Date of Board : 24th April 2019 Innovation & Improvement …... · coming from India and joining the NHS. 2.0 Enabling Our People 2.1 ProjectsTeam Update. ... and are currently working

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Date of Board: 24th April 2019 Title of Report:

Innovation & Improvement Quarterly Report

Purpose of Report

Quarterly update on projects and innovation within the Trust

Recommendation:

The report is presented for information.

Written by: Mike Yarde Presented by:

Paul Cracknell

Relevant Trust Objective or Quality Goal:

Improving quality/Securing our future/enabling our staff/Quality

Previous consideration by Committee or Executive:

Content informed by Trust Portfolio Programme Board and a more detailed paper discussed at Finance and Performance Committee

Appendices:

Implications considered for: Compliance with NHS Constitution, CQC registration, legal issues, equality & diversity, environment, stakeholders, staff, patients & public, risks & benefits, value for money, and governance. Executive summary This is the quarterly report that considers innovations within the Trust and reviews the three categories of projects managed by the Projects & Investment team:

• CIP

• Capital Programme

• Service Development projects The report also updates on the Projects and Investment team development and achievements.

ENCLOSURE: N

Innovation & Improvement Quarterly

Report

Wednesday 24 April 2019

Presented by Paul Cracknell

Deputy Chief Executive Officer

Looking after you locally

Contents

1.0 Summary

2.0 Project & Investment Update 2.1 Team Update

2.2 Ideas Generation

3.0 Programme Updates 3.1 CIP Update

3.2 Capital Programme Update

3.3 Service Development Update

4.0 Gateway 4.1 Gateway Update

CIP Programme

Weekly progress meetings are in place to maintain the momentum of CIP challenge and delivery. Initiatives currently underway are:

• Business unit CIP targets & detailed budget review (led by Finance)

There are 118 cost centres with a total underspend (i.e. possible recurrent CIP) of £4.98m. These are all to be investigated and

a comment completed for every budget line to explain the variance and identify the amount able to be realised as recurrent

CIP. This is to be completed within three weeks (03/05/19)

• Benchmarking Data

Projects, with support from Performance & Information, are finalising some key benchmarking data to enable localities to

identify where efficiencies could provide CIP opportunities. The Projects team will support localities in identifying changes and

CIP potential

Workforce

The Workforce Recovery Programme Board, led by our CEO, has achieved the desired outcome and has now move to a BAU

Programme Board. The project currently has an amber RAG status due to some missed milestones. A recovery plan for milestones is

planned. Currently the apprenticeship recruitment is on schedule.

Capital Programme

• The 2018-19 capital programme was completed £18K under budget, realising a spend against budget of 99.7%. There was less

spend in the final two months than previous years. Difficulties in completing some Estates projects at year end contributed to the

underspend

• The 2019-20 programme has been set at £2.4M plus an additional £200K of charitable projects.

1.0 Summary Overview

Projects Team Vision: The Vision for the Project and Investment team has now been agreed by all team members and the Trust

Portfolio Board.

REACH Awards: Projects and Investment team members were nominated for multiple awards and the following teams were finalists

and Runners up during the award event on Thursday 7 March 2019.

Winners in the Innovation Awards for Business Services Runners Up – Team of the Year Business services

Mobile App Team

2.0 Enabling Our People

2.1 Projects Team Update

Health Education England (HEE) – Project Management Competency Framework:

The Trust were approached to be involved in a new project by HEE, who are working on

developing a Project Management Competency Levels Framework. This project was

requested by central government, who observed that the standards of project management

and change expertise, generally within the NHS, were not at a level to manage the scale of

change required.

NCHC were approached to take part in developing the project, based on our implementation

of the Association of Project Management (APM) Competency Framework. HEE are looking

to set up a three level grade system similar to the one we have already implemented, so are using our experience to help

to develop the national standard.

HEE are also developing an online training course for clinicians who

switch into project management roles. The team asked if we could help them with

some video content for the training videos. Suzie Mallett, our Project Manager

who switched from a who changed her nursing career into projects, talked about her experience of

making the change from clinician to Project Manager, and the value that experiencing both of the

roles bring to her work.

