Board of Directors in public - October€¦ · Peter Sanderson Non-Executive Director of NHFML Non-Executive Director of Northumbria Primary Care ... The Chair advised that the presentation

Board of Directors in public - October

MEETING

19 October 2017 12:00

PUBLISHED

19 October 2017

Agenda

Location Date Owner Time

Hexham General Hospital 19/10/17 12:00

Public Trust Board

1. Opening items A. Richardson 12:00

1.1. Apologies for absence (verbal)

1.2. Declarations of interest (verbal)

1.3. Minutes of previous meeting - 19.7.17

1.4. Matters arising (verbal)

1.5. Items from the Chair (verbal)

2. Quality

2.1. Patient story (Enc. 1) TO RECEIVE D. Reape 12:15

2.2. Patient experience quarterly report (Enc. 2) TO RECEIVE A. Laverty 12:25

2.3. Corporate Quality & Safety Report (Enc. 3) TO RECEIVE B. Bartoli 12:40

2.4. Register of interests, gifts and sponsorship (Enc. 5) TORECEIVE

S. Stephenson 12:50

3. Strategy

3.1. Strategic refresh (verbal) B. Bartoli 12:55

3.2. Supportive/additional roles - 3 month review of pilot (Enc. 7)TO RECEIVE

C. Platton 13:00

4. Performance

4.1. Workforce Report (Enc. 8) TO RECEIVE A. Stringer 13:10

4.2. Corporate Financial Compliance Report (Enc. 9) TORECEIVE

P. Dunn 13:20

4.3. Committee key issues report (Enc 10a&b) TO RECEIVE Chairs 13:30

4.4. Guardian of safe working report (Enc. 11) TO RECEIVE N. Premchand 13:40

5. Any other business

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Board of Directors (Public)

Wednesday 19th July 2017, 12.00pm

The Village Hotel, Cobalt

Present:

Alan Richardson Chairman

Allan Hepple Non-Executive Director

Moira Davison Non-Executive Director

Malcolm Page Non-Executive Director

Alison Marshall Non-Executive Director

David Chesser Non-Executive Director

Martin Knowles Non-Executive Director

Peter Sanderson Non-Executive Director

Birju Bartoli Executive Director of Performance & Governance

Steve Bannister Managing Director of Estates & Facilities

Ann Wright Executive Director of Operations

Ann Stringer Executive Director of Human Resources

Debbie Reape Interim Executive Director of Nursing

Claire Riley Executive Director of Communications & Corporate Affairs

Daljit Lally Executive Director of Community Services

Jeremy Rushmer Medical Director

Mark Thomas Director of Health Informatics

In Attendance:

Julie Reed Deputy Director of Finance

Caroline Cornwell Corporate Governance Assistant

Susan Dungworth Board Observer

Heather Carr Public Governor

Brian Kipling Public Governor

Gill Close Public Governor

Alyson Raine Child Health Business Unit General Manager

Margaret Hill Public Member

Linda Pepper Public Governor

Rachel Mitcheson Head of Commissioning for CCG

Mavis Wilkinson- Hamilton Public Governor

Brenda Longstaff Charitable Funds Lead

1.2/7/17 Apologise for absence and declarations of interest:

Paul Dunn Executive Director of Finance

Annie Laverty Director of Patient Experience

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Director Details of nature and extent of interest

Alison Marshall Non-Executive Director at Northern Power Grid

(Northeast) Limited.

Non-Executive Director Northern Power Grid

(Yorkshire) plc.

Ambassador for North Northumberland Hospice

Care

School Governor for Felton Church of England

Primary School

David Chesser Chief Operating Officer University of Cumbria

Allan Hepple Councillor for Cramlington South East

Cabinet member for Economic Growth

Non-Executive Director at Arch the

Northumberland development company

Vice chair of Transport North East Committee of

North East Combined Authority

Moira Davison Director of Moira Davison Consulting Ltd

Malcolm Page Chief Operating Officer Teesside University

Non-executive Director - Your Homes

Newcastle

Ann Wright Director of Northumbria Primary Care

Director at Lindisfarne Health limited

Ann Stringer Directors of Northumbria Primary Care.

Martin Knowles Non-Executive Director at Two Castles Housing

Association.

Vice Chair, Audit Committee & Governance at

Sunderland City Council

Vice Chair Tyne & Wear Fire Service-Audit

Committee

Daljit Lally Interim CEO of Northumberland County Council

Transformation Lead for the CCG

Claire Riley Director of NPC

Explain Market research-Non-Executive Director

North Cumbria University Hospital Trust-

Honorary Contract and buddy arrangement

Governor at Ashington high school

Peter Sanderson Non-Executive Director of NHFML

Non-Executive Director of Northumbria Primary

Care

Mark Thomas Honorary Contract as Director of Health

Informatics with North Cumbria University

Hospital NHS Trust

Steven Bannister Managing Director of NHFML

Associate Governor at Morpeth First School

1.2/7/17 Minutes of the last meeting (dated 27th April 2017)

The minutes of Public Board 27th April 2017 were reviewed and were approved as a true and

accurate record of the meeting.

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The Board approved the minutes of Public Board.

1.3/7/17 Action log and matters arising

The action log was reviewed and noted.

The Board noted the action log.

1.4/7/17 Items from the CEO

The CEO’s update highlighted the following:

The Trust retains a strong financial performance at year end.

A&E targets and 62 day cancer targets remain a key area of challenge for the Trust

A national template for Urgent Care Centre provision launched this month.

Winter planning is on-going with the aim for 92% bed occupancy.

The ACO Business Case has been submitted.

The recent Primary Care event held last week proved to be very successful.

The Board noted the CEO update

1.5/7/17 Items from the Chair

The Chair reiterated the points discussed previously by the CEO, before discussing briefly the

outstanding work to do in relation to the Accountable Care Organisation.

The Board noted the update

1.6/7/17 Patient Story

Debbie Reape presented the patient story to the Board, reflecting on the patient experience and

support the patient felt throughout the journey.

The Board discussed and noted the report

2.Strategy, policy & planning

2.1/7/17 BU update Child Health

Alyson Raine delivered a verbal update on the Business Unit (BU) current position, and focused on

the performance against CIP. She noted that the BU continuously looks for opportunities to deliver

against its overall CIP target of £500k. Vacancy and sickness levels were discussed, with members

updated on the two advertised consultant posts. Nurse Practitioner roles are continuing to be

difficult to fill, given the competitive packages offered externally. Discussions continued on

retention or Nurse Practitioners alongside the financial packages from external sources, which are

contributing factors for Nurse Practitioner leaving to work in the community.

The Board noted the update

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3 Standard reports/regulatory information

3.1/7/17 Guardian of Safer Working update

Jeremy Rushmer delivered the report, advising that the remaining Doctor within the Trust who are

currently working on the older term contract will be moving to the new contract later this year.

There has been a drop nationally in the levels of applicants for medical posts, giving rise for on-

going discussions on retention of staff and the need for a workforce plan for the region.

The Board noted the report

3.2/7/17 Workforce report

Ann Stringer delivered the workforce report, highlighting the current sickness rate of 3.42%,

apprenticeship levy and the new national graduates currently in the service. Discussions continued

on coaching and management development, with the Board being advised that there are 30 new

trainees ready to start work in the Trust inclusive of the two new national graduates, who will be

following the intern programme.

The Board received the report

3.3/7/17 Patient Experience

Debbie Reape delivered the quarterly update report giving a brief update of the following:

Patient Perspective results- 97% inpatients and 99% outpatients rated care as good, very

good or excellent.

Real Time - The Trust scores consistently high for site performance and high quality care

being maintained across the Trust

Friends & Family - feedback from 7489 patients for the month. Inpatient and Maternity

scores are consistent with quarter 1 and are above the national average, with responses for

maternity above the national average.

CQC- results for 2016 place the Trust 12th out of 150 Trusts nationally.

Discussions continued on the patient experience information, with members recalling that during

the last Board meeting opportunities were discussed on how best to update staff of all the excellent

work they do. It was agreed that Claire Riley would draft a letter to acknowledge all of the work the

staff members are doing.

Action1: Claire Riley to draft a letter for staff prior to the September Board.


3.4/7/17 Q1 Assurance Framework

Birju Bartoli discussed the assurance framework, noting there are no amends following discussions

at the Assurance Committee. The Trust achieved 9 of the 10 standards, with 62 RTT missing the

target. Discussions continued on the Single Oversight Framework (SOF) inclusive of Fire, Cyber-

Crime and workforce issues.


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3.5/7/17 SOF segmentation NHSI

Birju Bartoli gave a verbal update advising that the Trust for Quarter 4 (SOF) remained at level 1

which is the best outcome. The Trust is awaiting the current Quarter 1 position, which is hoped, will

also remain as level 1.


3.6/7/17 Community services update

Daljit Lally and Rachel Mitcheson spoke to a presentation giving the Board an overview of the

current position within the community services business unit:

Better Care Fund - guidance originally expected December 2016 was published 3rd July 2017.

The guidance contains two elements:

o the DToC targets which must be met in order to receive 2018/19 funding;

o mandatory amounts which must be transferred to protect adult social care.

Social Care - funding in the spring will be monitored separately, with the funds used to

support social care markets;

NTCCG - discussions ensued on the key work within the first 18 months, to provide Primary

Care Home Model across 4 localities with the Multispecialty Community Providers model

due to deliver 14 pilots.

Locality - 4 Primary Care home Model (PCHM) across locality with 8 hubs, which include

single point access.

Discussions continued on County Wide Single Point of access and pilots within GP practices in Blyth.

Birju Bartoli noted that there is full support for the model, however questioned how this would be

evaluated. The Chair advised that the presentation demonstrated the excellent work from both

Clinical Commissioning Groups.


3.7/7/17 Charitable Funds update

Brenda Longstaff delivered the verbal update, outlining the following for information:

Staff Lottery-launched with the 1st draw on the 2nd May with prize of £1,377.34. The prize for

August is looking to be the biggest to date £1700 with over one third of staff now enrolled.

Pears Trust- at the next meeting there will be an update on young people.

Patient Experience- request for £97k for the RITA system, 20 units purchased to undertake

further research.

EMT-large bid in which has been agreed in principle following the due diligence process.

Art- workshop NTGH now to go to WGH

International- work on going with 6 Tanzanian students returning home

Volunteer- Harry Mercer 94year old in the evening chronicle after being nominated for the

Pride Award

Curious Monkey-£2.5k to work on a cultural exchange project

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Discussions continued on the various projects and donations, the Chair commented on the art work

at NSECH. Claire Riley advised that Brenda Longstaff and the team do an amazing job, working

continuously to engage staff and others.


The Chair asked the members of the public if they had any questions they wished to ask. The

members of the public had no questions or comments for the Board.

The next Public Board meeting will be on the Thursday 23rd November, 10am at Cobalt Conference

centre.

The Chair formally closed the meeting.

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RELATIVES’ STORY FROM CRITICAL CARE UNIT, NSECH, JULY 2017

Patient: Darren Bonner, Age 24

(Family interviewed on 26/07/2017, patient admitted 10th

July)

Pa e ts’ Comments:

Our son was attacked and left for dead in woodland. He is now dying, which will mean that he has been

murdered.

The staff do an amazing job, not just for our relative, but for us too. The teamwork is brilliant and we have a

million per cent trust in the doctors and nurses. It's like a well-oiled machine and they all click as a team. The

standards of cleaning and hand hygiene are immaculate. We call it The Hilton.

