King’s College Hospital Council of Governors - 366.1 - cog... · CV Praveen (Staff) I have been an ENT surgeon at the Princess Royal University Hospital for 15 years. I think the

King’s College Hospital Council of Governors

PUBLIC AGENDA

Time of meeting 18:30

Date of meeting Thursday, 15 May 2014

Venue Learning & Development Centre, Unit 4, KCH, Business Park, Denmark Hill

George Alberti Trust Chair

Elected: Anoushka de Almeida-Carragher Bromley Eniko Benfield Bromley Paul Corben Bromley Penny Dale Bromley Michael Robinson Lambeth Central Godwin Ubiaro Lambeth Central

Fiona Clark Lambeth North Chris North Lambeth North Nanda Ratnavel Lambeth South vacancy Lambeth South Alan Hall Lewisham Tom Duffy Patient Patti Kachidza Patient Derek Cookson Patient Pida Ripley Patient Jan Thomas Patient David Sullivan Patient Barbara Pattinson Southwark Central Pam Cohen Southwark Central Andrew McCall Southwark North Joe Onabaworin Southwark North Stuart Owen Southwark South Michelle Pearce Southwark South Phyllis Barnett Staff – Allied Health Professionals CV Praveen Staff - Medical and Dentistry Carolyn Campbell-Cole Staff – Nurses and Midwives Nicky Hayes Staff – Nurses and Midwives Helen Mencia Staff – Nurses and Midwives Mike Pedro Staff – Admin, Clerical and Management Rachel Burman Staff – Medical and Dentistry Ahmad Toumadj Staff – Support Staff

Nominated/Partnership Organisations: Jim Gunner Bromley Clinical Commissioning Group Cllr Robert Evans Bromley Council Diane Summers Guy’s & St Thomas’ NHS Foundation Trust Phidelma Lisowska Joint Staff Committee Chris Mottershead King’s College London Cllr. Jim Dickson Lambeth Council Sue Gallagher Lambeth Clinical Commissioning Group Warren Turner London South Bank University Richard Gibbs Southwark Clinical Commissioning Group Madeliene Long South London and Maudsley NHS Foundation Trust Cllr. Catherine McDonald Southwark Council

In attendance: Tim Smart Chief Executive Officer Jane Walters Director of Corporate Affairs Tamara Cowan Board Secretary (Minutes)

Marc Meryon NED/Senior Independent Director

Apologies:

Circulation to: Council of Governors

Enclosure Lead Time

1. STANDING ITEMS G. Alberti 18:30

1.1. Apologies

1.2. Declarations of interest

1.3. Chair’s action

1.4. Minutes of previous meetings Enc. 1.4

1.5. Matters Arising/Action Tracking (no outstanding actions) Verbal

2. FOR REPORT/DISCUSSION

2.1. Governor Engagement and Involvement & Development Day Feedback

Enc. 2.1 N Hayes 18:35

2.2. Sub-Committees Reports & Action Summaries

2.2.1. Membership & Community Engagement Enc. 2.2.1 A McCall 18:40

2.2.2. Strategy Enc. 2.2.2 C North 18:45

2.2.3. Patient Experience & Safety Enc. 2.2.3 J Thomas 18:50

2.3. Board Report to the Council of Governors Enc. 2.3 T Smart 18:55

2.4. Trust Finance Report Enc. 2.4 S Taylor 19:05

2.5. Trust Performance Reports Enc. 2.5 R Sinker 19:15

2.6. 5-Year Strategy Enc. 2.6 P Castro 19:25

2.7. Quality Focus & Engagement:

2.7.1. Final Draft Quality Report & Account 2013/14 Enc. 2.7.1 G Walters 19:40

2.7.2. Community Events Feedback/Open Day Plans

Verbal S Lingard 19:50

2.8 Summer Elections Enc. 2.8 J Walters 20:00

3. FOR APPROVAL/RATIFICATION

3.1. Transport Feeder Group Verbal J Walters/ A McCall

20.10

3.2. Annual Membership Report Enc. 3.2 J Walters 20.15

4. FOR INFORMATION

4.1. Register of Governor Attendance Enc. 4.1 4.2. Quarter 4 - Monitor Submission Enc. 4.2 4.3. Sub-Committees Confirmed Minutes 4.3.1. Membership & Community Engagement Enc. 4.3.1 4.3.2. Strategy Enc. 4.3.2 4.3.3. Patient Experience & Safety Enc. 4.3.3

5. ANY OTHER BUSINESS 20.25

6. DATE OF NEXT MEETING - Thursday, 25 September 2014, 14:00 – Venue (TBC)

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Council of Governors – Public Session Minutes of the meeting held on Wednesday, 05 March 2014 at 15:00 in the Large Hall, 4th Floor, Bromley Central Library, High Street, Bromley, BR1 1EX.

Marc Meryon Senior Independent Director – Chair of Meeting Elected: Anoushka de Almeida-Carragher Bromley

Eniko Benfield Bromley

Paul Corben Bromley

Penny Dale Bromley

Godwin Ubiaro Lambeth Central

Fiona Clark Lambeth North

Chris North Lambeth North

Nanda Ratnavel Lambeth South

Tom Duffy Patient

Derek Cookson Patient

Patti Kachidza (part) Patient

David Sullivan Patient

Jan Thomas Patient

Barbara Pattinson Southwark Central

Pam Cohen Southwark Central

Andrew McCall Southwark North

Joe Onabaworin Southwark North

Michelle Pearce Southwark South

Stuart Owen Southwark South

Rachel Burman Staff – Medical and Dentistry

CV Praveen Staff – Medical and Dentistry

Nicky Hayes Staff – Nurses and Midwives

Carolyn Campbell-Cole Staff – Nurses and Midwives Nominated/Partnership Organisations Phidelma Lisowka Joint Staff Committee

Diane Summers Guy’s & St Thomas’ NHS FT

Cllr. Jim Dickson Lambeth Council

Madeleine Long South London and Maudsley NHS FT

Richard Gibbs Southwark CCG

Cllr. Robert Evans Bromley Council

Jeff Warn Member

Cllr. Catherine McDonald Southwark Council (part) In attendance: Tim Smart Chief Executive

Jane Walters Director of Corporate Affairs

Simon Taylor Chief Financial Officer

Roland Sinker Chief Operating Officer

Michael Marrinan Medical Director

Pedro Castro Interim Director of Strategy

Tamara Cowan Board Secretary (Minutes)

Tooba Ahmadi Corporate Governance Officer

Leonie Mallows Corporate Governance Officer

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Sally Lingard Associate Director of Communications Apologies Chris Mottershead King’s College London

Sue Gallagher Lambeth CCG

Alan Hall Lewisham

Michael Robinson Lambeth Central

Ahmad Toumadj Staff – Support Staff

Prof Sir George Alberti Trust Chair Graham Meek Non-Executive Director

Geraldine Walters Director of Nursing and Midwifery Phyllis Barnett Staff – Allied Health Professionals

Warren Turner London South Bank University

Vacancies:

Public Governor Lambeth South

Item Subject Action

14/1 Welcome & Apologies The apologies for absence were noted.