Tarandeep Kaur, Capital Programme Manager, talked about her experience of

project management in other sectors, as well as her personal experience of

coming from India and joining the NHS.


2.1 ProjectsTeam Update

The following action plan has been implemented by the Projects Team:

• Bullying & HarassmentEveryone encouraged to share details of bullying and harassment - completeSuzie Mallet is a buddie and talked to the team about the role - completeSimon Bailey has been trained to be a Freedom to Speak Up rep - complete

• Clarity Team Roles & StructurePublish agreed parts of methodology - completeComplete methodology – due end MayReview methodology – due three months after finalisation

• FeedbackSenior Management Team to do 360 degree appraisals – two booked, one person on longterm sick and one on maternity leaveUse standard 1:1 form for everyone with headers for feedback & ideas - form agreedEncourage feedback to managers/team meetings on what is good/bad – happening

The QCP team are aiming to hold 3 cohorts of QCP in 2019/20, the first one to be held in May. We are exploring the possibility of holding future programmes with our STP colleagues, and are currently working with IC24 to explore this for the September 2019 cohort.

Business Analysts are now being involved in the projects to ensure that good ideas can be transferred to other areas of the Trust.


2.3 QCP

2.2 Projects Short Staff Survey

PROGRAMME STATUS

RAG Status

Overall CIP Time Cost Quality Benefit Risks

A GGAR AA

3.0 Programme Update - Secure the Future

This section details the current programme of CIP projects in the portfolio

3.1 CIP Programme Update

Overall Portfolio

CIP delivery

The Projects & Investment team will continue to attend Locality meetings to help use benchmarking data develop local CIP

plans.

Time:

The revised Workforce Plan is now on red status due mainly to slippage on key milestones. New resource has been added to this

project during the Programme Manager sickness absence. Completing outstanding milestones is being as the priority to bring the

project back to green.

Capital:

The Capital Programme was delivered £18K under budget, which represents 0.5% of the total budget. The variance was largely

due to variances within the Estates programme which had to be tightly controlled during month 12 due to a potential overspend of

budget of upto £100K. This was a good result for the Capital Projects team. The programme was closely managed and resulted

in less end of year spend than previous years.

Cost:

Resource and operating costs remain within budget. Recruitment, within budget, ongoing.

Quality:

No adverse impact has been reported for patient safety, patient experience and effectiveness.

Benefits:

A plan to reduce this years CIP planning gap of £800K is being actively pursued.

Risks:

Workforce Transition Plans should have been in delivery from 1st April 2018. The lack of completion of some of these is resulting

in delays to CIP identification and achievement and also preventing the closure of the Empowering Our people programme. This

causes a risk to achieving the required outcomes of the Workforce Plan as well as CIP targets. Target dates for completion of

outstanding Workforce Schemes have been agreed by EDT

PROGRAMME STATUS

RAG Status


STATUS

RAG Status


A AAn/a GG

A GGAG AG




Workforce Development

Health & Care Strategy

CIP

Self-Care: (p/l)

19/20 - £2580K

Clinic Des/Mgt(p/l)

19/20 - £25K

• Overall project status is amber due to milestone slippage.

• New meeting structure commenced 5th April 2019. New sponsor Laura Clear. Accountable owner review meetings established.

• Locality feedback for clinical education support is positive overall. No feedback received from clinical education leads.

• KPI review for 2018/19 ongoing including manual audit of current compliance for spans of control. Current structure charts

being sourced and manual comparison undertaken mid-April. KPIs for 2019/20 agreed. final template presented at May Board.

• Milestones being managed to bring project back to green

• Health & Care Strategy update included in March Exchange

• Health Coaching: Awaiting confirmation of funding and commencement of recruitment process for HC lead role to define

handover to BAU/project closure date

• Self-Care - Submit NHS England application for LEAD site status, now decision has been made – All three pilot phases now

delayed/missed

• Wound Care (3D) – Wound Cameras delivered - Staff identified for training - Supporting eLearning material drafted

• Clinic Design & Mgt: Kick off meeting with project group held - Updated analysis of clinic data completed - Outline business

case finalised for April TPB

A

PROGRAMME STATUS

RAG Status


A GGGG AG



Palliative Care

CIP

EOL Pathway Redesign:

18/19 - £39K

19/20 - £9K

Overall – the Palliative/End of Life Care Programme is amber.