Everyone treats us with dignity and respect. We are kept up to date and have been involved and informed

every step of the way. The security is great- the staff al ays dou le he k ho a y isito s a e a d ask if e’ e happy for them to come in to the room.

They are an absolutely wonderful group of people; every member of staff, from doctors to cleaners, are all

amazing in every aspect, and they all speak to us and make an effort. Even the cleaner who came to empty the

i s stood a d hatted. He’s al ays looki g afte us a d aki g su e e’ e ok a d o fo ta le, do to he ki g that e’ e e ough to els a d eddi g fo the fa ily oo hi h e’ e stayi g i .

The staff all mean a lot to us personally for what they've done. We can have a bit of carry on with them- some

o ality helps gi e hat e’ e goi g th ough. They treat us like family and we even know a bit about their

li es. They all ha e thei little ui ks a d e feel e’ e got to k o the ell.

The little touches which ease our time here have been wonderful and the support is phenomenal. The staff

bought matching teddies for our son and his little brother and took pictures of them so that he could be

comforted by knowing that they had the same one. Last night, a member of staff put a couple of electric tea

lights at the head of the bed, which created a lovely atmosphere.

There was talk about our son being mo ed to a hospi e, ut o they’ e ot su e a out o i g hi . He does ’t ha e lo g left a d e’ e pleased that he’s stayi g he e fo o e ause e e yo e has ee so i e and helpful. They are there to support us if we're feeling down and been more supportive than our own family;

they’ e outsta di g a d the e’s al ays so eo e the e fo us.

We want to write to the head of the Trust to express our gratitude. They've gone beyond their duty in a way

we wouldn't expect and we have never encountered, nor can we imagine, treatment like this in any other

hospital.

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Board of Directors Meeting 19th October 2017Patient Experience Update

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Patient Perspective data.

Inpatient / Day Case & Outpatients.

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Patient Perspective Data – IP / DC / OP Overall satisfaction, (rating the inpatient service as Excellent, Very good or Good)

Patient Perspective Data: Inpatients (n=1182)

Patient Perspective Data: Outpatients (n=1485)

Q2 Jul-17 Aug-17 Sep-17N % N % N %

Inpatient 216 95.6% 251 95.8% 208 94.6%Day Case 153 99.4% 94 98.9% 177 98.9%

Q2 Jul-17 Aug-17 Sep-17N % N % N %

Outpatients 332 98.2% 655 98.8% 446 98.2%

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Patient Perspective Data – Inpatients Q2In this quarter, the inpatient results continue to be very good.

• The average score for the Trust is 87.4%, and within the top 20% of Trusts in England (threshold 84%).

• The Trust is in the top 20% of all trusts for all 19 of the most important questions for patients.

• 95% of inpatients rate the Trust as excellent, very good or good.

Hospital Score Respondents

Hexham General Hospital 93% 95

NSECH 87% 316

Wansbeck General Hospital 85% 131

North Tyneside General Hospital 85% 144

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Overall, for the Trust, results remain good in all areas, but particularly:

• Overall ratings, respect and dignity, staff working well together

• All aspects of communication with doctors and nurses

• Cleanliness and hand-washing

• Pain management

• Discharge planning including information on medicines

Patient Perspective Data – Inpatients Q21

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Patient Perspective Data – Outpatients Q2In this quarter, the inpatient results continue to be extremely good.


• The Trust is in the top 20% of all trusts for 19 of the 20 most important questions for patients. All specialties are in the Top 20%

• 99% of inpatients rate the Trust as excellent, very good or good.

Hospital Score RespondentsHexham General Hospital 93% 254Morpeth NHS Centre 92% 22Wansbeck General Hospital 91% 357Alnwick Infirmary 89% 25NSECH 89% 64North Tyneside General Hospital 88% 387Berwick Infirmary 87% 25

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Patient Perspective Data – Outpatients Q2

Overall results are particularly good in these areas:

• All aspects of communication between doctors and patients, and information given

• Involvement in decisions• Discharge planning• Cleanliness• Letters copied to patients• Overall ratings and respect and dignity

The one question not in the top 20% of Trusts is:

• Before the treatment, did a member of staff explain what would happen?

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Patient Perspective data.

Emergency Care.

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Patient Perspective Data – Emergency Care Q2

In this quarter, the Emergency Department results continue to be very good.


• The Trust is in the top 20% of all trusts for 24 of the 27 most important questions for patients.

• Results vary across the site, average scores are :-

o Hexham 88%o North Tyneside 82%o Wansbeck 80%o The Northumbria Hospital 75%

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Patient Perspective Data – Emergency Care Q2Overall results are particularly good in these areas:

• Information on waiting times • Communication with the doctors and nurses• Cleanliness of the department and the toilets• Privacy whilst in the department• Planning for leaving Hospital• Overall ratings and respect and Dignity

The three questions not in the top 20% of Trusts is:

• How long did you wait before you first spoke to a nurse or doctor?• From the time you first arrived in the Emergency Department, how

long did you wait before being first examined by a doctor or nurse?• Do you think the hospital staff did everything they could to help

control your pain?

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Real time data.

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Real Time Domain Averages 20171

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Real Time Data Q2 2017

By Business UnitJul - Sep 2017 Q2

No of Patients Surveyed

Coord-ination

Respect & Dignity

Involve-ment Doctors Nurses Clean-

linessPain

Control Medicines Noise at Night

Kindness & Compassion

Domain Average

Recom-mendation

Medicine 1483 9.51 9.87 9.63 9.81 9.86 9.87 9.87 7.80 9.31 9.89 9.54 9.67Surgery 557 9.66 9.91 9.79 9.89 9.88 9.89 9.82 8.33 9.48 9.91 9.66 9.50

Childrens 57 9.67 9.91 9.76 9.87 9.94 9.96 10.00 9.63 9.69 10.00 9.84 9.96Total 2097 9.55 9.88 9.68 9.83 9.87 9.88 9.86 8.04 9.37 9.90 9.58 9.63

By SiteJul - Sep 2017 Q2

No of Patients Surveyed

Coord-ination

Respect & Dignity

Involve-ment Doctors Nurses Clean-

linessPain

Control Medicines Noise at Night

Kindness & Compassion

Domain Average

Recom-mendation

NSECH 768 9.59 9.92 9.71 9.84 9.91 9.91 9.86 8.14 9.62 9.91 9.64 9.79NTGH 569 9.46 9.82 9.64 9.80 9.83 9.82 9.83 7.44 9.16 9.84 9.45 9.18WGH 400 9.65 9.94 9.68 9.83 9.90 9.90 9.88 8.32 9.19 9.97 9.63 9.83HGH 139 9.49 9.89 9.70 9.85 9.85 9.82 9.81 8.51 9.66 9.86 9.64 9.77

Community 221 9.59 9.87 9.71 9.89 9.81 9.90 9.95 8.67 9.23 9.93 9.66 9.85Total 2097 9.55 9.88 9.68 9.83 9.87 9.88 9.86 8.04 9.37 9.90 9.58 9.63

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National Cancer Survey2016

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National Cancer Patient Experience Survey (CPES) has adopted the CQC standard for reporting comparative performance, based on calculation of "expected ranges". There were 52 questions, the Trust results showed 15 in the expected upper range (29%), 34 in the expected middle range (65%) and 3 in the expected lower range (6%)

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When comparing the 2016 / 2015 questions it showed the Trust was statistically significantly worse in one question, The other forty nine showed there was no significant change. The Trust weren’t statistically significantly better in any questions.

Significantly worse2015 Score (case mix adjusted)

2016 Score (case mix adjusted)

Q50. Patient definitely given enough support from health or social services during treatment. 71% 61%

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Regional Table

In the CPES survey all the Trusts have been calculated an expected upper and lower range for each question, depending on the case-mix of the patients surveyed. Northumbria exceeded their upper range.

Rank TrustOverall, how would you rate your care? (Case mix adjusted)

Perfor-manceRating

Expected Range(lower)

Expected Range(upper)

3 Gateshead Health NHS Foundation Trust 9.03 1 8.58 8.90

19 Northumbria Healthcare NHS Foundation Trust 8.92 1 8.59 8.89

23 The Newcastle upon Tyne Hospitals NHS Foundation Trust 8.91 1 8.62 8.86

27 South Tyneside NHS Foundation Trust 8.90 2 8.46 9.02

34 University Hospitals of Morecambe Bay 8.87 2 8.59 8.89

42 South Tees Hospitals NHS Foundation Trust 8.83 2 8.60 8.88

43 North Tees and Hartlepool NHS Foundation Trust 8.83 2 8.58 8.90

101 City Hospitals Sunderland NHS Foundation Trust 8.68 2 8.58 8.90

127 County Durham and Darlington NHS Foundation Trust 8.55 3 8.58 8.90

143 North Cumbria University Hospitals NHS Trust 8.30 3 8.57 8.91

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Friends and Family.

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Friends and Family Test – IP/DC

National Average FFT Score – 78National Average % Recommend – 96%National Average% Response rate – 25.6%

IP/DC Extremely likely Likely

Neither likely nor unlikely

Unlikely Extremely unlikely

Don't know Total Score Response

Rate Eligible

% of Extremely Likely & Likely

Jul-17 1651 154 14 13 3 17 1852 88 20.6% 9006 97%

Aug-17 1318 129 15 8 4 9 1483 88 16.1% 9227 98%

Sep-17 1536 150 25 12 8 23 1754 86 19.3% 9069 96%

Q2 2017 4505 433 54 33 15 49 5089 87 18.6% 27302 97%

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Friends and Family Test – A&E


FFT A&E Extremely likely Likely

Neither likely nor

unlikely

Unlikely

Extremely unlikely


Rate Eligible


Jul-17 664 195 43 25 35 41 1003 58 8.1% 12452 86%

Aug-17 604 195 47 25 33 21 925 55 7.5% 12256 86%

Sep-17 627 197 51 38 49 32 994 51 8.7% 11423 83%

Q2 2017 1895 587 141 88 117 94 2922 55 8.1% 36131 85%

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Friends and Family Test – Maternity


FFT Maternit

y

Extremely likely

Likely

Neither likely nor unlikely

Unlikely Extremely unlikely


Rate Eligible


Jul-17 369 46 5 2 0 0 422 86 29.2% 1444 98%

Aug-17 302 37 3 0 2 0 344 86 24.7% 1395 99%

Sep-17 253 24 0 2 0 0 279 90 19.3% 1448 99%

Q2 2017 924 107 8 4 2 0 1045 87 24.4% 4287 99%

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Patient Experience Collaborative

Successfully launch hosted by Northumbria on 26th September

15 organisations in the room

Testing Northumbria real time system at scale

Opportunity to influence future policy

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Your usage of a range of sources (real time, right time, qualitative, observational work, deep dives into data) to inform improvement was very refreshing to see and is really not as common as it should be.

The extent to which I observed staff view this as part of every day care

The ownership of this agenda at all levels of the organisation including senior backing

The cultural acceptance that this change in the power relationship and placing trust in patients is the key to organisational success.

King’s Fund Visit - Dan Welling’s observations

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Thank You

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Report to Finance, Investment & Performance Committee

Title of Report NHSI Regulatory Performance Report

Author Birju Bartoli, Executive Director

Executive Lead Birju Bartoli, Executive Director

Date of meeting 16th October 2017Executive Summary From October 2016, under the new oversight framework, Trusts are now

monitored and expected to deliver most key performance metrics on a monthly basis, as opposed to quarterly, with an opportunity to recover financial penalties at the end of each quarter based on an aggregated quarterly performance. On 13th July NHS Improvement published the latest provider segmentation (which is based on the level of support trusts need). This confirmed that the trust remains in Segment 1. This is the best possible segment.