14/2 Declarations of Interest There were no declarations of interests raised.

14/3 Chair’s Action There was no chair’s action reported.

14/4 Minutes of Previous Meeting The minutes of the meeting held on 11 December 2013 and were approved as a correct record.

14/5 Matters Arising/Action Tracking The action tracker was noted.

14/6 Election Results and Introduction of New Governors The Council noted that the election for four public governors from Bromley, one from Lewisham and two interim staff governors to represent the nurses and doctors on the new sites was very successful, with many candidates standing. The Council welcomed the newly elected governors and noted the apologies of Alan Hall and Helen Mencia.

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Item Subject Action

The following brief introduction was given by new governors:

Eniko Benfield (Bromley): I have a background in nursing and completed my Diploma in Nursing at King’s College Hospital. My nursing experience has mainly been in palliative care, acute oncology and cancer information. I also run a HomeCare Agency in Bromley for care of the elderly

Penny Dale (Bromley): I have been a Physiotherapist for 45 years working at The Royal London Hospital and in local NHS and private hospitals, latterly as a Risk Manager. I have a particular interest in patient care and patient experience.

Anoushka Almeida-Carragher (Bromley): My present role involves managing major grants for medical research and innovative healthcare, whilst working for a funding body whose main beneficiaries are Bart’s Health NHS Trust and Queen Mary University of London Medical School.

CV Praveen (Staff) I have been an ENT surgeon at the Princess Royal University Hospital for 15 years. I think the role of governor is very interesting and welcome the new changes.

Paul Corben: I was a patient governor at King’s College Hospital some year ago. I am a Barrister in private practice and I am happy to be representing the people of Bromley on the Council.

14/7 Governor Engagement and Involvement & Development Day Feedback NH presented the report on governor engagement and involvement and feedback from the recent development day. She also welcomed the new governors adding that their involvement will take the Council from strength to strength. The following key points were reported:

Governors have a duty to represent members and the general public therefore governors engagement and involvement initiatives are important;

Individually and collectively governors need to consider how best to do this;

The report includes a summary of ways in which governors can get involved and there are great examples of governors getting involved and engaged with the community;

The contributions of governors in the recent dignity month activities was very welcome and valued and they and other members of the Council are invited to the Dignity Awards on 17 March 2014;

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Item Subject Action

There is a full list of engagement and involvement activities taking place in the Trust and Governors can contact Jessica Bush if they are interested in contributing; and

In particular, PLACE assessments will be taking place on 8 March at the Princess Royal University site (PRUH) and 12 March at the Denmark Hill site.

MM noted the thanks of the Trust and the Board to those Governors doing so much to engage with the members and public.

14/8 Membership & Community Engagement (MCE) Committee Andrew McCall provided an update on the activities of the Membership and Community Engagement Committee and the recent meeting. He reported the following:

This was AM’s first meeting as chair;

The highlights from the meeting included reports on the good work and lessons learned from the membership recruitment activities in the Bromley and Lewisham area;

The recent elections also benefited from the membership drives as it reaped some excellent governor candidates and elected governors representing those areas;

In recognition of the governors duties to engage with members and the public the Committee has put this item at the forefront of its agenda;

Standing items will include hearing from governors about what they are doing to engage with members and the public, learning from other organisations who have strong membership links;

The Committee also heard about the plans for the Community Events, and contributed to the development of the next @Kings magazine;

All Governors and non-executive directors are invited to attend the next meeting on 08 April 2014; and

The minutes from the Transport Feeder Group are on the agenda for

information. The Council noted the verbal update from Andrew McCall and the supporting key discussion points and actions arising from the Membership and Community Engagement Committee meeting held on 23 January 2014.

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Item Subject Action

14/9 Strategy Committee Chris North provided an update on the activities of the Strategy Committee and the recent meeting. He reported the following:

The Committee had the opportunity to comment on the development process for the Trust’s strategy; and

The Committee agreed to focus particularly on integrated care, King’s Health Partners progress and the 5-year strategy at future meetings;

One of the key strategic issues for the Trust is the cultural change that is needed as part of the integration following the acquisition.

The Council noted the verbal update from Chris North and the supporting key discussion points and actions arising from the Strategy Committee meeting held on 11 February 2014.

14/10 Patient Experience and Safety Committee (PESC) Tom Duffy provided an update on the activities of the Patient Experience and Safety Committee (PESC) and the recent meeting. He reported the following:

The Committee benefits from having non-executive directors attend their meetings and Governors find this very useful;

Phlebotomy and Pharmacy continue to be an ongoing concern for some Governors;

The Committee received a very useful presentation on improving patient experience on acute medical wards. The lessons learnt from the review will be considered for implementation elsewhere in the Trust;

More positive and encouraged staff leads to better patient experience;

The Board is considering how to implement the three areas of focus detailed in the integration cultural workstream.

The Council noted the verbal update from Tom Duffy and the supporting key discussion points and actions arising from the PESC meeting on held on 11 February 2014.

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Item Subject Action

14/11 Board Report to the Council of Governors, including KHP Update The Council received and noted the report from the Board of Directors presented by Tim Smart. The following key points were noted:

The Trust and in turn the Board of Directors are occupied with ensuring the hospital, now operating across multiple sites, is operating efficiently and that the integration plans are delivered;

The Trust’s transformation programme falls within the ‘All together better’ banner with a key focus on cultural change;

The challenges facing the health economy in South East London are well known. This calls for ever more collaborative working and good engagement with key stakeholders;

The Trust needs to decide on its strategic priorities and will wish to take on board the views of key stakeholders, including members and governors at such events as the community meeting which will follow this Council meeting;

Feedback from the first community event included re-iteration of the need for excellence in the provision of patient care services and the desire to have GP surgeries open 24 hours per day, seven days a week;

Directors are regularly engaging with regulators including Monitor and the Care Quality Commission about our plans, and the Trust is also fortunate to have good and supportive relationships with its local commissioners;

The Trust is very pleased to welcome new governors representing the new areas served by the Trust;

The Trust was happy to host a recent royal visit of HRH Prince Charles and the Duchess of Cornwall. They visited a range of trust services, and hosted a round table discussion with experts in the field of volunteering.

In discussion the Council raised and noted the following key points:

The Trust recently ran a ‘Safer, Faster Hospital’ initiative at Denmark Hill which involved working with other agencies and all relevant clinical teams and frontline staff prioritising patients admitted via the emergency pathway, and effecting safe and effective discharge.

This initiative reaped very positive results and learning and the same initiative will be undertaken at the Princess Royal University (PRUH) site in the coming weeks;

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Item Subject Action

Despite a mild winter the Trust has seen an approximate 15% increase in admissions of over 75 year olds;

Accident & Emergency (A&E) performance is a key concern and is the focus of a big public health campaign; and

The Board is concerned about the continuing increase in emergency admissions and resultant impact on the ability to admit some elective patients.

14/12 Trust Performance Reports The Council received the Trust’s performance reports for month 10 and noted the verbal update from Roland Sinker.