For Portfolio Report – Palliative/EoL Care Change Programme Highlights

Leadership – Resources – RED . Unable to recruit to consultant post West impacting their CQC result. Exec level discussions and

action plan implemented

NCHC Workstreams - Key Points

Evidence & information – GREEN– West CCG and NCHC local incentive scheme commenced re Care Home education

Individualised Plans of Care – AMBER – Following CQC feedback at NNUH IPoC reviewed and changed. To implement the revised

document across NCHC

Co-design –GREEN– Hospice at Home live in all areas as of 1st November. Discussions with CCG about demand and capacity/skill mix

of team.

Marie Curie –GREEN – Norwich and North Marie Curie staff have been TUPE’d across and consultation underway. West Marie Curie

budget is being reviewed as significant overspend. To bring this budget back on track.

PBH (GREEN) – Terms of Reference for stakeholder development meeting to be shared with EDT.


PROGRAMME STATUS

RAG Status


STATUS

RAG Status


A GGAR GA

A AGAR AG




Community Gateway

CIP

Patient Check-In:

19/20 - £101K

eScheduling: (p/l)

19/20 - £605K

• CAST/Locality Admin Project: CAST & Locality Admin project scope reviewed and amended with project lead. Amendments

to be made and approved by project sponsor by 12/04/19.

• Patient Check-In: Project to close-down asap once final 2 devices deployed, supported into BAU by IM&T - CIP meeting

scheduled for 03/04/19 with programme manager and project sponsor for financial benefits and potential change control

discussion. CIP unlikely to be achieved by this project – currently being reviewed

• E-Scheduling: Risk has reduced to AMBER following improvements to system performance - Benefit remains at AMBER due

to the lack of real-time interface between SystmOne and eCommunity . Meeting arranged for 3rd April with TPP/Allocate/NCHC

to clarify API interface requirements and agree next steps/timeline.

• SafeCare – Clinical Lead for each unit would be required in order to develop, test and implement acuity model

Empowering ourPeople Programme

• Amber due to milestones being complete or transferred to DTWP Project Plan

• Risks have either closed or transferred.

• Closure report being prepared and closure meeting as soon as the last workforce transition plan approved EDT

PROGRAMME STATUS

RAG Status


STATUS

RAG Status


A GGAA GG

A AGAA R A




Estates & Facilities

CIP

Car Parking:

18/19 - £42K

19/20 - £24K

Staff Travel Review:

19/20 - £87K

Hybrid Mail: (p/l)

19/20 - £58K

Space Utilisation: Dereham: (p/l)

19/20 - £392K

Adelaide St: (p/l)

19/20 - £98K

King St – Dental: (p/l)

19/20 - £TBC

CYPASS

CIP

Dental consumables: (p/l)

19/20 - £25K

• Car Parking – Consultation Outcome Document has been circulated. EDT decision to now implement charges at Kelling

Hospital, this will effect CIP and a change control will be required

• Estates Workforce – Options analysis is currently being reviewed between Estates and Facilities and Procurement Dept for

Hard/Soft FM tender.

• Travel Review – Pool vehicles currently being reviewed, prior to re-procurement. Policy is being reviewed, as current scheme

not achieving value for money. Draft spec. written. It is being reviewed by procurement, however due to availability this has not

been reviewed by the end of March as planned. Once we have a timeline in place, a change control document will be required

as BUO fleet is not currently in scope of this project.

• Hybrid Mail– Delay in workbook due to finance availability. However as we have not yet gone to tender due to procurement

availability the costs in the workbook would only be indicative until a supplier has been selected.

• Overarching programme of work created for CYPASS showing all ongoing change requirements, both internally &

externally managed – reviewed and signed off by AD and Service Leads.