Performance in September for the A&E target was 95%, i.e. the Trust met the 95% target. The agreed trajectory is 96.0% for quarter 2: our performance was 95% for each month during the quarter, and we have received confirmation from NHSI that STF monies for quarter 2 will be received.

Referral to treatment times (RTT) for incomplete pathways: the standard is to have at least 92% of patients waiting less than 18 weeks at month end. This standard was met for September, with a performance of 92%. However, it should be noted that there has been an increase in the number waiting for treatment.

September performance data for the 62 day cancer waiting times GP referral to treatment target (85%) is still to be confirmed, but the provisional performance figure is 74%. The provisional figure for the quarter is 78%.

Performance for the 62 day bowel screening target (90%) – the provisional performance figure for September is 0% (based on 0 out of 1 case). The provisional figure for the quarter is 76%.

Diagnostics – percentage of patients waiting six weeks or less for a diagnostic test. We achieved the 99% standard for September.

IAPT. The proportion of people completing treatment who moved to recovery is provisionally 50.5% for September. The standard to meet for the quarter is 50%.

This report is written in accordance with NHS Improvement’s Single Oversight Framework, which became operational from 1st October, 2016.

Assurance Framework ref.

2.1 - 2.51 inclusive

Alignment to Trust’s Annual/ Strategic Plans or business unit annual plans

Yes – aligned

Risk rating (very high, high, moderate, low risk)/ any recommended changes

Moderate

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Compliance/ reg’tory requirements (if applicable)

Yes – compliant

Actions required by the Board

The Committee is asked to approve this report.

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Regulatory Performance Report

Finance, Investment & Performance Committee16th October, 2017

Strategic Objective: Excellence in safety, quality and complianceAt the same time as delivering the best quality healthcare and excellent customer services we have to ensure patients are safe and that we meet national regulatory safety and quality standards. This will provide independently verified assurance to our stakeholders and will give us the necessary freedom to focus on our priorities.

Key Strategic QuestionTo what extent are we providing high quality, caring, safe, health and care services in accordance with the national regulatory standards?

Key Findings and Performance LevelsThe purpose of this executive summary is to provide the Board of Directors with the evidence of achievement against the national regulatory systems, emerging risks and the assurance that an improvement plan is in place and is effective.

The Board has delegated full authority to the following Committees to ensure these standards are met: FIP, Safety & Quality and Assurance. The evidence to support the governance of these standards is provided to these Committees.

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NHS Improvement (NHSI) – Single Oversight Framework (SOF)

NHSI’s Single Oversight Framework became operational from 1st October, 2016

Q1 Q2 Q3 Q4

Trust overall assessment Actual Actual

Performance

Operational performance metrics(5 acute; 5 mental health) (see note 1)

9 standards

met***

8 standards

met***

Quality of care (safe, effective, caring, responsive) monitoring metrics

See quarterly Excellence in Safety & Quality report

Care Quality Commission

Quarter

1 2 3 4

Overall Trust Rating Outstanding Outstanding

CQC ‘insight’ performance monitoring to be included upon publication

Score = 1* Score = 1*

Annual Quality Governance Fully met Fully met

Material risks No No

Segment 1**

Segment1**

* Score = 1 is the best score possible

** Segment = 1 means the provider has maximum autonomy

*** Amber means there is a risk to the trust remaining in Segment 1 (because of performance on the

cancer 62 day GP referrals standard and the 62 day cancer screening referrals target)

Notes

1. Five acute standards with monthly frequency: A&E four hour wait; 18 weeks RTT incomplete

pathways; Cancer 62 day waits (2 standards); and 6 week wait for diagnostic procedures.

Two mental health standards with monthly frequency: Data quality metrics for Mental Health

Services Data Set submissions to NHS Digital (one for achievement by 2016/17 year-end);

Three mental health standards with quarterly frequency: Improving Access to Psychological

Therapies: proportion of people completing treatment who move to recovery and waiting times

(2 standards) to begin treatment

Performance and quality metrics

Care Quality Commission

Single Oversight Framework (SOF) Segment

Other factors

Finance and use of resources

Board statement

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Safety & Quality Regulatory Risk AssessmentThis section provides a risk assessment of the regulatory standards.

Strategic, Operational & Financial Risks: High Risks SOF Risk

A&E 4 hour wait (95% target)

Performance in September for the A&E target was 95%, i.e. the Trust met the 95% target. The agreed trajectory for the quarter is 96.00%: our performance was 95% for each month during the quarter.

A&E attendances remain stable at around 16,000-17,000 per month, but 0.3% higher overall than during the same period (Apr-Sep) last year.Length of stay has decreased compared to last year: 30% of patients stayed 3+ days compared to 31% for the same period (Apr-Aug) last year. But during August alone, 32% stayed 3+ days, compared to only 31% in August 2016. This may indicate that ‘winter’ pressures have already started.

No

Referral to treatment times (RTT) for incomplete pathways: % patients waiting less than 18 weeks at month end

Referral to treatment times (RTT) for incomplete pathways: 92% patients waiting less than 18 weeks at month end. This standard was met for September, with a performance of 92%. However, it should be noted that there has been an increase in the number waiting for treatment.

No

62 day referral to treatment Cancer standards: urgent GP referrals and referrals from the national screening service

September performance data for the 62 day cancer waiting times GP referral to treatment target (85%) is still to be confirmed, but the provisional performance figure is 74%. The corresponding (finalised) figure for September 2016 was 79%.

Summary level performance is adversely affected by performance at cancer-site level where there is a combination of low percentage achievement and relatively high volume of treatments. Urology and colorectal are of particular focus currently.

Performance for the 62 day bowel screening target (90%) – the provisional performance figure for September is 0%.

Yes

Diagnostics – percentage of patients waiting six weeks or less for a diagnostic test.

We achieved the 99% target for patients waiting at the end of September.

No

Improving access to psychological therapies: proportion of people completing treatment who move to recovery

The proportion of people completing treatment who moved to recovery is provisionally 50.5% for September, and 50.6% for the quarter. The standard to meet for the quarter is 50%.

No

MRSA While no longer a Monitor target, the expectation is that trusts will have zero cases of MRSA. There has been one case identified so far during 2017/18, in September, but this was not attributed to the trust.

Not appl

Clostridium difficile

During September there were two cases of C diff. The target for 2017/18 remains at no more than 30 cases. There were no cases between 1st and 9th October, so there have been 13 in total that count against the target of 30.

By default, each case is deemed to be ‘due to a lapse in care’ unless it has been through a formal appeals process.

Not appl

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NHS Improvement is currently consulting on changes to the Single Oversight Framework to be rolled out from September 2017. The additional operational performance metrics to be included that are relevant to the trust are those relating to Dementia assessment and referral (already reported to NHS England monthly) and the Data Quality Maturity Index for Mental Health data.

RecommendationsThis report is provided for information to Board members.Birju BartoliExecutive Director, October 2017.

Surgical site (deep) infection rates in Orthopaedics (in arrears; the position up to and including July 2017 is reported).

During August there was one deep joint infection – for a hip replacement. During 2017/18 to date there have been nine – three for a hip replacement, three for a knee replacement and three for a repair of a fractured neck of femur.

Not appl

Complaints Complaints responses within the period agreed with the complainant was 98% (out of complaints closed within the agreed timescale) for September. Monthly monitoring of Trust and Business Unit performance is undertaken at the Safety and Quality Committee.

Not appl

Assurance Framework References 2.1 – 2.51 inclusiveKey controls – Yes, key controls are in placePositive assurance – this report provides positive assuranceGaps in controls or assurance – There is no gap in our controls.

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Title of Report Register of Interests

Author Sophie Stephenson, Company Secretary

Executive Lead Alan Richardson, Chair

Executive

Summary

The Board of Directors is required to review the Register of Interests on at least an

annual basis. The register of directors’ interests is constructed and maintained

pursuant to Section 20 of Schedule 1 of the Health and Social Care (Community

Health and Standards Act 2003).

It is the responsibility of individual directors to ensure information relating to their

interests is captured accurately. Any changes to interests or new interests that arise

during the year should be notified in writing to the Chair and Company Secretary and

the register will be updated accordingly.

Recommended

actions

required by

Board/committ

ee

The Board is asked to review and approve the register of interests.

To ensure

quality

underpins

every

decision

To provide

the safest

health and

care services

to patients

and service

users

To be

recognised as

a caring

organisation

locally,

regionally

and

nationally

Maintain

long term

financial

strength

Attract

retain

support

and train

the best

staff

Develop an

internationally

recognised brand

and build strong

local and national

relationships

Link to strategic

objectives (please tick)

x

Assurance Framework

reference and risk rating

Caring Responsive Well-led Effective SafeLink to CQC KLOEx

Compliance/ regulatory

requirements (if applicable)

NHS Foundation Trust Code of Governance

Health and Social Care (Community Health and Standards

Act 2003)

Equality analysis

completed? (if not applicable, please

explain why)

Financial impact?

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Register of interests

The register of directors’ interests is constructed and maintained pursuant to Section 20 of Schedule 1 of the Health and Social Care (Community Health and

Standards Act 2003).

All existing directors (including non-executive directors) should declare relevant and material interests. Any directors appointed subsequently should do so

on appointment. If directors have any doubt about the relevance or materiality of an interest, this should be discussed with the Chairman.

The purpose of the register is to disclose information relating to any monetary interest (or other personal or professional material benefit) or conflict of

interest to which a director is subject which may reasonably be thought - by any other person - to influence his or her actions in the performance of his or

her duty as a director of Northumbria healthcare NHS Foundation Trust.

Entries in the register are required to be clear in their description of the nature and scope of interests. Directors are responsible for providing accurate and

clear content for their individual entry in the register.

Board member Position Description of interest Gifts Sponsorship

Alan Richardson Chair None X X

Alan Hepple Non-Executive Director County Councillor at Northumberland County Council X X

Martin Knowles Non-Executive Director Vice-Chair of Audit Committee at Sunderland City Council

Vice-Chair of Audit Committee at Tyne & Wear Fire Service

Non-Executive Director of Two Castles Housing Association

X X

Moira Davison Non-Executive Director Previously Managing Director of Northumbria Primary Care Ltd until

June 2017

X X

Alison Marshall Non-Executive Director Non-Executive Director of Northern Powergrid (North east) Limited and

Northern Powergrid (Yorkshire) plc

X X

Malcolm Page Non-Executive Director Chief Operating Officer at Teeside University

Non-Executive Director of Your Homes Newcastle Ltd

X X

David Chesser Non-Executive Director Chief Operating Officer at the University of Cumbria

Director of Northumbria Healthcare Facilities Management Ltd

X X

Peter Sanderson Non-Executive Director Director of Northumbria Primary Care Ltd

Director of Northumbria Healthcare Facilities Management Ltd

X X

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David Evans Chief Executive Officer Daughter works for NHCFT X X

Paul Dunn Executive Director of Finance Director of Northumbria Digital Solutions Ltd

Partner works for NHCFT

X X

Birju Bartoli Executive Director of Systems,

Strategy and Planning

None X X

Daljit Lally Executive Director of Delivery Acting Chief Executive of Northumberland County Council

Transformation Lead for Northumberland County Council

X X

Ann Stringer Executive Director of Human

Resources

Director of Northumbria Primary Care Ltd X X

Jeremy Rushmer Executive Medical Director None X X

Debbie Reape Executive Director of Nursing None X X

Claire Riley Director of Communications

and Corporate Affairs

Director of Northumbria Primary Care Ltd

Non-Executive Director of Explain Market Research Board

Governor – North East Learning Trust – Ashington School

Contracted to provide communications consultation to NHS

Improvement one day per week.