The following was noted: Bromley sites

Successes for the Bromley sites included: o Delivery and opening of the Orpington Hospital orthopaedic

elective facility; o Improvement in nursing establishment; o Reduction in the number of complaints and improvement in the

numbers of incident reported

Areas of concern at the PRUH included cancer pathways and the emergency (ED) pathway;

The ED performance is down at 60-67% for type 1, 15% lower than target;

Factors that have contributed to PRUH performance relate to the fact that the Trust had not inherited the levels of staffing it had expected on the dissolution of the former South London Healthcare Trust and the changes to the discharge function at PRUH. PACE had previously provided discharge services to the PRUH site but their contract ended on the acquisition;

In December the Trust had 80 patients who were medically fit for discharge but because of shortfalls in the system and network the Trust was not able to repatriate them to the correct setting;

NHS England and the Care Quality Commission both of whom have visited the PRUH recently realise the challenges facing the Trust;

The Trust is doing an enormous amount of improvement work and there is a big focus on improving discharge;

The Trust needs to ensure it has enough permanent frontline staff to improve patient care; a key area of focus is the frontline nursing and doctors recruitment;

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Item Subject Action

Denmark Hill (DH) site

In the last 18 months the Trust has seen the number of emergency patients admitted to the DH site increase by 15%;

The normal 20-30 admissions have increased to 40 and above on a daily basis;

Another significant factor is the increasing acuity of the patients being admitted. These patients are sicker and need to stay in hospital for longer;

The Trust has invested in more capacity and is doing a range of things in order to provide additional space and new wards. Some of the capacity did not come on line in the planned time frame and this delay has impacted on Trust performance;

Winter pressure funding was not awarded until January this year;

Key issues across the health system include the inability to efficiently repatriate patients back to their local hospitals or mental health providers and the growth in the acuity of patients;

Around 35 patients are currently waiting to be repatriated back to Croydon or Lewisham hospitals;

The Trust is working closely with local commissioners to address these issues and has already had good meetings with key commissioning colleagues; and

Despite implementing a range of options to meet increased demand and achieve the referral to treatment (RTT) target, including utilising expensive offsite options, the RTT target has not been fully met.

14/13 Trust Finance Report The Council received the Trust’s finance report for month 10 and noted the verbal update from Simon Taylor.

The following was noted:

As described above, the two main acute hospital sites are incredibly challenged and busy with increased numbers of very sick patients being admitted;

To do this efficiently and effective whilst guaranteeing patient safety is maintained the Trust has had to engage significant additional bank and agency staff;

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Item Subject Action

The Trust has outsourced elective work to the private sector in an effort to ensure that patients are not waiting too long and the Trust can improve its performance against the referral to treatment targets. This however has a significant cost implication;

The Trust has begun using Orpington Hospital to provide orthopaedic services but there is further opportunity to utilise the site’s additional capacity in an effective way

All of these factors have had an adverse impact on the Trust’s financial performance and next year will prove very challenging. Although the bottom line shows that income has increased the costs associated with treating more complex patient cases have also increased;

The Trust has been liaising with senior leaders across the organisation to begin planning for the challenges the Trust will face;

Nothing has changed significantly from the month 10 position detailed in the report and it is unlikely that there will be any significant change to the Trust’s overall financial position by year end;

The run-rate going into next year is the most significant financial issue for the Trust; The current situation is not sustainable in the long run;

A big change in the local health system is needed to address the predicted growth in the number of people attending the Trust’s acute sites next winter;

Integrated care pathway services are not yet fully established to help address the issues facing the Trust;

Temporary staffing costs equate to circa £3m on nurses to meet the increase activity and demand levels. In addition, when the Trust acquired the PRUH it flagged the shortfalls in nursing establishment. Recruitment of permanent nurses is taking a long time due to multiple factors.

14/14 Strategic Planning for Change The Council noted the update on the strategic planning report presented by Pedro Castro. The following was raised and noted:

There has been a change in the process this year;

Instead of an Annual 3 tear rolling plan, Trusts are required to develop a 2 year Operational Plan and a 5-year strategy;

The Trust needs to crystallise its key long term strategic priorities reflecting on the internal and external drivers and financial pressures;

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Item Subject Action

The community events are being used to capture comments from Governors, members and the local communities;

A joint session between the Council and the Board will be held to identify top priorities;

The Trust will engage with key stakeholders and using multiple forums to ensure it captures wider south east London and public health priorities into its strategy;

The Trust is committed to making integrated care pathways a success;

The Governors would be engaged in the process leading up to the submission of the 5-year strategy to Monitor at the end of June 2014.

14/15 Quality priorities 2014/15 and Quality Accounts The Council noted the report on the proposed quality priorities and local indicator for testing. The following was noted:

The Trust had performed well against most of the chosen quality priorities for 2013/14 with the exception of the following two areas where it is proposed they be taken forward as priorities for 2014/15;

o Improve patient experience of discharge o Surgical Safety checklist

Two successful stakeholder events were held and they have helped to shape and draw up the short-list of priorities for 2014/15;

Underlying the development of action plans achieving the proposed priorities for 2014/15 are the cultural changes the Trust are embracing;

Monitor has now reverted to the previous system where Governors choose the local indicator for testing as part of the quality reporting process. The Trust has chosen C. Difficile and 62 cancer waits as its mandated indicators for testing; and

The Council previously suggested that the 28-day readmission rate was chosen for testing, and this was one option for the Governors to consider as the local indicator.

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Item

Subject Action

1) The Council endorsed the following quality priorities for 2014/15: a. Improving the identification and management of patients at risk

of falling in hospital b. Improving surgical safety (2nd year) c. Improving patient experience and coordination of discharge d. Improving the experience of cancer patients e. Maximising King’s contribution towards reducing mortality due

to use of alcohol f. Improve the experience of patients with hip fracture

2) The Council also chose 28-day readmission rates (modified to 30

days) to test as the local Governor selected indicator.

14/16 Quarterly Patient Safety Report The Council noted the quarterly patient safety report presented by Mike Marrinan.


Every never event is investigated thoroughly, subject to a root cause analysis and reviewed by the Serious Incident Committee;

The I-mobile service at the Denmark Hill site is operating well and will be rolled out at the PRUH site in due course;

A new 60 bedded critical care unit will be built on the Denmark Hill site. In the interim, one of the existing wards has been designated as additional critical care capacity to deal with critically ill patients;

The Trust has protocols for the use of safer surgery checklists but there needs to be more education and cultural shift, hence it has been made a priority in 2014/15.

14/17 Register of Governors Attendance The Council of Governors Register of Attendance was noted.

14/18 Quarter 2 – Monitor Submission The Council noted the submission made to Monitor for quarter 3.

14/19 Sub-Committees Confirmed Minutes The Council noted the following sub-committee minutes:

Membership & Community Engagement Committee – 16/10/2013

Strategy Committee – 24/10/2013

Patient Experience and Safety Committee – 22/10/2013

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Item

Subject Action

14/20 Any other business There were no matters of any other business raised from discussion.

14/21 Date of Next Meeting Thursday, 15 May 2014 in the Boardroom at 17:30.

