets of skills with relevant professional/technical experience and who are able to devote a minimum of 3 days per month with flexibility to work longer days andsometimes evenings.

• A registered Medical Practitioner, perhaps at Royal College or Department of Health level or occupying a senior academic role at a Midlands University

• Senior level experience within a large, complex organisation or Legal profession preferably specialising in commercial/corporate work

• Senior level first rate financial experience including an accountancy qualification• Property development having managed substantial and complex building contracts

An advertisement will go live the first week in January with the closing date for applications 31 January 2013. Interviews will be held 8 March 2013. It will go onto NHS Jobs website on


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2/3 January, into British Medical Journal on 5 January, Health Service Journal on 10 January and several local newspapers during w/c 7 January 2013.

We also are planning to circulate the advertisement through the Chamber of Commerce as it has circa 10,000 people on its mailing list and we will also send to Senior Partners at local accountancy and law firms to distribute amongst their own staff who may be interested in the vacancies.

Council of Governors

Our series of Breakfast Seminars continue to be very popular.

Since I last reported in November:

All of our meetings were well attended and proved very informative. They generated lively discussion and Governors welcomed the open conversation as well as praising their work with patients and staff to improve and develop services.

In November we held a very productive Council of Governors Meeting where Adrian Stokes presented a financial performance update, Aresh Anwar presented a review of last year’s Winter Experience and Andrew Laverick gave a demonstration on Concerto. The Governors gave reports from their sub-committees which are continuing to add significant value to the Trust’s developments and future plans. This includes changes to the Trust’s Governance arrangements as in 2013 we look to Governor elections and the need to keep the significant skills and expertise our Governors have developed. The next meeting of the Council of Governors is scheduled for the 21 January 2013

VISITS and MEETINGS:

Since the last Board Meeting I have continued to go out and about internally and externally and these visits have included:

Prof Asif Ahmed – Aston University

I met with Prof Asif Ahmed, Aston University Pro-vice Chancellor (Health) to discuss aEuropean Development Fund application for a medical school project.

Chris Wood Interim Chair of Burton Hospital

I have met with Chris Wood Interim Chair of Burton Hospital where we discussed priorities for the health economy and the continued importance of working collaboratively.

HCDU Graduation Ceremony for Health Care Assistants

Many of us attended the Faculty of Education and Healthcare Careers Development Unit (HCDU) Graduation ceremony. This is an annual event held in order to celebrate our staff academic achievements over the past 12 months. This was an excellent event and highlighted the strong emphasis and importance the Trust places on training and development.


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Awards Pride, Passion, Professionalism - nurses awarded

Congratulations to the first tranche of nurses to be awarded their HEFT nursing badge at the ceremony held at Sutton Coldfield Town Hall. Special guest speaker, Baroness Emerton D.B.E. D.L., and chief nurse, Mandie Sunderland, hosted the event which celebrated the achievements of nurses gaining 100 percent in their VITAL training. The HEFT badge programme is continuing to be rolled out across the Trust, and it is hoped that midwives, paediatric and community nurses will be awarded at the next badge ceremony.

Carol Service, Solihull

I attended Solihull Hospital’s carol service on 21 December which was led by an excellent choir from one of the local Churches, Solihull Christian Renewal. As with previous years the event was well attended by staff and patients.

Chairman’s Lectures

The series of Chairman’s Lectures continues this year with lectures presenting a unique opportunity to hear a national perspective on changes within the NHS and how implementation and changes are affecting the whole of the health economy. They are open to all staff and we will be encouraging anyone interested to attend as we expand these with video links going forward. In December, Sir Ian Kennedy provided an insight into safety and the importance of putting the patient at the centre of our work.

The first lecture of 2013 is being held on Friday 11 January at 11am and sees Sir David Nicholson, Chief Executive of the NHS, as our special guest speaker. Sir David Nicholson has been Chief Executive of the National Health Service (NHS) in England since September 2006 and in October 2011 he became the first chief executive of the NHS Commissioning Board. His career in the service spans over 30 years starting in the NHS as a management trainee, having graduated from the University of the West of England. We are looking forward to hearing his views on the future of the NHS, the challenges and opportunities.

Lord Philip Hunt of Kings Heath Chairman

January 2013

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Q:\BOARD\BOARD PAPERS\2013\8 JANUARY 2013\WORD DOCS\ITEM 6 CHIEF EXECUTIVE REPORT BOD 8 JAN 2013 MTG.DOCX

CHIEF EXECUTIVE’S REPORT to the BOARD of DIRECTORS

PERFORMANCE, QUALITY AND FINANCE

Our focus on clinical safety remains our top priority and we are taking steps to ensure that we maintain this as the winter pressures impact on operational performance and delivery of our Cost Improvement Programmes (CIPs).The executive team is closely involved and along with the Finance Director I am managing the escalation process which is initiated when agreed trajectories are not being maintained. As reported to the Finance and Performance Committee, the Trust’s underlying financial position continues to cause concern with no material change in the month of November 2012. The challenge of our underlying paybill and delivery of CIP remains with little or no improvement made over the year so far, and during November and December a new initiative was implemented focused specifically on reducing pay costs.

As I detailed in my last report to the Board, one of the key changes we introduced was a MARS (Mutually Agreed Resignation Scheme) programme. This offered those staff who are not frontline, the opportunity to exit the organisation if it can facilitate reduced overall staffing costs. We have approved 17 applications under the scheme with a reduction in the paybill of £465k.This will ensure that the Trust currently does not immediately need to look at the option of a widespread redundancy programme.

The urgent care pressures continue at a very high level across all three hospitals, with the Trust experiencing an increase in demand for its A&E services and acute admissions of some 5% compared to last year. On top of this, Norovirus has remained at unprecedented levels leading to high staff sickness and significant ward closures and loss of capacity. The Trust will miss the 95% A&E target in Q3 (current position 93.19%).

The urgent care pressures are being seen across the region where there has continued to be a high and increased demand for acute hospital services. The NHS Midlands and East Board Meeting on 22 November highlighted the issue across the region noting that many Trusts are currently finding the 4 hour target challenging, citing the following for context:

•Milton Keynes, 92.7% (Failed three previous quarters) •University Hospital Leicester, 94.7% (Failed Q1, delivered Q2) •Northampton, 93.9% (Failed three previous quarters) •Nottingham University, 93.6% (Failed five previous quarters) •Sandwell and West Birmingham, 93.89% (Failed Q2) •University Hospital North Staffordshire, 92.8% (Failed Q1 delivered Q2) •Shrewsbury & Telford, 92.7% (Failed Q1 & Q2) •Worcester Acute Hospitals, 93.5% (Failed Q1, delivered Q2) •Cambridge University, 94.5% (Failed Q1, delivered Q2) •Peterborough & Stamford, 93.8% (Failed three previous quarters) •Princess Alexandra, 94.1% (Failed Q1 & Q2)

The Trust continues to meet other national targets with, notably, a significant improvement in


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the 62 day indicator. With regard to infection control, the Trust met the challenging c.diff target in November, which is excellent performance given the high rates of Norovirus in the Trust and community. The steady reduction in our mortality rates is continuing and we remain focused on ensuring this performance continues.

2012/13 Monitoring of NHS Foundation Trusts

We have received confirmation from Monitor (attached) that following analysis of Q2 the Trust has been given the following ratings:

Financial risk rating - 3

Governance risk rating - AMBER-GREEN

The Trust has been assigned an Amber-Green governance risk rating, which reflects that we have missed the A&E 4-hour wait target in Q2. This has previously been alerted to the Board as, across the region, we have seen, and continue to see, a rise in the demand for A&E services.

The Finance and Performance Committee is monitoring the action plans and the winter plan each site has developed to ensure that safety and care is maintained during this very busy period.

Visit to the Trust by Norman Lamb MP, Health Minister

Norman Lamb MP visited Heartlands Hospital, to gain first hand experience and an overview of the Rapid Assessment, Interface and Discharge (RAID) service which is run jointly with BSMHFT and provides in-hospital mental health expertise within our teams.

Following a tour of A&E the Minister had an opportunity to meet some of the frontline medical staff who work with RAID at Heartlands. This was a very successful visit and resulted in the Minister highlighting the excellent work on national radio.

Staff Recognition Awards

Every year, the Heart of England NHS Foundation Trust holds an award ceremony to recognise the excellent work that staff deliver on a daily basis. These awards are now in their 10th year, with the event providing the Trust with the opportunity to thank its staff and celebrate their achievement with their colleagues. This year’s awards ceremony was a tremendous success with a record number of nominations, and showcased just a small snapshot of the excellent work being delivered by our staff across every area from community services to our hospitals.

VISITS and MEETINGS:

BMA Medically Qualified Chief Executives’ Forum

I was invited to attend the BMA Medically Qualified Chief Executives’ Forum where we discussed the productivity challenge as well as national terms and conditions versus local pay bargaining. This was a stimulating forum which looked at the difficulties the NHS is facing as


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we implement the efficiency drive and maintain safety and standards for our patients.

Hospital Directions Event

I was asked to speak at this conference on the topic of ‘Clinical engagement and the Nicholson Challenge’. It was followed by a short presentation from me and a Panel discussion on the likely implications of the Francis Report.

Capsticks Seminar

I was invited with Peter Hay CBE, Strategic Director Adults and Communities, Birmingham City Council to present and discuss with Capsticks’ senior executives the local government and the health agenda. This proved a very interesting debate as it looked at the local climate and managing the staffing issues to support the changes which will need to be made as we see more care move out of hospitals into community settings.

World Economic Forum project on the Financial Sustainability of Health Systems

I took part in the World Economic Forum meeting on the Financial Sustainability of Health Systems. This event, which was organized jointly with the NHS Confederation, brought together very senior politicians, policy makers and leading figures from across the healthcare sector. It provided an opportunity to take a look at the vision for health systems in 2040 should be and what is needed for this to become a reality.

The Health Service Journal

I was invited to take part in a HSJ Round Table event on Achieving Large Scale Change, convened jointly with the NHS Institute for Innovation and Improvement. We discussed the enormous changes facing hospitals, including the pressures to centralise many acute services, more routine care being provided in the community, and a continual demand to do more at the same - or less - cost.

Social Era

I have taken part in discussions with NHS Institute for Innovation and Improvement on how we can put together an event to collectively discuss with the service, the impact of what has been termed the ‘social era’. This will cover crucial issues for hospitals such as how we involve patients and staff in the management and decision-making process, how we create better engagement in our communities, and how we communicate in an age when information passes immediately and discussion happens continually. The aim is to hold a web-based event in 2013 to ensure that we raise the issues social media can present as well as the opportunities it provides.

Local Education Training Council

I am continuing to Chair the Local Education and Training Council (LETC) which has been set up in the West Midlands as a way of providing local information to the West Midlands LETB (Local Education and Training Board).

A priority at the moment is the development of the 5 year workforce plan for the region, which


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needs to take into account the significant changes likely in healthcare provision over this timescale.

Social Media ‘Unconference’

I attended a social media ‘unconference’ where we debated the benefits and challenges of social media when engaging with staff and the public. Commissioners and Social Care were well represented, and there are clearly many opportunities to create new dialogue across the system and to determine and discuss what is important to staff, patients and our local population.

NHS Confederation Event - Speaking the truth to power

I attended the NHS Confederation Event on speaking the truth to power. This was a small development seminar for Chief Executives which facilitated discussion on important topics such as influencing and bringing about system change.

Hospital Forum, NHS Confederation

I chaired the second meeting of the Hospital Forum where we covered a number of current topics, in particular the winter pressures on hospitals and the national workforce arrangements.

The forum will allow Confederation members to identify the innovative work being done by hospitals around the country and help NHS organisations learn from each other on how to best deliver the highest standards of care for patients.

Waverley School

I attended my first meeting as a Governor at Waverley School, our neighbour at Heartlands Hospital. I am keen to create closer working with this key local stakeholder, ahead of our joint Studio School initiative which opens in September 2013. It is clear this is an excellent local school and that constructive joint working can create significant local benefit. The school moves to its new facilities opposite Heartlands Hospital’s Yardley Green entrance in April.

Death Certification Reform Meeting

As part of the Birmingham Bereavement Project the Trust became an early adopter for the new death certification reforms in April 2012, ahead of the proposed national implementation date of April 2014. A working sub-group was set up with representatives from the Register Office, HM Coroner office, faith advocacy group, bereavement service, voluntary sector and clinical governance, to look at the operational issues associated with the new process both internally and across organisations. These meetings are held quarterly.

Professor Furness (Chair of the National Steering group for medical examiners) contacted us and asked if he could attend one of these meetings as he felt that we had progressed further than many of the national pilot sites and wished to hear more about how we had implemented processes across the Trust.

I opened the meeting and we heard from Prof Furness who gave a national perspective about the roles and responsibilities of Medical Examiners. Dr Chris Ellis from the Trust provided an


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excellent and positive reflection on the first 6 months as early adopters and the lessons learnt so far. This was attended by a wide variety of external partners including other trusts seeking to implement the reforms and provided a showcase for the outstanding work the team has done to improve this service.

LOOKING FORWARD TO THE END OF THE FINANCIAL YEAR

We are now in our busiest time of year managing the complexity of patients, the rise in demand and needs of the increased number of critically-ill patients. We remain focused on delivering on the important safety and efficiency agenda and supporting our staff during this very demanding and relentless period.

We are working closely with our external partners, including the new Clinical Commissioning Groups, and are discussing a range of new measures to support care provision across the conurbation.

We are making progress with our transforming HEFT programme and have developed planswhich bring together clinical transformation across the sites, improving our business system infrastructure, and achieving the cost efficiencies that will be necessary. Progress on these work streams will be reported regularly to Board.

Finally, Robert Francis QC’s report into Mid Staffordshire NHS Foundation Trust is scheduled to be released in late January / early February and it will be important for us to consider any recommendations as a matter of priority, to ensure that we are doing everything needed to deliver consistently safe and respectful care. Safety will remain our top priority and this will continue to be our guiding principle when considering any changes going forward.

Dr Mark NewboldChief Executive


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10 December 2012 Dr Mark Newbold Chief Executive Heart of England NHS Foundation Trust Birmingham Heartlands Hospital Bordesley Green Birmingham West Midlands B9 5SS

Dear Mark Q2 2012/13 monitoring of NHS foundation trusts Our analysis of Q2 is now complete. Based on this work, the Trust’s current ratings are:

Financial risk rating - 3 Governance risk rating - AMBER-GREEN

The Trust has been assigned an Amber-Green governance risk rating, which reflects that it has failed to meet the A&E 4-hour wait target in Q2. Should the Trust fail to meet the A&E 4-hour wait target twice in any two quarters over a twelve month period and fail the indicator in a quarter during the subsequent nine-month period or full year, its governance risk rating may be overidden to Red by Monitor in line with the procedures set out in the Compliance Framework and considered for escalation for potential significant breach of its terms of Authorisation. Compliance with targets, national priorities and CQC registration conditions is a requirement of the Trust's terms of Authorisation. The Compliance Framework sets out the significance that Monitor attaches to a failure to comply. Monitor expects the Trust to have plans in place such that your Board will be in a position to submit unqualified self-certifications in future monitoring cycles. As communicated in the FT Bulletin in November, Monitor’s review of Q2 includes consideration of the accuracy of Board self-certifications submitted in the annual plan against trusts’ actual performance in the first half of the performance year. The criteria against which this assessment is made were included in the November Bulletin. In order for Monitor to operate a compliance regime combining the principles of self-regulation and limited information requirements, it must be able to rely on the accurate assessment of risk by NHS foundation trust boards via the self-certification process. A significant number of trusts met the criteria for a self-certification review this quarter. I would like to take the opportunity to remind you that Monitor takes the self-certification process very seriously, and will be following up with trusts where self-certification discrepancies may be considered to be indicative of a wider governance concern. For your

4 Matthew Parker Street London SW1H 9NP T: 020 7340 2400 F: 020 7340 2401 W: www.monitor-nhsft.gov.uk


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reference, I have included at Appendix 2 a summary of recommendations which have arisen from previous independent self-certification reviews. Monitor is currently undergoing a restructuring exercise to meet both the requirements of the 2012 Health and Social Care Act and to align our Provider Regulation function (formerly Compliance) with the regional structures of other health bodies, including the Care Quality Commission. Consequently, there are now four regional regulatory directorates within Provider Regulation: North, South, London and Midlands & East, each headed by a Regional Director. As a result of this change, it will be necessary for us to make changes to relationship teams between now and 1 April 2013. You will also note job titles of your relationship team have been changed to reflect the move to a regional structure. Your Trust is in the Midlands and East (Central) region. We do not expect to make significant changes to relationship managers however some movement may be necessary ahead of Q4 and the annual planning round to ensure portfolios are balanced and that continuity is achieved as much as possible going forward. Your relationship team therefore is as follows:

Your Regional Director is: Adam Cayley (020-7340-2538, [email protected]) Your Senior Regional Manager is: Alexandra Coull: Mon-Tues & Fri (020 7340 2473, [email protected]) or Laura Mills: Wed-Thurs (020 7340 2473, [email protected]) Your Regional Manager is: John Sparrowhawk (020-7340-2575, [email protected])

If you have any questions about the structural changes within Monitor, please contact me and I would be more than happy to discuss this further. I have attached a one page executive summary (Appendix 1) of your Trust’s Q2 results for your information and a report on the aggregate performance of the NHS foundation trust sector will shortly be available on our website (in the News, events and publications section) which I hope you will find of interest. For your information, we will shortly be issuing a press release setting out a summary of the key findings across the NHS foundation trust sector from the Q2 monitoring cycle. If you have any queries in relation to any of the above, please contact me or Laura Mills by telephone on 020 7340 2473 or by email ([email protected] or [email protected]) at the earliest opportunity. Yours sincerely

Alexandra Coull Senior Regional Manager cc: Lord Philip Hunt, Chairman Mr Adrian Stokes, Finance Director


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0

• At Q2 the Trust has delivered EBITDA of £18.1m, an adverse variance of £4.6m. Income over-performance of £11.0m, including £2m recognised from the PCT contingency relating to activity within the JRMA, has been off-set by additional costs of activity, additional resources required in relation to the A&E 4-hour wait target and CIP under achievement.

Key risks Action taken / committed Gaps and residual concerns

• Joint Managed Risk Agreement: The 12/13 PCT Contract is fixed under a block funding arrangement. This puts an emphasis on effective demand management and cost control. Activity trends YTD are showing growth rather than planned reductions.

• The PCT Cluster has set aside a £4m contingency fund, made available if the Trust can demonstrate it has incurred additional costs to deliver activity above plan. The £1m Q1 claim from the contingency has been formally agreed.

• The Trust has set up a demand management committee to monitor progress on demand management initiatives.

• The Trust has continued to over-perform in Q2. There is a risk that the £4m contingency fund is not adequate to cover additional costs, if demand is not managed effectively.

• Pay and non-pay over-spends indicate that the Trust needs to do more to control operating expenses.

• CIPs: The Trusts planned delivery of an FRR 4 was predicated on effective demand management and delivery of CIPs, the latest forecast has been downgraded to an FRR3.

• An escalation process has been put in place following review of operational overspends and CIP shortfalls, this will be reviewed by the Deputy CE.

• The Trust has initiated a MARS scheme in light of the under-delivery of CIPs and anticipated financial pressures in 2013/14.

• There is a concern that CIPs continue to be under-delivered against a back-loaded target.

• The value of savings achieved through the MARS scheme is not yet known.

• A&E target breach: The Trust has failed the A&E 4 hour wait target in Q2 2012/13 and is currently slightly behind the target in Q3. There is pressure across emergency services in the West Midlands.

• The Trust is due to open the refurbished A&E department at the Good Hope site in November.

• The Trust Board signed off a remedial action plan in November 2012, this focuses on the following areas: Admission avoidance, A&E systems and process, access to discharge, alternative care options and accountability.

• There is a concern that the Trust will breach the A&E target in future quarters.

• There is a concern that costs associated with achieving compliance will continue to impact on the Trust’s profitability margins.

Next steps Continue quarterly monitoring Tripartite call with the CQC Trust to provide monthly A&E target performance data

Risk ratings

Financial Risk Rating:

12/13 Plan: YTD FY YTD Actual: Q2

3 4 3

Governance Risk Rating:

12/13 Plan: YTD Actual:

Declared Risks:

• None Breaches: • AETime

2012/13 Authorised limits

Long term borrowing

£124.3m Working Capital Facility

£30.0m

Heart of England NHS FT Q2 2012-13 reporting executive summary

GREEN AMBER-GREEN

Financial summary £m Q2 only Year to date

Plan Actual Variance Plan Actual Variance

Op. Rev for EBITDA 147.7 152.9 5.2 294.4 305.3 10.9

Employee Expenses (93.8) (95.8) (2.0) (188.9) (191.6) (2.6)

PFI Op. expense (0.2) (0.2) (0.0) (0.4) (0.4) (0.0)

All other Op. costs (42.7) (48.3) (5.6) (84.4) (97.2) (12.8)

EBITDA 11.0 8.7 (2.4) 20.6 16.1 (4.5)

Surplus /(Deficit) pre exceptionals 3.1 1.1 (1.9) 4.7 0.7 (3.9)

Net Surplus/(Deficit) 3.1 1.1 (1.9) 4.7 0.7 (3.9)

EBITDA % 7.5 % 5.7 % -1.8 % 7.0 % 5.3 % -1.7 %

CapEx (Accruals Basis) (10.9) (9.7) 1.2 (18.8) (16.7) 2.1

Net cash flow (8.0) (12.4) (4.4) (6.3) 12.0 18.3

Cash & Equiv 91.0 109.2 18.2 91.0 109.2 18.2

FRR Liquidity days 31.0 27.7 (3.3) 31.0 27.7 (3.3)

CIP% Op. Ex less PFI 3.1 % 2.3 % -0.7 % 2.8 % 2.2 % -0.6 %

Net current assets 55.2 53.1 (2.1) 55.2 53.1 (2.1)

Borrowing 5.3 5.3 0.0 5.3 5.3 0.0


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Internal audit • A rolling programme of internal audit work should be used to support the self-

certification process; • The Audit Committee should commission internal audit to assess whether the

trust’s risk mitigation actions have been successful at reducing risk; and • Internal audit assurance should be reflected in board reports.

Training • Implement development sessions for the trust Board to enable them to better

challenge self-certification recommendations.

Appendix 2: Summary of recommendations from previous independent self-certificationreviews of foundation trusts The Board’s role • Introduce an additional level of executive challenge within the overall self-

certification process. For example, peer review sessions; • Provide for an initial NED challenge to the level of assurance obtained before

consideration by the trust Board; • Ensure that executive directors and NEDs properly assume responsibility for self-

certification declarations; and • Ensure that sufficient time and focus is given at trust Board meetings to challenge

self-certification recommendations.

Board reports • Clear ownership, process and timetable (including data ‘freeze’ dates) for

recording, validating, and reporting of data are required to ensure that all performance reports are based on the same information;

• Ensure that Board minutes provide sufficient detail of key discussions held by the Board;

• Trust performance reports should contain sufficient detail to enable NEDs to scrutinise and challenge self-certification proposals;

• Draft self-certification declarations should be prepared well in advance of submission deadlines to allow time for proper scrutiny and challenge;

• Board assurance documents, discussions of risk and the self-certification process should be aligned;

• Ensure that trust’s risk register is updated and reported to the Board on a regular basis;

• Board minutes to clearly document the decision making process of self-certifications; and

• Self-certification to Monitor to be added as a standard Board meeting agenda item.