Acting Director of Communications at Northumberland County Council

X X

Annie Laverty Director of Patient Experience Consultancy Support – Royal College of Physicians X X

Mark Thomas Director of Informatics Director of Northumbria Digital Solutions Ltd X X

Steven Bannister Director of Estates and Facilities Partner works for NHCFT X X

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1

Report to the Board of Directors

Title of Report Update on Supportive Roles for Ward Teams

Author Christine Platton Associate Nurse Director

Executive Lead Debbie Reape Interim Executive Director of Nursing

Responsible sub-committee Delivery Board

Date of meeting 19 October 2017

Executive Summary This report provides an update on the current position following the Supportive Roles Report presented to the Board of Directors on 22 June 2017.

Progress with the introduction of the additional supportive roles in the three pilot wards have taken time to get off the ground. Plans have been identified and agreed with the Chief Matrons and the Deputy Business Unit Directors in Medicine and Surgery for implementation. The source of funding needs further consideration which will be addressed by the Chief Matrons and Deputy Business Unit Directors and will be reported to the Delivery Team.

On Ward 4 WGH, the pilot was to extend the Ward Medicines Assistant from five days to seven days. Following the role was not fully utilised over the weekend as it was over the five days. The agreement was that this should not be extended over seven days. The role due to the benefits identified should be extended to Base Site Wards. The original funding for the current Ward Medicines Assistants was centrally funded and therefore moving forward the Chief Matrons and Deputy Business Unit Directors plan to review the funding source so there is consistency across all wards. The Discharge Co-ordinator role is under review following further role out at The Northumbria with an outcome of this in the next four weeks.

On Ward 5, WGH, the pilot included a Ward Medicines Assistant post over seven days. Following the pilot on Ward 4 this will now be reviewed for five days and included in the Chief Matron and Deputy Business Unit Director’s review.

On Ward 10, WGH, the pilot included the introduction of a Band 3 Ward Co-ordinator role. The role has not yet been implemented by the Business Unit and has taken longer than originally planned. The post was at the stage of planning for recruitment. The Chief Matron and General Manager have reviewed the role and banding following concerns raised by the Band 6 Ward Sister’s regarding the skills required and funding source. The timescale for advertising this post is now in the next three weeks.

In Medicine at The Northumbria they have extended the Discharge Co-ordinator role in five wards for a further 12 months fixed term. This was at financial risk where there is no underspend in the ward staffing budgets. There is concern from Ward Managers who have successfully recruited to their vacant posts as to how these posts are to be funded and the number of Discharge Co-ordinators for allocation across the wards. An outcome of this is expected in the next four weeks.

For all pilots the Chief Matron and Deputy Business Unit Director will update

Enc x

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2

the Board of Directors of any changes in the monthly Ward and Community Monthly Assurance report and the Delivery Team will monitor progress and any reviewed timescales.

It was highlighted in the last report of the risk of external regulators reviewing planned RN staffing levels with the introduction of the supportive roles which would be included in the planned numbers. The Interim Executive Director of Nursing and Executive Director of Systems, Strategy and Transformation met with the CQC in July 2017 and discussed supportive roles and a ward or departments planned staffing levels. The CQC were supportive of the Trust’s approach and advised that planned levels for the ward need to identify all roles and triangulate with outcomes such as Patient Experience, Complaints, HCAI, Pressure Ulcers and Falls.

Moving forward the work will continue on supportive roles to address Registered Nurse staffing and the “Model Ward” in line with the Trust’s Clinical Strategy and future workforce plans.

Assurance Framework

reference

Ref 13 Staffing

Alignment to Trusts

Annual/Strategic Plans or

business unit annual plans

N/A

Risk rating (very high, high,

medium, low risk)/ any

recommended changes

High Risk

Compliance/ regulatory

requirements (if applicable)

N/A

Actions required by the Board The Board of Directors is asked to review the report and note the timescales for new roles that will be delivered by the Business Units and reported to the Delivery Team.

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1

SUPPORTIVE ROLES FOR WARD TEAMS

BOARD OF DIRECTORS, 19 OCTOBER 2017

1. Introduction

This report provides an update on the current position following the Supportive Roles Report presented to the Board of Directors on 22 June 2017.

The Interim Executive Director of Nursing (IDEoN) reported to The Board of Directors in June 2017 the mitigations in place for nurse staffing which, since the last supportive roles report, was reduced from very high risk to high risk on the Board Assurance Framework in July 2017. Each Business Unit has a varied level of risk for nurse staffing which is reported monthly in the Ward and Community Nursing Team Assurance Report with Medicine and Emergency Care Business Unit consistently reporting staffing as a very high risk.

On 5 October 2017 the first meeting led by the Executive Director of Systems, Strategy and Transformation was held to review workforce and roles across all services in line with the Trust’s Clinical Strategy. Moving forward the work completed on supportive roles to address Registered Nursing (RN) shortfalls and the “model ward” will be included in this review in line with the Trust’s Clinical Strategy.

2. Update on Proposed Pilot wards

Two pilots across three wards in the Surgery and Medicine Business Units were outlined in the last report. The funding for the new pilot roles is from RN vacancies in the ward’s budget. Progress with the introduction of the additional supportive roles in the pilot wards have taken time to get off the ground. Plans have been identified and agreed with the Chief Matrons and the Deputy Business Unit Directors in Medicine and Surgery. The source of funding needs further consideration which will be addressed by the Chief Matrons and Deputy Business Unit Directors and will be reported to the Delivery Team.

2.1 Update on Surgery Pilot Ward 10 WGH

The pilot included the introduction of a Band 3 Ward Co-ordinator role. This role will provide support for the RN in non-clinical tasks through co-ordinating the high patient flow and activity for patient admission and discharge processes. The role has not yet been implemented by the Business Unit and has taken longer than originally planned. The post was at the stage of planning for recruitment. The Chief Matron and General Manager have reviewed the role and banding following concerns raised by the Band 6 Ward Sister’s regarding the skills required and funding source. The timescale for advertising this post is now in the next three weeks. The Chief Matron and Deputy Business Unit Director will update the Board of Directors of any changes in the monthly Ward and Community Monthly Assurance report. The Delivery Team will monitor progress and any reviewed timescales.

2.2 Update on Medicine Pilot Ward 4 WGH and Ward 5 WGH

Ward 4 WGH

The pilot was to extend the Ward Medicines Assistant from five days to seven days. With the support of Pharmacy the Ward Medicines Assistant worked over seven days for a trial period. Following the evaluation of this pilot the consensus from the Ward Manager, Matron, Chief Matron, Pharmacy Lead and Ward Medicines Assistant was that the role was not fully utilised over the weekend as it was over the five days. All were in agreement that this should not be extended over seven days. The role however and priority it was agreed should be extended to Base Site Wards. The original funding for the current Ward Medicines Assistants was centrally funded and therefore moving forward the Chief Matrons and Deputy Business Unit Directors plan to review the funding source so there is

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consistency across all wards. There is a delay in introducing the Discharge Co-ordinator role as this is under review including source of funding by the Chief Matron and Deputy Business Unit Director following further role out at The Northumbria. An outcome of this is expected in the next four weeks. The Delivery Team will monitor progress and any reviewed timescales.

Ward 5 WGH

Ward 5 had previously introduced a Ward Discharge Co-ordinator role to address workload and support the RN due to the number of RN vacancies. This post is currently funded within budget. The pilot also included over seven days, a Ward Medicines Assistant post. Following the pilot on Ward 4 this will now be reviewed for five days and included in the Chief Matron and Deputy Business Unit Director’s review. The Delivery Team will monitor progress on this and any reviewed timescales.

2.3 The Northumbria

In Medicine at The Northumbria they have successfully introduced the Discharge Co-ordinator role in five wards which has been extended for a further 12 months fixed term. This was at financial risk where there is no underspend in the ward staffing budgets. There is concern from Ward Managers who have successfully recruited to their vacant posts as to how these posts are to be funded and the number of Discharge Co-ordinators for allocation across the wards. An outcome of this is expected in the next four weeks. The Delivery Team will monitor progress and any reviewed timescales. The Chief Matron and Deputy Business Unit Director will update the Board of Directors of progress in the monthly Ward and Community Monthly Assurance report.

3. External Regulators

It was highlighted in the last report of the potential risk of external regulators reviewing planned RN staffing levels with the introduction of the supportive roles which would be included in the planned numbers. The Interim Executive Director of Nursing and Executive Director of Systems, Strategy and Transformation met with the CQC in July 2017 and discussed supportive roles and a ward or departments planned staffing levels. The CQC were supportive of the Trust’s approach and advised that planned levels for the ward need to identify all roles and triangulate with outcomes such as Patient Experience, Complaints, HCAI, Pressure Ulcers and Falls.

4. Conclusion

Progress with the introduction of the additional supportive roles in identified wards has taken time to get off the ground. Plans have been identified and agreed with the Chief Matrons and the Deputy Business Unit Directors in Medicine and Surgery. The source of funding needs further consideration which will be addressed by the Chief Matrons and Deputy Business Unit Directors and will be reported to the Delivery Team.

Moving forward the work will continue on supportive roles to address Registered Nurse staffing and the “model ward” in line with the Trust’s Clinical Strategy and future workforce plans.

5. Recommendations

The Board of Directors is asked to review the report and note the timescales for new roles that will be delivered by the Business Units and reported to the Delivery Team.

Debbie Reape Christine PlattonInterim Executive Director of Nursing Associate Nurse Director9 October 2017

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/tmp/transcoder/efcb74ca-6dc1-49cf-96a5-fc70692dab86.pdf

Human Resources/Organisational Development

ReportPurpose of report [For information/discussion/approval]

EWE ☐

Northumbria Healthcare NHS Foundation Trust

Report to: Board of Directors Date: 19th October 2017Presented by: Executive Director of HR/ODPrepared by: Ann Stringer/David Chesser Enc.

The purpose of this report is to provide the Trust Board with a progress report on our OD/Learning & Development, Staff Health & Wellbeing, CQC compliance and other key HR performance indicators.

Sickness absence over the last quarter has largely remained within target, the apprenticeship schemes are now underway and we have launched a revised performance appraisal scheme.

Health & Wellbeing initiatives continue to meet our contract with NHS England.

Sickness absence is at 3.80% for September which is lower than the previous year (September 2016 settled at 4.13%).

Q1 2017/18 figures for Appraisals and Statutory & Mandatory Training are at 33% and 71.9% respectively. Information Governance is at 56.7%

Trust Board are to be assured that CQC/NHSLA requirements are met

This report has previously been presented at:

Workforce Committee ☒The topics included in this report were discussed at workforce committee since the last Board report.

The paper was not presented.

☐

Executive

summary

Risks associated

with this report

Assurance

Framework

reference

The following Board Assurance Framework references cover this report – 1.5, 2.10, 2.20,

2.21, 2.22, 2.30, 5.3 50 5.18.

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Workforce StrategyReport to the Board of Directors, October 2016 Date of Sub-committee Meetings: Workforce Committees (20th July, 21st September 2017)

1. Minutes are located on the Trust intranet

2. Our key strategic performance indicators cover the following areas:- Creating a learning environment for quality and continuous improvement- Providing excellent patient centric customer service- Management and maintenance of robust HR policies and systems for safety

and compliance.