• Stroke Pathway Change Control being submitted to April TPB

• Seconded staff member returned to substantive role, resulting in a reduction of PM capacity

• Overall RAG status has improved to Amber, based on the collective position of the individual projects

PROGRAMME STATUS

RAG Status


A GGA AG


The section monitors the capital programme for 2018-19.

Overall Programme

Capital - £3.7M

Unallocated -

£7K

Pending ATIRs

- £0K

Programme

Administration

- £200K

Overall the Trust Capital programme for FY2018/19 is mostly delivered and complete expect a couple of projects which have

been moved into Q1 FY2019/20. These projects are being monitored by relevant programmes closely to ensure full delivery prior

to closure. The Capital spend for FY2018/19 is within acceptable tolerance.

IT

• All sites now have new equipment installed, and been migrated to HSCN. Digital Inpatients has implemented as supported both

Alder and Foxley ward, with North Walsham going live in April 19. All equipment for Mobile working rollout, Digital Inpatients and

cyber security were received within the 18/19 FY. A TMT presentation on the overall rollout of Purchasing and Inventory

management and benefits realised is planned for April-2019. Windows 10 build delayed to pick up NHS Digital technical

approach, IM&T are investigating and testing a robust and secure build. Resourcing for FY 19/20 projects is now complete for

most projects. Teams assurances provided to and approved by IG, IAO’s and SIRO. Drop-in and training sessions held across

all localities. Rollout now in progress, all sites to be enabled by April 19

Estates

• Staff Wellbeing and PLACE works projects are ongoing. The works completed by suppliers are being challenged as of poor

quality and conversations ongoing to bring them to the standard expected by the Trust. Procurement team providing support

with this. Simpson centre and the Squirrels projects have moved into FY19/20 partly due to delay on NCHC’s part and partly as

additional works have been identified at Simpson centre. Procurement plan to tender and procure services for the works in

Dereham office admin block are deferred until early Financial year 2019-20. The Capital programme changes for FY 2019/20

are ongoing post review of the latest Estates strategy.

Clinical Equipment

• Commodes were delivered and receipted within 2018/19. All other purchases have been reconciled or are anticipated by

Finance. The plan is now fully delivered and has justified the full spend within year.

N/A


Programme Status

Issues/

Points for

Escalation/

Decision

Current

RAG

Estates Backlog

maintenance

(£826.9K)

• ZT 110 The contractors performance on the staff wellbeing project has given significant concerns.

The situation has been escalated and is being mitigated alongside Procurement team

• ZT 111 Place works at Swaffham has been poorly delivered by the contractor and a remedial

action plan is in development with all parties concerned

• ZT119 - Simpson Centre refurbishment project started, the project will have a two week overrun

and cost overrun due to extra steel works and demands from building control. with potential for

small time overrun

• ZT125 - Squirrels additional works are due to complete by 10th April 2019. This is due to delay in

sending the PO to the supplier post tender approval

• The Capital plan for 2019-20 has been developed and items of backlog capital investment are

monitored

None

Estates

Development

(£1.105M)

• Procurement plan to tender and procure services for the works in Dereham office admin block are

deferred until early Financial year 2019-20

• Negotiations with BBC to move most of Dereham Hospital into The Enterprise Centre Dereham are

picking up again and we now have a new Programme Manager appointed to support with this. Due

diligence survey works at Dereham Hospital and Kelling Hospital, are underway. The survey

reports will feed into the requirements of Homes England to enable the master plan for the

Dereham Hospital and Kelling Hospital

None

Estates Charity

Works

(£15K)

• Initial discussions to determine the FY19/20 Charity works projects are now complete

• The funding request for the Dereham Hospital – day rooms development has been approved under

ATIR 1920-003

None

A

A

G



Programme Status

Issues/

Points for

Escalation/

Decision

Current

RAG

Clinical

Equipment

Group

(247K)

• Commodes were delivered and receipted within 2018/19.

• All other purchases have been reconciled or are anticipated by Finance.

• The plan is now fully delivered and has justified the full spend within year.