Board sub-committees • Ensure that the Audit Committee and Information Governance Committee review

their operations to ensure they provide appropriate levels of assurance to management and the Board;

• Audit Committee operations need to embrace the full remit of the NHS Audit Committee Framework; and

• The Audit Committee should review the accuracy of self-certification declarations made to Monitor.

Directorate responsibility • Ensure that directorates engage effectively with the trust’s governance agenda;

and • Ensure clear ownership of reporting performance to the Board by executive and

directorate management.

Risk reporting • Risk reporting processes at clinical business unit level need to ensure that the

trust’s risk register is complete; and • The Trust Assurance Framework should map the risks of the trust not achieving

its strategic objectives to the controls in place to mitigate these risks and the assurances over the effectiveness of the controls.

January 2013

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External and Strategic Review


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EXTERNAL and STRATEGIC REVIEW

There have been a number of publications recently concerning the ongoing efficiency challenge facing the NHS.

1. Nuffield Trust – ‘A decade of austerity?’

This report attempts to quantify the pressures facing the NHS in England over the decade to 2021/22.

Key Points from their report:

a) After 2014/15, to avoid cuts to the service or a fall in the quality of care patients receive, the NHS in England must either achieve unprecedented sustained increases in productivity, or funding will need to increase in real terms.

b) Cost pressures on the NHS are projected to grow at around four percent a year up to 2021/22. These arise from growing demand for health care – to meet the needs of a population which is ageing, growing in size, and experiencing more chronic disease. They also result from increases in the cost of providing health care – of which the largest item is workforce pay.

c) If NHS funding is held flat in real terms beyond this spending review period, the NHS in England could experience a funding gap worth between £44 and £54 billion in 2021/22, unless offsetting productivity gains can be delivered.

d) The NHS is committed to improving productivity (the ‘QIPP challenge’) by around four per cent a year to 2014/15. If this is achieved, the funding gap of £44 to £54 billion would be reduced to a potential shortfall of £28 to £34 billion by 2021/22. This would require continued efficiency savings of around four per cent a year if funding is kept flat in real terms (as it is now) beyond 2014/15.

e) If NHS funding increased in line with the historic average (four per cent a year) after 2014/15, this would be sufficient to meet the projected demands on the service. However, the outlook for public finances makes this highly unlikely, as such a settlement for the NHS would have significant implications for other public services andwelfare spending, or would require major increases in taxation.

f) If spending grew more modestly, in line with the forecast growth in Gross Domestic Product (GDP) (2.4 per cent a year), the NHS would need to make efficiency savings of around two per cent a year if the current QIPP challenge is achieved. This represents a profound challenge for the NHS.

g) Managing demand, particularly among people with long-term chronic conditions, will be critical – pressure on costs from this group is at least equal to, if not more than, that from the expanding and ageing population.

h) Pay restraint is likely to contribute around 40 per cent of the required QIPP savings by 2014/15. The scale of the productivity challenge facing the NHS after 2015 is increased by the very different outlook for pay across the NHS workforce. If NHS earnings start to increase in line with the historic increase of two per cent a year above inflation, greater savings will need to be made in other areas.


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This report reinforces the point that the current difficult financial climate is the new norm for the NHS and all our future planning and strategy work should be set in this context. While there may be small windfalls along the way, these will quickly fade into obscurity when set against the overall macro picture of reduced funding.

Although the NHS has had hard times before, it is difficult to see how it can meet this challenge without a transformation of how healthcare is provided. This revolution has taken place in many other industries where one can observe trends such as:

• labour substitution of cheaper staff for more expensive staff – and using expensive staff in very different ways;

• new and cheaper channels of communication available for consumers (patients) to communicate with the industry (health care professionals);

• consumers (patients) will have to become important as producers of value (healthcare);

• cheaply produced value will have to replace expensively produced value and the expensively produced value will disappear.

Hospitals carry the burden of high fixed costs (arguably much of the paybill can be classed as fixed or semi fixed cost in the NHS) and therefore will continue to feel the pressure to reduce activity, and receive real term reductions in prices.

Consequently we can expect to spend more time looking at different ways to deliver our services, exploring how we can encourage innovation from our workforce, initiatives to reduce the paybill and system reconfiguration of those services that remain hospital based.

The importance of service transformation is highlighted in a recent report from the National Audit Office.

2. NAO – Progress in making NHS efficiency gains

This report produced for Parliament in December 2012 recognises the progress made to date by the NHS in meeting the QIPP challenge. It notes that most of the savings made to date were due to contractual levers applied by the DoH (e.g. reduced tariff) and the two year pay freeze, rather than service transformation.

Looking ahead the report observes that it will be increasingly difficult for the NHS to generate new efficiency savings. It calls for a greater focus on service transformation (e.g. integrating care and expanding out of hospital care) to reduce demand on acute hospital services. However, the report also highlights the need for the National Commissioning Board to develop better evidence to underpin service transformation (many clinicians and managers remain sceptical) and develop more sophisticated payment mechanisms to overcome financial disincentives for providers.

Finally the report recommends improvements in monitoring progress around service transformation. This is something that we have had some difficulty with in our Trust. The quote from the report sums up the challenge well:

“Transformation comes in many different forms and progress is difficult to measure. Currently, NHS organisations report progress against project milestones but these can be achieved without the delivery of financial or other benefits. The Department should explore output


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measures that assess, for example, whether resources are shifting from hospitals to community services to provide a better indication of progress.”

NAO Progress in making NHS Efficiency savings, December 2012

The Nuffield and NAO report both set the scene for the new NHS Operating Framework for 2013/14. This document is now produced by the National Commissioning Board and has been renamed “Everyone Counts”.

3. Everyone Counts: Planning for Patients 2013/14

Published just before Christmas by the National Commissioning Board (NCB), this document sets out the planning priorities and funding principles for the NHS for the next financial year.

It is fair to say that the guidance is less prescriptive than has been the case in previous years but still remains very challenging for all parts of the system.

The guidance sets out “five offers” from the NCB to produce better health outcomes:

i. Seven day working for ‘routine’ services – primarily aimed at hospitals but does give some recognition of the importance of ‘out of hours’ primary and community services

ii. More transparency and choice – aiming to publish activity, clinical quality measures and survival rates from national clinical audits for every consultant practising in the following specialties (most of which are provided by the Trust):• adult cardiac surgery; • interventional cardiology; • vascular surgery; • upper gastro-intestinal surgery; • colorectal surgery; • orthopaedic surgery; • bariatric surgery; • urological surgery; • head and neck surgery; and • thyroid and endocrine surgery.

iii. Listening to patients and increasing their participation - the Friends and Family Test which will be introduced for all acute hospital inpatients and Accident and Emergency patients from April 2013 and for women who have used maternity services from October 2013.

iv. Better data, informed commissioning, driving improved outcomes – including a commitment to build ‘care.data’ system across health and social care.

v. Higher standards, safer care – including a commitment to address the recommendations of the forthcoming Francis report, alongside the recently published “Compassion in practice” addressing nursing standards and revalidation for medical staff.

With regard to financial planning the guidance sets out the following expectations:

a) Each commissioning organisation should plan to make a cumulative surplus at the end of 2013/14 of at least 1 per cent of revenue, including any historic surplus not drawn down. This surplus will be carried forward into 2014/15.


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b) Commissioners should plan to be in 2 per cent recurrent surplus by the end of 2013/14; further guidance on this will be published in January. Clinical commissioning groups (CCGs) will be expected to ring fence these funds and only make expenditure commitments against them which are non-recurrent and are approved by the Board's Local Area Teams.

c) In addition, CCGs are asked to hold a contingency of at least 0.5 per cent of revenue within their plans to mitigate risks within the local health economy.

d) Primary care trust accumulated surpluses up to the level of the 2012/13 operating plans will be attributed to individual CCGs and direct commissioning units in proportion to the final 2012/13 baselines.

e) The national provider efficiency requirement for 2013/14 tariff setting is 4 per cent. This is a net adjustment of -1.3 per cent, once offset against estimated cost inflation of 2.7 per cent. This is also the base assumption for discussions about prices for off tariff services.

f) The 30 per cent marginal tariff for non-elective admissions will continue, with the 70 per cent balance spent locally in relevant demand management schemes, jointly owned by commissioners and providers.

So, in short for the Trust, this equates to a 4% efficiency challenge and for commissioners there is an expectation that they will hold back 3.5% of expenditure, of which 2.5% will be for contingency or non-recurrent expenditure.

Recent year’s experience around the use of money for winter and very short timescales to put together funding proposals has left a legacy of concern about how well non-recurrent monies will be used in the future.

4. ‘Rating review’ - review of aggregate assessment of providers of health and social care in England

The Secretary of State has recently announced his intention to examine whether the introduction of an aggregate ‘rating’ to summarise and compare the performance of NHS organisations or the services provided by them. It is believed that such a rating might be of value to the public, in helping to choose the right services, and to those purchasing or providing services constantly to seek better performance.

In the media this has been referred to as the equivalent to an ‘Ofsted-style’ system of ratings for hospitals and care homes.

The Nuffield Trust has been commissioned to consider whether aggregate ratings of provider performance should be used in health and social care, and if so how best this might be done.One of the objectives of the review will be to determine how best use can be made of existing metrics, rather than require costly new data collection, and not to create extra burdens on providers.

The review is expected to report in the Spring.

Simon Hackwell Commercial & Strategy Director


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Patient and Public Feedback Report


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PATIENT and PUBLIC FEEDBACK REPORT

This document provides an update on the Trust’s Patient and Public Experience Activity and highlights views with regard to patient and public perceptions. Following the Patient and Public Board Report presented in November, this report also details, as requested, the complaint numbers, locations and themes by hospital site for all formal complaints received in November 2012.

Summary/Key Points:

• The Trust is continuing to see a rise in patient information perceptions being provided and is focusing on improving performance in key areas, including A&E and Renal, and across the organisation on discharge.

• The Friends and Family Test (NRI), which measures those patients who would recommend the services/hospitals to members of their family and friends, is continuing to show scores in the early 60s (currently 63).

• Looking ahead to the media for the New Year, the Trust is focused on building on its work in volunteering and fundraising with the aim of getting more people from the local community involved in their hospitals.

Complaints:

• Complaint themes are monitored and reported by site, by specialty and by ward area• Further centralisation of complaints is expected to help drive further improvements in

2013 and work has commenced to roll this initiative out initially in Women’s and Children’s areas.

1. PATIENT FEEDBACK SUMMARY

95% of inpatient wards areas were surveyed in November 2012 (664 inpatients and 14 visitors).

The Trust received 83 formal complaints in November; the main themes were clinical care, decision regarding treatment and staff attitude. Work has commenced in Women’s and Children’s areas to close the outstanding 16 open complaints.


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2. NET RECOMMENDER SUMMARY

The Patient Opinion and NHS Choices websites provide an opportunity for patients and visitors to rate hospitals. Year to date, 122 patients have rated our hospitals with 74% stating that they would recommend the care they received to a member of their family or friends.

The Trust’s NRI score is being monitored by site and ward. This is published with the aim of improving promoter numbers.

November: Percentage of patient comments from the Net Recommender Survey Site Q1. Anything we did well? Q2. We could have done better? Q3. Staff nominationHeartlands 44% 19% 37%Good Hope 39% 24% 37%Solihull 51% 12% 38%Trustwide 44% 19% 37%

NET RECOMENDER

Apr-12 May-

12 Jun-12 Qtr1 Jul-12 Aug-12 Sep-12 Qtr2 Oct-12 Nov-

12

NRI Score -24 -30 56 4 52 61 64 60 63 63



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3. COMMISSION FOR QUALITY AND INNOVATION TARGETS (CQUIN)

Commissioners monitor patient feedback against the following measures:

Inpatient CQUIN (Commission for Quality and

Innovation Targets)

Dec-11

Jan-12

Feb-12

Mar-12

Apr-12

May-12

Jun-12

Jul-12

Aug-12

Sep-12

Oct-12

Nov-12

Able to discuss worries with staff 97% 99% 98% 95% 95% 92% 90% 94% 95% 94% 95% 92%

Given enough privacy discussing treatment 95% 95% 97% 98% 96% 96% 97% 95% 96% 96% 95% 96%

Involved in decisions about your treatment 92% 93% 93% 92% 91% 87% 94% 93% 90% 91% 89% 91%

Told about side effects of medication 87% 94% 93% 92% 86% 83% 86% 82% 89% 90% 89% 88%

We are continuing to look at mechanisms for automating and supporting these patient interactions, as we are seeing numbers of patients who have been provided with the information, reporting they do not remember having the details. 4. COMPLAINTS SUMMARY

The chart below illustrates the number of formal complaints received in September, October and November 2012. Overall there has been a small but steady increase in formal complaints received month on month over this period. Heartlands receive the highest number of formal complaints followed by Good Hope and then, lastly, Solihull Hospital.

This pattern was slightly different in October when Solihull received more complaints relating predominately to patient care, staff attitude and delayed discharge (see details below). This is not considered statistically relevant at this stage and more a normal monthly variation.

0

5

10

15

20

25

30

35

September October November

BHH

GHH

SHH

Complaint locations by hospital site (November 2012)



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Heartlands HospitalFormal Complaints by location TotalMain Outpatients Department 5

Heartlands Ward 11 2


Fracture Clinic 2Heartlands Ward 08 (AMU2) 2Accident & Emergency 2Operating Theatre –Reception 1Labour Ward / Delivery Room 1



MIDRU 1

Glaxo Renal Unit 1


Heartlands Ward 10 1Heartlands Devon House 1Heartlands Cedar Ward 1


Willow Suite 1

Obstetrics Theatre 1

Heartlands Ward 19 1Ophthalmology Outpatients 1Heartlands Ward 19 Day Unit 1Heartlands Ward 20 (AMU) 1

Heartlands Ward 15 1 Total 33

Good Hope HospitalFormal Complaints by location TotalAccident & Emergency 4

Operating Theatre (General) 3

Main Outpatients Department 2

Labour Ward / Delivery Room 2

Good Hope Ward 12 2

Obstetrics Theatre 2

Good Hope Ward 14 2

Good Hope AMU Female 2

Preoperative Assessment Unit 2

Good Hope Ward 04 1

Good Hope AMU Male 1

Good Hope Ward 10 1

Good Hope Ward 24 ECAU 1

Good Hope Ward 02 1

Good Hope Ward 26 1

Good Hope Ward 23 1Gynaecology Outpatients Department 1

Good Hope Ward 16 1Total 30

Solihull HospitalFormal Complaints by location TotalOperating Theatre (General) 8Main Outpatients Department 4Gynaecology Theatre 1

Solihull Ward 17 1

Solihull AMU 1

Solihull Ward 16 1Neurology Department 1

Solihull Ward 18 1Gynaecology Outpatients Department 1

Radiology 1

Total 20

The team is working initially with Women’s and Children’s areas to centralise the complaints process, improving the quality and timeliness of responses. Once the process has been tested this will be rolled out across the organisation. Early indicators show some positive results using a different approach. From 1.1.11 – 1.1.12 we received 131 obstetric complaints and 21 came back requiring further resolution which is where complainant was unhappy with the original response and / or it took a lot longer to resolve than planned.

From 1.1.12 – 1.1.13 we received 127 complaints and the system is only showing 3 as coming back requiring further work. This saves staff time and, importantly, helps a complainant get faster resolution.



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Clinical care and staff attitude are consistently the more common drivers for complainants. December’s patient experience report (featuring the themes by site of complaints received in November 2012) is attached for information. A programme of staff engagement and training is being developed to raise awareness of attitude with complaint themes and locations are widely reported on a monthly basis to service and site leads with summaries presented at strategic site-level meetings. Common themes include poor staff attitude, communication, delays in treatment and clinical care. Work remains on-going concerning lessons learnt from complaints with further work to centralise complaints through Q1, 2013 expected to be a key driver in ensuring lessons are learnt and services are developed based on customer feedback.

5. VOLUNTEERING

It has now been 12 months since the restructure of the volunteering service and 2012 has been the most successful year for volunteering in the Trust to date. The goals set for the department at the beginning of the year have all been met and there has been a 22% growth in the number of active volunteers across the hospitals and in the community. For 2013 the aim of the department is to increase the number of active volunteers to 1,000 through the development of new roles and the expansion of existing roles into new clinical and non-clinical areas. The first quarter of 2013 will see the start of a consultation with volunteers and staff on the brand and image of the department and those that work within it along with a ‘Volunteer Satisfaction’ survey to identify areas where satisfaction and motivation can be improved supporting the Trust’s vision of providing caring services. This will be followed by a survey of staff that use the volunteer service to identify areas for improvement or development. The results of both surveys will be provided to the Trust Board.

The current method of recognising volunteers for long service, with 5-yearly lapel badges, is being reviewed by the Head of Volunteering, with a view to implementing twice-yearly long-service recognition award events, where it is proposed that a senior representative of the Trust will attend and present those volunteers eligible with a trophy and certificate in recognition of their commitment.

6. FUNDRAISING

The fundraising consultant employed to support the recommendations made by Wootton George Fundraising Consultancy has now completed his 12-month contract and a benefits analysis report has been prepared for the Donated Funds Committee. The report demonstrates a return on investment in excess of 150%, despite a limited number of active projects, and includes only the income or benefits in kind that were received as a direct result of the consultant’s work. Following the end of the contract and utilising the skills and knowledge imparted, the activity in raising funds from trusts and foundations has continued and a further £103,000 has been received either in donations of money or services in the past 8 months with additional outstanding applications in excess of £200k awaiting decisions from trustees. It should be noted that the Trust has benefitted from a total of £250k in funds, equipment or



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activity from a source of income that it has never before received and this will continue to riseyear on year.

In addition to this activity, the fundraising department has taken on the task of funding and delivering the Trust’s GP Lecture programme through sponsorship which has already seen an additional £10k income in the first two months alone enabling these important events to continue at no cost to the Trust. For the current financial year, the level of income attracted by the fundraising department to the charity will be at least equal to the cost of the fundraising department, which is in line with the challenge the departments has set itself and above industry expectations for a relatively new team. The coming year for the fundraising department will bring a new challenge of raising an amount of money equal to four times the cost of the department which, over the next 5 years will increase to ten times cost but in order to achieve this target the right projects will need to be available and supported by the Trust.

7. IN THE NEWS

In-line with the start of the November Norovirus outbreak, Diane Tomlinson gave the first interview with Radio 5live with a series of prevention messages to stop visitors with symptoms coming into our hospitals.

A vital new piece of equipment to help bowel cancer sufferers was given to Good Hope following the £60,000 fundraising efforts from The Holly Trust and local Sutton Coldfield charities. The chemotherapy machine is one of only three in the UK.

The team has been working with the Governors to raise their profile and Governor David Roy supported the Trust by awareness on national diabetes day. He was interviewed about the condition by Switch FM.

Radio 3 covered the Children in Need activities on the Heartlands Children’s ward.

The success of the launch of the Heartlands ‘Speight of the Art’ project reached local news including ITV Central, the Birmingham Mail, Solihull News and the Warwick Courier.

Key highlights for trade press articles about the Trust during November included:

• An article in Nursing Standard regarding topics discussed at the HEFT diversityconference.

• Articles in The Lancet and Ciencias Médicas News about transforming Tuberculosis control.

• UK Hospital live streams operations to teach surgery skills article in AV interactive magazine.



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The Trust’s Twitter account reached 2,160 followers in November gaining 121 new followers. During that period the Trust account generated 89 new re-tweets and 228 mentions.

The focus going forward is aimed at supporting key messages on staying well and using hospitals appropriately. We will also be re-launching the Trust’s website, a new programme internally and externally focused on harm free care and a ‘crowd boosting’ system to allow many users on ‘Twitter’.



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Appendix: SCHEDULE OF COMPLAINTS

Heartlands Hospital

ID Location (exact) Sub-subject (primary) Description Opened Current Stage

12135 Accident & Emergency Rudeness of staff Concern re staff attitude 22/11/2012 Local Resolution

12208 Accident & Emergency

Lack of assistance with hygiene needs

Concern regarding alleged unhelpfulness of nurse regarding hygiene needs of patient in BHH ED.

29/11/2012 Local Resolution

12092 Fracture Clinic All aspects of clinical treatment

Issues rose in relation to lack of medical treatment, OPD information and difficulty getting an appointment.



issues raised in relation to clinical care, decision making, delay in A&E and delay in WMAS taking patient home


12117 Glaxo Renal Unit Rough handling Concern re alleged lack of care + nerve

damage caused by injection in hand 22/11/2012 Local Resolution

12196 Heartlands Cedar Ward

All aspects of clinical treatment

Issues rose in relation to delay in administration of antibiotics, lack of communication with the patient and information not recorded in the medical records.


12059 Heartlands Devon House

Information/communication - written

Ms Hoath called to advise that her deceased husband received survey and would like his name taken off the list. (letter with reference 1P/12RR10308)

14/11/2012 Closed

12083 Heartlands Ward 01


Issues rose in relation to tests results and GP not being made aware she had been admitted.



Decision regarding treatment

Concern regarding care during admittance on Ward 2. 28/11/2012 Local Resolution

11993 Heartlands Ward 04 Rudeness of staff Concern re alleged rudeness of

consultant 05/11/2012 Negotiated timescale

12171Heartlands Ward 08 (AMU2)

Patient dignity - general issues raised in relation to lack of nursing care 26/11/2012 Local Resolution



Patient discharged with Cannular in situ and delayed being discharged. 27/11/2012 Local Resolution



Issues raised in relation to patient fall and delay in family being advised 30/11/2012 Local Resolution


Delay in treatment -Inpatient

Concern regarding alleged delays during admissions. 05/11/2012 Local Resolution

11974 Heartlands Ward 11 Bereavement issues Concern regarding decisions made

during patient's end of life care. 01/11/2012 Local Resolution



Issues rose in relation to medical treatment and poor communication. 19/11/2012 Local Resolution



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Issues raised in relation to reaction of chemotherapy, care and treatment of the patient and staff attitude


12013Heartlands Ward 19 Day Unit

MisdiagnosisConcern re alleged suspected fall resulting in fractured arm that was initially missed


12063 Heartlands Ward 20 (AMU) Rudeness of staff

Concern re alleged poor attitude of 2 members of medical team on Ward 20 and the lack of information given re side effects of medication


12042 Heartlands Ward 28 Medication error Concern re alleged inappropriate

prescription of Co Trimoxazole 12/11/2012 Local Resolution


Patient property lost by Trust Lost property on Ward 30 at BHH. 13/11/2012 Local Resolution

12049 Heartlands Ward 30 Problem with discharge Complaint regarding decision to

discharge patient from Ward 30. 13/11/2012 Local Resolution

12160 Labour Ward / Delivery Room


Issues rose in relation to medical and nursing care and staff attitude. 26/11/2012 Local Resolution

12207Main Outpatients Department

All aspects of clinical treatment Baby misdiagnosed 29/11/2012 Local Resolution



Issues rose in relation to a report by the consultant. 20/11/2012 Local Resolution


Results delayed/unavailable -Outpatient

Concern regarding delay in obtaining results. 28/11/2012 Local Resolution


Disappointment with staff conducting a consultation

Concern re alleged lack of thorough examination + treatment plan 21/11/2012 Local Resolution



Issues raised in relation to cancellation of surgery and lack of communication between staff


12110 MIDRU Administrative error -Outpatient patient sent a questionnaire in error 21/11/2012 Local Resolution

11987 Obstetrics Theatre Complication of surgery

Concern regarding alleged contraction of necrotising fasciitis following an emergency C section.