1. Organisational Development Activity and Progress

Board Report Figures Q2 July – September 2017

ProgrammeNumber

of Sessions

Number of NHCT

Participants

Number of NCUH

Participants

Other/ Wider NHS

Network

ACO Event1 73 0 0

Allied Health Programme2 38 0 0

Assessment Centres July - Sept 20164 15 0 0

Clinical Leaders Programme1 16 0 0

Coaching - External8 8 0 0

Coaching – Strategic Leadership4 10 0 0

Consultant Appraisal Skills1 18 0 0

Insights Masterclass1 10 0 0

Junior Doctors Programme1 19 0 0

Pathology Team Event2 16 0 0

Psychometric reports in July9 posts 20 reports 0 reports 0

Psychometrics reports in August7 posts 29 reports 0 reports 0

Psychometrics reports in September 15 posts 56 reports 0 reports 0

Trust 19 Strategic Leadership Programme5 120 0 0

TOTAL: 30 448 0 0

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Leadership & Management Development

As outlined in the Q1 Board report, good progress continues to be made to revise our

leadership development programmes in response to the findings of the first phase of the

Collective Leadership Culture pilot programme and the introduction of the Apprenticeship

Levy in April.

In particular the two leadership and management development apprenticeship

programmes are ready for deployment with the launch of the Team Leader Apprenticeship

Programme in late September and the Management Apprenticeship Programme in mid-

October. Both will have 25 participants on the first cohorts.

By designing these programmes around the national leadership and management

apprenticeship standards we can offset the costs for design, delivery and the End Point

Assessment (EPA) against the Apprenticeship Levy we are already paying.

Collective Leadership Culture Programme Pilot

We are now in the strategy design phase using the findings and insight from the discovery

phase deployed in 2016.

Three work streams have been reviewing our relevant leadership related processes and practices to ensure they promote, reward and support the development and embedding of collective leadership.

The outputs from these have been shared with the Executive Steering Group for the programme and most of the recommendations agreed for inclusion in the trust’s collective leadership strategy which will be appended to the People and Organisational Development Strategy 2017-2020.

The strategy will be designed in Q3 and shared accordingly.

Appraisal review and re-design

Although the Trust’s compliance levels for appraisal were consistently high, feedback from

the Staff Survey in 2016 indicated that staff felt their appraisals were not as meaningful an

experience as they should be.

A substantial redesign of the appraisal workbook was undertaken and developed into a

Performance and Development Review (PDR) document. The PDR introduces a career

conversations section and repositions objectives and development planning at the

beginning. The document and accompanying guidance was trialled in all business units in

quarter 1 and, following a brief evaluation and at the request of the business units, the

document went live across the Trust on 1st September. A communication strategy was

developed with the Communications team, to maximise staff awareness and engagement

and a new webpage was introduced.

Accompanying workshops for managers were also redesigned to equip managers with the

knowledge, skills, tools, behaviours and confidence to hold meaningful, high quality

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conversations about performance, development needs and plans and career ambitions

with their team members.

We have also revised the senior management appraisal documentation and this is

currently being launched

Next steps include reviews of:

the Staff Development & Review Policy

the Probationary Period document in line with the changes

Fleet Solutions Appraisal documentation.

A review of the workshops will be on-going and the training will be incorporated into the

Leadership & Management Apprenticeship Programmes.

Coaching

The 30+ coaches who make up the Northumbria Coaching Network continue to be in high

demand for their services. In order to meet this demand a new cohort of coaches will be

trained in November which will enable us to respond accordingly and also offer coaches to

those on the leadership and management apprenticeship programmes.

These new coaches will be supported in their development and expected to access the

supervision and continuing professional development sessions provided by the trust to its

coaches.

In addition to the provision of coaching services to individuals (and some team coaching)

we have also scheduled a series of one day Manager as Coach Workshops from

November 2017 to June 2018 to equip those in a leadership / management role with core

coaching skills and behaviours. This supports our collective leadership culture aspirations

and sets our leaders up for success. These workshops will also be a feature of our new

leadership and management development programmes so by summer 2018 approximately

100 managers will have received coaching training in their own right.

We now have 8 coaches who have formally qualified as coaches with the Institute of

Leadership and Management (ILM) having completed a series of assignments, coaching

hours and supervision sessions. This helps us quality assure our coaching provision.

The trust’s coaching strategy is due for review and this will take place in Q3 with a

summary report of progress to date and the next year’s priorities identified.

2. Delivery of the Nursing & Midwifery Staffing Strategy

Progress continues with the activities detailed in the action plan which underpins the

strategy and are focused around retention, attraction, recruitment and development.

Recent and ongoing activities include:

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the sharing of findings from the second cycle of the Nursing and Midwifery Survey

to determine the current climate in this community relating to morale, satisfaction,

engagement and career intentions

ongoing fortnightly meetings with Chief Matrons and recruitment team members to

monitor recruitment activity and vacancies

the commencement of 20 trainee Nursing Associates on the regional 2 year training

pilot programme

the ongoing provision of resilience training for nursing staff to support their health

and wellbeing and to develop individual coping strategies

exploring options for how we will respond to the new Nursing Degree level

apprenticeship

the ongoing provision of coaching services to nursing staff (individually and

collectively)

Progress continues to be reported at quarterly Workforce Committee meetings.

3. Learning and Development – Activity and Progress

The Care Certificate

409 staff have now completed the initial three taught days of the Care Certificate Programme (CCP).

Of these 325 have completed the full programme and have been awarded the Care Certificate and 14 people have been awarded the Northumbria Certificate of Care. The remaining numbers are those who are due to submit their Care Certificate or who have left before submission.

The programme continues to be delivered every month and is continually updated to ensure that evaluations from the attendees are listened to and the taught sessions reflect their comments. The programme is also updated to ensure that it meets national and local guidelines to ensure practice reflects the trusts values and behaviours in the care that they deliver to our patients.

The CCP continues to be delivered to all new nursing assistants/support workers who commence in the trust in a substantive post, nutrition assistants and health apprentices. There has been no decision whether new nursing assistants from the flexi bank will undertake the programme.

EPortfolio is to be used for the first time for the Health apprentices who commence their roles in October to upload their Care Certificate. This will improve the mapping process for both the apprentice and the marker as all of the evidence will be on the same learning platform.

Apprenticeships

We have been contributing to the Apprenticeship Levy since April 2017 at approximately

£105k per month. There is currently £556,838 in the digital account and 8 apprentices

registered on the system currently. A further 21 Level 3 Leadership & Management

Apprentices commenced on programme in late September and 25 Level 5 Leadership &

Management Apprentices are due to commence in October. There are a further 10 Health

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apprentices and 10 Business Administration apprentices in recruitment and expected to

start in October or November.

In July the apprenticeship delivery for 2017/18 plan was agreed as below:

Quarter 2 (July - Sept 2017) 100 apprenticeship starts

First apprenticeship cohort:

Business Administration level 3 - 20 learners (I)

Healthcare Support Worker – 20 learners (I)

Senior Healthcare Support Worker - 25 learners (I)

Team Leader/Supervisor - 25 learners (I)

Management Trainees - 10 learners

Quarter 3 (Oct - Dec 2017)40 apprenticeship starts

Second apprenticeship cohort:


Operational/Dept Managers - 15 learners (I)

Quarter 4 (Jan - Mar 2018) 105 apprenticeship starts

Third apprenticeship cohort:

Business Administration level 3 - 20 learners (E)

Healthcare Support Worker - 20 learners (I)

Senior Healthcare Support Worker - 25 learners (I)


Operational/Dept Managers - 15 learners (I)

Total 245 I – internal E = External

The apprentices referred to in the table will be a combination of:

Apprentices that will be young people recruited (as historical practice)

Apprentices who will be existing staff who access an apprenticeship rather than other

vocational or academic qualifications

The majority will be existing staff who access programmes which we have been

‘converted’ into an apprenticeship e.g. leadership and management development as

previously outlined

Some will be outsourced to a local college to deliver where they are better placed to

do so

Northumbria Trainee/Intern programme

Undergraduate / trainees

In September we started 2 new Junior Trainees/Higher Apprenticeship (formally

undergraduate trainees) to the trust. One is a is a General Management Trainee ( based

within Child Health for their first 12 month placement) and the other is a HR Trainee(

based within Corporate HR for their first 12 month placement). Both trainees are due to

start a Chartered Management Degree with Sunderland University on 25th September

2017.

We also have 2 undergraduate trainees currently on programme in year 2 and they are

progressing well within their placement and with their academic studies.

Most of our current year 3 undergraduate trainee cohort have gained successful

employment within the trust and other local trusts following the completion of the BSc in

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Health and Social Care Leadership demonstrating the enhanced knowledge and skills they

have gained throughout the 3 years with the trust. One has gained a Project Manager role

within IT, a further trainee has gained a Regional Manager post within NHS Improvement

and lastly a HR trainee has gained a HR Assistant role with Newcastle upon Tyne

Hospitals.

Postgraduate / interns

We have appointed 5 Interns (formally Postgraduate Management Trainees) who are due

to start on 9th October 2017 comprised of 3 General Management Interns, 1 HR Intern and

1 Finance Intern. They will complete a 10 day orientation before formally starting in their

respective placements on Monday 23rd October.

From the current Postgraduate trainees 2 out 4 trainees have gained permanent

employment whilst on programme as Assistant OSM and an OSM. Both will be based

within Community Services.

National Graduate programme

We welcomed 2 new Year 1 graduates from the NHS National Graduate Management

Trainee Scheme in September for their orientation before commencing their pathways in

Finance and HR respectively.

As shared previously, the region only had 7 Year 1 graduates to place so for one trust to

be allocated two is testament to the quality of learning experiences from former graduates

and the reputation of Northumbria.

Step Into Health Programme - Promoting NHS Careers to Armed Forces Service

Leavers and Veterans

The Step in to Health national project is now hosted jointly by Health Education England and NHS Employers.In Quarter 2, we held one information day in August which was well attended and

evaluated well.

We also hosted an Officers Association Project Management development session, with

live streaming of the event. The next Step in to Health event is on 30th November and

there are currently 14 service leavers/veterans who have requested work placements at

Northumbria and these are being processed.

We are actively attending a number of events across the region to promote the Step in to

Health programme. These are with NHS and non-NHS organisations and designed to

spread the messages around Step in to Health and encourage other employers to offer

work placements and experience. We have engaged with our regional partners in the NHS

to share best practice and to support them to engage with the Step into Health programme

themselves.

We are supporting the Officers’ Association and this has included presenting at their

events as well as offering facilities to run events. We have also been networking with

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various reservist units to promote a career within the NHS. The Reservists policy is due to

policy sub group in November.

4. Health and Wellbeing – recognising the link between staff health and wellbeing

and patient outcomes

NHS England Healthy Workforce pilot - update

Several projects being funded by NHS England are now underway or in the planning

stages. This includes work for World Mental Health Day in October and a social marketing

research project to develop an internal weight management initiative.

Collaboration with the five other demonstrator sites continues, with joint working on data

collection and usage, staff engagement and healthier food environments.

Mental health

Headspace – mindfulness app

Codes for 12 months free access have been given out to 1,485 staff to date. However,

following discussions with Headspace, it was discovered that only a third of these have

been redeemed. An evaluation will commence in October to try to identify any barriers that

staff may have had to accessing it, as well as to understand the benefits it has brought to

those who have used it.

Psychological wellbeing practitioner

The PWP role continues to be promoted across the Trust. Over this quarter there has

been a drop in individuals requesting appointments with the PWP. It was therefore agreed

that the PWP would start picking up referrals from the general waiting list from the staff

psychology and counselling service. Below is a breakdown in the activity over the past

quarter.