None

ZT001 - Mobile

Community

Working Phase

2

(£229.2K)

• 704 Staff trained on the Mobile App (MILESTONE completed)

• 264 mobile working devices have been issued to clinicians

• Video conferencing within meeting rooms has been installed in 13 rooms across the trust

• Mobile working assets received in March 19

• Closure report for Project completed

None

ZT002 -

Enhancing

Cyber Security

&

Infrastructure

(£634K)

• HSCN - All 3 sites now have new equipment installed, and been migrated to HSCN.

• Windows 10 build delayed to pick up NHS Digital technical approach, IM&T are investigating

and testing a robust and secure build.

• SAN storage, firewalls and servers delivered

• Disaster Recovery, Equipment to value £128k ordered and received within the 18/19 FY

None

ZT004 – Joint

Directory

(£20K)

• Project handed over to other Project Manager – outstanding actions being determined with

project team and supplier

• Data matching issues now resolved – mostly differences in names e.g. Mike vs. Michael. HR

have agreed this to be consistent with ESR name going forward

• To-be processes to be determined – supplier to share notification options. Configuration in

Support-works expected by IM&T to cater for new processes (starters, leavers, change of

circumstances)

• Test plan being drafted and communications plan needed to inform staff of updates to details

that will be made in AD – this will not cover phone numbers

• Expected go live was reported as March, actual date anticipated as early-mid May.

None

G

G

G

A



Programme Status

Issues/

Points for

Escalation/

Decision

Current

RAG

ZT005 -

Introducing Digital

Inpatients

(£149K)

• Alder and Foxley ward have been supported for Digital inpatients.

• Project has gone live with North Walsham on the 2nd Apr 19

• IT Equipment has been procured, all assets received in the 18/19 FY

• Digital Inpatients Governance Group (DIGG) is ongoing with good representation from operational

teams to ensure engagement and communication is consistent

• High risk raised relating to TWS and scanning of documents – discussion held with senior

stakeholders 29th March.

None

ZT006 - Enhancing

Public, Patient and

Trust Wi-Fi

(£179K)

• Public and staff Wi-Fi rolled out across the Trust Estate on 26/02. Full details on locations and user

guides available on Intranet

• Project Ready for closure and closure report submitted to TPB for approval

None

NC002

Purchasing and

Inventory

Management

• Phase 2 rollout in progress.

• Wheelchair services is likely to go live in Q1 2019/20 due to complexity around product

identification and lack of historic order data in Eros/Powergate resulting in additional resource

needed during setup phase

• A TMT presentation on the overall rollout of Purchasing and Inventory management and benefits

realised is planned for April-2019

None


G

A


G



Programme StatusRAG Status

Overall

Overall

ProgrammeProgramme flagging amber as most projects within the programme are Amber.

SystmOne

Optimisation

• Authority to Invest Paper presented at Investment Group to optimise 13 services which include 400 mobile working

staff. Decision made not to fund this project and focus on benefiting from existing services where Mobile working is

rolled out

Wound

Cameras

• Capital funding approved

• Cameras ordered and delivered

• Staff identified for training - Supporting eLearning material drafted

Health

Coaching

• Awaiting confirmation of funding and commencement of recruitment process for HC lead role to define handover to

BAU/project closure date

eScheduling

• Risk has reduced to AMBER following improvements to system performance –

• Benefit remains at AMBER due to the lack of real-time interface between SystmOne and eCommunity .

• Meeting arranged for 3rd April with TPP/Allocate/NCHC to clarify API interface requirements and agree next

steps/timeline.

NC001 Enabling

Collaboration

Services

• Teams assurances provided to and approved by IG, IAO’s and SIRO. Drop-in and training sessions held across

all localities. Rollout now in progress, all sites to be enabled by April 19.

• OneDrive – technical actions continue to be worked through. ‘

• SharePoint – high level plan to be created

Operational

Management

System

Optimisation

Programme

(OMSOP)

• PROGRAMME GOAL: To have removed unwarranted variation, increased productivity and reduced risk, through

optimisation of operational and staff management systems across NCH&C

• A review of the programme to take place over the coming days (this will be tied-in in with the Community

Gateway review)

• Workstreams:

1. HealthRoster/ESR 2. Competencies 3. Mobile Working 4. Care Plans

5. eScheduling 6. Reporting/IMAS 7. Self Care 8. Case Management

3.3 Service Development Programme UpdateThis section outlines projects that either update or enhance a service or are enablers for CIP projects.