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Report to: Council of Governors Date of meeting: 15 May 2014 Presented By: Nicky Hayes, Lead Governor Subject: Governor Involvement and Engagement Report

Governors have a general duty to “to represent the interests of the members of the corporation as a whole and the interests of the public”. Monitor’s guidance for governors suggests the following key principles as the means for governors to represent the interest of members and the public:

Governors should seek the views of members and the public on material issues or changes being discussed by the trust.

Governors should feedback to members and the public information about the trust, its vision, performance and material strategic proposals made by the trust board.

Governors should try to make sure when they are communicating with directors of the trust that they represent the interests of members and the public rather than just their own personal views.

This report includes examples from some governors on the initiatives they have undertaken to engage with members and the public at external meetings and events. The report also provides the list (Appendix 1) of ongoing engagement activities provided by the Trust with which governors are encouraged to get involved. Governors have also recently been invited and will continue to be invited to participate in the Go See Visit. It has been suggested that Governors may find it useful to start a rota. The current schedule (Appendix 2) is enclosed. The Governor Membership and Community Engagement Committee continues to take the lead on governor-led initiatives to engage with members and the local community. Action required: Governors are asked to: 1. Note the report from fellow governors on their engagement activities; and

2. Consider and submit their interest in the opportunities for engagement and

involvement.

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Barbara Pattinson Constituency: Public, Southwark Central Term began: 01 December 2011 Period over which the activities listed below were undertaken: On a regular basis since I became a governor in 2011

Engagement activity, actions and feedback

Membership & Community Engagement Committee

Attend Membership & Community Engagement Committee meetings and put the Camberwell grassroots case when appropriate.

Through community activism as Chair of SE5 Forum for Camberwell promote the improvement of Camberwell in which King’s is a very important player.

To promote King’s membership, @King’s is prominently displayed and distributed by SE5 Forum at the weekly Camberwell Green Farmers Market.

SE5 Forum has a stall at King’s open days and volunteer events.

Other activities/memberships that offer opportunities to promote King’s membership

Member or the Camberwell Society Executive Committee

Patron of the Southwark Day Centre for Asylum Seekers

On committee of local Residents’ Association

Regular attendance at Community Council and Safer Neighbourhoods meetings.

Transport Feeder Group

Attend Transport Feeder Group meetings and put the Camberwell grassroots case when appropriate.

Member of other local transport groups (e.g. Camberwell Travel Plan Group, Southwark Living Streets) and share knowledge and experience built up through long engagement in transport issues.

When contacted through SE5 Forum I can bring Camberwell views and issues to the attention of the group.

General comments

I want Camberwell to have ownership of King’s and King’s to have ownership of Camberwell. This is not helped by the Camberwell site being referred to as Denmark Hill.

Camberwell is an extremely important and complex transport hub but its profile does not reflect this. In my view, important contributory factors are the name of the rail station and the major institutions designating their campuses Denmark Hill and not Camberwell.

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Michelle Pearce Constituency: Public, Southwark South Term began: 04 December 2008 Period over which the activities listed were undertaken: On a regular basis since I became a governor in 2008


Trust-led Community Events

I became a Governor at the end of 2008 and I have attended almost all of the community events that the Trust has arranged for members since 2009, including Annual Public Meetings and Annual Members Meetings.

In the past couple of years most of these events have been organised as roundtable discussions on issues of real significance to the hospital.

Southwark and Lambeth Integrated Care Citizens Forum

In the past year I have attended three meetings arranged for members of the public in Lambeth and Southwark who are interested in the progress and implementation of integrated care in the community

These meetings have also taken the form of roundtable discussions.

General comments

The input of members at community events has been very valuable.

Integrated care is a very important initiative for the future of King’s and interesting ideas and suggestions have emerged from members of the public attending these meetings.

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Penny Dale Constituency: Public, Bromley Term began: 31 January 2014 Period over which the activities listed were undertaken: 01 February – 12 May 2014


PLACE Assessment, PRUH

I was a member of the assessment team for the patient-led assessments of the care environment, known as PLACE assessments.

These are annual assessments of the quality of services and condition of hospital buildings, as recommended by the Department of Health and NHS England.

Go-See Visits

I have participated in Go-See visits to wards clinical areas at both the PRUH and at Denmark Hill.

These are open to all governors and take place immediately following the public session of Board of Directors meetings.

The areas I visited were Medical Wards 8 and 9 at the PRUH and the Derek Mitchell Unit and Lonsdale ward at Denmark Hill.

Bromley Clinical Commissioning Group

I met with Angela Bahn, Chair of Bromley CCG, at Beckenham Beacon on 09 April.

I am intending to go the next Bromley CCG meeting on 12 May where I have tabled a question for the Open Forum.

General comments

As a new Governor I felt that it was important to understand the way the BOD and COG worked. I therefore tried to attend all the relevant meetings to gain an understanding.

As a Public Governor I also thought that it was important to have a knowledge of the external bodies responsible for health care in Bromley and how they interacted with the Trust.

Participating in PLACE and Go See visits have introduced me to the working environment of the Trust and given me an opportunity to meet different groups of staff and patients. I hope that all this interaction will help me to become a useful and informed Governor when important issues are discussed.

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Stuart Owen Constituency: Public, Southwark South Term began: 01 December 2011 Period over which the activities listed were undertaken: On a regular basis since I became a governor in 2011


Participation in Governor Sub-Committees

My focus as a King’s Governor has been to represent the views and experience of current and potential patients in my constituency of Southwark South, and other users of King’s service regardless of location, so that hospital facilities and procedures are based on putting the needs, dignity and individuality of the patient being treated and the top of their priorities. I have therefore been a regular contributing member of the following governor sub-committees:

o Patience Experience and Safety Committee o Membership and Community Engagement Committee o Transport Feeder Group

Additional engagement with the work of the hospital as a governor and patient representative

Active and influential participation in the Phlebotomy Department Transformation Working Group, and continuing involvement in the ongoing Phlebotomy Monitoring Group.

Attending and contributing to meetings of the Outpatient Experience Staff Workgroup.

Participating in annual PLACE assessment inspections of various hospital departments.

Participating in the annual Dignity Awards assessments.

Volunteering to participate in recording Patient Video Stories.

Taking part in ‘How Are We Doing?’ surveys in various different outpatient departments.

Informal liaison with the Facilities Department over cleanliness and maintenance of toilet facilities in public areas.

Talking about the role of governor as patients’ representative at local community gatherings (e.g. library, residents associations, GP surgery).

Raising questions from the patients’ perspective during Council of Governors meetings regarding the effectiveness of joint-venture or privatised services and their ability to meet promised standards of quality and service.

General comments

My priority is to maintain and improve the range and quality services provided to everyone under the NHS at King’s College Hospital, and to ensure that a high standard of patient care and experience is always of defining importance in any treatment or service carried out by the hospital.

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Jan Thomas Constituency: Patient Term began: 04 December 2008 Period over which the activities listed were undertaken: 23 January to 14 May 2014 Engagement activity, actions and feedback

Kings in Conversation

These were listening events with staff and patients

I co-facilitated one round table event and interviewed staff and patients at the Denmark Hill, PRUH and Beckenham Beacon sites.