36 individual clinical appointments offered for face to face contact

8 telephone appointments

2 team training sessions delivered on managing stress at work

5 psycho-educational lunchtime or early evening classes delivered on

managing stress & anxiety and managing your mood

3 nurse training sessions at NSECH provided on managing stress and

resilience

Training session with physiotherapy department at WGH on CBT

approaches and mindfulness

Working with library staff to promote self-help reading materials in library

sites across the trust

Resilience Training

The trust has committed to continuing the funding of a post to provide resilience training

for staff. We are currently in the process of recruiting to a new post to continue the

programme of work started over the past year.

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Training provided over the last quarter:

Introduction to Resilience for Social Workers (Belford) – 1x3 hour session

Resilience course for staff on ward 10 NSECH -1x3 session course

Introduction to Mindfulness (NCC Staff) 1 hour session

Musculoskeletal health

Musculoskeletal absence has fallen significantly (0.19%FTE) since implementation of the

service from an average of 0.84%FTE in 2015 to an average of 0.65%FTE in 2017.

The cost of sickness absence has also significantly reduced: from January to July 2017,

there has been a total cost saving of £211,352 in reduced musculoskeletal absence

compared to a similar period in 2016.

Jan Feb Mar Apr May June July

£0

£20,000

£40,000

£60,000

£80,000

£100,000

£120,000

£140,000

£160,000

£180,000

2016

2017

Costs of msk absence 2017 v 2016

Graph 1: Comparison of costs of musculoskeletal absence between 2016 and 2017

As demand for the staff physiotherapy service has continued to increase it has impacted

the ability to offer appointments within 3 working days (see table 1 and 2 below).

Table 1: Capacity and demand of staff physiotherapy service

Number of New Staff Physiotherapy

Referrals

Capacity/month

Difference % above capacity

July 109 79 +30 +38%

August 128 79 +49 +62%

September 118 79 +39 +49%

Table 2: Percentage of referrals offered an appointment within 3 working days

Date % of appointment offered within 3 working days

July 2017 69

August 2017 79

September 2017 45

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To sustain the continued benefits of offering appointments within 3 working days and self-

referrals, increased service capacity is required.

Obesity

Food environment

The restaurants and volunteer-led shops continue to work towards meeting the CQUIN

and sugar-related requirements. The shops are fully compliant with all requirements, whilst

the restaurants continue to run down their remaining stock of sugary drinks.

Physical activity

The Globetrotter Challenge, a Trust-wide physical activity competition to ‘travel’ the world,

took place in July and August. A total of 370 people across 50 teams took part and

achieved the goal of travelling 33,771 miles in just 39 days. This has been our most

popular challenge to date and feedback from participants has been extremely positive:

75% of respondents reported that they had increased their activity levels as a

result of the challenge

53% of respondents were meeting the 150 minutes per week guideline as a

result of the challenge (compared to 28% prior to the challenge)

66% of respondents plan to make longer term changes

68% of respondents reported that the challenge had improved team morale

Four fitness classes continue to run, with good attendance at North Tyneside General and

Hexham General Hospitals. Attendance at the two classes at Wansbeck General has

dropped but this is being addressed through new promotions.

The staff running group at Morpeth continues to be popular. The leader of this group, Roy

Young, won the Inspiring Wellbeing Award at the Staff Awards in September.

Another member of staff also attended run leader training in September with plans for a

beginners’ running group at North Tyneside General.

Staff Wellbeing Checks

During this quarter, 58 individuals have attended for a Wellbeing Check, bringing the total

to date to 251.

Feedback has continued to be positive but due to the lower number of attendances, the

team has reviewed and revised the Wellbeing Check offer. Starting in quarter 3, the

Wellbeing Checks will convert to a shorter ‘Know Your Numbers’ appointment. It is

believed that time has been a barrier to attendance, so the new sessions will be 20

minutes instead of 45 minutes, and will cover blood pressure, BMI, waist circumference,

alcohol (AUDIT-C) and carbon monoxide levels. The team is also exploring the option of

including a cholesterol test, as staff have fed back that this would be a significant draw for

them.

The team will also offer to bring the Know Your Numbers sessions to wards and

departments to make it easier for staff to attend.

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Line manager training

The one day Leading a Healthy Workforce’ training course gives managers improved skills

and increased confidence for supporting staff with their wellbeing, particularly mental

health. It also focuses on how a manager’s own behaviour can impact on the wellbeing of

their team. There are 3 further training dates in the next quarter with 50 places available

to line managers (35 booked).

We also offer Health at Work training for line managers. This course aims to raise

awareness of health and wellbeing initiatives, compliance standards within the Trust

Health at Work Policy and other statutory obligations (specifically reasonable adjustments

and the Equality Act, Risk Assessment and Health and Safety Legislation), to help build

confidence of line managers in preventing and managing sickness absence through

effective conversations during reporting of absence, return to work discussions and formal

review meetings. Over the next quarter, there are 2 training dates with 40 places available

to supervisors/line managers.

Smoke-free

The Trust continues to work towards becoming smoke-free in March 2018.

To build capacity for supporting staff, the Trust’s two Staff Health Trainers have attended

the initial part of smoking cessation advisor training, with the second part to be completed

in October.

In order to help staff make quit attempts, the Communications team have an added an

interactive banner to the smoke-free intranet pages which staff can click, fill in their details

and receive a call back from a Health Trainer about their options for smoking cessation.

Plans were developed to promote Stoptober in October and stalls were held throughout

September at a number of sites to promote smoke-free, the risks of smoking and the

support available.

CQUIN

The 2017/18 CQUIN indicator 1a ‘improvement of health and wellbeing of NHS staff’ is

linked to NHS Staff Survey results, as set out below.

Question Requirements Baseline (2015/16 data) for 5% improvement

9a) Does your organisation take positive action on health and well-being?

Providers will be expected to achieve an improvement of 5% points in the answer “yes, definitely” compared to baseline staff survey results or achieve 45% of staff surveyed answering “yes, definitely”.

52% responded “yes definitely”

9b) In the last 12 months have Providers will be expected 80% responded “no”

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you experienced musculoskeletal problems (MSK) as a result of work activities?

to achieve an improvement of 5% points in the answer “no” compared to baseline staff survey results or achieve 85% of staff surveyed answering “no”.

9c) During the last 12 months have you felt unwell as a result of work related stress?

Providers will be expected to achieve an improvement of 5% points in the answer “no” compared to baseline staff survey results or achieve 75% of staff surveyed answering “no”.

73% responded “no”

In this quarter, we increased visibility of the programme through promotion of initiatives

such as the Globetrotter Challenge, resilience training and lunchtime classes. There have

been regular articles in the Staff Update, Team Brief and on social media.

An action plan was implemented following the focus groups in the previous quarter and a

‘you said, we did’ message was communicated in the Staff Update.

With the support of the Director of Communications, a new design concept for the health

and wellbeing programme has been created to help bring more cohesion and identity to

the work. This will be launched in the next quarter.

5. Progress and Achievement of Key Performance Indicators

Recruitment Time to HireMonthly Stepchange reports are now incorporated into the monthly business unit dashboards so individual business units can track their recruitment activity. Stepchange reports also features monthly on the Workforce Committee agenda and is reported by exception in regards to overall time taken to recruit.

We have developed an action plan to reduce the time taken to complete the various stages of recruitment, and “Stepchange” is a recruitment management system that we have now commissioned. An indication of our level of recruitment and processing times are shown in the reports below.

We are currently leading a regional work stream on streamlining recruitment between all 11 NE Trusts, as a high percentage of external recruitment is between Trusts within the region. As well as speeding up recruitment it should significantly reduce cost.

Stepchange Report

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In conclusion, these charts show some reduction in some of the recruitment processing times; however efforts are still on-going to continue to reduce this.

Medical and Dental recruitment times are artificially inflated by the long lead in time for the F1 Foundation Doctor recruitment which begins in Spring for an August start date. Similarly, nurse’s recruitment time is artificially inflated by newly qualified student nurses awaiting the completion of their training and PIN numbers

Sickness absence resultsThe Trust's SAR% for Q2 – Jul - Sep 2017 is 3.66% which is a marginal increase on Q1 (which settled at 3.63%). This does not follow the pattern of a seasonal decrease for this quarter experienced in previous years (Q1 2016-17 = 4.15%, Q2 2016-17 = 4.06%); however the overall figures for both quarters in 2017-18 have been significantly lower than in 2017-18.

The last 12 months rolling sickness absence results are as shown in the table below:

4.30%4.47%

4.77%5.01%

4.60%

4.09%

3.65% 3.66% 3.52% 3.50%3.67% 3.80%

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

October November December January February March April May June July August September

Absence Rate % 4.30% 4.47% 4.77% 5.01% 4.60% 4.09% 3.65% 3.66% 3.52% 3.50% 3.67% 3.80%

Trust 12 mth Average % 4.09% 4.09% 4.09% 4.09% 4.09% 4.09% 4.09% 4.09% 4.09% 4.09% 4.09% 4.09%

Trust Target 3.50% 3.50% 3.50% 3.50% 3.50% 3.50% 3.50% 3.50% 3.50% 3.50% 3.50% 3.50%

Sic

kn

ess

%

The NHS operating framework has stipulated an absence target of 3.5% for this financial year. Sickness absence is currently running slightly above this.

Sickness Absence Rate Benchmarking DataThe Trust also participates in a Regional Benchmarking exercise, with the data being compiled by a colleague at South Tyneside NHSFT. Unfortunately Q2 results have not yet been released; these figures will be reported in the next Board Report.

Labour TurnoverThe Trust’s Labour turnover is currently at 15.69% (Headcount); 10.69% (FTE) compared to last quarter’s 10.21% (Headcount); 10.72% (FTE). This increase in Headcount turnover can be attributed in part to the staff movements in relation to NDS and NHFML in July and August respectively.

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Statutory and Mandatory Training and Appraisal For 2017/18 our approach and communication for statutory and mandatory training has been to ensure each department has targeted department set dates for statutory and mandatory training and appraisals to be completed. The relevant managers and business units will be held accountable for their performance at Workforce Committee.

Appraisal completion

For Q2 2017/18, overall compliance is standing at 33% (as at the end of September 2017). Focused activity is required to deliver 85% by the end of March 2018. This was discussed at Workforce Committee

Statutory and Mandatory Training for 2017/2018

Overall compliance is standing at 71.9% (as at the end of September 2017).

6. Audit, Risk and Assurance Reporting

HR Risk Register – 3 Highest Risks

Roll out ESR Portal – High Risk. National roll out of Web based ESR Portal, impact on HR data quality/Trust’s ability to assess compliance relating to training, appraisals, professional registrations (excluding NMC, GMC), revalidation and potential for overpayments due to late notification of changes and terminations being processed. ESR web based portal went live 1st October 2017, interim arrangements (stickers on identified PC's in all areas) provided limited access to ESR across BU’s. Action plan/Business Case for long term solution being finalised by Kevin Dickinson, Ann Stringer and Mark Thomas.

Nurse Recruitment – risk remains the same as last quarter: Nurse and Midwifery strategy devised and activities underway.

Junior Doctor contract – risk remains same as last quarter: detailed action plan in progress for completion by August 2018 implementation date.

Audits which have commenced in the last quarter;

NHFT 1718/11 - Staff retention and workforce management.

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The audit will focus on the range of actions in place to retain existing staff and planning for recurring staff shortages or business expansion.Safe staffing and staff rotas are covered in separate audits. Detailed reviews of some controls in this area, for example appraisals and training, are covered in separate audits.