05/11/2012 Negotiated timescale

12043Operating Theatre -Reception

Delay in surgery -Inpatient concern re cancellation of urology op 13/11/2012 Local Resolution

12081 Ophthalmology Outpatients Rudeness of staff Concern re attitude of consultant during

ophthalmology outpatient appointment 16/11/2012 Local Resolution

12055 Willow SuiteIssues rose in relation to midwifery care, staffing levels, communication, and standard of the delivery room.




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Good Hope Hospital


12135 Accident & Emergency Rudeness of staff Concern re staff attitude 22/11/2012 Local

Resolution

12208 Accident & Emergency

Lack of assistance with hygiene needs

Concern regarding alleged unhelpfulness of nurse regarding hygiene needs of patient in BHH ED.



Issues rose in relation to lack of medical treatment, OPD information and difficulty getting an appointment.



issues raised in relation to clinical care, decision making, delay in A&E and delay in WMAS taking patient home


12117 Glaxo Renal Unit Rough handling

Concern re alleged lack of care + nerve damage caused by injection in hand


12196 Heartlands Cedar Ward


Issues rose in relation to delay in administration of antibiotics, lack of communication with the patient and information not recorded in the medical records.


12059 Heartlands Devon House


Ms Hoath called to advise that her deceased husband received survey and would like his name taken off the list. (letter with reference 1P/12RR10308)

14/11/2012 Closed



Issues rose in relation to tests results and GP not being made aware she had been admitted.




Concern regarding care during admittance on Ward 2. 28/11/2012 Local

Resolution

11993 Heartlands Ward 04 Rudeness of staff Concern re alleged rudeness of

consultant 05/11/2012 Negotiated timescale


Patient dignity - general issues raised in relation to lack of nursing care 26/11/2012 Local

Resolution


All aspects of clinicaltreatment

Patient discharged with Cannular in situ and delayed being discharged. 27/11/2012 Local

Resolution



Issues raised in relation to patient fall and delay in family being advised 30/11/2012 Local

Resolution


Delay in treatment -Inpatient

Concern regarding alleged delays during admissions. 05/11/2012 Local

Resolution

11974 Heartlands Ward 11 Bereavement issues Concern regarding decisions made

during patient's end of life care. 01/11/2012 Local Resolution



Issues rose in relation to medical treatment and poor communication. 19/11/2012 Local

Resolution



Issues raised in relation to reaction of chemotherapy, care and treatment of the patient and staff attitude




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12013Heartlands Ward 19 Day Unit

MisdiagnosisConcern re alleged suspected fall resulting in fractured arm that wasinitially missed


12063Heartlands Ward 20 (AMU)

Rudeness of staff

Concern re alleged poor attitude of 2 members of medical team on Ward 20 and the lack of information given re side effects of medication


12042 Heartlands Ward 28 Medication error Concern re alleged inappropriate

prescription of Co Trimoxazole 12/11/2012 Local Resolution


Patient property lost by Trust Lost property on Ward 30 at BHH. 13/11/2012 Local

Resolution

12049 Heartlands Ward 30 Problem with discharge Complaint regarding decision to

discharge patient from Ward 30. 13/11/2012 Local Resolution

12160 Labour Ward / Delivery Room


Issues rose in relation to medical and nursing care and staff attitude. 26/11/2012 Local

Resolution


All aspects of clinical treatment Baby misdiagnosed 29/11/2012 Local

Resolution



Issues rose in relation to a report by the consultant. 20/11/2012 Local

Resolution



Concern regarding delay in obtaining results. 28/11/2012 Local

Resolution


Disappointment with staff conducting a consultation

Concern re alleged lack of thorough examination + treatment plan 21/11/2012 Local

Resolution



Issues raised in relation to cancellation of surgery and lack of communication between staff


12110 MIDRU Administrative error -Outpatient patient sent a questionnaire in error 21/11/2012 Local

Resolution

11987 Obstetrics Theatre Complication of surgery

Concern regarding alleged contraction of necrotising fasciitis following an emergency C section.

05/11/2012 Negotiated timescale

12043Operating Theatre -Reception

Delay in surgery - Inpatient concern re cancellation of urology op 13/11/2012 Local Resolution

12081 Ophthalmology Outpatients Rudeness of staff

Concern re attitude of consultant during ophthalmology outpatient appointment


12055 Willow SuiteIssues rose in relation to midwifery care, staffing levels, communication, and standard of the delivery room.




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Solihull Hospital


12061Gynaecology Outpatients Department

Rudeness of staff Issues rose in relation to staff attitude. 15/11/2012 Local Resolution

12088 Gynaecology Theatre


Issues rose in relation to complication during laparoscopic sterilisation. 19/11/2012 Local Resolution



concern re process for provision of mammogram results 16/11/2012 Local Resolution



issues raised in relation to cancer being missed 29/11/2012 Local Resolution


Other Patient not happy with the consultant’s attitude towards her. 27/11/2012 Local Resolution


All aspects of clinical treatment Breast complaint 27/11/2012 Local Resolution

12003 Neurology Department

Disappointment with staff conducting a consultation Concern re neurology consultation 06/11/2012 Further Local

Resolution

12153Operating Theatre (General)

All aspects of clinical treatment Breast - was patient's cancer missed? 26/11/2012 Local Resolution




Decision regarding treatment Breast Complaint 09/11/2012 Local Resolution


Decision regarding treatment Breast Complaint 09/11/2012 Local Resolution



issues raised in relation to misdiagnosis (THE CLUSTER INVOLVED)





All aspects of clinical treatment Breast complaint 27/11/2012 Closed

12182Operating Theatre(General)

All aspects of clinical treatment ?CSM/breast complaint 27/11/2012 Local Resolution

12077 Radiology Unexpected outcome

Concern regarding alleged pain + swelling that patient believes is the direct result of an angiogram performed on 15 November 2012.


12030 Solihull AMU Delay in treatment -Inpatient

Alleged delays in process and lack of communication. 09/11/2012 Local Resolution

12158 Solihull Ward 16


issues raised in relation to nursing care and patient fall out of bed 26/11/2012 Local Resolution


Information/communication - verbal

Concern re alleged lack of care plan in place + poor communication 07/11/2012 Closed



Concern re decision to put patient on Liverpool Care Pathway 22/11/2012 Local Resolution


January 2013

Board of Directors

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Finance and Performance

9.1 Finance and Performance Committee Report (Enclosure)

9.3 Business Plan Update (Q2) (Enclosure)

9.2 Business Case Approval - Car Parking Scheme, Yardley Green Road

(Enclosure)


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Finance and Performance Report

EXECUTIVE SUMMARY

The underlying financial position continues to cause concern with no material change in the month of November 2012. The Trust benefited from two non recurrent items in month.

The challenge of our underlying paybill and delivery of CIP remains with little or no improvement made overthe year so far. The Finance and Performance Committee reviewed a series of rectification plans and in the majority of cases those rectification plans have once again not delivered the improvement in November which Sites planned for. November performance on rectification for actual cost reduction is as follows:

SUMMARY OF FINANCIAL RECTIFICATION

Movement in month

Performance in month

Underlying

Position

Site Actuals Change

Plan Actual

Shortfall

Oct Nov

Nov Nov

£k £k £k

£k £k % £k

BHH 144 189 45

780 189 24% (591)

GHH* 455 631 176

825 631 76% (194)

SHH* 140 227 87

434 227 52% (207)

W&C's 43 43 0

101 43 43% (58)

Total 782 1090 308

2,140 1090 51% (1,050)

n.b. excludes growth budget

*GHH includes £150k benefit from Non recurrent income *SHH includes £75k benefit from Lucentis rebate

November signals a full quarter of rectification and if we had delivered all of our plans we would have made a stepped improvement in our underlying cost base in quarter 3.

The main challenge across the rest of this year is a concerted effort on implementation of plans. We have sufficient plans to get us into recurrent balance by the end of this financial year but November’sperformance demonstrates further cause for concern.

The escalation process continues to identify areas where recruitment can only be agreed at CEO level.

Within year the key issues remain as;

• Underlying pay controls.• Delivery of full efficiency programme.• Managing activity within funded capacity.• Managing activity without recourse to waiting list initiatives or use of the private sector.• Creating a work force plan that is consistent with the scale of challenge the Trust faces.• Creating a narrative that describes the organisation three years from now that matches our work

force plan.

A&E 4 hour target remains the ongoing main areas of concern from a performance perspective.

FINANCE EXECUTIVE SUMMARY & KEY PERFORMANCE INDICATORSMonth 8 to 30th November 2012

Adrian Stokes, Finance and Performance Director


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NOVEMBER POSITION

The Trust had a I&E surplus of £0.9m in November.

November delivered a better than expected surplus. This was due to a one off benefit from non recurrent income and Lucentis rebate coupled with some reduction in pay partly due to a 4 week month.

It is the third quarter of operation under the Jointly Managed Risk Agreement which allows directorates to reduce activity whilst mitigating the financial impact of this. The Trust has an over performance valued at £1.8m in November, £9.9m year to date. Of this £5.5m relates to the Jointly Managed Risk Agreement, £2.9m to Specialised Services, £1.0m to Non Contract Activity, £0.4m to non JMRA Acute & £0.1m to Solihull Community Services.

Non Elective Activity is 0.4% above plan in month and 4.1% above plan year to date. Activity is 5.0% above last year. A&E activity is 3.4% above plan in month and 2.1% above plan year to date. A&E is 1.1% busier than the same period last year. Elective / Daycase activity is 0.1% above plan in month and 1.4% above plan year to date. Activity is 2.2% above last year. Outpatient activity is 2.3% above plan in month and 1.8% above plan year to date. Direct Access is 3.9% above plan in month and 7.0% above plan year to date. Direct Access activity is 3.8% higher than last year.

Overall Theatre measures show that activity and efficiency is at a similar level to last November. This suggests that there has been no material movement in efficiency levels compared to last November.

Pay costs remain a key concern with ongoing costs of additional capacity and managing the A&E target as well as an unaffordable underlying pay bill. The cost of utilising the private sector to deliver 18 weeks has been £0.8m in year. CIP delivery saw a reduction in month and remains significantly below target year to date.

The table below summarises our current Finance & Performance position:

Category Nov Headlines

Finance

Rectification deliveryDemand ManagementEfficient delivery of carePay expenditure remains high and unaffordableAdditional capacity outside winter planCIP delivery

Performance A&E BHH and GHH

Contracting

In Month 8, A&E and Emergency activity continues above plan above last year’s level. Specialised Services income remains at the same level as in October suggesting outturn will be £4.5m above plan. The Commissioners continue to challenge activity levels in Cardiology and the income team is continuing to support the resolution of these issues.


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1. FINANCE

The Trust’s income and expenditure position in November was a surplus £0.9m providing a surplus of £2.9m year to date. Against operational budget the Trust is over spent by £1.1m in November and £14.1myear to date.

The table below shows the key issues influencing the financial position:

Category Nov Headlines£m

Medical Staffing (0.4)

Expenditure remains unaffordableWaiting List Initiatives spend of £0.1mGreatest pressures in BHH and GHH

Nursing & Midwifery (0.5)

Expenditure remains unaffordableGreatest pressures in BHH and GHH

AdditionalCapacity/A&E (0.2) Outside of winter plan

CIP (0.7)

£0.7m slippage against plans and target in month and £0.8m in month carry forwardMost significant shortfall is in BHH with further material shortfall in SOL and Women’s and Children’s

Overall Position

1.1 Medical Staffing – Total medical expenditure remains unaffordable at £8.5m in month compared to a required run rate of £7.7m. Further reduction is required in coming months. £0.4m overspent in month and £2.2m overspent year to date.

1.2 Nursing & Midwifery – Nursing expenditure remains unaffordable at £12.8m in month compared to a required run rate of £11.6m. Further reduction is required in coming months. £0.5m overspent in month and £3.9m year to date.

1.3 CIP – Actual delivery in November was £1.4m and £9.7m year to date (66% of plans). The current forecast for 2012/13 shows expected delivery to be £14.9m in Category 4 and 5, with a further £1.7m in Category 3 and £6.3m in Category 2 and below. The challenge remains to quicken the pace of delivery and progress schemes to category 4 and 5 for 2012/13.

Focused effort is also required now on finalising 2013/14 plans which sites will present next month.

1.4 Cash Deposits – Our cash balance at 30 November is £115.0m, which is deposited as follows:• £30m has been placed for 12 months (maturing March 2013) with Lloyds Banking Group.• £30m invested in a 9 month Co-op fixed term deposit maturing in January 2013.• £46.0m is in a RBS current account earning 92bp.• The balance of funds remain in GBS.

In September FPC authorised the use of RBS up to £60m on instant access up to the year end. This limit will be used to the maximum effect over the remaining 4 months of the year. Treasury Management Committee met in December and recommendations on cash placing to the end of the year have been made to FPC.


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1.5 Monitor Targets – The Monitor three year plan had full year financial risk rating (FRR) of 4, the forecast shows a risk rating of 3.The Trust has performed as below on the key Monitor targets;

• EBITDA margin at 5.7% is hitting the 3 financial risk rating. EBITDA is achieving 85% of plan indicating a 3 on achievement of plan eight months into the financial year;

• The Trust is recognising a year to date surplus of £2.9m indicating a score of 2 on I&E surplus margin and 3 on net return after financing;

• Liquidity remains healthy at around 28 days meaning a score of 4 is achieved. More than 60 days of liquidity are required to achieve a 5 rating.

The Trust’s reported FRR of 3 for quarter 2 was confirmed by Monitor on 11th December. A governance risk rating of amber – green has been reported due to a failure to meet the 4 hour A&E target in quarter 2.See attached letter.

1.6 Risk Register – The residual risk is currently £30.2m (£15.2m within the position and £15.0m outside the position). The main concerns being non delivery of CIP and pay controls.

2. PERFORMANCE

The table below shows the performance targets at most risk

Indicator MonthTarget

MonthActual Headlines

A&E BHH and GHH 95%

BHH –90.85%GHH –89.24%

Both sites failed to meet the target in month; Trustoverall position was 93.24%. Risk of failure against Q3 Monitor compliance framework

Cancer 62 day (reported 1mia) 85% 88.04% Target met in Oct,

Over 26 week waits 159 464 Over 26 week waits increased by a further 40 in month

Overall Position

2.1 A&E BHH and GHH - The Trust failed to meet the 95% A&E target in November with the Q3 position at 94.41%

Both BHH and GHH failed to meet the in-month target. With a significant dip in performance on the BHH site.

2.2 Cancer 62 day target - The Trust met the national target for the 62 day indicator in October with a significant improvement in performance. This indicator will remain under close scrutiny to ensure performance is maintained. Following last month’s escalation meeting with the Chief Executive the final action plan is provided for information

2.3 Infection Control - The Trust met the c.diff target in November, which is excellent performance against the high rates of norovirus in the Trust.

There was one case of MRSA in month


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2.4 Over 26 week waits – Although the Trust is meeting the Monitor 18 week compliance frameworkindicators, the over 26 week backlog continues to grow, increasing by 40 in month.

Guidelines for the management of 18 weeks were circulated to all Heads of Operations in November and local processes are being developed to ensure that all directorates are either complying with or working towards complying with them. It is recommended that these are managed locally and only escalated to FPCif there are significant causes for concern.

2.5 Other performance issues

Cancelled Operations

The Trust failed the cancelled operations target in month; this is the second time this year. It is proposed that this is monitored locally unless there is another breach in December or the PCT choose to escalate it

3. CONTRACTING

There are currently no issues putting Month 8 contracted income at risk for the Acute contract under JMRA.M8 income was as per forecast. The Q2 bid against the JMRA risk pool has been approved by JCCG and the Contract Review Board, resulting in a £1.08m share of the risk pool being allocated to HEFT.

Specialised Services in 2012/13 are commissioned using a cost and volume contract. M8 YTD over performance is £2.9m and a forecast of £4.5m by year end. Specialised Services are continuing to look for elements of over performance they can challenge because this represents a significant cost pressure for them.

4. ESCALATION

The following table represents the escalation process:


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5. FORECAST

Following quarter 2 our forecast remains £5.0m surplus for 2012/13.

The below table shows best, likely and worse:

FORECAST Best Likely WorstIncome 617.9 617.1 615.9

Expenditure (607.7) (611.9) (612.4)

Surplus/(Deficit) 10.2 5.2 3.5

The likely assumes the following;

• Full non recurrent benefit of £6.0m PCT efficiency monies.• £4.0m from JMRA risk pool.• No further private sector spend.• Flexed capacity withdrawal.• Winter plan does not exceed £2.0m. • Bad debt provision sufficient at £3.0m.• Modest delivery on CIP and rectification.• Excludes any extraordinary provisions or estate revaluations.

6. CURRENT ACTIONS

The below actions are currently in place for 2012/13:

• Small Executive Group set up.• MARS scheme agreed by Trust Board to be progressed.• Continued escalation for non performance.• Rectification reporting to Finance and Performance Committee to continue.• CIP Board to continue.• 2013/14 CIP due to complete end of December.

7. CONCLUSION

The November position continues to see minimal response to the paybill and efficiency challenge with little change during quarter 3. Immediate action is needed to respond to this to secure the financial position for 2012/13 and mitigate risk for 2013/14.

8. RECOMMENDATIONS

The following are recommended from Finance and Performance Committee:

• 2013/14 Budget setting policy approved.• Purchase orders 714558 and 175961 approved.• Linen and Laundry contract award approved.• Treasury Management recommendation to maximise interest payments approved.• MARS timeline and quantification to be presented January.• Continued rectification updates from Sites.• Continued escalation and improved performance management.• 2013/14 Cost Improvement Plans to be presented January• Accept review of more significant provisions.• High level 5 year capital forecast approved.

A StokesFinance and Performance Director, Heart of England NHS Foundation TrustNovember 2012


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TRUST WIDE FINANCIAL AND PERFORMANCE RISK REGISTER – 2012/13

Dire

ctor

ate

Description of

Risk

Risk if no action taken

Action to be taken to

mitigate risk

Lead

Dat

e to

be

com

pete

d

Residual Risk

Progress / Completion

Ris

k S

core

Fina

ncia

l V

alue

(£

’000

)

Ris

k S

core

Fina

ncia

l V

alue

(£

’000

)

TRUST CIP Non Delivery 15 £11.7m

Sites tasked with earlier delivery, progress Cat 3 schemes and below.

Site Leads

On going 12 £6.3m

Site CIP response to F&PC.

TRUSTVolatile energy market

15 £1.5m

Monitor usage and implement approved strategy paper.

JSellars

On going 10 £0.9m

Review undertaken and implementation underway.

TRUSTPay related

control issues

15 £12.9m

EVCP, Exec led Medical and Nursing control.

Site Leads

On going 12 £6.0m

Trust Wide paybill challenge / rectification plans.Escalation.

TRUST No access to risk pool 9 £4.0m

Ensure shadow over performance is captured and shared with the cluster

Finance On going 6 £2.0m

First request for risk pool funds made for Q2, Q1 paid.

TRUST Demand Management 15 £2.7m

New DMC set up to strategically TWmonitor activity and impacts, plan for further change and raise awareness

DMC On going 15 £tbc

New Committee set up and running and reporting into F&PC

Within Position Sub Total £32.8m £15.2m

TRUST Valuation 15 £15.0m

Management by site strategy team to ensure no delays in buildings project. Interim review when buildings completed. Finance manage valuation project plan.

Finance On going 15 £15.0m

Audit Committee agreed assumptions in November. Three main hospital sites have been visited. Draft report expected end of January 2013.

Outside Position Sub Total £15.0m £15.0m

Total £47.8m £30.2m


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0

• At Q2 the Trust has delivered EBITDA of £18.1m, an adverse variance of £4.6m. Income over-performance of £11.0m, including £2m recognised from the PCT contingency relating to activity within the JRMA, has been off-set by additional costs of activity, additional resources required in relation to the A&E 4-hour wait target and CIP under achievement.

Key risks Action taken / committed Gaps and residual concerns

• Joint Managed Risk Agreement: The 12/13 PCT Contract is fixed under a block funding arrangement. This puts an emphasis on effective demand management and cost control. Activity trends YTD are showing growth rather than planned reductions.

• The PCT Cluster has set aside a £4m contingency fund, made available if the Trust can demonstrate it has incurred additional costs to deliver activity above plan. The £1m Q1 claim from the contingency has been formally agreed.

• The Trust has set up a demand management committee to monitor progress on demand management initiatives.

• The Trust has continued to over-perform in Q2. There is a risk that the £4m contingency fund is not adequate to cover additional costs, if demand is not managed effectively.

• Pay and non-pay over-spends indicate that the Trust needs to do more to control operating expenses.

• CIPs: The Trusts planned delivery of an FRR 4 was predicated on effective demand management and delivery of CIPs, the latest forecast has been downgraded to an FRR3.

• An escalation process has been put in place following review of operational overspends and CIP shortfalls, this will be reviewed by the Deputy CE.

• The Trust has initiated a MARS scheme in light of the under-delivery of CIPs and anticipated financial pressures in 2013/14.

• There is a concern that CIPs continue to be under-delivered against a back-loaded target.

• The value of savings achieved through the MARS scheme is not yet known.

• A&E target breach: The Trust has failed the A&E 4 hour wait target in Q2 2012/13 and is currently slightly behind the target in Q3. There is pressure across emergency services in the West Midlands.

• The Trust is due to open the refurbished A&E department at the Good Hope site in November.

• The Trust Board signed off a remedial action plan in November 2012, this focuses on the following areas: Admission avoidance, A&E systems and process, access to discharge, alternative care options and accountability.

• There is a concern that the Trust will breach the A&E target in future quarters.

• There is a concern that costs associated with achieving compliance will continue to impact on the Trust’s profitability margins.

Next steps Continue quarterly monitoring Tripartite call with the CQC Trust to provide monthly A&E target performance data

Risk ratings

Financial Risk Rating:

12/13 Plan: YTD FY YTD Actual: Q2

3 4 3

Governance Risk Rating:

12/13 Plan: YTD Actual:

Declared Risks:

• None Breaches: • AETime

2012/13 Authorised limits

Long term borrowing

£124.3m Working Capital Facility

£30.0m

Heart of England NHS FT Q2 2012-13 reporting executive summary

GREEN AMBER-GREEN

Financial summary £m Q2 only Year to date

Plan Actual Variance Plan Actual Variance

Op. Rev for EBITDA 147.7 152.9 5.2 294.4 305.3 10.9

Employee Expenses (93.8) (95.8) (2.0) (188.9) (191.6) (2.6)

PFI Op. expense (0.2) (0.2) (0.0) (0.4) (0.4) (0.0)

All other Op. costs (42.7) (48.3) (5.6) (84.4) (97.2) (12.8)

EBITDA 11.0 8.7 (2.4) 20.6 16.1 (4.5)

Surplus /(Deficit) pre exceptionals 3.1 1.1 (1.9) 4.7 0.7 (3.9)

Net Surplus/(Deficit) 3.1 1.1 (1.9) 4.7 0.7 (3.9)

EBITDA % 7.5 % 5.7 % -1.8 % 7.0 % 5.3 % -1.7 %

CapEx (Accruals Basis) (10.9) (9.7) 1.2 (18.8) (16.7) 2.1

Net cash flow (8.0) (12.4) (4.4) (6.3) 12.0 18.3

Cash & Equiv 91.0 109.2 18.2 91.0 109.2 18.2

FRR Liquidity days 31.0 27.7 (3.3) 31.0 27.7 (3.3)

CIP% Op. Ex less PFI 3.1 % 2.3 % -0.7 % 2.8 % 2.2 % -0.6 %

Net current assets 55.2 53.1 (2.1) 55.2 53.1 (2.1)

Borrowing 5.3 5.3 0.0 5.3 5.3 0.0


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Finance and Performance ReportBusiness Case - Yardley Green Road

YARDLEY GREEN CAR PARKING SCHEME - UPDATE

This report is provided as an update to the Board on the progress made and the residual items to be resolved, in connection with the Yardley Green Car Parking Project, since the Full Business Case received approval from the Executive Management Board on 20th November 2012. At the date of approval, three contractors had returned tenders within the budget figures allowed within the Full Business Case, but with clarifications and caveats.