Dignity Visits

As part of the series of visits to clinical areas during Dignity Month 2014 I visited and commented on three areas. Patient Experience, Organ Donation and End of Life Committees

I am committed to attending these Trust-led committees, all of which met once during the period 23 January- 08 April 2014

My role is to reflect the governor, patient and general public viewpoint on the issues raised. ‘Video Stories’ Project

As the governor representative on the steering group of this project, I have continued my involvement by conducting a interview with a patient on camera.

Speaker at NICE Annual Conference

Governors were invited to apply to participate in NICE working groups in January 2014.

I made preliminary enquiries at the time and was subsequently invited to speak at a question and answer session entitled ‘From Board to Ward’, exploring ideas of involving patients in the healthcare transformation agenda.

University of the 3rd Age

This is one of the community groups with which I am involved.

At meetings I talk to attendees about the work of King’s and my role as governor.

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Appendix 1 Governor Involvement May 2014

For further details or if you would like to get involved in a particular activity, please contact

Jessica Bush, Head of Engagement and Patient Experience, [email protected] or 020 3299 4618

Apart from the standard committees and workstreams, a range of opportunities come up on a regular basis and these are circulated to

Governors. Recent examples include assisting with a survey in the Emergency Department, conducting clinic observations

in outpatient clinics. If you would like to hear about new opportunities for gathering patient feedback, please let Jessica Bush know.

Involvement Activity

Governor Trust Lead Description Status Date

Public Health Committee

Michelle Pearce Chair - Mike Marrinan Contributing lay/Governor perspective to Public Health issues

Ongoing Meets quarterly

Staff Commendation Panel

Tom Duffy, Jan Thomas Chair - John Karani, Contact - Angela Huxham

Contribute to decisions on staff awards Ongoing Ongoing

Improving King's Patient Food Service- Food Service and Nutrition Group

Jan Thomas Rick Wilson Contributing lay/Governor perspective Ongoing Ongoing

Patient Food Audits (DH)

Pam Cohen Rick Wilson Governor / Lay input into daily ward audits of the patient food service

Ongoing Bi-weekly

Organ Donation Committee

Jan Thomas Contributing lay/Governor perspective Ongoing

Community Events (DH and PRUH)

All Governors Jane Walters / Sally Lingard Series of annual events for members Annual Feb 25 DH adn 5 March Bromley

Patient Experience Committee

Jan Thomas, Tom Duffy Jane Walters / Jessica Bush Lay representation on trust committee which reports to the Board's Quality and Governance Committee.

Ongoing Monthly

End of Life Care Steering Group

Jan Thomas Wendy Prentice Lay involvement Ongoing

Enc 2.2

8









National Governors' Forum (FTN Network)

Tom Duffy and Jan Thomas n/a External networking Current

Serious Incident Committee

Tom Duffy Richard Hinckley Contributing lay/Governor perspective

Serious Complaints Committee

Tom Duffy Chair: Faith Boardman, Trust Lead: Jane Walters

Contributing lay/Governor perspective February 21 2014

Bi-monthly

Maternity Services Liaison Committee (Maternity Matters)

Patti Kachidza Maxine Spencer, Director of Midwifery, Lay Chair - Joanna Brien

Lay representation of trust wide maternity group which seeks to improve all aspects of maternity care. MDT group with lay membership of women who have had babies at King's. Meet bi-monthly.

On-going Bi-monthly

End of Life Care Steering Group

Jan Thomas Jessica Bush and Wendy Pentice

Governor involvement in End of Life Care Steering Group looking at all aspects of end of life care

On-going

Older Person's Group

Fiona Clarke Graeme Groome Governor representation on Older Person's Group

Ongoing

Enc 2.2

9









Patient Video Stories (Trust-wide)

Stuart Owen, Tom Duffy, Jan Thomas and Michelle Pearce. Other Governors welcome across all sites.

Jessica Bush / Rachel Sugarman

To take part in filming patient video stories. We are also looking at the possibility of Governors linking with Divisions to support the project and work with areas on service, improvement. Current areas of focus include Haematology, patient stories linked to nursing priorities of falls, pressure ulcers etc, working with nursing executive.

Jan-14 On-going

Francis Steering Group

Tom Duffy Jane Walters Trust-wide Steering Group to lead on KCH's response to the Fances Report

May-13

King's In Conversation (PRUH and other SE sites)

Tom Duffy, Fiona Clark, Jan Thomas

Jessica Bush To be facilitators at King's In Conversation Events.

Oct-13 Completes March 2014

Phlebotomy (DH)

Stuart Owen, Michelle Pearce

TBC To provide lay and service user perspective on transformation to improve King's phlebotomy service

Apr-13 TBC

Friends and Family (DH and PRUH)

Fiona Clarke, Pam Cohen. Further Governor involvement welcome.

Jessica Bush Assisting with gathering of Friends and Family survey feedback. Including in DH and PRUH Emergency Departments and on PRUH inpatient wards.

Ongoing

Improving Ophthalmology Services (DH)

Michelle Pearce Alex Forster, Outpatient Service Manager

To provide lay and service user perspective on transformation to improve DH Ophthalmology service

December 2013 TBC

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10









Pharmacy Service DH Site

Stuart Owen, Michelle Pearce, Carolyn Campbell-Cole

Chris Barrass To provide Governor input into improving pharmacy service

Current TBC

Quality Account Stakeholder Meetings (Trust-wide)

All Governors Jessica Bush Stakeholder involvement in developing annual quality priorities

Autumn 2014

Enc 2.2

11

Appendix 2. Governors Go and See Visit Rota

25/03/2014 29/04/2014 27/05/2014 24/06/2014 29/07/2014 26/08/2014 30/09/2014 28/10/2014 25/11/2014 16/12/2014

Alan Hall

Andrew McCall √

Anoushka de Almeida-Carragher

√

Barbara Pattinson

Carolyn Campbell-Cole

Chris Mottershead

Chris North

Cllr Robert Evans

Cllr. Catherine McDonald

Cllr. Jim Dickson

CV Praveen

David Sullivan

Derek Cookson √

Diane Summers

Eniko Benfield √

Fiona Clark √

Godwin Ubiaro

Helen Mencia

Jan Thomas

Jim Gunner

Joe Onabaworin

Madeliene Long

Michael Robinson

Michelle Pearce

Michael Pedro √

Nanda Ratnavel

Nicky Hayes √

Pam Cohen √

Patti Kachidza

Paul Corben

Penny Dale √ √

Phidelma Lisowska

Phyllis Barnett

Enc 2.2

12

25/03/2014 29/04/2014 27/05/2014 24/06/2014 29/07/2014 26/08/2014 30/09/2014 28/10/2014 25/11/2014 16/12/2014

Pida Ripley √

Rachel Burman

Richard Gibbs

Stuart Owen

Sue Gallagher

Tom Duffy √

Warren Turner

Date Highlighted in blue denote meetings held in bromley area The Go See Visit has been cancelled for the Field highlited in Red as there is full day of meetings on this date.