European Working Time Regulations (EWTR)Work is continuing to establish the current financial impact and the possible solutions; the operational issues are different within in each department and may require different solutions, which may cause some difficulty in finding a standardised approach to managing on call services.

Next Steps:-

Develop action plans to address compliance issues and agree implementation plans.

Implement the reporting functionality in Health Roster to assist management.

Reliance on Bank and Agency StaffA total of 26,140 bank shift requests were filled and worked in Q2 (Jul - Sep 17) which is an increase on Q1 (23,133). Of these, 93.3% (24,811) were undertaken by the Trust's Bank Staff, and 6.7% (1,259) were undertaken by Agency Staff. Work continues to improve the quality and availability of temporary staffing within the Trust and also manage the supply of agency staffing required by the Business Units.

Of the 93.3% of filled Bank shifts for Q2, 75% of the employees working these shifts were also employed substantively by NHCFT. The remaining 25% are employed by Northumbria as Bank Staff only. There has been a slow rise in the ratio of Bank Only / Substantive/Bank. Reasons for this could be attributed to a recruitment drive for Bank staff and it is also worth noting that a significant number of employees who take Flexible Retirement also return on a ‘Bank Only’ basis.

Requested Shifts Filled Jul-17 Total By Bank By Agency

Trust Total 8711 8247 4664

Requested Shifts Filled Aug-17 Total By Bank By Agency

Trust Total 8811 8378 433

Requested Shifts Filled Sep-17 Total By Bank By Agency

Trust Total 8618 8256 362

Combined Total for Q2 Jul-Sep 17

Requested Shifts Filled Q2 2017/18 Total By Bank By Agency

Trust Total 26140 24881 1259

93.3% 6.7%

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25%

75%

Bank Only Bank and Substantive

Bank and Bank/Substantive Contract Analysis -

Jul-Sep 2017

This detail should provide assurance to the Board that 75% of Bank staff also have a substantive contract with the Trust.

7. Recommendation to the Board of DirectorsTrust Board is asked to note the contents of this report.

ANN M STRINGER DAVID CHESSERExecutive Director of HR/OD Non-Executive Director

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Report to the Board Enc

Title of Report Financial Performance Period Ended: September 2017

Author Paul Dunn

Executive Lead Paul Dunn

Date of meeting 16th October 2017

Executive Summary At the end of September 2017, the Trust YTD position is an adjusted surplus of £9.4m.

This is £0.1m ahead of the plan and the YTD control total (excluding £0.4m of additional STF funding received in relation to 2016/17).

The position assumes receipt of YTD STF funding of £3.0m for 2017/18, for delivery of the YTD control total, A&E performance requirements and the milestones for implementing GP streaming in A&E.

Based upon this performance the Trust has delivered a ‘use of resources’ rating of 1.

The month 6 cash balance stood at £21.6m, which is £18.4m below planned levels. This predominately relates to NHS debt.

At the end of month 6, liquidity days were 12.98 (generating a liquidity risk rating of 1).

Clinical income is £3.7m behind plan at the end of month 6. Elective activity continues to be below both planned and 2016/17 levels; and the case mix of non-elective income continues to reduce. The Trust will need to manage the risk of sustained reductions in clinical income through further off-setting reductions in cost.

Assurance Framework

reference

High level risks will be included in the assurance framework

Alignment to Trusts

Annual/Strategic Plans

In line with Trust policies.

Risk rating (very high,

high, medium, low risk

High

Compliance/

regulatory

requirements

In line with Trust SFI’sIn line with NHSI in year monitoring return

Actions required by

the Committee

The Board is asked to

a) Note the financial position for the period ended September 2017

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Financial Performance Period Ended: September 2017

1. Summary

1.1.The Trust’s control total for the 2017/18 financial year is to deliver an adjusted surplus of £24.4m. The planned for the period ending September 2017 is a cumulative adjusted surplus of £9.3m

1.2.At the end of the first 6 months of the financial year the adjusted surplus stands at £9.4m. This is £0.1m ahead of plan.

1.3.The ‘use of resources’ Rating is 1. This is the highest rating available.

2. Clinical income

2.1.At the end of month 6 clinical income is £3.7m behind plan, with in-month income below plan by £2.5m.

2.2.Elective activity continues to be below both planned and 2016/17 levels. Elective activity was adversely impacted by the cyber-attack in month 2, which resulted in a number of cancelations. We are working hard to rectify this position.

2.3.The case mix of non-elective income also continues to reduce, through the work of the vanguard and other initiatives to reduce admissions and improve patient flow.

2.4.The Trust will need to manage the risk of sustained reductions in clinical income through further off-setting reductions in cost.

3. Sustainability and Transformation Fund

3.1. In 2017/18 Trusts continue to be able to access a share of additional income from the Sustainability and Transformation Fund. £1.8bn of STF funding is available nationally, and is allocated to individual organisations on the basis of non-elective activity.

3.2.The Trust is entitled to receive £8.58m of STF funding during 2017/18, provided it satisfies the following 3 conditions:

Delivery of the financial control total

(Adjusted surplus of £24.4m)

Performance above the minimum levels required for A&E 4 hour waits

(Q1: >=92.30%, Q2: >=95.00%, Q3: >=91.45%, Q4: Mar >=95.00%)

Achievement A&E front door streaming to GPs milestones

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3.3.The STF funding is weighted so that 70% relates to delivery of the financial control total, 15% relates to A&E performance, and 15% relates to A&E GP streaming.

3.4.Entitlement to STF is assessed on a quarterly basis, with the delivery of the financial control total acting as a binary trigger (i.e. if the financial control is not hit, no STF funding is available regardless of performance against the other criteria).

4. Financial Risk Rating

4.1.The financial risk rating in place for 2017/18 is the ‘Use of Resources’ risk rating.

4.2.This rating is made up from 5 different metrics:

Capital servicing capacity

Liquidity ratio (days)

I&E Margin

I&E margin distance from plan

Agency

4.3.The value for each metric is calculated and given a score, from 1 (highest) to 4 (lowest), based on the thresholds NHSI has put in place for each metric.

4.4.Each of the five metrics carries an equal (20%) weighting, and their combined score gives an overall ‘use of resources’ risk rating for the Trust.

4.5.The best score available is 1, and the worst score is 4.

4.6.At the end of the period the Trust scored a ‘use of resources’ risk rating of 1.

5. Agency Expenditure

5.1.Over recent years NHS Improvement has introduced a number of controls on agency spend, with a view to driving down nationally the cost and reliance on agency staffing in the NHS.

5.2.The NHSI controls on agency now include setting each Trust an annual ceiling for agency spend, which Trust’s must not exceed. Performance against the agency ceiling now features as a metric within the financial risk rating calculations.

5.3.The Trust has been set an agency ceiling of £7.6m for the 2017/18 financial year. Cumulative agency expenditure stands at £3.1m, which is £1.0m less than the year to date agency ceiling.

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6. Cash

6.1.At the end of September 2017 the Trust’s cash balance was £21.6m. This is £18.4m behind plan the planned cash balance for September of £40.0m

6.2.The adverse variance against plan for cash predominately relates to NHS debt.

6.3.The Trust continues to pursue recovery of all debts, and maximise the cash position as far as possible through management of working capital.

7. Capital

7.1.The financial plan for 2017/18 included £19.6m for capital expenditure. At the end of September 2017 capital expenditure was behind plan.

8. Cost Reduction

8.1.At the end of September 2017 cost reduction was in line with plan. However due to the weighting of some schemes later in the year, focus must be maintained in this area.

9. Recommendations

9.1. The Board are asked to note the financial position for the period ending September 2017.

Paul DunnExecutive Director of Finance

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Key issues report: FIP

EWE ☐

Contractual update – the Trust will be going to arbitration in order to seek clarification and

closure on the contract with Northumberland CCG.

Action required: For noting.

No change required

Report to: Trust Board Date of meeting: 16 November 2017

Presented by: Martin Knowles Prepared by: Sophie Stephenson

Financial contingencies – The Committee reviewed the contingency paper, however it was

noted that the arbitration matter with Northumberland CCG could have a material impact.

Winter plan – The Committee ecei ed an update on the T ust’s inte plan and e uested a further update at the next meeting on key areas of risk.

Cancer performance – the Committee expressed its conce n ega ding the T ust’s performance against key cancer targets and this will remain a key area of focus for the

committee. It was noted that actions are being developed in conjunction with consultants in

various clinical areas.

CIP – The Committee discussed risks associated with the delivery of schemes and noted that

there is a need to ensure schemes for the next year are not profiled towards the second half

of the year which is busier from an activity perspective and therefore harder to deliver. The

Committee reviewed proposals to revise the governance arrangements associated with CIP.

NEP – the committee was updated re implementation and reviewed the associated risks. This

relates to the roll out of a new ledger system for the Trust as well as 37 other organisations,

the systems for which are hosted by the Trust.

Terms of reference reviewed and approved, subject to Board approval.

Scheme of delegation reviewed and approved, subject to Board approval

Treasury policy reviewed and approved.

Matters for

escalation:

Other matters

considered by

the

committee/

group:

Key decisions

made/ actions

identified:

Impact on the

Assurance

Assurance

Framework:

reference:

4.1 – 4.3: Overall Healthcare Funding

2.1 NHSI Single Oversight Framework

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Key issues report: Safety & Quality

EWE ☐

Cat A SUI due to a significant event but not a never event. A lady post thyroidectomy bled out

and sadly died. Formal debrief Monday 16 or Tuesday 17 October 2017. SUI will report to

the Safety Panel.

Pressure Ulcer report – S&Q agreed with the proposal to reduce the high risk on the Board

Assurance Framework to medium

Changing risk of pressure ulcers as above

Report to: Trust Board Date of meeting: 19 October 2017

Presented by: Alison Marshall Prepared by: Debbie Reape Enc.

Quality Lab first 3 / 7 Q1 training completed. The members are reviewing materials and

rollout. By November will have clear plans which will include a focused project with

approved plans including senior leaders to be trained (Board of Directors and Executive

Directors)

Falls – a detailed look at the progress and explanation for the falls per 1000 bed days

National measure for which the Trust is reporting high against the National figure of 6.68.

S&Q agreed with the approach the Falls Team are taking to review this metric and add other

more appropriate measures given the differences in patient flow in the Trust compared with

more traditional patient flow models. In the meantime falls will remain as a high risk

S&Q Priorities – the Sepsis Project is being reviewed. The view from Senior Clinicians is that

Sepsis care is good, however, the process and data evidence is currently poor and not

providing assurance. The view was that Sepsis remains a high priority and appropriate

metrics are needed, Dr Sykes will share progress with S&Q.

Frailty Project – the Committee agreed to realign the focus of this project. Data will be

reported for October as planned

Breathlessness – the Committee heard that the first two quarters focusing on the scope of

the project needed more primary care involvement than expected and, as such, the scope

may be broader

Clinical Audit – S&Q were assured by the report

Terms of Reference and cycle of business were approved -15 steps reports to come before

S&Q Committee on a quarterly basis

Pressure Ulcer report – S&Q agreed with the proposal to reduce the high risk on the Board

Assurance Framework to medium

Matters for

escalation:

Other matters

considered by

the

committee/

group:

Key decisions

made/ actions

identified:

Impact on the

Assurance

Framework:

Assurance

Framework:

reference:

Board Assurance Framework ref 2.3

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1

Report from the Guardian of Safe Working (GoSW) for the

Trust Board Meeting October 2017

Executive Summary:

211 trainees on the 2016 TCS since August 2017

o 28 Exception Reports (ER) – 27 for hours and rest, 1 for education

o 25 from Medicine & Emergency Care (MECCBU), 3 from surgery

o 6 from F1, 12 from F2, 4 from Core and 5 from StR trainees

49 F1 on the 2016 TCS December 2016 – August 2017

o 66 ER – 57 for hours and rest, 9 for education

o 64 from MECCBU, 2 from trauma & orthopaedics

Vast majority of ER agreed by supervisor, move towards time off in lieu (ToIL) as resolution

No fines applied to the trust so far

Predicted gaps in A&E and medicine largely filled but ongoing concerns in 2018 affecting A&E,

medicine, and paediatrics.