Subsequent negotiations with the three tenderers and the use of formal tender addenda has led to further clarity and increased levels of confidence in the ability to undertake the scheme (as outlined in the FBC) within the approved sum. Negotiations are being held between the Trust and B Braun to discuss a minor issue of land ownership between the two parties which should be resolved by the end of January. A slightly amended alternative is available in the unlikely event that agreement is not reached.

Summary/Key Points:

• Tenders were returned on 12th November 2012, a two week period of analysis then took place

• Tender addenda issued to all three contractors, regarding clarifications and caveats, with responses subsequently being provided by all three

• Interviews have been held with all three contractors

• On 14th December 2012, the Trust received a Draft Tender report, from its Employer's Agent, that provides a further level of confidence that the works can be undertaken within the budget allowances identified in the Full Business Case i.e. £3.75m additional capital (£311k previously approved and expended in 2010) and £47k per annum recurring revenue

• A two week "no obligation" finalisation period with the preferred contractor, to investigate and clarify a few residual risks, is now proposed prior to final trust commitment to a formal contract. The contractor was made aware of this requirement within the tender documentation.

Strategic Risk Register:

• The scheme is intended to be the first of a number that addresses the problems and risks associated with parking on the hospital sites.

Performance KPIs year to date:

• N/A

Resource Implications (e.g. Financial, HR):

• Capital Cost £3.75m in addition to the previous £311k spent in 2010 obtaining a design and planning consent (Total £4.061m)

• £47k recurring revenue costs• Improvements in Staff dissatisfaction, morale, on-street parking, staff safety and security on Yardley

Green

Assurance Implications:

• Staff and visitor parking is constantly the cause of complaint, concern and loss of productivity.

Information Exempt from Disclosure:

Nil


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Gain Loss Net Gain/Loss Total Staff Parking

Nov-08 Heartlands/Yardley Green Parking Spaces 0 0 0 1678

Dec-08 Transfer of Staff Spaces to Visitors 0 -50 -50 1628

Feb-09 Various Small Improvements on Main Site 30 0 30 1658

Mar-10 BHH Temp Parking Block 10 (Wards 34/35) 140 0 140 1798

Jun-10 BEN PCT Reproviding Temporary Car Park 290 0 290 2088

Feb-11 BSMHT Development 0 -160 -160 1928

Oct-11 BSMHT Development 0 -60 -60 1868

Nov-11 BSMHT/BENPCT Boundary Movements 0 -90 -90 1778

Oct-12 BENPCT Development 0 -200 -200 1578

Jul-13 Provide New Deck & Surface Parking 317 0 317 1895

12001300140015001600170018001900200021002200



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Finance and Performance ReportAnnual Business Plan Update (Q2)

ANNUAL BUSINESS PLAN UPDATE

Purpose of Report

Following sign off of the Annual Business Plan at April Trust Board, this report and the attached appendices provide an update of progress in Q2 and month to date Q3.

The report also gives an update on the planning process for 2013-2014.

Summary/Key points

The report provides an update in respect of business planning activity including:

• Key observations of progress against plans – (within report)

• Update on Auditors Review of the business planning process – (within report)

• Key Priority scorecards for all groups – (attached as Appendix 1)

Recommendation

1. To note Q2 and month to date Q3 progress against plan.


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1. PROGRESS – KEY OBSERVATIONS

Efficiency Goal – Performance & Operational Efficiency

• All areas are rated red or amber for CIP delivery in Q2 and Q3 with the exception of Clinical Support Services who are rated as green.

• Planned bed reductions have been realised at Good Hope Hospital with the closure of 36 beds on Ward 26.

Heartlands have closed 12 beds on the back of their redesign work, however, these have not been realised as they are currently being used for winter pressures.

Solihull has reported no funded beds closures.

Women and Children’s have closed 4 inpatient beds (Ward 2 GHH) in Q2 and reconfigured the area into an admissions lounge and achieved a 10 bed reduction in Paediatrics.

• Achievement of the 4 hour A&E target remains an issue for Q2 and Q3 on both the Heartlands and Good Hope sites.

Safe and Caring Goal – Quality and Safety

• Performance metrics for improving patient experience and safety are primarily green rated across all sites and divisions.

• Workforce plans are still slow to be progressed in Q2 and Q3 with some areas rated as red or amber. Clinical Support Services are progressing well in this area and are rated as green with £2 million savings identified. Estates and facilities have produced a competency matrix to aid them in workforce planning.

• Most plans are rated as red in Q2 and Q3 for both voluntary turnover and sickness rates, however, all have identified plans and activities to resolve this.

• To note that appraisal and mandatory figures are reported as low with only one quarter left to achieve the full year target.

Innovative Goal – Service Development and Pathway Redesign

• Much of the service development section is concentrated around Reshaping HEFT and due to not wishing to duplicate effort; progress is measured through that programme.

• Implementing innovative practices in relevant directorates is not progressing well. Where there is no commissioner support and no agreement by site or division to fund them as a cost pressure, these schemes are halted.

• Pathway redesign work in specific directorates is also progressing at a slow pace with most areas reported as amber.


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Locally Engaged Goal – Integration and Partnership Working

• Good progress is being made in this area especially at Solihull and Good Hope. Other areas are also reporting more work being undertaken with Primary Care, providing GP advice services and admission avoidance schemes.

2. BUSINESS PLANNING for 2013/2014

Due to the restructure of the organisation and the move to 3 sites and 2 divisions, it was felt timely to undertake a review of the business planning process. As part of our internal audit contract our auditors have been commissioned to undertake a review which commenced at the end of November.

The purpose of the review is twofold:

• To help the Trust understand the strengths and weakness of the current business planning process compared to other NHS organisations (both the business plan and the Monitor Annual Plan)

• Make recommendations on how the planning and monitoring process can be improved and identify best practice examples of how to embed the process across the whole organisation

There are two key lines of enquiry:

1. How well the current process works from the perspective of the operational areas and the Board

2. Identify areas of improvement and best practice that the Trust could adopt both in terms of engagement with operational areas, presentation of the plans and monitoring reports.

Feedback from the auditors will be given in early January and recommendations from this will be used in the 2013-14 planning round.

Simon Hackwell Joanna HodgkissCommercial & Strategy Director Head of Planning & Development



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`

85-100% = Green,51-84% = Amber,

0-50% = Red

Linen Contract£2.6m pa -

complete Quarter

£2.5m pa

£64k pa

Open dialogue on sustainability

framework with 2 bidders (Quarter Appoint partner

(Quarter 3) *Commence (quarter 4)

Carbon Footprint

Extend quality standards

Deliver Reshaping HEFT work stream

Presented to Board & Governors

YES/NO

Corporate and Facilities Objectives and Progress Report - Quarter 3 2012/ 13

Q4Jan - Mar

0 (£129k received)

-109.9

Timescale to be determined by Operational requirements

Q1Apr - Jun

Q2Jul - Sep

Q3Oct - NOV ONLY

3-Year Ward Refurbishment Plan

0 (£92k received)

-309,895

YesYardley Green car park. Tendering for

Design & Build contractor

Reviewed Opportunities

Service development and pathway redesign - Innovative

Achieve financial balance and deliver CIP for areas of

responsibility, including controls over pay

CIP Performance (£K)

Objective /Measurement Current Position

Income (Variance)

-86.0 -79.8

Performance Allocation (Variance) 0 (£70k received)

2012/13

Innovative Funding Solutions/Opportunities outside

Trust resources

1) CHP @ GHH - EMB approved

ISO 14001 for Facilities Team at SHAchieved

1. Initiate phase 2 of ISO 14001 at GHH2. Extend ISO 9001 to GHH Estates

(Initiate) 3. Initiation phase complete

Waste recycling initiatives(implemented). Continually under review.

Dalkia PLC have been appointed as the preferred bidder.

GHH CHP - start on site

Undertake Re-tendering exercises for key

contracts

2 bidders (achieved)

Yes

Invite bidders to submit best and final offer. This is scheduled for January 2013.

127,888

Re-Tendered Cost

Develop programme of works for agreed parking redevelopments (Quarter 2) (brought forward)

Agree income target from new developments (Quarter 2) (brought forward)

Develop parking and transport strategy No - Delayed until Quarter 2

Cost Saving

Workforce Development Plans

Work is ongoing in developing a standard rota format. A competency matrix has been produced in Estates to ensure that each individual has the relevant skills to deliver a service.

The Help Desk facility is still under review, currentlylooking at the existing resources, and requirements. Visits to other Help Desks continuing.

Quality and Safety - Safe & Caring

Previous Cost

Ward Reviews

Wards ReviewedQ1

GHH scope of works agreed with users and project tendered.

GHH: wards 10 & 12 complete.Awaiting strategy for Solihull Hospital

Costs Clinical Waste Contract

55,870

-327,003 -531,453-451,343

-505,017 -747,420

Wards ReviewedQ4

Pay Expenditure (Variance)

Non-Pay Expenditure (Variance)

43,329

Aligning Cross Site Strategy project to Trust Wide Service re-design

Implement the Capital PlanTimescale to be determined by Operational Requirements

Wards ReviewedQ3

Car Parking Strategy - draft delayed until quarter 3

Complete Quarter 4

Wards ReviewedQ2

Update: Capital Plan agreed, timescales to be determined by operational requirements. Currently working on Maternity; Hybrid Theatres/ Endoscopy; ward refurbishments at GHH; OPD; Restaurant at GHH; Pathology; A&E and Theatres at GHH; Estates Workshops; Customer Services Centre; new escalators to Main Entrance; energy sustainability project; GHH CHP; long-term parking solution.

Develop Sustainable Energy Plan (Partnership with Private Provider)

Preferred partner notified and now currently working through the schedules and project agreement

Complete ISO 9001 for GHH Estates

Final Business Case for Yardley Green to Board for approval

Yes

4 bidders

Performance and Operational Efficiency - Efficient

Standard Ward Refurbishment Programme

Schedules and Project agreement progressing

Final Business Case approved by the Board Start on Site

Wards reviewed and short term works agreed. No long term programme until bed reductions

achieved at GHH and BHH. Solihull works to be incorporated as part of the Elective Care Centre

set up. Order placed for GHH: wards 8, 10 and 12.

Ward 8 to start January 2013 dependent on bed capacity.

'Other' Contracts

YES

Measured through the Reshaping HEFT programme structure

On - Call Rotas Developed (Oct 12) (B/F by a quarter) YES

The development of the new BHH Facilities offices has allowed the inclusion of a designated and Trust-Wide, Helpdesk

Room. This will be available early 2012/ 13.

Develop 'fit for purpose' workforce in line with service strategy whilst delivering HR KPIs by Improving

flexibility of Workforce

Skills Mix review. Completed for Hotel Services and Estates (Oct 12)

Help Desk Review Completed (Oct 12) (delayed by a quarter)

EMB to agree new payment levels for car parking. Awaiting final confirmation from EMB. Board and Governors to agree in Q4

Option Study completed

Consultation with GPs and Board. Awaiting feedback from EDs.

Redevelop the Trusts Sustainable Energy Plan

2) Energy Programme

Sustainability project - reduced to 4 preferred bidders, currently in the dialogue phase and scheme option appraisal made by each bidder. This will lead to reduction ofthe 4 down to 2, it is envisaged that this scheme will realise savings of approximately £10‐£11m over a 15 year period.

sustainability Project Progressing Sustainability project - reduced to 2 preferred bidders

3) Car parking

Car parking initiatives developed and agreed by the Board. Agreed to be wholly self funded.Order for phase 1, Yardley Green car park, due to be placed in quarter 4.

Car parking initiative in development


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Chairman'sReport

Chief Executive's

Report

External and

Strategic Review

Patient and Public

Feedback

Safety, Governance

and Risk

Council of

Governors

Any Other

Business

Board Commitee

Reports

Part Three

Financeand

Performance

`

Corporate and Facilities Objectives and Progress Report - Quarter 3 2012/ 13

Q4Jan - Mar

Q1Apr - Jun

Q2Jul - Sep

Q3Oct - NOV ONLY


2012/13

On Track Issues Severe Issues

Plans not as yet defined in terms of suitable accommodation and geographical location nor the extent of services to be provided from a City Centre site. Also now a Reshaping HEFT

project being managed by the Commercial Director.

SH Dermatology Relocation

Scoping work completed, strategic case being developed, brief being constructed

Rheum OPD service mapped and measured mid November, MDH scope & measurements commencing (end of November completion). Design lead working with senior nurse re: oncology service

Currently in planning/strategy phase

Process Design Team Projects

SH Elective Care Centre

SH Rheum/Oncology facility

SH Site Strategy

BHH Endoscopy

Brief required for end Jan, OBC submission in April 2013

90% of OPD clinics map & measured, modelling work due to be completed end of November, links with SH elective care centre

Comments

BHH OPD Refurb/OPD Clinical Design

BHH Maternity ProjectProject board set up, work streams, leads and outcomes identified. Workshop Jan to launch workstreams and individual projects.

BHH Hybrid Theatre

Reviewed Opportunities

Integration and Partnership Working - Locally Engaged

Scoping works & brief being developed for options appraisal Jan/Feb

A Solihull project team headed by Gloria Cooke has been formed to manage the overall impact of the closure of Union Road and the relocation of

staff.

Project scope continuing.

Business case recommends ward 21 as the preferred solution. Discussions are

continuing with Birmingham and Solihull Cluster regarding preferred options and associated transfer of building. Move

planned by end of February 2013.

2) Chest Clinic (relocate - now a Reshaping HEFT project)

BHH Surgical Admissions Lounge

Opportunity identified. Programme to establish future direction to be developed

Short term action plan agreed for immediate issues. Longer term plan tba in new year.

Horizon Scanning to maximise opportunities

(E.g. Union Road lease)

3) Break clause in 2014 on lease at Lyndon Place

1) Union Road

Redecorate BuildingExpected to remain in this building for the next 5 years therefore redecorate in 2012/

13.

Scheme

Brief required for end Jan.



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Chairman'sReport

Chief Executive's

Report

External and

Strategic Review

Patient and Public

Feedback

Safety, Governance

and Risk

Council of

Governors

Any Other

Business

Board Commitee

Reports

Part Three

Financeand

Performance


Target

CIP Performance variance and percentage achieved (£K) Cumulative YTD85-100% = Green,51-84% = Amber,

0-50% = Red

Income (£ Variance)

Non-Admitted patients treated within 18 wks of referrals (mia) >=95%Admitted patients treated within 18 wks of referral (mia) >=90%18 Wk incomplete pathways >=92%Reduction of incidence of MRSA bacteraemia (post 48-hrs) <=1Reduction of incidence of Clostridium (post - 48hrs) <17A&E <= 4 hrs from arrival to admission/discharge/transfer >=95%

Emergency Assessment Area Variance against Plan (Cumulative YTD)

Reduce capacity on the back of redesign and demand management initiatives

Nursing Metrics - Quality of care >=95%Nursing Metrics - Patient Experience >=95%Complaint Response Times (mia) >=90%Cluster Led Complain Response Times with 21 days (mia) >=90%

Staff in Post v Budget Established - Percentage > 95%

Voluntary Turnover<=6.25%

by Mar-13

Sickness - YTD Moving Annual Average<=3.75%

by Mar-13

Clinical Staff Undergoing Mandatory TrainingCumulative Since Start of Programme

2,000 by Mar-13

Number of Appraisals Completed (Cumulative - YD)8,500

by Dec-12

Improve medical productivity

Deliver Reshaping HEFT work streams

Implement Recovery@ Home

Review Elderly Care Rehab Services

Reconfigure Acute Medicine in line with Acuity Model inc 7day working

To understand and respond to local health economy requirements

Development of South Staffs Accountable Care Partnership

Plans are in place for this project to commence at the end of September.

An Acute Med Consultant has been appointed and 7 day working will commence in Q2/Q3.

Positive meetings have been held and to progress we have been asked to present a paper on principles of collaborative working in October at the Health and Wellbeing Board.

Programme endorsed by Health and Well being Board, Plans outlined and operational group formed.

Awaiting Update

7 day working commenced 3/12/12

4.07%

4.73%Sickness Absence Management support

project has commenced.Sickness absence rates and costs

snapshots being produced for each ward with intention to put this info in staff

rooms.

1280


Completion of Job Plans are currently in progress

Undertake Skills mix review-ongoing with Medical Lead

Job timetable plans completed-ongoing with Medical Lead

Ensure that management of activity within contracts is achieved to aid the delivery of financial balance 9%

0% 0%


4.07%

130

Complete Job Plans/ Review skill mix and Implement review


198

Develop 'fit for purpose' workforce in line with service strategy whilst delivering HR KPIs

8.74%

896

Please note: The 'Deliver key performance indicators in contractual and regulatory frameworks' and 'Improve patient experience and safety measurements' are taken from the Performance Teams Trust KPI. The data is split by Site of activity therefore women's and Children's and 'Clinical Support Services' is not split out and will be included under the relevant Site.

98 (YTD 228) 36 (264 YTD)

Fully implemented and trajectory with activity numbers produced.

104.57% 101.97% 97.54%

8.49% 8.92%

100% 100%92.54% 85.71%

7 day working plans completed In progress In progressCompleted for AMU. Others are

progressing

Workforce plans by Directorate completed Completed

Improve patient experience and safety

97% 95% 94%92% 93% 93%

91.94%

19.0%

454 (371 Ghh, 50 Bhh 33 Sol)

No funded bed closures Ward 26 -36 beds closed in November

16 5 7

6.8%-1% 1%

90.86% 90.21%

95.41%0 0 0

94.98%

Achieve financial balance and deliver CIP for areas of responsibility, including controls over pay

93.25% 92.18% 93.78%97.99%

Deliver key performance indicators in contractual and regulatory frameworks including: A&E; 18 wks;

Infection prevention

90.22%

-£ 765£ 1-£

£-237.1(38.9%)

5,168-£ 41,220-£

OP Variance against Plan (Cumulative YTD)

Good Hope Objectives and Progress Report 2012/13


Q1Apr - Jun

Q2Jul - Sep

Q3Oct - Dec

Q4Jan - Mar


97.11%

Implement innovative practices in relevant directorates

Elective and Daycase Variance against Plan (Cumulative YTD)-1% -1%

1%9%

100%


Bed Capacity - Currently Funded Beds

Emergency Variance against Plan (Cumulative YTD)

2,445,767-£ 1,095,731£

Performance Allocation (£ Variance)

Non-Pay Expenditure (£ Variance)Pay Expenditure (£ Variance) 1,069,093-£ 653,306-£

3,921-£

95.18%

YTD £-460.6(39.6 %) YTD £-528.5( 51.9%)

-3.0%

310,651-£ 722,949-£

97.27%


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Part Two

Declarationof

Interest


Chairman'sReport

Chief Executive's

Report

External and

Strategic Review

Patient and Public

Feedback

Safety, Governance

and Risk

Council of

Governors

Any Other

Business

Board Commitee

Reports

Part Three

Financeand

Performance


Target

CIP Performance variance and percentage achieved (£K) Cumulative YTD85-100% = Green,51-84% = Amber,

0-50% = Red

Performance allocation ( £ Variance)

Non-Admitted patients treated within 18 wks of referrals (mia) >=95%Admitted patients treated within 18 wks of referral (mia) >=90%18 Wk incomplete pathways (mia) >=92%

Patients receiving their first definitive treatment for cancer within two months (62 days) of urgent referral from a consultant (consultant upgrade) for suspected cancer mia

>=85 %

Patients receiving their first definitive treatment within one month (31 days) of a decision to treat (as a proxy for diagnosis) for cancer mia

>=96%

Reduction of incidence of MRSA bacteraemia (post 48-hrs) <=3Reduction of incidence of Clostridium (post - 48hrs) <66A&E <= 4 hrs from arrival to admission/discharge/transfer >=95%


Nursing Metrics - Quality of care >=95%Nursing Metrics - Patient Experience >=95%Complaint Response Times (mia) >=90%Cluster Led Complaint Response Times with 21 days (mia) >=90%

Net recommender index *(Please note Apr/Mays scores are inaccurate due to some patients rating the TV service rather than Hospital Service)

>70

Sickness - YTD Moving Annual Average<=3.75% by Mar-13

(3.83% in month Trajectory)

Voluntary Turnover<=6.25% by Mar-13

(6.75% in month Trajectory)

Staff in Post v Budget Established - Percentage >= 95%


2,000 by Mar-13

Number of Appraisals Completed (Cumulative) 8,500 by Dec-12



Demand Management Initiatives Divert Activity from the Hospital to local services in a safe managed way

Clinical Opportunities Group have identified the TOP TEN projects which BHH is part of : Unplanned Care Board are working on admission avoidance clinics set up at the front door with the Birmingham and Solihull Clusters.

Telephone advice line to be established within AMU from November 2012.

There has been a steady increase from 46 in 2009 to 69 in 2011.

Concern regarding accreditation at BHH - Estates working with team to propose short term solution.

Delayed as not negotiated as part of JMRA. Will be a service development planned for this year as long as no additional costs incurred.

ESD and admission avoidance schemes up and running. Telephone advice line delayed due to commissioner process issues with the SPA.

Pay Expenditure ( £Variance)Non-Pay Expenditure ( £ Variance)

2%1% 2%

96.63%

9 7

98.00% 96.79%

65,826-£

96.16%

93.18% 94.34%

93.35%

Heartlands Objectives and Progress Report 2012/13


Q1Apr - Jun

Q2Jul - Sep

Q3Oct - Dec

Q4Jan - Mar


1£ Income ( £ Variance)

YTD £-2609.6(43.2%)

159£

£-893.7 (41.6%) YTD £-1990.0(41.0%)

£ 263,744

Achieve financial balance and deliver CIP for areas of responsibility, including

controls over pay £ 21,947 1,084,893-£ -£ 1,081,857 -£ 426,454 3,146,842-£

-£ 159

96.91%92.45% 92.96%

-£ 3,652,483 -£ 2,376,595

2 0 18

90.00%

95%93% 93%

12% 12% 11%

91.80% 85.48% 92.85%

12 Beds closed but not realised as being used for Winter Pressures.



94%

Workforce plans (incl 7 day working) by Directorate agreed first Phase Agreed live 1/11. New Rota commences 1/11. AMU has full consultant

cover at weekends.

Yes

3.35%

96.59%

229 (498)

97.08% 98.34%

2124



Implement innovative practices in relevant directorates

Increased EVAR procedures under Vascular

JAG accreditation achieved in Gastroenterology

Cardiology remote monitoring in place

Estates issues still unresolved.

95.93%

4%


Not supported by commissioners or by site as a cost pressure. Therefore development not going forward.