1

Membership & Community Engagement Committee Key discussion points & actions arising from the meeting on

08 April 2014

Issue Discussion Point/Action Lead

Learning from other organisation: Millwall Community Trust

Richard White, Community Development Team Leader at Millwall Football Club Community Trust outlined MiIllwall Community Trust’s (MCT) approach to engaging with the community in a positive way through a wide variety of outreach and community activities with the aims of:

promoting healthy lifestyle opportunities and awareness campaigns; and

providing social opportunities, particularly for young people.

MCT work with a wide range of different partners, including schools, disability groups, over-50s groups, young offenders’ institutions, Southwark NHS and local fitness centres. When approached, MCT support initiatives run by other organisations. They receive support from the football club and local media promote activities. Once a month MCT sends out a news update and occasionally a brochure. Recent programmes have included: ‘Kick the habit’ smoking cessation; cardiac awareness; prostate cancer awareness and tackling obesity. The Committee discussed what opportunities there might be for King’s to link with MCT to promote public health and the Chair invited suggestions from Committee members.

Governors in the Community

Jan Thomas presented a summary of the involvement and engagement activities she has undertaken since 23 January and a written update from Michelle Pearce was circulated. Penny Dale provided an update on her efforts to explore the Bromley area in order to understand which the appropriate groups to become involved with are and what opportunities there may be to engage. Patti Kachidza reported on her involvement with the Maternity Services Committee and how valuable it is for governors to get involved at first hand and talk to those working ‘at the coal face’. It was noted that governors can act as ‘eyes and ears’ for the Trust and can add to the stakeholder database that Sally Lingard and team maintain.

2


Membership Engagement

Rachel Sugarman reported that the Trust now had circa. 21,000 members, including staff. RS outlined proposals to widen the Trust’s programme of engagement and provide additional opportunities for members to get involved. The Committee noted that engagement activities have been divided along the ‘Involvement Continuum’ and the intention is to offer more incentives/benefits to members; to retain members and encourage them members to become involved in activities across the whole spectrum at different points in their membership, It was also noted that these proposals will feed in to the Membership Engagement Plan for 2014/15 which will be monitored through this Committee. Tamara Cowan outlined the timetable for the governor elections to be held this summer and the proposed programme of promotion and engagement activities around them. The Committee noted that there would be several occasions when governors were called upon to help with promotional activities.

Engagement with the Public

Sally Lingard outlined planning for the Trust’s Annual Open Day which this year will take place at the PRUH. The Committee noted that the charity would provide funding for the event and that is was a valuable opportunity to welcome the local community. Governors are invited to volunteer for the membership recruitment stand and make suggestions for other stands/activities and how the day could be used as an opportunity for members and governors to get involved. The Committee had a lengthy discussion about how the Council might self-assess its performance in meeting its obligations (according to the Code of Governance) and provide assurance to members that it is doing so. It was noted that there are a number of mechanisms already in place e.g. overview of governor activity at Annual Members Meeting presented by Lead Governor, ‘Governors in Focus’ feature in @King’s, section in Trust annual report. It was agreed that it was not a case of producing new or more information but reviewing whether the information was being presented/organised in the most effective way which made it:

accessible to members;

reflective of the personal experience of governors;

useful in engaging members/encouraging members

All Govs

3


to stand as candidates and/or vote in governor elections.

The Committee noted the outline for the forthcoming edition of @King’s which will include a special feature on the summer governor elections.

Annual membership Report: Annual Plan Submission

RS presented the membership report which included a break down analysis of the current membership numbers, demographics and a comparison with 2012/13.

The report also outlined membership engagement activity over the past 12 months.

The Committee endorsed the report and noted that the information contained in this report would be submitted as part of the annual plan submission to Monitor.

Transport Feeder Group

The Committee discussed the Trust’s relationship with the Transport Feeder Group. It was agreed that the business of the Group is now only peripherally connected to the Trust and as regular attendance by governors was very low, the following proposal should be put to the Council of Governors for approval:

Disband the group but continue to maintain relationships with the external stakeholders that currently sit on the group; and

Add ‘transport issues’ to the Committee’s agenda as a standing item in order to track the issues that are relevant to the Trust and make recommendations as appropriate.

This page has been left blank

SUBJECT TO CHAIR’S APPROVAL Enc. 2.3.2

Governors’ Strategy Committee Key discussion points & actions arising from the meeting on

10 April 2014


Trust-wide Strategic Matrix Q4

David Dawson, Deputy Director of Strategy, presented the Trust’s Strategic Matrix for quarter 3 which outlined Trust-wide and divisional strategic priorities. The Committee noted that progress towards achievement of the Trust-wide and divisional strategic priorities should be considered in the context of the enormous operational pressures the Trust had been under in recent months. In particular the Committee noted progress of the integrated care programme; utilisation of the Clinical Research Facility, a KHP facility that allows more complex and advanced clinical trials; resubmission of the Outpatients transformation business case outlining implementation in a phased way; new orthopaedic theatres at Orpington having a positive effect on waiting times for elective procedures; and gynaecology services replicating the service provided at the Denmark Hill site have been established at the PRUH. George Alberti, Trust Chair, reported that discussions with Guy’s and St Thomas’s and commissioners were on-going in relation to the model for providing vascular services. The Trust Board were uniform in advocating a one team, two site approach. Pedro Castro, Interim Director of Strategy, reported that the Trust’s portfolio of tertiary services was being considered as part of the development of the 5-year strategic plan. Understanding commissioner intentions, practicalities and financial implications were all for consideration.

Strategic Issues

Joe Farrington-Douglas, Senior Strategy Advisor, outlined current key issues for the Trust’s strategy. The Committee noted that Simon Stevens had started his role as Chief Executive of NHS England and his inaugural speech had indicated a shift towards new models of care and joint working. The Committee discussed NHS finances, an area of significant concern which had recently been highlighted by the publication of Monitor’s 3-year strategy, commentary in the Health Service Journal and the prospect of severe local authority cuts.

Current pressures, Operational Plan and Strategy Development

Pedro Castro and Simon Taylor, Chief Financial Officer, presented data outlining current pressures on Trust beds and services. It was noted that this had been shared with commissioners and that it provided context for the 2-year operational plan and 5-year strategy which incorporated financial, operational and quality planning. The Committee noted that the Trust would be submitting to Monitor what it considered to be an achievable financial plan. Key elements were the need to balance emergency and elective care and to ensure funding for creating extra capacity/further expansion of the Trust’s estate.

SUBJECT TO CHAIR’S APPROVAL Enc. 2.3.2


It was noted that it was paramount to maintain patient safety, experience and quality of care and that this required a better planned way of working. Peer hospitals within the Shelford Group were facing similar pressures. Meeting the capacity requirements over a 3-5 year period has implications for staffing and the Committee noted that there was a need to incentivise medical staff to work at the Trust and to reach a pan-London agreement in relation to agency working. It was also noted that a partnership approach was vital, particularly in areas such as repatriation and delayed discharge and provision of mental health beds.