£633,654 spend on additional non-consultant level staff in Q1 and Q2 2017

o Data not consistently recorded

Move to the Allocate ER system deferred until August 2018 due to difference in calculation method

for on call rotas, so switch can only take place when most trainees move jobs.

GoSW time allocation: 2PA/week

Administration support: Safe Working Administrator 1 WTE (but also supports Workforce Team)

Background:

The 2016 Junior Doctors Contract (TCS) came into effect on 3 August 2016. This contract applies to all

junior doctors in England and junior doctors will progressively start working under these TCS over the

coming year. The F1 in all of England started working under the TCS on 7 December 2016 and psychiatry

trainees followed on 5 April 2017. Since 2 August 2017 all junior doctors in England are working under the

TCS, however the situation is somewhat different in the North East (NE) as due to the Lead Employment

Trust (LET) arrangements 1650 doctors are in longer term contracts and they will not move to the 2016 TCS.

Consequently, in our region we will have a mixed contract economy with trainees on both the 2002 and

2016 TCS for several years to come.

In NHCT we now have 211 trainees working under the 2016 TCS, but some higher trainees (≥ST3) may or

may not be on the 2016 TCS depending on whether they have a long term contract with the LET or not.

As part of the introduction of the 2016 TCS, a new role of GoSW was created for a senior clinician, not

involved in the trust management structure, to monitor and ensure the safe implementation of the 2016

TCS. The GoSW reports directly to the medical director and presents a summary of progress and concerns

to the trust board on a quarterly basis.

Key changes:

The 2016 TCS provide the first ever contractual link between education and training for junior doctors.

Activity in each job is set out in a work schedule that sets out the expectations and training opportunities

for the junior doctors in that post in addition to the duty pattern and out of hours work. Junior doctors can

report deviations from the work schedule using the process known as Exception Reporting using an online

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system. All Exception Reports (ER) are dealt with by the supervisor in the first instance with the GoSW

having ultimate responsibility for the hours and rest ER and the Director of Medical Education (DME)

carrying ultimate responsibility for ER relating to education and training. ER can be dealt with by either

allowing Time off In Lieu (ToIL) for additional work that has been undertaken or payment at the relevant

rate if ToIL is not possible. Education ER are dealt with on a case by case basis.

There are a number of other changes in the 2016 TCS relating to hours of work. The main changes are that

the total number of hours worked per week (on average over a rota cycle) is 48 with an absolute maximum

number of72 hours in any rolling seven day period. Shifts can now be a maximum of 13 hours in length and

trainees can only work 5 long shifts (classified as a shift >10 hours) or 4 late or night shifts before a break. A

full list of the rules can be found on the NHS Employers website in the Junior Doctors’ 2016 Contract area.

Breaches of certain hours and rest rules results in the trust having to pay fines to the trainee and the GoSW

controlled fund. This fund can only be spent on delivering services that will benefit other junior doctors,

over and above the core services the trust is already providing, that it must also continue to do so going

forwards.

The other significant change for trainees working under the 2016 TCS is that they are now paid for the

hours they work rather than based on which pay supplement bracket the rota pattern they are working on

falls into. The previous system resulted in large pay fluctuations across the year as the supplements ranged

from 0 – 50% of the basic salary whereas the 2016 TCS provide a higher basic salary with a smaller

proportion paid for out of hours work. Trainees on the 2016 contract are also mandated to offer any

additional locum hours they choose to work to the NHS in the first instance via a staff bank. The rates of

pay for additional work are prescribed in the Pay Circular from NHS Employers and are significantly lower

than rates previously offered to doctors at the same stage of training. Given the mixed economy we will

continue with in the NE, this may cause some issues when looking for locums as the doctors still working

under the 2002 TCS will be able to offer any additional hours they choose to work via an agency or at a rate

agreed outwith the national pay scales for trainees working under the 2016 TCS. NHCT has decided to

implement a staff bank with rates of pay above the national rates but in line with what other trusts in the

NE are paying.

Exception Reports:

Since the introduction of the contract we have received a total of 94 ER.

07 December 2016 - 04 April

2017

SUMMARY - Date of Submission

BU Department Total H&R Ed. Both

MECCBU Gastro NSECH 15 14 2 1

MECCBU Gastro Base 4 4

MECCBU ED 1 1

MECCBU Geriatric 9 9 1 1

MECCBU Cardio Base 5 5

MECCBU Cardio NSECH 8 5 3

MECCBU Resp Base 3 3

MECCBU Resp NSECH 1 1

Totals 48 41 7 2

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http://www.nhsemployers.org/~/media/Employers/Documents/Need%20to%20know/Factsheet%20on%20rota%20rules%20for%20guardians%20August%202016%20v2.pdf

3

05 April 2017 - 01 August 2017


BU Department Total H&R ED. Both

MECCBU Gastro NSECH 4 4

MECCBU Gastro Base 4 4

MECCBU Resp NSECH 2 2

MECCBU Geriatric 3 3

MECCBU Stroke 2 2

MECCBU ED 1 1

ESECBU Traum&Orth 2 2

Totals 18 16 2 0

02 August 2017 - 05 December 2017


BU Department Total H&R ED. Both

MECCBU ED 1 1

MECCBU Resp Base 16 16 1 1

MECCBU Acute Med 1 1

MECCBU Geriatric 6 6

ESECBU Gen Surg 3 3

Totals 28 27 1 1

The majority of ER have arisen in MECCBU due to pressure of work and trainees having to stay late to

complete this. Since August the ER have been submitted by trainees of all grades. Resolution is mainly

occurring with ToIL, however this is commonly the case early in a rotation and less feasible towards the end

of a rotation when there may be less opportunities to take ToIL.

A weekly ER summary report is produced for the departments and BU with open ER to attempt to reduce

the delays in ER closure. Supervisors receive a detailed email outlining what action they need to take every

time an ER is submitted for their trainees and this is then followed up with repeat emails every 3-4 days.

Further supervisor education has taken place at a departmental level and 2 further trust education

department organised training sessions will be delivered in 2018.

To date there has not been the need to undertake a formal work schedule review at NHCT.

At a regional level, it appears that the NHCT trainees have submitted more ER than doctors in other trusts.

For example, at NUTH a total of 13 ER were submitted between August and October despite there being

approximately three times the number of trainees on the 2016 TCS there. In South Tees the number of

trainees on the 2016 TCS is approximately double the number at NCHT, yet only 12 ER were submitted in

the first 2 months from August. However, the validity of this metric is difficult to establish as this may

reflect a more open culture or alternatively, a true issue with workload. Furthermore, the number of ER

submitted depends on the individual thresholds trainees have adopted at which they are prepared to

submit an ER. We will continue to share our data regionally and monitor our ER submissions to ensure we

aren’t a significant outlier.

Nikhil Premchand has now been elected to the role of regional GoSW representative for the NE.

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Gaps:

The GoSW highlighted the impact of gaps on rotas at the board meeting in January. We have now

established a baseline population for each of the 33 rotas where junior doctors are involved. This will

enable us to determine if contraction has occurred to cover the service which may have an adverse impact

on training. Following national and local recruitment in 2017 there were concerns about gaps in A&E and

paediatric staffing levels, however these problems have been mitigated by employing additional trust

doctors. However, there are plans to contract the F1 rota at NTGH to an 8 person rota. Going forwards

there are 1.4-2 gaps in medicine on each site until February. Beyond February there are currently at least

15 gaps in A&E and medicine due to poor fill rates, principally in the GP training scheme. A working group

is exploring both the short term and long term solutions for this recurring and increasing problem which

impacts severely on A&E. The trust gap management group will continue to sit year round now to look at

other solutions to gaps in medical staff rotas.

Locum Activity:

NHS Employers has suggested that the GoSW provides the Trust Board with a quarterly update on agency

and internal locum activity by grade and department. Collating this information has been a significant

undertaking and it is clear that information is recorded differently in different departments. We are

discussing standardisation across departments going forwards. The attached table provides a detailed

summary of where additional activity has taken place in Q1 and Q2 2017.

By business unit the additional spend is as follows:

Business Unit Sum of Total Spend Hours

Child Health £71,386.18 1279.00

Clinical Support and Cancer Services £71,724.00 1032.00

Corporate Services £24,843.68 218.00

Emergency Surgery and Elective Care £73,074.27 1477.91

Medicine and Emergency Care £392,626.20 7195.01

Grand Total £633,654.33 11201.92

The top three departments are as follows:

Department Spend Hours

Medicine and Emergency Care

Emergency Medicine £246,653.56 4481.77

General Medicine £92,532.69 1659.49

Child Health

Paediatrics £71,386.18 1279.00

Junior Doctor Forum:

One of the other facets of the 2016 TCS is the Junior Doctor Forum (JDF). The JDF is the body where the

GoSW, DME, chair of the Local Negotiating Committee (LNC) and HR representative meet trainee

representatives who have volunteered to monitor the delivery of the 2016 in the trust. At NHCT, our JDF

has 2 members at F1 level, 2 members at F2 level, 2 core level trainees and 1 higher level trainee (1

vacancy) from across the business units. The meeting is quorate if 3 or more trainees are present in

addition to the other members. We have had 4 JDF meetings since the inception of the contract and these

are held every quarter. In the event any fines are raised via the ER process, the JDF will be responsible for

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allocating how these should be spent. The members of the JDF are also responsible for performance

managing the GoSW. To date we have not incurred any fines at NHCT.

Systems and Support:

To facilitate the introduction of the 2016 TCS, NHCT have employed a WTE Safe Working Administrator

(SWA). This individual is responsible for assisting the GoSW in implementing the 2016 TCS and in managing

the administrative elements of the ER that arise. They are also responsible for determining if trainees are

able to undertake additional work based on the hours and rest limits in place and their knowledge of the

shift patterns trainees are already working. The SWA assists the GoSW in trying to ensure that the ER are

dealt with by supervisors in a timely fashion and facilitates access to the ER system for trainees and

supervisors. The SWA and the GoSW meet weekly and the GoSW and the DME meet 3 times a month on

average.

In line with most other trusts in the NE, the NHCT GoSW is paid 2 PA for the role. Although this was to be

reviewed in August with the intention of a reduction to 1 PA, given the ongoing workload the time

allocation will remain at 2 PA with a further review later in the year.

Information about the 2016 TCS is available on an intranet site that is maintained by the GoSW and

following trainee feedback, we have recently made several key documents and policies available on the

internet via a Google Docs site.

At present NHCT are using the ER system provided by Skills for Health. This is a rudimentary online system

which does not allow errors to be corrected or any analysis of the ER to detect patterns from individuals

and departments, so we are collating this information manually. Although there were initially plans to

move to using the Allocate ER system that is linked to the Health Roster platform, this is on hold, as a move

can only happen in August when the main body of junior doctors rotate as the pay calculation basis is

different between the 2 systems.

Nikhil Premchand, Guardian of Safe Working; 19 October 2017.

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http://intranet2.northumbria.nhs.uk/home/junior-doctor-tcs/