94%

100%

Deliver key performance indicators in contractual and regulatory frameworks

including: A&E; 18 wks; Infection prevention

95.10% 93.56%

7%

Bed Capacity - Funded Beds (Closure of 30 Beds)

8%Ensure that management of activity within contracts is achieved to aid the

delivery of financial balanceEmergency Assessment Area Variance Against Plan (Cumulative YTD)A&E Variance Against Plan (Cumulative YTD)OP Variance against Plan (Cumulative YTD)

0.8%


Job plans in progress.

7.11%

Job timetable in progress.

7.21%(All areas have been reminded of the importance of

monitoring reasons forleaving in order for appropriate action to be taken)

92%

Yes

54 (YTD - 552)

7.04%


Some specialties complete. Ongoing for other specialties

320

Continuously improving.

Develop 'fit for purpose' workforce in line with service strategy whilst

delivering HR KPIs

3.72%3.99%

(Analysis undertaken identified increase in HCA sickness. Process in place to address).

96.41%

No funded bed closures584

(463 Bhh, 61 Ghh, 60 Sol)

-2%

5% -16%

92.88%

5%

3343

269

Emergency Variance against Plan (Cumulative YTD)

43.4 - June Only* 53.0 57.3

5%

Workforce Group set up

Quality and Safety Board established

92.41% 79.57%

100% 50%

Daycase and Elective Variance against Plan (Cumulative YTD)


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Part Two

Declarationof

Interest


Chairman'sReport

Chief Executive's

Report

External and

Strategic Review

Patient and Public

Feedback

Safety, Governance

and Risk

Council of

Governors

Any Other

Business

Board Commitee

Reports

Part Three

Financeand

Performance


Target

CIP Performance variance and percentage achieved (£K)85-100% = Green,51-84% = Amber,

0-50% = Red

Non-Admitted patients treated within 18 wks of referrals (mia) >=95%Admitted patients treated within 18 wks of referral (mia) >=90%18 Wk incomplete pathways (mia) >=92%Reduction of incidence of MRSA bacteraemia (post 48-hrs) <=1Reduction of incidence of Clostridium (post - 48hrs) <17A&E <= 4 hrs from arrival to admission/discharge/transfer >=95%


Nursing Metrics - Quality of care >=95%Nursing Metrics - Patient Experience >=95%Complaint Response Times (mia) >=90%Cluster Led Complain Response Times with 21 days (mia) >=90%

Staff in Post v Budget Established - Percentage > 95%

Voluntary Turnover<6.25%

by Mar-13

Sickness - YTD Moving Annual Average<3.75%

by Mar-13


TBC

Number of Appraisals Completed TBC

Conduct a review of senior clinical posts and management support required within Community

Services.

Deliver Reshaping HEFT work streams

Develop and deliver new models for children’s and public health services.


Emergency Assessment Area Variance against Plan

AQP Accreditation achieved

Procurement advice received to develop excellent tender applications

Appropriate HR/Service models considered to mitigate risk of loss in demand

Bed Capacity - Funded Beds

94.29% 93.88% 90.00%


Pay Expenditure (£ Variance)Non-Pay Expenditure (£ Variance)

95%

3%

-£125,607

Emergency Variance against Plan

OP Variance against Plan

100% 100% 100%

94% 94%95%

£-240.4 (70.2%)

-1.0%

99.14%

0

£-556.2 (69.2%)

-3%

98.66%

0

92.17%

-£510,830

£361,831 £358,756-£304,516 -£227,163 -£184,474

Elective and Daycase Variance against Plan


Job plans - Completion Delayed until Quarter4



Implement new service pathways in Dermatology/ Rheumatology (linked with MSK), ENT and

Ophthalmology

Review In Progress Review completed. Recommendation - to go to Nursing and Midwifery in Q3.

Workforce proposals developed. Recommendation has been accepted by Nursing and Midwifery Board. Review and development of Clinical posts and Management Support

Job Plans to be completed

Reduction in Locum use

Not Available Output of Job Plan Review - anticipate impact in Q3

There has been considerable reduction in locum use for juniors at Solihull Hospital since the appointment of our Clinical Lead however high levels of sickness in Ac Med Seniors has led to Consultant Locum spends.

With the recruitment of an Associate Medical Director and Clinical Lead for Solihull Hospital it is planned that medical job plan reviews will begin

Following the successful recruitment to two of our medical leadership vacancies the project is beginning and will be completed in Q4. A project plan has been agreed with Trust MD.


99.03% 99.20%

4.25%

134

118

740

87 (205 YTD)

In progress - dermatology started.

7 day working plans completed

A consultation has been completed with the matrons. In the autumn we will have 12 hours cover from 9am - 9pm for site capacity issues 7 days a week. This will then be increased to 18 hours and 24 hours respectively over a gradual period of time.

24/7 project complete. Agreed implementation to 12/7 level at Solihull Hospital. All staff in post from January 2013. A review of Medical Staffing is underway with our new Clinical Lead and will establish the potential for 7/7 within existing resources.

Workforce plans by Directorate completed Not complete

Implement Adult Community Nursing Vital

Implemented for Community Nursing, looking to roll out to Virtual Wards and SPA Awaiting Update Roll out

Comments: (Adult Community VITAL) On schedule for launch mid November.

Community Nursing Metrics

No

Yes Yes

99.04%

No procurement support, but still achieved accreditation.

Yes

-2%

**150 (136 Sol, 14 Bhh) **150 (136 Sol, 14 Bhh)

-7% 13.6%

4.0%5.0% 8% 9%

20%

95.45%0

3 3 1

Deliver key performance indicators in contractual and regulatory frameworks including: A&E; 18 wks;

Infection prevention

97.03% 95.67% 96.19%91.93% 92.45%

96.67% 96.02%


£1,781 £119,133 £21,426

£-782.1 (68.7%)


-£877,656 -£1,406,210

Solihull Objectives and Progress Report 2012/13


Q1Apr - Jun

96.99%

Q2Jul - Sep

Q3Oct - Dec

Q4Jan - Mar



94% 95%

Prepare strategy and plans for AQP tenders of podiatry and audiology services

Awaiting Confirmationfrom application

Complete

Ensure that management of activity within contracts is achieved to aid the delivery of financial

balance

-4.8%

Pathways agreed and Implemented

Work ongoing

929

4.53%

5.32%(This is predominantly due to 53 current

long term sickness cases. All cases are being actively managed).

In Progress

No Bed reductions - Awaiting Confirmation

No. of Advice and Guidance appointments/contacts undertaken

Awaiting UpdateImplement New Service

Delivery Models

Pathways and Implementation delayed

31 (dermatology) 38 (dermatology) 38 (dermatology)

Pathway work advancing in Dermatology and Diabetes but not yet started for Ophthalmology.

Comments: Dermatology – CCG changed plans in June because of funding constraints, we are working on new proposal with them expected in Sept, ENT – internal work on audiology, proposal for consideration in Aug. Opth – early discussions with commissioners and optometrists about glaucoma pathway

SN draft service spec requiring some additional work but will be in final draft by 09/10/12. Project plan will be in place by Oct SN

Steering Group meeting

24 (229YTD)

6.40% 7.12%

7.84% (Reasons for turnover do not pose any real

concern.However the management team will continue

to be supported by HR colleagues in conducting a coordinated review of all exit

feedback to ensure anyissues are addressed appropriately).

Develop and Deliver new models


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Part Two

Declarationof

Interest


Chairman'sReport

Chief Executive's

Report

External and

Strategic Review

Patient and Public

Feedback

Safety, Governance

and Risk

Council of

Governors

Any Other

Business

Board Commitee

Reports

Part Three

Financeand

Performance

Target

Solihull Objectives and Progress Report 2012/13


Q1Apr - Jun

Q2Jul - Sep

Q3Oct - Dec

Q4Jan - Mar


Deliver the programme plan for the Integrated Care Partnership (integration)

Deliver the Frailty Programme (integration)

Develop Framework

An agreed way forward for delivery of urgent care

Support Resources identified

Plan and Implement model


Review Solihull Urgent Care Models (integration)

Comments: Initial performance framework and phase 2 proposal reported to and accepted by July HEFT Board. Second milestone will be overtaken by development of Solihull site brand and prospectus

Comments: CCG have completed their review but not shared this with us as yet. Our AMD and Clinical Lead for Medicine have now been appointed, giving us the medical leadership to take this work forward. The Division is presently attempting to identify management resource to this project along with other change initiatives which we anticipate resolving in the near future.

GlCo - Agree Project Plan An externally led review is underway and as part of that an internal review begins January 13 with completion by end of Q4.

Programme Delivery

Internal Supporting resources identified.External supporting resources still under negotiation

Commissioning offer received Sept 2012, response from ICP to be completed in Nov 2012. Decision re external support sitting with Director of Resources.

Locally defined resources committed recurrently by commissioners. Draft response from ICP completed, and being shared with wider stakeholders.

Implement new comprehensive model for

Frailty

Support Resources Agreed Commissioning offer received Sept 2012, response from ICP to be completed in Nov 2012. Decision re external support sitting with Director of Resources.

Draft Memorandum of Understanding has been developed. External support commissioned - work to be completed in quarter 4. Agree New Contract

Develop a framework for community services integration that balances internal and external

opportunities to achieve optimal benefit for HEFT

Integration plan developed and Agreed

Work ongoing to develop Strategic Services Development plan / Integrated Business Plan

This objective has moved on to now incorporate the whole of the Solihull site. Site level dashboard presented to Trust Board, currently in final stages of development.

Development of plans

Acute links into priority ICP Identified and local arrangements established for linking with Solihull LMC/CCG and cluster

Raising awareness through directorate strategic planning of ICP within new acute directorates

In the areas of frailty and LTC, the work is progressing through the ICP. JMRA now focuses attention on demand management rather than income generation.




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.01

Apologies

.03

Part Two

Declarationof

Interest


Chairman'sReport

Chief Executive's

Report

External and

Strategic Review

Patient and Public

Feedback

Safety, Governance

and Risk

Council of

Governors

Any Other

Business

Board Commitee

Reports

Part Three

Financeand

Performance

Target

CIP Performance variance and percentage achieved (£K)Cumulative YTD

85-100% = Green,51-84% = Amber,

0-50% = Red

Non-Admitted patients treated within 18 wks of referrals >=95%Admitted patients treated within 18 wks of referral >=90%18 Wk incomplete pathways >=92%Reduction of incidence of MRSA bacteraemia (post 48-hrs) <=1Reduction of incidence of Clostridium (post - 48hrs) <17


Deliver CNST level 2 accreditation in 2013

Nursing Metrics - Quality of care >=95%Nursing Metrics - Patient Experience >=95%Complaint Response Times >=90%Cluster Led Complain Response Times with 21 days >=90%




Develop 'fit for purpose' maternity information system

Work with primary and community care to develop services

-£

33,993-£


Business case developed, Presented to December EMB. EMB deferred and awaiting advice on future consideration by EMB.

188 Beds ( 117 BHH, 71 GHH)

Gynae: 4 Beds (Ward 2) GHH closed and reconfigured into an admissions Lounge

Income ( £Variance)Performance Allocation (£Variance)

Pay Expenditure ( £Variance)Non-Pay Expenditure ( £Variance)

-£

OP Variance against Plan (Cumulative - YTD)

3,346-£ -£

20,101-£

Elective and Daycase Variance against Plan (Cumulative - YTD)Emergency Variance against Plan (Cumulative - YTD)

Included within the Site Split Templates

£-578 (48.4%)£-205 (55.1%)

2% 1%

£-828(47.7%)

Actions for delivery


-3%

0%

Bed Capacity - Funded Beds (Excludes Delivery Suite at Solihull)

On the advice of the NHSLA it is recommended that the Trust undergo Level 1 Assessment in February 2013. The CNST for maternity is then suspended for 2013/14 and we will seek Level 2 Assessment at the earliest

opportunity in 2014/15 with Level 3 Assessment 6 months thereafter.

Feedback from Level 1 Assessment

Plans developed for 'Birth Rate Plus' compliance and ensuring safe theatre staffing in Obstetrics.

Workforce plans by Directorate completed

Proactively engage in and influence the pan Birmingham Acute Paediatric review

Business case approval and delivery Spec completed and providers shortlisted.

Business Case in development. A Business Case developed for consideration at EMB in December. Decision deferred; awaiting guidance on how to move forward.


Dialogue with GPs undertaken.

Initiative being progressed.



Demand management initiatives to be undertaken

Agreed plan for the neonatal unit at Heartlands

Gynae pilot commenced. Working with Sth Staffs on delivery of an enhanced primary care service at GHH. GP Advice line set up.

This is being progressed via a series of workstreams. HoEFT is represented by Dr Clive Ryder (who is chair of the Review’s strategic workstream) and the Division will ensure that local implementation plans are developed as guidance emerges from the Review and CEO forum. We are anticipating a conclusion to the review process in March 2013.

Review of impact of demand management initiatives.

1% 1%

-9% 14.0% -16.0%

-2% -3%


Deliver key performance indicators in contractual and regulatory frameworks including: 18 wks; Infection prevention

227,028-£ 333,486-£ 1,416,605-£ 1,465,282-£ 939,435-£


Womens and Childrens Objectives and Progress Report 2012/13

Objective/Measurement Current Position

Q1 Q2 Q3 Q4

Ensure that management of activity within contracts is achieved to aid the delivery of financial balance

Maternity Variance against Plan (Cumulative - YTD)Cot Days Variance against Plan (Cumulative - YTD)

-1%-4%

5%

12,902-£

Paeds: 10 Beds closed (4 - Ward 15/16 BHH) and 6 - Harvey GHH)

0%

Plans developed for Safer Child Birth with 24 hr labour ward cover at BHH.

Job Planning undertaken at GHH. PAs recycled to improve Emergency cover and provide advice to GPs.

A scheme to make interim amendments to the BHH neonatal unit will be presented to EMB/Board by October 2012. This scheme will be intended to secure accreditation of the service whilst the full redevelopment of the Unit is progressed within the agreed capital case for expanding the Princess of Wales building. This is anticipated to be a five year project.



Option Appraisal undertaken.

Plans progressed. Interim scheme for Neonates agreed and building works commenced.

Options plan and business case approval

Business case developed, Presented to December EMB. EMB deferred and awaiting advice on future consideration by EMB.



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Target

CIP Performance variance and percentage achieved (£K) (Cumulative - YTD)

85-100% = Green,51-84% = Amber,

0-50% = Red

Non-Admitted patients treated within 18 wks of referrals >=95%Admitted patients treated within 18 wks of referral >=90%18 Wk incomplete pathways >=92%

No. of patients waiting 26+ weeks (Variance against forecast)Specialties with a volume >=100 have been listed

% of diagnostic waits > 6 wks (Imaging) - As at Month EndOP DNA Rate 11%New to Fup Ratio 2.23

Heartlands OP Nursing - Patient Experience >=95%

Solihull OP Nursing - Patient Experience >=95%


Accreditation of Immunology service UKPIN External Accreditation

Aligning theatre expertise and capacity with service reconfiguration and site

developments

Implement a new Theatre Management Information System (TMIS)

Radiology - delivery of long term replacement strategy.


Immunology are in the process of implementing action plans against the

gaps identified against the accreditation standards and a date for formal review

is to be agreed

Work is underway to gather evidence and close any gaps identified. Date for review is anticipated to be Feb or March but no firm date has been agreed.

Surgical reconfiguration meeting held on the 28th June to discuss theatre options with the theatre users. Theatre users (Directorates) have been tasked with reviewing their service need and feeding this back into the process. Follow up meeting to be arranged.

Implementation

£84.0 (103.6%)

349,671£ 236,555£ 259,497-£

Workforce transformation plans continue to evolve, now £2 mill

workforce saving identified

Completion of Workforce Structure on track

Complete

Job plans now complete in most Directorates, skill mix review as part

of overall workforce reviews

Project Plan reviewed and rolled out

Roll out for Dermatology planned at the end of December

Achieving BRRP Requirements

SMPG and site Q & S groups have yet to agree what safety metrics will be used. High priority projects in place.

66%

81%

51%

Procurement and roll out across sites

Internal solution being rolled out across all sites. Phase 1 has been rolled out at Heartlands Hospital. Phase 1 is currently being rolled out at Solihull with Good Hope planned roll out in October. Phase 2 is currently being written and will be rolled out across all sites before Christmas. TMIS roll out completion is scheduled for the end of this calendar year and is currently on track for delivery. The second TMIS Steering Group Meeting has been scheduled for

Complete

78%

58%

Comments: Partial Booking is live in Rheumatology and Ophthalmology and work is currently underway with elderly.

Theatre Efficiency

Roll out in Gyane


Safety Metrics

CQUINS (safer transfer of medication across the interface) 78%

Requirements Scoped and plan rolled out

Rollout Rapid access DBS in 9 areas

Implemented in Ophthalmology & Rheumatology

Currently on track - OBC expected to be completed Feb 2014

Phase 1 roll out delayed at Solihull as we were awaiting for Orthopaedics to go live on Ultragenda. Orthopaedics are now booking through Ultragenda and to that end roll out has commenced at Solihull for theatre 1,2 and 3 (Orthopaedics). We will then be looking at rolling out at Good Hope in the first 2 weeks of November. We are still on track to deliver phase 2 roll out for Christmas 2012.

Clinical Support Services Objectives and Progress Report 2012/13

Objective/Measurement Current Position

Q1Apr - Jun

Q2Jul - Sep

Q3Oct - Dec

Q4Jan - Mar

982-£ 8,378£


58,671£ 73,643£

£36.5 (103.4%) £76.3 (102.4%)

13.0%0

10,672£


Pay Expenditure (£ Variance)Non-Pay Expenditure (£ Variance)

0

917£

Reduction of incidence of Clostridium (post - 48hrs)

381,657-£ 291,915-£

Reduction of incidence of MRSA bacteraemia (post 48-hrs)

0

Deliver key performance indicators in contractual and regulatory frameworks including: 18 wks; Infection prevention

Achieve financial balance and deliver CIP for areas of responsibility, including controls

over pay366,272£

Medical Devices - delivery of long term procurement and replacement strategy


PQQ submitted

Award and Execute selected tender


Develop 'fit for purpose' workforce in line with service strategy whilst delivering HR

KPIs

Executive Team have engaged the services of Provex to independently review elective surgery configuration options. Final report and next steps are scheduled for February 2013.

The Project plan, as prepared by Dave Coley (Head of procurement), is being followed and currently on track.

Rollout Rapid access DBS in remaining 2 areas

scope and rollout implementation of DBS for diagnostic services

Building handover to operationProject Plan on ScheduleCompletion of Pathology Transformation

Programme

Approval of Business case

Plan to restructure workforce and achieve non pay savings are on target

Scope Diagnostic Services

Yes / No

Workforce reviews in progress in all directorates. Pay costs reducing

month on month. £1 million of pay savings identified in next year's CIP.


Rolled out

Daycase and Elective Variance against Plan (Cumulative - YTD) -19%


Direct Referrals Variance against Plan (Cumulative - YTD)

Emergency Variance against Plan (Cumulative - YTD) -16% -17%

Contract Indicators (NPSA alert report, gap analysis, risks)

Contract Indicators (Medication incident report quarterly)

Complete

Complete

Submission Delayed. Decision to be made at EMB as to how this moves

forward

Workforce plans by Directorate completed Submitted

7 day working plans completedRadiology/Pharmacy/ Pathology & OP

all consulted for 7 day working7 day working now in place

for identified areas

Ensure that management of activity within contracts is achieved to aid the delivery of

financial balance6% -4% -3%Critical Care Variance against Plan (Cumulative - YTD)

-12%OP Variance against Plan (Cumulative - YTD) -4%

-19%

8%

-20%

7%


12.6% 14.6%

-5%7%

1 : 2.29 1 : 2.18

376 (Jun Snapshot)T&O 161

326 (Sep Snapshot)T&O 116

Gen Surg 100

464 (Nov snapshot)T&O - 151

Gen Surg - 127

2.29

-10%

Complete

Complete

Roll out of phase 1 is now complete at BHH and Solihull. Roll out has been delayed at GHH pending roll out of Ultragenda. Therefore full roll out will not be achieved by the end of December 2012. The delay has pushed the project back by around 4 months. The delay is not business critical as we are continuing to use Galaxy as the theatre reporting system at GHH which is licensed until the end of March 2013.

Expand directly bookable services through Choose & Book

Complete

Theatre Nursing Dashboard - Over-all ScoresThe Overall nursing metrics scores have

achieved the target in all areas

Contract Indicators (antibiotic stewardship) (Target 76 = 95%) (Action plan) 78%

Lead on Improving Medicines Management across the Trust

Implement a partial booking system for outpatient follow up appointments

Job timetable plans completed

Yes / No

Nursing metrics created for Theatres, day surgery, Critical care and

Outpatients.

The Overall nursing metrics scores have achieved the target in all areas

Creation a nursing metrics dashboard

98%

92%

The Overall nursing metrics scores have achieved the target in all areas



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Develop an academic centre for Infection

Sexual Health in the community

BE SURE - Chlamydia Screening >=6%

New Attitudes - Number of attendances at Erdington 12,000 annually

Expansion of Interventional RadiologyProcedures undertaken in a more appropriate location (OBC due for completion 2014)Released Theatre Capacity (OBC due for completion 2014)

The Search Committee are meeting on the 4th September to discuss the potential candidates for the post. It is anticipated that we may be able to recruit to the post in 6 months (this may be delayed to tie in with academic year etc).

The search committee are discussing potential candidates for the post.

Justification case completed The business case for additional Interventional radiology room, will be presented to cross site programme board in January


3607 3841 1345 (Oct Only)

Chair and senior lecturer recruited


HEFT provides a number Sexual Health Services in the Community:Health Gay Life - Sexual Health for the Gay CommunitySafe Out Reach - Providing Sexual Health Facilities to Sex WorkersCSP - Chlamydia Screening - The services is aiming to increase its screening Rates to >= 6%SHP Sexual Health in Practice - Training and Education of Community StaffNew Attitudes: One stop Sexual Health

6.7% 6.9% 6.2% (Oct/Nov)


January 2013

Board of Directors

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Reports from Committees

10.1 Governance and Risk Committee Report (inc Safety Sitrep Update and Board Assurance Framework

(Oral/Enclosure)

Safety, Governance and Risk

10.3 Hollier Team - TeamSTEPPS Training Update (Enclosure)

10.2 Norovirus Update (Oral)

10.2 Organ Donation Annual Report (Presentation)


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Safety, Governance and Risk Governance and Risk Minutes

These minutes are DRAFT until approved at the Feb Governance and Risk Committee 2013.

Minutes of a meeting of the GOVERNANCE AND RISK COMMITTEE

of Heart of England NHS Foundation Trustheld in the Board Room, Devon House, Heartlands Hospital on 10 December 2012

Name Title Present EAST, Anna Non-Executive Director/Chair

ANWAR, Aresh Medical DirectorHARRIS, Richard Non-Executive DirectorHENSEL, Paul Non-Executive DirectorHUNT, Lord Philip ChairmanSUNDERLAND, Mandie Chief NurseWOOLLEY, Sarah Director of Safety and Governance

In Attendance BLACKBURN, Rachael Head of Corporate Risk and ComplianceCHAUHAN, Mish Senior Manager, KPMGJARVIS, Simon Head of Patient Engagement (attending for Lisa Thomson)KEOGH, Ann Director of Medical SafetyMOORE, Sue Managing Director, Good Hope Hospital RICHARDS-EVERTON, Lisa Expert Patient Volunteer RYDER, Clive Associate Medical Director – Women and Children’sSERRANT-GREEN, Laura Non-Executive Director SMITH, Steve Associate Medical Director – Heartlands siteSHARIF, David Senior Manager, KPMG

Presentations CHAPLIN, Dawn Head of Bereavement ServicesELLIS, Chris Consultant - Infectious Diseases MedicineHACKWELL, Simon Commercial Director

Minutes REES, Alison Executive Assistant to Sarah Woolley

1. Apologies for absence

Apologies were received from: Alan Jones, Claire Molloy, Sue Moore, Sue Nicholls, Liz Steventon and Lisa Thomson.