Update on Organisational Development Strategy

Sarah James, Associate Director of Education and Development, provided an update on the activities that have commenced as part of the organisational development strategy. The Committee noted that cultural integration was hard to achieve and that although some progress had been made, there were no ‘quick fixes’. The activities fall under the broad areas of: leadership and talent; patient experience and safety; performance assessment and development; and continuing professional and personal development. In particular the Committee noted that the results of the recent cultural integration survey would be considered alongside feedback from King’s in Conversation to produce definitive areas of action. It also noted the need for improved training and education facilities at the Princess Royal University Hospital in order to reach compliance with required levels of statutory and mandatory training. Phase 1 had been approved and received funding. Further funding options were being explored.

Transformation and Integration Programme

Anand Shah, Director of Transition and Integration, delivered a presentation on the progress of the integration programme six months on from the acquisition. The Committee noted that the Trust was now operating on many sites and services and that approx. 3000 staff had been integrated into the enlarged organisation, with robust leadership models now in place. These were all achievements on a journey to improve, integrate and innovate within the enlarged organisation. The Committee noted key issues and risks to the success of the integration programme including severe operational pressures, recruitment issues, financial pressures and cost improvement plans, and the interest and scrutiny of external stakeholders e.g. MPs, Health Overview and Scrutiny Committees. The Committee discussed current priorities and actions which included cultural integration and Monitor’s review 12 months following acquisition; encouraging behaviours in line with King’s Values and resolving issues with some senior medical personnel; visibility of senior staff at the Trust’s new sites, including governors, as part of a communications and engagement programme of activity.

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Patient Experience & Safety Committee Key discussion points & actions arising from the meeting on 10 April 2014


Hospital to Home Volunteers

Sam Block, Senior Change Leader presented the Hospital to Home (H2H) Volunteers Project. Key points included:

The Trust obtained some funding to help implement new initiatives such as the H2H volunteers’ project;

The aim of the project is to empower volunteers to help bridge the gap between hospital and home;

The H2H service model keeps volunteers within the ward team to ensure appropriate support and training is provided to the volunteers;

An extensive and robust recruitment and training process have been put in place that ran in parallel with preparing volunteers for the H2H programme;

Staff identify patients who may benefit from home visit following discharge and volunteers are involved from early on to build a rapport with the patients whilst on their ward; and

Patient feedback has strongly supported this service but it has been challenging to gather more timely feedback. Increased resource for in-person feedback and an action plan is in place to improve obtaining more patient feedbacks.

The Committee noted the update and commended the team for the innovative project, which may help improve discharge performance and importantly, the experience of patients leaving hospital.

National Inpatient Survey Results

JW presented the results of the 2013 National Inpatient Survey, which was published in February 2014 from the sample drawn in July 2013.


Data from the PRUH is not included but a comparative report was run based on data collected internally;

Overall, there has been a slight drop in performance. The Trust was rated Red in 3 questions with ‘notice of discharge’ and the ‘length of time on waiting list’ scoring particularly poorly compared to 2012 scores;

The significant pressures faced by the Trust and the unprecedented volume of patients coming to the Trust, is impacting adversely on the organisations operational processes. As a result the Trust has seen a shift to red scores;

The full and final report to include national comparative data would be published by the CQC on 08 April 2014; and

Action plans will be reviewed and implemented to improve on areas of poor performance. The key areas of focus would be ‘discharge’, ‘waiting lists’ and ‘ED’.

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The Committee noted the report and highlighted that a different approach should be considered to improve ‘information giving by the anaesthetist’. This will be discussed with the Medical Director and at the Patient Experience Committee.

Listening to Patients

TD reported on his involvement in the ‘Kings in Conversation (KiC)’ programme and presented a summary of some patient feedbacks from Dawson Ward.

Key discussion points included:

The patient feedback highlights that ‘patient anxiety’ is often an area of concern;

Delivering patient centred care in a very busy hospital is very challenging but it is what Francis calls for;

NH highlighted that a project is underway to improve on issues around handover, bedside communication, noise at night and delivering patient centred care. The patient feedback findings would be useful source of information for training purposes;

An area that can be explored further by the Trust is impact of volunteers on patient outcomes; and

KiC results should be consolidated and incorporated with the cultural change programme. Governors would be interested to be involved in the cultural change programme.

The Committee noted the feedback and suggested that there should be an update on the Dignity Project at a future PESC meeting.

NH

Quality Accounts

The Committee noted the draft Quality Report with some minor updates since it was reviewed at the last Council of Governors meeting on 05 March 2014.

The following key points were noted:

The report outlines performance of the Trust against last year’s priorities and set outs the priorities for next year; and

The draft quality report went for consultation to stakeholder and Governors on 09 April 2014. Any comments and feedbacks should be forwarded directly to Helen Day, Associate Director of Nursing by 02 May 2014.

The Committee noted that the final draft report will be presented at the next Council of Governors meeting on 15 May 2014 before it is approved as part of the Trust’s Annual Report & Accounts (ARA) at the Board of Directors meeting on 27 May 2014. The final ARA would be submitted to Monitor on 30 May 2014.

Serious Complaints Committee

TD reported on the work of the Serious Complaints Committee, which he is member of.

The following key points were noted:

Numbers of complaints are running at 1200 per year and target response rates are not being met;

The Serious Complaints Committee is Chaired by Faith

3 of 3


Boardman, Non-Executive Director and its purpose is to improve patient experience and safety as well as preventing recurrence and in due course to reduce the number of complaints;

Case studies are being considered and discussed in depth at each Serious Complaints Committee meeting;

Learnings are currently identified and shared with divisions to use as a training tool; the Committee will address how learnings can better be implemented across the Trust; and

On the evidence of the case studies, responding to complaint is not a universal talent. It requires clinical knowledge and expertise but it is also important to be compassionate and focussed on the patient’s needs n responses.

The Committee noted the updated and requested GW and HD to be invited to a future Committee meeting to report on the “Commit to Care” initiative which has recently been launched at the PRUH site

GW/HD

Patient Experience Report

The Committee noted the Patient Experience Report for month 11 and key points included:

The Trust is engaging with Monitor on monthly basis to discuss the Referral Time to Treat (RTT) performance. To date, Monitor is satisfied with the Trust’s action plans to track RTT performance;

The issues of long waiters and delayed discharge were discussed. Governors expressed concern for patients who have to wait for long periods to be treated. It was highlighted that long waiters have been a key focus of the Trust. The majority of long-waiters are obesity surgery and bariatric surgery patients, both of which are high demand services; and

Patient pathways and moving patients faster through the system is an area of concern. The Trust is in continuous discussions with the Commissioners in relation to repatriation.


Enc. 2.3

Board Report to CoG 15 May 2014 1

Report to: Council of Governors Date of meeting: 15 May 2014 Presented By: Tim Smart, Chief Executive Subject: Board of Directors’ Report to the Council of Governors Purpose of the Report: To provide the Council of Governors with an overview of the key strategic, operational and performance issues facing the Trust. Action required: The Council of Governors is asked to receive the report and is invited to ask questions or to discuss the issues raised in the report.