A

A

G

A

3.0 Programme Update – Improve our Quality

A

G

A

3.3 Service Development Programme Update


Programme Status

RAG Status


Indicator 9:

Preventing Ill

Health by Risky

Behaviours-

smoking and

alcohol

• Data collection ongoing for inpatient units and HomeWard

• Percentage compliance for screening for smoking has remained

static across all units since Q3 and has meant that once again is

short of the targets set. There has been an improvement in the

number of patients given brief advice and referred on to specialist

stop smoking services.

• Screening for alcohol has remained static and has again met the

targets for the Quarter

• The roll out of the Digital Inpatients project will see all units using

the same data collection process via SystmOne. Training will

include data collection against the template and it is hoped that

compliance levels will improve during 2019 – 20

• Full report due end April 2019

N/A N/A N/A

Indicator 10:

Improving the

Assessment of

wounds

• Wound Care Training for community nursing staff is ongoing

• Q4 audit is underway and closing on 12.4.19 . Looking at the

number of responses so far, the sample size has once again

exceeded the requirement of the CQUIN.

• Analysis scheduled w/c 15.4.19 and the full report is due for

submission end April 19

N/A N/A N/A

Indicator 11:

Personalised

Care

and Support

Planning

• Patients identified in the cohort for this CQUIN have been re-asked thepatient activation question. Analysis is underway to ascertain if anyimprovement in scores can be seen following the Care and SupportPlanning interventions. Reports due for submission end of April 19

• Anecdotal evidence has shown that for some patients the Care and SupportPlanning approach has resulted in significant benefits for patients and theircarer/families. See quote below:

‘……The feed -back of my work has been really positive, patients felt involved, more in

control with a little prompting and assistance to enable a pathway of care to refer to.

They liked having phone numbers all in one place also. I had lots of compliments and as

a nurse felt I was making a huge difference to the patients that I care about…..’

Specialist Neuro Nurse

N/A N/A N/A

3.3 Service Development Programme Update

National CQUIN Programme 2017-19.


A A A A

GG

G

G A

GG G

Pipeline/Scheme

#Project Gateway

Change

ControlClosure Date

Financial

BenefitOutcome

To be

allocated Clinic Optimisation 11.01.19 £777.4K

The previous project had been closed. The replacement

project ‘Clinic Design & Management’ is being scoped.

New leads have been agreed:

• Sponsor, Andrew Hopkins

• Project Lead, Lisa Edwards

PL213 Staff Travel Review GW3 11.01.19 £87.5kStaff Travel Review Phase 1 GW2&3 was signed off and

agreed at meeting.

IT17-01

(PL200)SystemOne Efficiencies X 11.01.19 £0

CIP delivered successfully in FY 17/18, agreed for

closure.

WTP14Palliative Care

workforce planX 08.02.19 £143k Change control approved

WTP22 Procurement X 08.02.19 £468k Change control approved

NC&HC Projects and

Investment – Vision and

Proposed Programme

Structure

08.02.19 £0Vision logo and statement was approved by board

members. Board members happy to implement strucutre.

ZT124Thorpe Health Centre

Refurbishment 08.02.19 £0 Capital PID approved by board members

ZT119Simpson Centre


ZT131Caroline House Door


ZT123 Mulberry Refurbishment 08.02.19 £0 Capital PID approved by board members

WTP02Neurology Rehab

Service X 08.03.19 £121k Change control approved

Final Capital

Programme 08.03.19 £0 Final Capital Programme approved by board members

TPB Terms of

Reference & Approval

Process Map

08.03.19 £0

Changes to Workforce

Programme Board08.03.19 £0

Paper presented in meeting and approved by board

members in attendance

4.0 Project Decision Update – Secure the Future

This section highlights the decisions made at Transformation Programme Board (TPB) during the last three months.

Documents

Date of Board : 24th April 2019 Innovation & Improvement …... · coming from India and joining the NHS. 2.0 Enabling Our People 2.1 ProjectsTeam Update. ... and are currently working