2. Minutes of the meeting held on Monday 8th October 2012 / matters arising and standing agenda items

The minutes of the meeting held on 8th October 2012 were agreed as a true record. Please see the updated actions at the end of these minutes.

Updates from previous actions:

Simon Jarvis confirmed that work is progressing with regards to the discharge process on the Solihull site and improving the questions that patients are asked about their discharge experience. It is still early days and Simon will provide an update at the February meeting.

3. Patient safety story

Anna East welcomed Chris Ellis (Medical Examiner / Consultant - Infectious Diseases Medicine) and Dawn Chaplin (Head of Bereavement Services) to the meeting. AE explained that that today’s patient safety story was linked to bereavement services and end of life care / the medical examiner role and the strengthening of governance and patient safety systems as well as having greater scrutiny on death and the process surrounding this.


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There has been much media attention regarding the Liverpool Care Pathway and DC stressed the importance of getting bereavement care right and acknowledging individual care.

Overview of bereavement care services initiatives

• HEFT has a centralised bereavement service covering all three sites• There are approximately 4,000 deaths per year Trust-wide• Bereavement services and support also extends to relatives and carers• HEFT bereavement services work extensively in conjunction with internal and external

partners• Bereavement care covers emotional, practical and social issues• We are now moving from a more task focussed approach to very person-centred

care along the bereavement journey – initiatives include:- Collaborative working with other services- ‘care’ not ‘counselling’ approach- Early intervention- Longer term support for carers and relatives (if appropriate)- Bereavement helpline and website (approx. 30-50 calls a week in Birmingham)- Community support- Bereavement questionnaires (currently 20% return rate)

• Benefits of new initiatives and changes to bereavement services for bereaved people:- Better care for the dying / deceased person and their carers / relatives- Improved communication- Integrated systems

• Benefits of new initiatives and changes to bereavement services for service providers:- Access to appropriate training and education- Improved communication- Understanding of roles and responsibilities along the journey

Chris Ellis then talked briefly through the new Medical Examiner role and how this will impact on bereavement services and the way in which the Trust deals with death certification.

CE reported that the Medical Examiner will become nationally adopted in April 2014.

The role of the Medical Examiner:

• Improve quality of death certification • Safeguard the public • Improve the experience for the bereaved

The Medical Examiner will:

• Decide on the cause of death• Agree the cause of death with a certifying doctor• Talk to the bereaved about the certified cause of death• Ensure that the notes of every patient that dies are fully scrutinised (with the exception of

those cases that are referred to Coroner - CE clarified that for any case where a patient was on an end of life pathway and following their death, when the notes were scrutinised, their death was found to be unnatural causes, it would be referred to the Coroner).

SW gave an example of the power of this new system at last week’s Quality and Safety meeting when a case of wrong diagnosis was discussed. Key issues were immediately picked



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up which could then be linked into the Trust learning cascade. Without this new system, this would not have happened so quickly and so effectively.

CE reported that every family he had spoken to were grateful for the information provided by the Trust.

Lisa Richards-Everton gave personal thanks to the Trust for implementing this new system.

AA confirmed that it is now a GMC requirement for anyone to report anxieties about a colleague and that they are fully supportive of the Medical Examiner role.

GRC sought clarity on the following points:

Organ donation – DC confirmed that we immediately link in with organ donation team at the point of death. There are also very close links with the Faith Advocacy Group and end of life care has been improved particularly around the Muslim and Jewish groups by liaising with communities. Work is in progress to appoint an outreach worker to provide support in this area.

Bereavement support for children at school – LR-E raised the importance of linking in with schools to support the bereaved child. This was noted by DC who will feed back the comments to CRUSE and report back to Governance and Risk Committee in February 2013.

Conflicts of interest within the ME role – CE confirmed that despite being an employee of the Trust, he felt well supported by the Medical Director and Chief Executive to raise any concerns about how the organisation handled patient safety or quality care and issues that arose throughhis role in scrutinising patient care.

AE gave thanks to DC and CE for their very informative presentations.

MATTERS FOR DISCUSSION

4. Hollier Centre TeamSTEPPS programme

The Governance and Risk Committee has previously supported the adoption of the TeamSTEPPS programmed led by the Hollier Simulation Centre.

TeamSTEPPS is an evidence based and field tested teamwork system that is designed to support improvement in quality, safety and efficiency of healthcare. Historically, the Hollier Centre has focussed purely on simulation skills drills - taking a particular clinical programme and putting a team collectively through the specific pathway.

With TeamSTEPPS, rather than focussing on a particular clinical scenario, the programme is about the team working collaboratively and in a specific way. It is an organisational development programme and has been shown as a valid approach to improve team working.

There are three steps to the formal TeamSTEPPS programme:1. Select the area you wish to focus on2. Build a “change team” within each team focussing on the specific team needs / problems.

Working out the appropriate interventions around those particular needs (coaching / using simulation centre / conflict resolution for example)

3. ‘Train the trainers’ within the TeamSTEPPS methodology which can then be rolled out to the wider team.

The GRC was asked to note, in particular, that:



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• The Board has formally signed off the TeamSTEPPS programme.• The Hollier Centre has been very successful in training junior doctors / medical students

and the programme is now in the early stages of implementation in maternity, surgery and theatres and patient transfer.

• Whilst the outcomes of the TeamSTEPPS programme have been found to be very powerful, the current issue remains the time currently available for clinical teams to undertake training and developmental work and work is ongoing with regards to communicating TeamSTEPPS within the Trust.

SH made three recommendations to the Governance and Risk Committee:

1. That the Governance and Risk Committee recommended to the Trust Board that the TeamSTEPPS Organisation Readiness Assessment be discussed at the January Board meeting.

2. That a quarterly monitoring report is presented to future Governance and Risk Committee meetings which tracks progress around implementation of the TeamSTEPPS programme.

3. That a further report on the resource implications of the TeamSTEPPS programme be presented to the Committee early in 2013.

These recommendations were all accepted and approved by the Governance and Risk Committee.It was agreed that the Trust would focus on the TeamSTEPPS programme as the main contribution that the Hollier Centre could make to HEFT.

SW proposed that all Trust Board and Executive Directors go through the TeamSTEPPS programme. The Committee agreed with this proposal.

5. Maternity services assurance report

Clive Ryder presented an overview of the current maternity services, incorporating the current and historic service context, current performance measures and key areas of concern as follows:

July 2010 saw the closure of the Solihull obstetric unit and transformation into a midwifery led unit and relocation of significant number of births to the Heartlands site. This has resulted inthe Heartlands site in particular, having a very cramped physical environment and an increased volume of high acuity of patients.

CR reported that the general number of births in the city is steadily increasing, however, that neighbouring Trusts are also suffering in a similar way to us.

Midwifery numbers across the county are low and at BHH, we are currently dealing with increased sickness, maternity leave and vacancies.

A maternity dashboard of current service performance was presented, based upon the Royal college of Obstetricians and Gynaecologists Maternity Clinical Performance and Governance Score Card. Current outcomes do not suggest any immediate significant concerns.

However, SW commented that there are some indicators suggesting we are possible outliers, e.g. 3rd degree tears and patient experience metrics. There is not any comparative benchmarking data for many of the indicators and therefore, we need to set some organisational goals and monitor trends over time for these metrics.

Key concerns in maternity risks relate to:

• Medical, midwifery and physical capacity and the high acuity of patients on the BHH labour



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ward.• Ability to recruit midwifery staff.• Ward leadership and culture.• Midwifery staff morale.• Never events, relating to retained swabs.• BHH obstetric theatre governance.• The Directorate’s difficult financial position.

Maternity programmes of work are in place to address these issues and risks, as follows:

• Maternity Improvement Action Group (MIAG) to monitor delivery of improvement programmes.

• Business case in progress to address staffing concerns.• Transfer of obstetrics theatre to theatres directorate.• Planned rebuild of BHH maternity unit.

It was also noted that KPMG had undertaken a review of the financial situation including CIP delivery and governance arrangements in maternity service and we are awaiting sight of the final report.

The Governance and Risk Committee discussed this report and noted that the maternity service appeared to be a “service under pressure”. However, the maternity service is an area that will require ongoing scrutiny from CQPG and we will need to have metrics and systems in place to keep this under review. Risks and concerns were under active management.

6. Clinical Quality Performance Group minutes

The minutes of the meetings were taken as read. Clarity was sought on the following points in the minutes:

Dr Foster data / outliers – AA reported that there are already two forums that address any outliers (including the Mortality and Morbidity Committee and CQPG) and that a third tier is being implemented to work on specialty outcomes metrics.Management of acutely ill patients requiring HDU at Solihull – AA confirmed that we have pathways in place which allow the appropriate escalation of patients arriving at Solihull – this may involve transfer to Heartlands.

7. Revised Safety SIT REP (draft)

Three new SUI’s to report:

• Retain tampon (never event)• Failure to escalate deteriorating surgical patient• Complications of laparoscopic surgery

SW explained that we are currently developing a revised format for the Safety SIT REP. This is to accommodate changes in our management systems and national changes to the incident grading systems.

From February 2013, we will look at amber risks and adverse events as well as red risks andincidents. The Clinical Quality Performance Group will focus on the detail whilst the Governance and Risk Committee will receive assurance regarding our risk profile as an organisation.

We are working with all teams regarding the old orange incidents (‘severe harm’ incidents)



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which are a rich source of learning that needs to be cascaded Trust-wide. We will be focussing on theming information of regulatory matters and picking up learning from CQC investigations nationally in order to apply that learning to HEFT.

SW reassured the committee that we will continue to report good practice and learning within HEFT. Medication safety is our number one priority going forwards and there will continue to be regular updates regarding this.

The “Lesson of the month” dashboard is cascaded Trust wide every month via the Chief Exec’s Team Brief and other communications avenues.

The new SIT REP will be presented to Governance and Risk Committee from February 2013 onwards.

8. Patient experience report

Simon Jarvis provided an overview of the patient experience report for November 2012 as follows:

The summary patient experience results for October 2012 are as follows:

Overall satisfaction – 93%Hand cleanliness – 98%Feel staff cared for me – 96%Call buzzer reaction time – 86%Told about discharge – 57%Net recommender index results – 63 (within expected range)

Recognising staff who deliver great care – This is a new programme that has been introduced across all wards. SJ confirmed that this is going down really well with staff.Net recommender – SJ reported that there had some long debates about the validity of the net recommender score and that we are now getting to a critical mass where the scores are starting to make sense.A&E ‘red’ metrics results – SJ confirmed that this was not indicative of any major issues. Metrics are set quite high and A&E by the nature of the service, may not always be a pleasant environment. More in depth work is planned for A&E to check for any issues.Ex-employees questionnaire – A piece of work has been commissioned to question staff who had left the Trust. The first airing of these results will be at Executive Management Board but SJ will bring the report to the February Governance and Risk Committee. Urology patients – the issue of men not always being able to see a same-sex practitioner was raised. MS confirmed our current urology practitioner is female and is extremely experienced in her field. MS reported that the issue is more likely around being sensitive and that the same-sex issue was something that was rarely highlighted by patients.Low paediatric inpatient score in October 2012 – CR confirmed that the score showed as low due to only three patients being questioned during that month. There were concerns that children as young as four took part in the questionnaires and that family involvement may be more appropriate in order to record a more accurate score. SJ would investigate this.

9. Safety strategy update

Sarah Woolley provided an update regarding the Safety Strategy.

SW confirmed that the majority of actions and the action plan are progressing well. We still need to carry out more work in terms of analysing appropriate measures and benchmarking for



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safety and this is progressing in line with the performance team (quality dashboard) and Aresh Anwar (working with bespoke specialty metrics with all Medical Directors).

Richard Harris sought clarity regarding whether the strategy direction remained appropriate. SW responded that we keep it under review; however this is why we planned to commission an external patient safety review.

10. Multi-professional stance for responding to adverse events

SW reported that she had recently met with Hazel Gunter (Acting Director of HR), Aresh Anwar (Medical Director) and Mandie Sunderland (Chief Nurse) and agreed that we need to do a review of our approach to responding to errors from all the professional groups. This is a national issue. We need to review a range of policies and procedures and develop a revised, aligned approach. We need to look at our multi-disciplinary / incident procedures as there appear to be slightly differing procedures for doctors and nurses.

SW proposed that a report was brought to the April 2013 Governance and Risk Committee.This was agreed.

Compliance

11. Supervisor of midwives annual review

Mandie Sunderland explained that this report was completed by the West Midlands Local Supervising Authority (LSA) and is the 2011/2012 annual report which is submitted to the Nursing and Midwifery Council.

MS reiterated that this report is a statutory requirement of the SHA Cluster in its role as the Local Supervising Authority and reports on the statutory supervision of midwives and midwifery practice.

The report was brought to the Governance and Risk Committee for information. The report was noted.

Internal Audit

12. KPMG – Directorate Clinical Governance Review

David Sharif gave an overview of the report, which was taken as read by the Committee. This report gave significant assurance for the Trust Directorate Clinical Governance programmes in the areas which were reviewed.

PH questioned the extent of the burden for the organisation with implementing these clinical governance and audit programmes.

SW responded that we are required to do this from a regulatory perspective but the burden of monitoring performance could be reduced by use of improved clinical data capture and informatics systems.

Information and assurance

13. Reports from the sub committees

• Safety committee – taken as read• Clinical standards committee – taken as read• Clinical Quality Review Group –Taken as read



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• Safeguarding children committees – taken as read• Safeguarding adults committee – taken as read• Trust infection prevention committee – taken as read

Director of governance report

14. Terms of Reference for Governance and Risk – SW confirmed that she is currently working through the Terms of Reference and will bring them to the February Governance and Risk Committee to be signed off.

Any other business - Nothing to report this month.

15. Appendices (Maternity assurance report)

Taken as read.

16. Date and Time of Next Meeting:

The next meeting will be on Monday 11th Feb 2013 @ 10.00am in the Board Room of Devon House, BHH. Please send any apologies through to [email protected].



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GOVERNANCE & RISK COMMITTEE

Ongoing Actions – December 2012

Date ofMinutes Action Target

date Owner

Dec 2012 AA to circulate data to all Governance and Risk members with regards to mortality data / best practice tariff for the Good Hope site.

ASAP AA

Dec 2012 SW to speak to Claire Molloy with regards to the report following the recent CQC visit to Solihull and which Board Committee the report will be submitted to.

ASAP SW

Dec 2012 SW to ensure that the TeamSTEPPS Organisation Readiness Assessment is discussed at the January Trust Board meeting.

Jan 2013 SW

June 2012 Mandie Sunderland to include the dashboard for community nursing in the next quarterly nursing assurance report for the February Governance and Risk meeting.

Feb 2013 MS

Oct 2012 AA to bring the quarter 3 for the clinical quality dashboard report to the February Governance and Risk Committee.

Feb 2013 AA

Dec 2012 Simon Jarvis to provide an update for the February meeting with regards to improved questions re: discharge on the Solihull site.

Feb 2013 SJ

Dec 2012 Dawn Chaplin to feed comments back to CRUSE with regards to bereavement support in schools (and report back to the Governance and Risk meeting in February 2013).

Feb 2013 DC

Dec 2012 SW / SH to ensure that a quarterly monitoring report ispresented to future Governance and Risk Committee meetings which tracks progress around implementation of the TeamSTEPPS programme.

Feb 2013 / ongoing

SW/SH

Dec 2012 SW / SH to bring a further report on the resource implications of the TeamSTEPPS programme to the February Governance and Risk Committee.

Feb 2013 SW/SH

Dec 2012 SW to bring the new Safety SIT REP to the February Governance and Risk Committee.

Feb 2013 SW

Dec 2013 SW to bring the revised Terms of Reference for Governance and Risk Committee to the February meeting

Feb 2013 SW

Dec 2012 SW to bring a report to the April 2013 Governance and Risk Committee with regards to ‘multi-professional stance for responding to adverse events’.

Apr 2013 SW

Dec 2013 SW to arrange for all Trust Board and Executive Directors to go through the TeamSTEPPS programme.

DATE SW

Dec 2013 AA / MS / SW to ensure that the maternity service receives ongoing scrutiny from CQPG and has metrics and systems in place to keep this under review.

DATE SW/MS/AA



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HOLLIER SIMULATION CENTRE – TEAMSTEPSS UPDATE

Governance & Risk Committee - 10th December 2012

Introduction

The Governance and Risk Committee has previously supported the adoption of the TeamSTEPPS programme led by the Hollier Simulation Centre. This report provides an update on implementation and highlights some key issues for the Committee to consider.

Recommendations

1. The Committee is asked to recommend to the Trust Board that the TeamSTEPPS Organisation Readiness Assessment be discussed at the January Board meeting.

2. A quarterly monitoring report should be presented to future Governance and Risk Committee meetings which tracks progress around implementation of the TeamSTEPPS programme.

3. A further report on the resource implications of the TeamSTEPPS programme be presented to the Committee early in 2013.

Background

A copy of the TeamSTEPPS progress report is attached as Appendix 1. Unfortunately Jon Stewart, Head of Faculty at the Hollier Centre, is unable to be present at the meeting due to a long standing annual leave commitment.

Following support from the Governance and Risk Committee earlier this year, the initial phase was spent in setting up the programme and arranging external training for two senior clinicians. The Trust is now in the first phase of implementation.

Initially the Trust agreed to focus the programme in three areas:

• Maternity

• Surgery / theatres

• Patient transfer

Progress against these is contained in the attached report. During the set up phase it was agreed that a more sensible approach for engaging with surgery and theatres would be to begin by focussing on just one surgical area. This was the colo-rectal service which is delivered by two multi disciplinary teams at Heartlands and Good Hope. The learning from the colo-rectal programme would form the basis for rolling out TeamSTEPPS to other surgical / theatre teams.

Key Issues

Practical application of the TeamSTEPPS programme has identified a number of important issues that the Committee should consider:

• the time currently available for clinical teams to undertake training and developmental work appears very limited. There have been numerous cancelled and rescheduled meetings as operational pressures on the day take priority;

Safety, Governance and Risk Hollier Team - TeamSTEPPS Training Update


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• there is still a significant piece of work to be undertaken around communicating the TeamSTEPPS programme. It is a behavioural and culture change programme not a “I have come for my half day training” programme. By its nature, therefore, TeamSTEPPS isongoing and requires a different mindset and as such is complimentary to the Trust’s overall safety strategy;

• at present the TeamSTEPPS programme is delivered through the Hollier centre and this should continue to ensure quality assurance. However, the current team and facilities are limited at the Centre. To date the Centre has received capital funding from the Hollier charity and generated its own income to cover running costs, including staffing. In effect the Trust has not had to invest in the TeamSTEPPS programme so far.

In order to address these issues the following actions are to be put in place:

1. The Trust Board will be asked to make a specific commitment to the TeamSTEPPS programme. It is suggested that this take place in January 2013 (with Jon Stewart) and a discussion around the Organisation Readiness Assessment should take place (see Appendix

Following this commitment a stronger message can be communicated across the organisation about the TeamSTEPPS programme. This will be very helpful in ensuring clinical and operational teams create more time to engage in the programme.

In addition, now the programme is up and running it is proposed that quarterly monitoring and lessons learned reports are presented to the Governance and Risk Committee.

2. At present the Commercial and Strategy Director has management responsibility for the Hollier Centre and was closely involved in getting the concept off the ground. Given the increasing nature of the Centre’s work around safety and the linkages with the Trust’s safety strategy it would seem sensible to give consideration for the Centre to come under the responsibility of the Director of Safety and Governance. This would not involve a significant change since the Director of Safety and Governance has been closely involved in the development of the TeamSTEPPS programme.

3. A further report is presented to the Governance and Risk Committee about the resource implications associated with the TeamSTEPPS programme. It is likely that this will require investment from the Trust in staffing to deliver the programme and an understanding about the time commitment required from clinical teams.

Simon HackwellCommercial & Strategy Director10th December 2012



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APPENDIX ONE

TeamSTEPPS™

Team Strategies & Tools to Enhance Performance & Patient Safety

‘Creating a Safety Net for Your Organisation’

Progress Report: November 2012

TeamSTEPPS™

Team Strategies & Tools to Enhance Performance & Patient Safety

TeamSTEPPS is an evidence based and field tested teamwork system that is designed to support improvement in quality, safety and efficiency of healthcare. The framework was developed by the USA Department of Defence, with the goal of optimising patient outcomes by improving communication and other teamwork skills among healthcare professionals. It is now being rolled out across healthcare organisations in the USA.



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Healthcare systems, like many high-reliability organisations, depend on the coordinated interactions of multiple teams operating in a dynamic, complex, and high-risk environment. High-reliability work units thrive on teamwork. Patient safety experts agree that communication and other teamwork skills are essential for the provision of quality healthcare and the prevention of medical errors and patient harm. Despite the importance of teamwork, most conventional medical, nursing and AHP training curricula lack teamwork training. Teamwork skills are not innate – they must be learned and practiced. Human factors research has shown that even highly skilled, motivated professionals are vulnerable to error due to inherent human fallibility and healthcare system design. Research has shown that teams of individuals who

• Communicate & lead effectively • Are situationally aware • Back each other up

will compensate for individual fallibility and system traps - and as a consequence will enhance safety and improve performance TeamSTEPPS is designed to produce highly effective medical teams that optimise the use of information, people and resources to achieve the best clinical outcomes for their patients. The framework is rooted in over 20 years of research and lessons learned from the application of teamwork principles, as identified in Crew Resource Management and within High-Reliability Organisations. TeamSTEPPS provides a methodology, as well as a comprehensive suite of materials and training curricula to support the Heart of England Foundation Trust in developing high performing clinical teams, that are trained to provide optimal care to patients. This in turn has the potential to improve operational performance as well as reduce the organisational and human costs of clinical harm.

HEFT: Practical Application of TeamSTEPPS

• Board sign off: Support & involvement of the executive and senior management team • Completion and sign off of an organisational readiness assessment by the Trust Board • Identification of areas/specialities: Maternity, colorectal surgery & patient transfer • Formation of an effective multidisciplinary Change Team, that leads each speciality/service work

stream. Composing of influential leaders & representatives from each discipline (including front line staff). This team will:

1. Define the problem, challenge, or opportunity for improvement, during initial diagnostic Change Team meeting.

2. Identify priority interventions 3. Define the aim(s) of the intervention/s 4. Design the intervention using improvement principles and tools as appropriate to support

the intervention 5. Develop a plan for testing the effectiveness of the intervention (improvement measures &

qualitative evaluation + PDSA cycles) 6. Develop an implementation plan – both for team training and for the intervention/s 7. Develop a plan for sustained continuous improvement – sustainability & scale up 8. Identify an effective communication plan 9. Review the action plan with key personnel and modify according to input

• Change Team Leads quantify & plan the delivery of multidisciplinary teamwork training with support of Hollier Simulation Centre team



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• Developing training capability (training TeamSTEPPS trainers) : 1. Master Trainers who lead & advise all aspects of the training as well as the programme

structure (Training already delivered in USA) 2. Delivery of formal Train the Trainers, Fundamentals & Essentials courses (classroom based). 3. Delivery of training & coaching within work place by trainers that are embedded within

specialities. This includes delivery of principles and tools learned within the TeamSTEPPS fundamentals course (e.g. SBAR etc), as well as any training resulting from the interventions that the Change Team select to work on.

• Clear understanding of challenges of large scale cultural change & potential risks to success. Monitoring of planning & progress using the NHS Change Model (DOH, 2012) components:

1. Shared purpose 2. Leadership 3. Engagement to mobilise 4. System drivers 5. Improvement methodology 6. Rigorous delivery 7. Transparent measurement 8. Spread of innovation



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TeamSTEPPS Organisational Structure

Trust Board

Executive Lead TeamSTEPPS S. Woolley

Maternity Change Team

Leads: M.Wyldes – Obstetrics M.Errington – Maternity K.Pottinger – Hollier

+ Representatives of all

disciplines

Surgical Change Team Colorectal

Leads: C.Hendrickse - colorectal S.Dale - theatres G.Kelly – Hollier


disciplines

Patient Transfer Leads: Dr. Jagadeeswaran to be agreed


disciplines

Steering Team Executive lead: S. Woolley Executive management lead: S. Hackwell Surgical Board lead: R. Steyn Hollier Faculty Lead: J. Stewart Hollier Faculty support: A. Abbassi Anaesthetic Lead: G.Ragurahman

Support / training / Facilitation / advisory

Function

By

Hollier Simulation Centre Team

+ Governance & Safety

Team

Clinical Teams

TeamSTEPPS Trainers

Clinical Teams

TeamSTEPPS Trainers

Clinical Teams

TeamSTEPPS Trainers



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TeaffdfdTeamSTEPPS™ Training Structure

TeamSTEPPS trainers deliver to teams

Train the Trainers course: Part I (full day)

Foundation day aimed at clinical staff that will become core TeamSTEPPS trainers. (Attendance requires commitment to delivery of minimum 2 days per year or 4 half days)

Introduction to human factors / team structure / leadership / situation monitoring / mutual support / communication

Train the Trainers Course: Part 2 (Full day)

Further developing underpinning knowledge & skills to support clinical teams in implementing training & interventions / initiatives

Change management / coaching / implementation / teaching practice / Assessment

Fundamentals Course: Clinical TeamsAimed at multidisciplinary teams that deliver patient

care.Initial training to deliver knowledge skills & tools to

enhance team working & clinical safety.On-going support will be provided in response to

evolving requirements

Essentials Course: Managers / ExecutivesAimed at managers & leaders who are not directly involved in delivery of care but are supporting &

leading clinical services.Delivering an overview and leaders perspective, roles

& responsibilities(Change team / senior leaders / executive)

TeamSTEPPS Training Structure

Master Trainers



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Dec 2011

Governance & Risk Committeeapproved TeamSTEPPS

Programme Planning:

• Scoping • Redefining scope &

expectations • Defining Structure • Recruiting trainers • Set up of Train-the-Trainer • Defining Change Teams • Engaging Change Team

leads • Readiness assessments • Engagement • Data / information support • Communications • Resources • Delivery of Train-the-Trainer

course part 1

Implementation: • Baselines surveys• Initial Change Team Meetings• Formal action plans• Initial implementation of

interventions• Clinical Leadership• Communications• TeamSTEPPS Fundamentals

training• Steering team meeting dates• OTAS set up• Information / data • Clinical risk:

• Glitches / IR1s / SUIs / Never Events ?

• WHO checklist?

Pre-planning phase 2 • Identify speciality• implementation & set up• JS present to Board Jan 13

Cohort 1:

• 6/12 initial evaluation• Sustainability plan• Embedding continuous

improvement cycle with team

• On-going safety data set?• Improvement measures• ? review operational

measures• Follow up surveys

Cohort 2:

• Implementation – adapted in response to evaluation of cohort 1

Approval Jan 2012

SetupJuly – October 2012

Initial Implementation 6/12

November – End April 2013

2013 initial evaluation

Embedding /Sustaining /

2012 2013 onwards

Proposed Timeline



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Progress Update

Situation: The TeamSTEPPS programme has commenced work with the three clinical areas which were originally specified by the Trust Board in 2011:

• Maternity • Surgical teams • Patient transfer

Background: The planning and preparation phase began in July 2012. This has involved:

• Understanding the challenges of transferring the USA framework into the context of an NHS Organisation. • Scoping and planning • Developing training capability • Forming Change Teams and holding the initial diagnostic meetings • Initial action planning and implementation – progressing in maternity

Assessment: By the nature of this work, each stream of work will evolve and progress according to the context of the service and the current state and structure of the team working and leadership at all levels. 1. Maternity: Status – ahead of anticipated timeline

Cohesive and dynamic Change Team formed Initial diagnostic Change Team meeting held and 4 key issues/opportunities have been identified. Multidisciplinary break out groups have

proposed action plans for first two interventions and work on these has already begun. i. Leadership: To identify a senior strategic level multidisciplinary maternity services team. To develop this group as an effective and

dynamic leadership team. An away day is planned where the leadership team will received the essentials course all together in the morning. The afternoon session will be dedicated to a workshop on team development & vision for the service.

ii. Improve the quality of performance in category 1 caesarean sections



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Process mapping of current practice has commenced at GHH & also planned to commence at BHH. All disciplines and levels will be included as the mapping will be carried out in the clinical areas.

iii. Customer focus: Improve communication and professional behaviours within clinical areas. iv. Clinical Handover: Optimisation of multidisciplinary handovers/safety huddles

Change team leads have begun to quantify how the fundamentals training can be delivered to all members of the multidisciplinary team Train the trainer: a comprehensive group of obstetricians, midwives, anaesthetists trained in part one. They will be delivering the

fundamentals course in partnership with a Hollier trainer – novices delivering one module to gain experience. Communication plan agreed

2. Colorectal Surgery: Status – at risk

Change team being developed Members of theatre, anaesthetic and surgical teams have been trained as trainers – part 1. More surgeons required from BHH Discussions ongoing over way forward with this particular work stream Meeting being arranged with Change Team leads & Hollier team to discuss

3. Patient Transfer: Status – on track

Patient transfer has been phased to start up later than the two previous speciality based work streams Lead Clinical has detailed initial plans in place Change team being identified

4. Training Capability: Status – on track

Part one of the Train the Trainer course has been delivered 2 dates for part 2 have been circulated in January Essentials course will be delivered to Maternity leaders and managers on 18th January 2013 Maternity leaders are planning for the delivery of fundamentals course to commence in early in 2013 Colorectal training under discussion Patient transfer – yet to be planned Further support of trainers being developed by Hollier team. The fundamentals course is currently being reviewed: This has been delivered to trainers as a one day course that includes a human factors

module. The content of this day cannot be condensed into a half day for clinical teams.



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Risks: (For review at next Steering Team meeting)

1. Training: Currently half a day for the Fundamentals course. Feedback and experience to date would suggest a full day will deliver a superior quality of foundation training for clinical teams. Discussion required to consider whether this be supported by the organisation.

2. Engagement: Active involvement, champions, role models, communicators, enablers - not yet fully achieved 3. Understanding of TeamSTEPPS components:

As a vehicle for large scale cultural change over several years Training requirements – class room as well as workplace training & coaching by trainers embedded within the specialities Improvement methodology required for interventions and rigour required to deliver action plans

4. Communication – identifying an effective communication plan that works at all levels and across all disciplines and provides clarity over what TeamSTEPPS is - and can deliver

5. Leadership for change + energy for change within the teams. 6. Team commitment to participating in ongoing TeamSTEPPS activities e.g. meetings / training etc 7. Ability to release teams for training and activities in the context of operational pressures 8. Resources: Time / funding: (not yet fully understood & quantified)

E.g. Funding of requirements (printing, pocket books) Data analysis & effective reporting of improvement & operational measures / surveys Clinical trainers – time for self directed learning of underpinning knowledge, as well as preparation for delivery of training No funding identified for costs e.g. medical illustration services, communications.

Recommendations: 1. Sign off of Organisational readiness assessment document 2. Change Teams leads to quantify the numbers of staff requiring Fundamentals & Essentials courses training 3. Identify opportunity to deliver Essentials course for senior management teams 4. Discuss and decide on whether the Fundamentals course can be supported as a full day course for clinical teams 5. Colorectal Change team to meet with Hollier Simulation Centre Head of Faculty to discuss and develop an effective plan 6. Resources to be identified and quantified. 7. Effective communication strategy to be developed and implemented


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11.1 Audit Committee Report (Oral)

Board Committee Reports

11.2 Stakeholder and Community Engagement Committee

(Enclosure)


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Board Committee Reports Stakeholder and Community Engagement Committee Minutes

STAKEHOLDER & COMMUNITY ENGAGEMENT COMMITTEEMinutes for meeting

Thursday 20th September 2012, 13.00 – 15.00

Attendance ApologiesSimon Hackwell Edward PeckNajma Hafeez – ChairEmma HaleRichard HarrisLord Philip HuntRiaz JanjuaSimon JarvisMark NewboldMalcolm PyeSurraya RichardsLisa Thomson

Welcome and Minutes of previous meetingMrs Hafeez welcomed everyone to the meeting and the minutes of the previous meeting wereagreed as an accurate record.

Matters ArisingMr Jarvis presented on the bereavement and community engagement work highlighting the cross-boundary working which would work with Cruse to produce a video for local people to explain, particularly, the role of the Coroner. A lot of work had been done with the South Asian community and was making good progress. A list of community advocates was being compiled. Mr Janjua suggested using the Faith Advocacy groups; a combined group of 20 different religious backgrounds. He added that there were no issues with 80% of deaths; it was the out-of-hours deaths and ones that were referred to the coroner that experienced difficulties. HEFT was the first trust to do the ‘early release’ scheme.A formal launch of the bereavement service was to be arranged.Links were needed with cemeteries, crematorium and burial sites.Dawn Chaplin to be invited to the next Stakeholder meeting to present on bereavement.Action: Invite Dawn Chaplin to present on bereavement at next meeting

Mr Harris chaired the Organ Donation Committee. He asked if people from different ethnic backgrounds cited religious regions for not allowing organ donation. The message at a national level could be used to provide support, nationally. Mr Harris to supply Mr Jarvis with contacts. To be raised with Organ Donation Committee.Action: RH to supply contacts re Organ Donation to SJAction: RH to raise religion vs. Organ Donation at next Organ Donation Committee meeting


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Membership StructureMr Pye presented a review of membership structure including the ratio of Governors/members.At the last Committee Meeting, a discussion was held around Membership and Governors ratios. Further work had been done on the topic and the following proposal is put forward for consideration by the Committee. The Committee discussed the paper and agreed that:

Membership

• Auto enrolment all year

• Minimum target of 100,000 members

• Align the Trust’s constituency areas with local Council constituency boundaries

Governors

• Allocation of approximately one governor to 100,000 population

• Not directly reference Deprivation Index, ethnicity or other factors in governors/membership ratios

• Allocate one extra governor to the constituency immediately adjacent to each of the three main hospital sites.

There were no changes are proposed to current Staff Governor arrangements. The number of governors should remain at five.

It was agreed that Patient Governor constituency be remodelled as ‘patient and out of area’ (or something similarly worded) so as to capture membership from both patients and also from interested parties from outside the immediate catchment areas of the three main hospital sites. The number of governors should remain at two.

There were eleven Stakeholder nominated posts, although several were no longer filled. It was agreed to refocus a reduced number of posts more towards the current stakeholder groups which would be Universities, Councils and CCGs.

This would produce an overall Governor structure of:

Approx Catchment area Population

Current number of Governors

Prospective number of Governors

Birmingham Heartlands Hospital 1,000,000 13 10Solihull Hospital 200,000 7 5Good Hope Hospital 250,000 6 4

26 19Patient/out of area 2 2Staff 5 5Stakeholder 11 8Total 44 34



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As could be seen from the attached Benchmarking schedule, this would bring the total number of governors more into line with HEFT’s relative size and the average for Foundation Trusts. Mrs Hale asked for consideration to be given to having the staff category expanded to include a volunteer category. It was agreed that this would be put to the Governors’ Constitutional Review Committee.Action: Suggest a volunteer category to the Governors’ Constitutional Review Committee

Elections would happen in March/April 2013.There was a discussion around conflicts of interest, especially concerning having councillors on the governing body. Mr Pye confirmed that stakeholder governors did not contribute as much as the other governors. Mr Harris was concerned that there was also a lack of people from the business community.A discussion was had around the term ‘Stakeholders’ to see if there was a better name for that group of people. Solihull CCG was to be considered as the lead CCG. The Council of Governors would look at that.

The Chamber of Commerce presented an overview of the advantages of membership. Lord Hunt highlighted HEFT’s importance in employment, apprenticeships and the development of investment in Birmingham.Mrs Hafeez asked if there was £14k available to be a Patron of the Chamber rather than a Member. Being a Patron would give personalised relationships with other Patrons; there were 30 Patrons in the Chamber. West Midlands Police and Fire were members of the Chamber. Mr Hackwell also suggested using ‘Marketing Birmingham’.

VolunteeringMrs Hale gave an overview of the Volunteer and the Olympic Legacy. She highlighted that the Trust had over 750 active volunteers across three sites and in the community, with specific leads for service. The Trust’s volunteering programme had benefited from a focus on recruitment of local people, changes in process and training and the introduction of a new database for advanced communications. It was confirmed that a dedicated Volunteer Trainer had been recruited and a senior volunteer post developed. Part of their induction involved Customer Care.

It was agreed that volunteering reports and updates would be brought to the Committee for review and comment as part of raising the awareness of the volunteering activity.

Diabetes CommissioningSurraya Richards presented an update on the website Engagement and Diabetes commissioning. HEFT was working in partnership with BBC and Channel 4 around programmes on diabetes. There were also plans to engage with local television channels.

Website Engagement PresentationMr Harris highlighted that anyone, anywhere in the world could use it. There should be interactive patient forums, social media and community engagement and the Trust needed to ensure that at least the basic information was available.


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Council of Governors

Report from meeting held on 21 November 2012 (Oral)

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Any Other Business

Dates of Future Meetings

• 5 March 2013, Heartlands Education Centre• 7 May 2013, St Johns Hotel, Solihull• 2 July 2013, Good Hope Hospital

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14. I M and T Update (Presentation)

PART TWO

15. Good Hope Hospital Report (Enclosure)

16. Solihull Hospital and Community Report (Enclosure)

17. Heartlands Hospital Report (Enclosure)


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GOOD HOPE HOSPITAL SITE REPORT – January 2013

1. OVERVIEW of DELIVERY AGAINST WORK PROGRAMME

Emergency pressures remain central to activities on the Good Hope Site with a very challenging November and December. Throughout both months Norovirus in the community and on the hospital site impacted on our ability to discharge patients and optimise patient flow through the hospital. The outbreak was well contained with rigorous attention paid to infection control procedures; whilst at its peak there were 5 wards with restricted visiting and upwards of empty 20 beds.

Key areas of progress are summarised below, however, additionally the site has successfully appointed an Associate Medical Director to replace Dr Alastair Williamson, who is stepping down from the role in March 2013. His successor Dr Kiran Patel will be joining Good Hope in March 2013.

2. KEY AREAS of PROGRESS

2.1 Quality and Safety

The Accident and Emergency moved into its new facility on 29th Nov, this will now allow the separation of Acute Medical Unit functions –GP Assessment; which addresses a key safety risk that has been ongoing with mitigation for 12months.Additionally 7 day working in the AMU commenced on 3rd Dec, this we hope will facilitate senior decision making across our most vulnerable times.

Following the successful a consultation with the lead nurses, the role has now changed to provide onsite cover 18/7 with a clear focus on safety, quality and capacity. This is a particularly important change as following on from this we be will initiating a review of the capacity model including site practitioners and bed managers.

2.2 Finance and Business Performance

Progress with the GHH Financial Rectification continues. GHH Division was £424k overspent in month, £6.3m YTD. In month, GHH delivered 76% of its best case rectification plan, £631k. This includes efficiencies from the ward closure, nursing control and the non-recurrent £150k Staffs ACP. Performance against 12/13 CIP was green for the first time in month. Further 2012/13 efficiencies are forecast over coming months with new schemes for 2013/14 being finalised. Winter costs are being incurred i.e. R@H and extra medical shifts.

The graph below shows the reduction in actual costs in 12/13 and the best case forecast based on Rectification. The forecast excludes winter costs or reimbursement for growth.

Good Hope Hospital Report


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2.3 Service Development and Partnership Working

South East Staffs and Seisdon CCG had their authorisation and site visit on 20th

December. Good Hope was the only acute provider representative. The peer review team reduced the number of ‘red buttons’ from 52 to 8 and the feedback was very positive with regard to partnership working.

The Accountable Care Partnership with South Staffordshire continues to develop. The next step in January is to agree a trajectory and performance dashboard across the programme objectives re delays, time to referral and placement.

2.4 Communications and Engagement

A number of local voluntary sector groups have requested site presentations –Breath Easy, Parkinson’s Support and Sutton Cancer Support Centre

In January, I will be meeting with Jan Sensier –CEO, ‘Engaging Communities Staffordshire to discuss the links with Good Hope. Additionally, we are developing our relationships with Tamworth Borough Council.

Andrew Mitchell remains an advocate of the hospital and visited on 21st December to wish both patients and staff good wishes for the Christmas period.

.3. ‘SPOTLIGHT ON’ ….

Recovery at Home Service at Good Hope HospitalSummary to end of November 2012

Introduction

The Recovery at Home (R@H) Service is provided by Healthcare at Home Ltd (HaH) and commenced on 24 September 2012 following a competitive tender process. The service provides capacity for 26 patients who are clinically stable and can complete the remainder of their acute care pathway at home. Initially focusing on four elderly care and T&O wards, the service is currently expanding to an additional eight wards.Patients are transferred to a virtual ward and remain patients of the hospital under the care of their Consultant while they are on the R@H service. The discharge date from



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the service is agreed with the Consultant prior to taking patients out and in the majority of cases is the hospital expected date of discharge. A virtual ward round is held twice a week with Dr Helen Chamberlain, where the clinical evaluation forms for all patients on service are reviewed. These are transferred electronically from HaH and are available to view within the patient’s record on iCare.

Clinical care is provided by a multidisciplinary team comprising registered nurses, physiotherapists, occupational therapists and healthcare support workers and includes an element of personal care so that patients who are waiting for packages of care to commence can be taken home and a bridging service provided.

SERVICE SUMMARY to end of November 2012

Patient referrals and bed nights saved

The service is currently ramping up to the full capacity of 26 patients on service as follows:

Oct 2012 Nov 2012 Dec 2012 Jan 2013 OngoingNo. of referrals

23 46 69 92 92 per month

Cumulative 23 69 138 230No. of bed nights saved

198 395 593 791 791 per month

Cumulative 198 593 1186 1977Capacity 25% 50% 75% 100%

Up to the end of November, 65 patients had been taken onto service, slightly below the target figure of 69, but the bed nights saved were above target at 605. This figure represents an equivalent saving of 10 beds for the period.

Patients have been taken onto service from a range of specialities, with the majority from elderly care and T&O, which is to be expected as these are the wards that the team have been focusing on:



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There have been a number of patients who, following referral and assessment, have not been suitable to take onto service, as shown in the table below. This is for a variety of reasons, but mainly because these patients require complex packages of care or are not sufficiently mobile to cope at home. On some occasions, the patient has declined the service.

Length of time on service

Prior to service commencement, and based on a 2 week survey of hospital inpatients, it was estimated that patients would remain on service for an average of 8.3 days. To the end of November the average length of stay was 8.2 days. Patients are tracked against the estimated date of discharge whilst on service to ensure that the overall hospital length of stay is not being extended by the R@H service. To the end of November, of the 40 patients who completed their acute pathway at home and were discharged from R@H, 24 finished on the expected date, 1 finished 1 day late with the agreement of the Consultant, and 15 finished early, generating additional bed day savings for the hospital.

Transfer back to hospital

Up to the end of November, eight patients became unwell and were transferred back to hospital. This is to be expected with the cohort of patients that are being taken onto service i.e. frail elderly. A comprehensive escalation policy has been agreed with each specialty for this eventuality and in all cases the hospital requested that the patients were transferred back. In some cases, this could potentially have been avoided, but as with any new service, there is an element of caution by all involved until the service becomes established and confidences grows.

Care Bureau

A key feature of the R@H service is the Care Bureau, which provides 24 hour support for patients, carers and clinicians. Staffed by qualified nurses, the Care Bureau holds all



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patient records, so can quickly identify any problem areas. To date, 92 calls have been made to the Care Bureau, 6 of which have resulted in a patient triage. These range from complaints such as haematuria or a rash, which can be dealt with initially in the community, to a fall or severe nausea and vomiting, which resulted in a transfer back to hospital.

Patient satisfaction

All patients are asked to complete an anonymous patient satisfaction questionnaire on completion of treatment. Eleven questionnaires have been received to date, and of these, 89% were very satisfied with the treatment they received (11% satisfied) and 88% reported a much improved level of mobility.

Some verbatim comments:• Mrs E M -‘Coming home after an operation can be daunting especially when you live

alone. I was very relieved to hear I would have help daily. I was extremely grateful to all the carers, physios, nurses, and OTs who were so sensitive, thoughtful and kind and worked so hard to assist me when I needed help the most. Thank you All.

Early discharge from hospital & recovery at home in my own familiar surroundings certainly benefited me. Knowing I could phone the emergency help line at any time with any problem was also very reassuring. ‘

• Care Bureau had a call from Mr JB “to thank us for the brilliant service he has received. The staff he worked with made him believe he could get himself independent again and without their help he would have never been able to do it. He would recommend our service to anyone and says he will miss the staff at Healthcare at Home greatly. He wishes to say a huge thank you for having faith in him and helping him so much with our service”

Finances

A ward on a hospital site typically costs in the region of £1.4m to £1.5m per annum to operate when considering all direct costs i.e. Nursing, Medics, AHPs and non-pay including facilities. When compared to the costs of the fully operational R@H model and providing a ward closes as a result, there are likely to be efficiencies of c. £100k-£200k to HEFT excluding other health and social providers. Greater margins of efficiencies are likely to be achievable if the model can be expanded because of economies of scale that could reasonable expected from the private provider i.e. reduced overheads. A formal evaluation of the current service including financials is due to be completed in April 2013 in line with the approved Business Case.

Sue MooreManaging Director Good Hope Hospital

January 2013



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Solihull Hospital and Community Report

SOLIHULL HOSPITAL and COMMUNITY SERVICES – January 2013

1. OVERVIEW of DELIVERY AGAINST WORK PROGRAMME

It has been a challenging Quarter with the senior management team balancing the implementation of a programme of development and redesign with tackling a number of significant operational challenges, including winter pressures and increased activity; CQC visit and outcome; financial recovery, and improving performance in a number of key areas such as Stroke and 18 week waits.

Robust accountability and governance arrangements are now fully in place. A Divisional Board has been established with clinical and managerial representation from the 8 hospital and 4 community Directorates the site has responsibility for. This is jointly chaired by the Managing Director and Associate Medical Director. Sub committees for Quality and Safety; Finance and Performance, and Operations are already established and have been meeting regularly. However, single committees for hospital and community have now been put in place.

A detailed work programme has been developed to reflect the priorities of the site and to support achievement of the Trust Annual Business Plan. This includes 53 key projects or pieces of work considered critical to the Solihull Business Unit achieving its ‘share’ of the Business Plan. As highlighted to the Board in November, the site is developing a robust programme management approach to the delivery of this work programme and is working with the Performance Management team to establish a high level dashboard of key performance and quality indicators. All managers are currently being trained in the methodology and it is planned to present the first report of the new format to the next meeting of the Solihull Divisional Board in January.

In general, there is good progress being made against the majority of the work streams, with the following areas of progress pulled out for comment at this stage: 2. KEY AREAS of PROGRESS


A detailed quality and safety report has been prepared for the Trust’s Clinical Quality and Performance Group and will be presented in January. This highlights key areas of concern for the site. Nursing metrics for Solihull acute are 95% and a process has commenced to roll out community metrics. The Net Recommender Index score for acute and community is good at 73 although areas for improvement have been identified and its sensitivity in highlighting areas for greater focus has been validated by the recent CQC visit. The formative phase of VITAL for adult community nursing was launched in December.


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The main areas of focus for the site are:

• Implementation of an Action Plan in response to the unannounced CQC inspection at Solihull Hospital on 28th November

• ITU/HDU – joint work with the Clinical Support Services Division on the future development of ITU/HDU services at Solihull in the context of the Trust’s evolving Clinical Strategy

• AMU/A&E – implementation of a detailed local action plan covering staffing; environment and pathway improvement to address concerns raised by increasing activity and highlighted in the patient safety walkabout in October. This internal work will inform the wider review of urgent care within Solihull that has now commenced with the CCG.

2.2 Finance and Business Performance

The corporate performance report sets out detailed information on areas of underachievement, so the intent is not to replicate this reporting in site updates. However, in summary, the main areas of focus for the site are highlighted below:

Monitor Compliance Framework

Contract indicators

An unannounced CQC inspection at Solihull Hospital on 28th November declared non-compliance with outcome 1. Action plan is in place

Solihull Community Services is currently not achieving the CQUIN for ‘Making Every Contact Counts’. Quarter 4 is the key quarter for evaluation linked to payment. A corrective action plan is in place

The unit is meeting targets for both A&E waiting times and Infection Control. However, of concern is the increased level of emergency activity and impact on A&E performance. This is particularly worrying given the work taking place on integration and admission avoidance schemes and further analysis is taking place to understand this further

Targets for stroke care are not being met (73% against 90% target for time spent on a stroke unit). This is due in part to reliance on the stroke ward manager assessing and pulling from AMU which is not always available. We are working to ringfence stroke capacity within the ward to do this in a timely way as part of our capacity plan and are exploring solutions to our data input shortfall.

A comprehensive piece if work is being led by the HoO to review capacity and demand in those areas of concern with a focus on the development of robust job planning to support improved medical productivity. There will also be an impact on 18 weeks of the recent decision to suspend all elective in-patient surgery in the context of winter pressures and increasing activity.

Solihull is the Trust lead for the CQUIN target for the number of people receiving an assessment for dementia. Site AMDs, HoN, and HoOs get weekly updates of their local performance against the CQUIN. Compliance has risen from 3% in September to 33% in December. Significant drive is needed to improve this on all sites.

Delivery against the Financial Recovery Plan is currently not in line with our trajectory. However, performance is improving month on month, with the majority of schemes that are not yet delivering considered deliverable by the year end.



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2.3 Service Development and Partnership working

Progress has been made on the following service developments:

• The Respiratory Ambulatory Day Service went live in December in Solihull • In partnership with Birmingham and Solihull Mental Health Foundation Trust we are

developing an integrated hospital and community model supporting both mental and physical needs. This builds upon the successful linkage between community mental health and virtual ward services. Funding has been secured for this service through commissioners. HEFT will hold the contract for these services through an exploratory ‘prime provider model’

• An enhanced recovery ward to support people in hospital with dementia will be opened in early January as part of the above development

• A supported discharge service for stroke and orthopaedics is now fully up and running and had enabled the closure of 12 orthopaedic rehabilitation beds on ward 12 although these have been re-opened as ‘flex’ due to winter pressures

• Joint work on improving the out of hospital pathway is seeing an improvement in performance in delayed transfers of care, with SMBC on target against the agreed trajectory agreed in the Service Level Agreement

• Our Breastfeeding Support Services including Health Visiting and Maternity Services have been awarded the UNICEF Baby Friendly Accreditation with one of the highest scores ever recorded during an assessment. Particular thanks to Carmen Baskerville as the service lead


• A contract has been awarded to Pricewaterhouse Cooper to support the development

of the formal and contractual arrangements which will underpin the Integrated Care Partnership. Work will commence for a three month period in January

• We have developed a detailed memorandum of understanding (Compact) for the Integrated Care Partnership to make explicit how core partners (HEFT; SMBC, Solihull CCG, BSMHT, Primary Care and Third Sector) will work together. This will inform the work PWC do

• Support has been given to the Local Authority during their Children’s and Adult Social Care Services Peer Reviews, both of which resulted in positive feedback on progress

• We have engaged with the Centre for Independent Living Consortium of voluntary sector organisations in Solihull with agreement to jointly look at opportunities for volunteers to support hospital and community based healthcare

• We have established a joint hospital and community staff engagement and workforce forum which is responsible for improving staff welfare and our HR performance metrics, and leadership in the workforce transformation necessary to support integration



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3. ‘SPOT LIGHT ON’ …. Our Approach to Complex Need and Long Term Conditions Our Shared Narrative with CCG and Social Care Partners Through our local Integrated Care Partnership a shared narrative is being finalised which will explain why we are working together. This is told in the story of ‘Jack and Eileen’ and the communications teams from partner organisations are currently working on a supporting DVD to inform a communications strategy

Jack and Eileen are typical of people in this group. It is clear that as people get older the average number of long term conditions they have increases. This is particularly significant for those over the age of 75 when the majority of people have more than 3 conditions as well as becoming increasing frail due to the process of aging itself. People therefore have increasing complexity of need both in relation to their separate conditions and how they interact with each other, but also in relation to difficulties in managing to remain independent. These latter needs are not specific to any condition but generic and often require support from both health and social care services. It is this group of people that we have focused on in the last 12 months both in relation to preventing hospital admissions but also in moving people out of hospital as quickly as possible.



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What have we done so far? 1. Defined and put into place our core clinical processes and way of working with

primary, acute and social care - using the nationally recognised model for long term conditions and complex care, we are working to ensure all of the elements below are in place and co-ordinated through a case or care management approach.

So far, we have: • Implemented a risk stratification tool in all Solihull GP practices • Developed common nursing assessments between services • Aligned virtual wards with community nursing localities • Introduced Elderly Care Consultant support to Out of Hospital Services ( 4 sessions

per week from February with Consultant mobile contact at other times) • Instigated weekly virtual ward multi-disciplinary case conferences attended by social

care, mental health services, individual specialist community services and community nursing

• Placed integrated care plans within patient’s homes • Instigated monthly case conferences with primary care • Developed integrated out of hospital pathway with social care (ready for wider

consultation) • Completed implementation of System 1 (community PAS) shared with the majority of

primary care practices and local hospice. • Developed integrated acute, community and primary care pathways for diabetes and

respiratory services. Commencing for heart failure. • Conducted audits with the Clinical Director for Therapies and a senior community

nurse to establish those patients in both Heartlands and Solihull Hospitals who could be supported in a community setting.

2. Proposed an overall complex need and long term conditions model within the

ICP, supported by the CCG – we have developed 3 localities with large scale multi-disciplinary teams of elderly medicine consultants, nurses, therapists, pharmacists and social workers, supported by generic care workers with skills in nursing, therapies and



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social care. The three types of admission avoidance and facilitated discharge activity are shown below and will be run through ‘virtual ward’ models, supported by hospital based activity by both acute and community staff. In December 2012, 310 people were supported in virtual wards within the community and detailed referral and activity data is available to demonstrate impact. Further analysis is being undertaken to understand more fully the impact on admission avoidance and length of stay of the service. However, the model being developed was recently highlighted as an exemplar in the national Long Term Conditions QIPP programme. Sir John Oldham visited Solihull on 13th November to talk to partners about our work and praised the progress being made.

R,R,R = recovery, recuperation , rehabilitation

These wards will be wrapped around by core community activity including specialist long term condition teams (respiratory, diabetes and heart failure), re-ablement and end of life care and aligned to primary care.

3. Agreed the use of significant investment monies to implement shared priorities – building on the winter plan initiatives from 2011/12, the integrated care partnership has agreed the shared use of £1.5m investment in services for frail elderly and complex care. This includes investment in transition/intermediate care beds; Community Enhanced Assessment Service; Enhanced intermediate care services – therapies and social care; telecare; GP support, and additional domiciliary care support over the winter period.

4. We have agreed an outcomes framework with commissioners - this is linked to the previous presentation to the Board in July 2012 and is now incorporated into the Site Dashboard



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Are the changes we are implementing making a difference? It is genuinely difficult to say. Positive indicators include a 10.5% reduction in admissions for Solihull residents with long term conditions (specific HRGs) however this has not equated to a similar reduction in occupied bed days. This needs further investigation to understand. In addition SMBC have significantly reduced delayed transfers of care in line with agreed trajectory. There are clear differences in changing activity for Solihull residents between Heartlands and Solihull Hospitals over the period from April 2010 to November 2012, the point previous commissioner investment in community services started to come on line: • At Heartlands Hospital Solihull residents are identified as accounting for 17% of

activity through A&E and 21% of activity through AMU. The overall Solihull activity through AMU has reduced slightly over the period for April 2010 to November 2012 - this is consistent with the overall picture for Heartlands AMU. This is in the background of a demographic picture of 552 (17 per month) additional Solihull residents over the age of 65, including 205 (6.4 per month) people over the age of 85, in the Heartlands Hospital catchment area over the same period.

• At Solihull Hospital the Solihull residents are identified as 50% of A&E activity and 60% AMU activity respectively. The picture over the same period shows an overall increase in activity of around 150 admissions per month over the 32 month period. This equates to a month on month increase of 5 per month against a demographic picture of 1421 additional Solihull residents over the age of 65 (44.4 per month), including 528 (16.5 per month) people over the age of 85, in the Solihull Hospital catchment area over the same period. This is reflected with a similar increase in admissions on to base wards, with people discharged from AMU remaining consistent. The Birmingham residents around the boundaries of Solihull are likely to have a similar demographic picture.

Once admitted, there are statistically significantly less people pro rata waiting for up to 14 days in Solihull Hospital than those in Heartlands or Good Hope for interventions that can be provided safely in the community. This has been attributed to our excellent IV therapy and end of life services available in people’s homes. We are a national leader in end of life care with over 80% of people within our end of life services dying in their place of choice.



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Community based Single Point of Access Service receives an average of 110 referrals a month which by definition are an avoided admission. They continue to support patients over the defined 7 day period if they believe they are a readmission risk. Virtual Wards, community nursing and Macmillan use a tool to assess for an avoided admission and identify an average of 320 avoided admissions per month; this is being validated by clinical leads. What Next? In response to these findings we are focussing on the following next steps: • Increasing attendance of SPA and community services staff into AMU and onto post

take ward rounds to increase numbers discharged • Given the demographic changes in Solihull are set to continue over the next 17 years,

by 2030 a significant and sustained investment in community services is required. A comprehensive analysis of acute and community service activity factoring in the impact of demographics is being undertaken by a HEFT analyst. This also includes a review of virtual wards and use of the risk stratification tool.

• As a starting point an increase in capacity within domiciliary (as opposed to bedded) intermediate care services and the re-specification of intermediate care bedded services with commissioners is being made. This will allow discharge of long stay patients from acute beds if required. A business case has been supported by both Solihull and Cross City CCGs for £2 million investment for increased capacity for both Birmingham and Solihull residents.

• Building upon developing relationships with Birmingham and Solihull Mental Health FT to integrate mental health services into community localities and acute services

• Developing clinical pathways for falls, urinary tract infections, cellulitis, and breathlessness which move people into community alternatives following presentation at primary or secondary care

• Establishing multi-disciplinary and multi-condition rapid access clinics which implement a comprehensive geriatric assessment and make positive decision to admit following assessment not admission to assess.

• Implementing ‘Frailsafe’ assessment/screen in appropriate clinical settings • Undertaking a debate within the ICP about differential levels of investment for those

with complex needs between north and south Solihull given the emergent picture. Claire Molloy Managing Director Solihull Hospital and Community Services January 2013



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HEARTLANDS HOSPITAL, BIRMINGHAM SITE REPORT – January 2013

1. OVERVIEW OF DELIVERY AGAINST WORK PROGRAMME

This report concentrates on the current urgent care pressures in the hospital, which have reached crisis proportions over the recent holiday period.

2. KEY AREAS OF PROGRESS


The main focus currently is on the urgent care pathway. Professor Matthew Cooke is leading some work to look at transforming the way we see and treat emergency attenders and admissions at Heartlands, which will include the implementation of greater 7 day working in the hospital. As part of this, GP’s from the Birmingham Cross City CCG have visited to discuss changes including the implementation of a large ‘acute clinic’ or ambulatory acute medical facility at the front end of the hospital. Following the scoping phase, it is anticipated that this will become a project within the Clinical Transformation Board programme.

The need for this work has been highlighted by the current pressures detailed below.

2.2 Finance and Performance

The site team is currently facing two significant challenges; one focused on finances and under delivery against CIP, and the other the 4 hour A&E access target. The team is under escalation and have been tasked with developing robust plans to address both issues.

Both elective and emergency activity is above plan. Over the Trust there were 76,704 outpatient attendance during November, 1,744 (2%) more attendances than planned, with Heartlands seeing2,706 attendances above plan. This was a 12% increase in month and 18,853 (11%) more attendances than planned year to date. In November, Heartlands reported A&E activity of 5% above plan, significantly busier than the previous year. This high level of activity has continued and the hospital is continuing to experience high attendance levels as well as clinical teams reporting seeing an increase in the acuity of the patients. The Trust missed the 95% A&E target in November and Q3 with the Heartlands site missing the in-month target and showing asignificant dip in performance.

There is an increasing understanding that this represents a ‘whole system’ issue rather than simply a hospital one, as GP services, community health services, ambulance services and social care are all important factors in the provision of urgent care. Future actions will therefore need to be system-wide rather than hospital-focused if we are to make headway. A ‘summit’ has been called for early January by the Local Area Team where this will be addressed.

A detailed audit of the pressure this year, as compared to last, is included in the ‘Spotlight’ section

As at November Heartlands Hospital budgets were over spent by £11.5m. The site team is subject to escalation in respect of this, and has been tasked with improving performance via a rectification plan and this is being monitored via the Finance and Performance Committee.

Heartlands Hospital Report


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2.3 Service Development and Partnership Working

Pathology Build on plan

The new build and development of the site’s pathology service is continuing on schedule with the internal works now well underway. The jointly funded £8 million development involves a two storey extension to the current pathology building on the Heartlands Hospital site and will accommodate a new centralised core laboratory. It will also house a state of the art molecular biology laboratory for the diagnosis of infectious diseases and genetically acquired conditions.

The team of 400 laboratory medicine and HPA staff currently working in the laboratory turn around more than 2.6 million clinical sample requests every year for the Hospital Trust and GPs in the surrounding community plus public health samples from across the region. The extension will increase the laboratory’s capacity in line with demand, whilst modernising and improving the services provided for patients and Public Health.

Tamarind Centre to open

The Tamarind Centre development, which is Birmingham and Solihull Mental Health NHS Foundation Trust’s (BSMHFT) new medium secure unit in Bordesley Green, will open its doors to the first service users during December. Wards will open on a phased basis, with the centre expected to be fully operational by summer 2013. The Tamarind Centre will provide assessment, treatment and rehabilitation for men of working age (18 - 65 years) who require care in a medium secure environment.

Park and ride at Birmingham City Football Club

To support staff and ease congestion on the Heartlands site whilst work is continuing on our multi-storey car park, staff working at the Heartlands site will be able to park at the football ground once capacity on site has been filled. This is accessed between McDonalds and Morrisons on the Coventry Road.

A free shuttle service runs from the football ground to Heartlands, with return journeys in the afternoon. Alternatively a local bus service is available (number 73) every 30 minutes.


What our Patients are Reporting

The Trust had a Family and Friends Test (FFT) score of 66 in November. Heartlands score was 54, which was one point up from the previous month. Of the 3,716 patients who provided their feedback 2,326 said that they would actively recommend us (promoters), 1,058 patients scoring as passives and 332 as detractors.

We are continuing to monitor the FFT as well as additional information highlighting where we can improve our services. The table below shows that the additional responses from patients at Heartlands Hospital mirror those for the Trust as a whole.

November: Percentage of patient comments from the Net Recommender Survey Site Q1. Anything we did well? Q2. We could have done better? Q3. Staff nominationHeartlands 44% 19% 37%Trustwide 44% 19% 37%



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The main focus going forward is to increase the number of patients providing their views and improving scores by continuing to concentrate on care standards and improving communication.

We received 33 complaints in November with the most (5) in the main outpatients department. We are addressing the key theme of communication and staff attitude through a campaign focused on highlighting where we get it wrong and where we get it right. This includes patients having the opportunity to name staff for the care they provide and this is fed back to the ward manager and to individual members of staff.

New Patient Services Function

Estates are in the final stages of completing works on the new Patient Services function located in the front of Heartlands Hospital. Staff will be moving into the facility from the end of January. It will create for the first time a visible centre for patients, relatives and visitors not just to find out information about the Trust but also a focal point to raise issues and share their concerns. We believe that this will make us more accessible and responsive, helping to quickly allay fears and address concerns speedily. This will assist in reducing formal complaints and proving opportunities for those who may normally leave the Hospital without sharing their experience a comfortable environment in which to do so.

Media Coverage

The Hospital has had some strong media coverage including a campaign to support the winter plans and highlight the options available other than A&E.

One of our baby’s made national coverage. Baby Seren Duran Rabbitt has a birth date that will be easy to remember – 12/12/12 – and the midwife who delivered her was celebrating her birthday on the same day too. The number 12 theme didn’t end there. Seren was born in delivery room 12 in Heartlands Hospital’s Princess of Wales Maternity Unit.

BBC Documentary - “Protecting Our Parents” - As you may be aware, the elderly care department at Heartlands is working with the BBC in making a series of observational documentaries following the health and social care of frail and elderly people in Heartlands and the surrounding communities. The BBC’s aim is to produce a documentary series, which is to be aired on BBC2 in the summer/autumn 2013, which honestly reflects the care of frail and elderly people in Britain. This is an excellent opportunity for us to showcase some of the work we are doing with some of our most vulnerable patients.

3. ‘SPOTLIGHT ON’ ….ED performance at Heartlands - November/December 2012

This spot audit was carried out by Dr Steve Smith, Associate Medical Director for Heartlands Hospital, to look at the urgent care demand situation by comparing it to the same month in 2011. The Board will be interested to read the highlights of this analysis.



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Situation

ED four hour performance at BHH for the last 4 weeks has been significantly below the 95% target and well off the trajectory in the rectification plan. There is a striking contrast with the same period last year when performance was satisfactory.

Background

The poor performance of the BHH site has occurred despite increased input into the service. Additional shifts have been introduced in ED. Extra resource has been put into capacity management. Additional flex wards have been opened.

This analysis was undertaken to determine the reasons for the deterioration in performance. The output will be used to test the validity of the current 4 hour action plan and inform the development of additional remedial actions.

Data was analysed for the 28 day period from 13th November to 10th December 2012 and compared with the same period in 2011.

Headlines are as follows:

• Increased pressure at the front dooro ED attendances increased by 6 a day (2%)o Ambulance arrivals increase by 5 a day (5%)

• Increased pressure on the hospitalo There were 127 more admissions to the hospital base wards and assessment areas (5 a

day, 6%). o These patients account for approximately 1000 bed days equivalent to 1 wardo The specialties with the biggest increases are General Medicine (+5%), General Surgery

(+23%), and T&O (+30%)o Just over half the extra patients were in surgical specialitieso 4% increase in beds open (all flex capacity)o Average of 4 extra beds a day lost to norovirus

• Things which did not change significantlyo Emergency length of stayo DTOCo Age of patients at any point of the pathway

• Further analysis is underway. These analyses are still outstanding:o Assessment of social services input

Discharge destinations and numbers going to nursing homes Numbers of packages of care requested Number of active section 2 and section 5s

o Time to assessment in EDo Bank/locum shifts used in ED/AMU and ward areaso Measures of ward performance

Discharge before 1.00 Ward discharge rates

o Breach analysis



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Assessment

It seems likely that there are several reasons for current underperformance. A plausible explanation of the data is as follows:

• There is a definite increase in activity in ED with more serious illness – as indicated by ambulance transfers. Under pressure it is easier to admit than discharge.

• This leads to a disproportionate increase in admissions to hospital. • The increased admissions equate to the increased ambulance transfers but there is likely to

be a reduction in admission threshold as not all ambulances get admitted.• In turn this puts pressure on the assessment units and their conversion rate goes up.• The bed base is swamped with all flex occupied leading to further pressure at the front door• Efficiency of flow through the hospital is compromised because patients are in the wrong

beds or on inadequately serviced flex wards• As series of vicious circles result which makes it difficult to get control

In addition there is anecdotal evidence of changes in the confidence of practitioners and willingness to take responsibility for risk. At each stage in the patient pathway clinicians (ambulance personnel, GP, ED doctor, AMU doctor etc) have a clear choice. They can take responsibility and sort the problem or they can pass it on. Even quite small changes in this willingness to deal with the problem can cause large changes in patients eventually being admitted (this is a particular issue when there is severe pressure on the system and staff).

The lack of change in LOS does not mean the efficiency of the wards is unchanged. A lower threshold for admissions should in theory lead to a reduction in LOS. We cannot assume that there are no problems at the back door. Indeed a big contributor to the problem is over-occupancy and clearing social blocks could be a significant contributor to the solution.

Recommendation

In the short term we need to concentrate on reducing the pressure on and the conversion rate from our ED and admission units. This should include:

• Admission avoidance schemeso Development of urgent review clinicso GP referrals should be initially considered ambulatoryo Elderly ambulatory pathwayso ED diversion/ Pathways

• Communications to the local community about appropriate access to ED• Intelligent conveyancing• Additional staffing at peak times in ED

We also need to clear beds and reduce occupancy toward 90%. In addition to the existing 4 hour plan we need:• Urgent discussions with social services improved turnaround times for packages



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Concluding note (MN)

This analysis has been used to inform our immediate actions over the recent weeks, and will be taken to the system-wide discussion at the Urgent Care Forum in January.

Despite the target performance, our staff are managing an extremely difficult situation with commitment and professionalism, and are to be highly commended. As a Board, and as major influencers within the wider health and social care system, we need to be making significant changes if we are to avoid a similar level of pressure next winter.

Mark Newbold Lisa ThomsonChief Executive Director of Corporate Affairs

January 2013


January 2013

Board of Directors

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18.1 Growth Strategy (Oral)

PART THREE

18.2 Aston University (Oral)

18.3 University of Birmingham - Pre Registration Nurse Education

(Enclosure)

18.4 Mr I P Update (Enclosure)

18.5 Community Pathology Tender (Enclosure)

18.6 Nominations Committee (Enclosure)

The Board will be asked to resolve “That representatives of the press and other members of

the public be excluded from the remainder of the 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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AGENDA

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Board of Directors€¦ · 08/01/2013 · Board of Directors 8 January 2013 9.30am MIDRU Birmingham Heartlands Hospital HELD IN PUBLIC. Board of Directors anuary 2013 .2 Agenda.01