Enc. 2.3


Board of Directors’ Report to the Council of Governors

15 May 2014 | Introduction

There is good reason to feel apprehensive about another, tougher year of financial and operational challenges. The expansion of the Trust through the acquisition last October of sites and services from the former South London Healthcare Trust, including Princess Royal University Hospital (PRUH), marked the most important strategic development in 100 years of King’s College Hospital. It also brought many challenges. Patients have continued to flow into our hospitals, there is huge demand for our services, and the Board has become increasingly alert to the intense pressure on our human, building and financial resources. I anticipate that when foundation trusts across the country submit their 5-year projections to Monitor at the end of June, several will be forecasting very difficult financial futures. Simon Stevens is the new chief executive of NHS England and spoke frankly about such pressures in his first speech in his new role. He also spoke of the biggest team effort the NHS has ever seen. We at King’s recognise and value team work. The Board is working hard to develop and maintain relationships with those who commission our services, those who regulate them and of course those who use them. By working together we will find ways to become a stronger and more sustainable organisation, not least because the frontline staff who provide excellent care to patients feel supported and encouraged to innovate. Our new staff and public governors and the members they represent have added to the richness of King’s. They are a valuable link and source of energy and I thank them for the enthusiasm with which they have joined Team King’s. | Key Strategic Issues

1. Strategic Forward Plan

All foundation trusts were required by Monitor to submit a two-year operational plan and financial projections on 04 April. King’s is now three hospitals in one plus many additional services at other sites across outer south east London. We are an exceptionally busy acute emergency hospital, a very large district general hospital, and a tertiary specialist hospital with high impact academic research. All of these elements were taken into account when preparing the forward plan. Governor input to the process was of significant value. Underway now is development of a longer term 5-year strategic plan, to be submitted to Monitor at the end of June. Together these two plans will be used as a cornerstone of scrutiny and assessment of organisational fitness and progress over the medium and long-term. Compassionate, high quality, patient-centred care is uppermost in our minds and a central tenet of the All Together Better transformation programme, but it is inevitable that important, sometimes difficult, decisions will need to be taken to ensure financial sustainability.

Enc. 2.3


On behalf of the Board I would like to thank governors who participated in community meetings and the Board to Council joint meeting in March. Your ongoing input and views about the future direction of the hospital and its services are a valuable part of the process. 2. King’s Health Partners

The new governance structure of KHP is now in place and functioning well with Professor Sir Rick Trainor as Chair of the KHP Board. Both the KHP Board and the KHP Executive Board held their inaugural meetings in mid-April. Chief Operating Officers and the Clinical Academic Development Group are holding regular meetings. It is anticipated that the new structure will promote improved working relationships, support progression towards developing a full business case for closer integration and a provide a resolution for a model for providing vascular services across the two acute trusts. Johns Hopkins Medicine in the United States is a leading international example of an integrated approach to translational research, clinical care and education and it is hoped that a delegation from KHP will visit Johns Hopkins later this year to share learning. Integrated care will be a particular focus for all partners this year and Matthew Patrick will be leading on this on behalf of KHP. 3. Integration and Culture Change: All Together Better

One of the key themes of the 2-year operational plan which the Trust has submitted to Monitor is the transformation programme: All Together Better. Transformation is a broad term but it encapsulates efforts to integrate all sites and services and the change in culture that is required to make the organisation stronger and sustainable in the long-term. In real terms this will mean changes to buildings, configuration and location of services, working practices and staff. Feedback gathered through ‘King’s in Conversation’ listening events, which were conducted across all sites between May 2013 and March 2014, have been distilled and incorporated into transformation plans along with output from the recent culture survey. Doctors, nurses, AHPs and managers working effectively together; promoting positive behaviours and performance; and empowering staff to take decisions provide the foundation of the All Together Better programme. At a more granular level, cross-site issues and issues specific to each individual site within King’s have been identified. It is important that all of the benefits of being an enlarged, multi-site organisation are realised and that challenges are overcome through innovation and through constructive working relationships with commissioners, regulators and partner organisations. It is an ambitious vision but the Board remains committed to achieving one high-performing hospital across our now multiple sites, delivering consistently high quality care at every patient interaction. 4. Progress with Capital Projects

The Trust now has three estates to maintain and with demand for additional capacity rising there are a number of projects in progress to build new facilities and improve existing ones in order to enhance the environment for patients and staff and to improve efficiency.

Enc. 2.3


Site-wide Infrastructure Project, Denmark Hill – Phase 1 of this new project to improve infrastructure across the Denmark Hill site is near completion. Detailed design works for the second phase are now being progressed and will involve some preparatory works for the helipad. Helipad, Denmark Hill – Final logistical arrangements are being made with the contractor and it is anticipated that building work will commence in summer 2014. Ultrasound Expansion, Denmark Hill – Plans for the expansion of the ultrasound unit in order to address capacity, single sex compliance and privacy issues are in place, with a view to commencing works in the new financial year.

Princess Royal University Hospital (PRUH) and Orpington Hospital – A variety of modular schemes are being considered to address capacity issues for some clinical pathways and the need for on-site training and development facilities. This is in addition to the remodelling of a number of areas including paediatric outpatients, the antenatal clinic, gynaecological wards and the receipt and distribution zone at the PRUH. | Current Operational Challenges

5. Operational Performance

Both the Denmark Hill and PRUH sites were extremely busy throughout the final quarter of 2013/14. On Monday 17 March the highest recorded number of attendances was recorded at the Denmark Hill emergency department. Non-achievement of the emergency care target in quarter 4 is consistent with the Trust’s annual plan submission to Monitor; however, management of this performance target remains a priority for the Trust on both sites and action plans for both sites are reviewed at the Emergency Care Board meetings. These action plans have been informed by learning from the planned internal incidents which took place at Denmark Hill and the PRUH in January and March respectively. Five cases of C-difficile were reported during March at Denmark Hill, bringing the year-end total to 49 cases which is consistent with the annual trajectory of 49 cases. One case of C-difficile was reported at the PRUH during March bringing the total number of cases reported since October to 13, which is above the year-end trajectory of 10 cases. In the new financial year the Trust has a combined site trajectory of 58 cases. This will be a challenge to achieve. Infection prevention and control will remain an area of focus for the Trust, particularly given the rise in incidence of multi-resistant organisms such as CRE. Referral to treatment (RTT) targets for admitted completed pathways have been a key area of focus at the Denmark Hill site this year. Efforts were focussed on reducing the backlog position for patients waiting for 18-weeks or more. In the new financial year the Trust will look to use data tracking systems comparable with those used to track patients waiting for cancer treatment in order to improve this position. At the PRUH site, the RTT incomplete pathway target was achieved; the admitted and non-admitted completed pathway targets were not achieved The number of complaints that the Trust management teams are handling since the acquisition of the PRUH have doubled which has impacted on our ability to respond to them within 25 working days. The number of responses that were either still open or not responded to within the 25 day internal target increased from February to in

Enc. 2.3


March. The Serious Complaints Committee continues to meet to review Trust processes and metrics for responding to complaints. Scores for the ‘How are we doing?’ patient experience survey at the PRUH improved slightly in March, although they remain below target. For Denmark Hill, the overall section score for questions about the environment fell to one point below the target of 79, but section scores for questions about care perceptions and patient engagement achieve their targets. Following last month’s Board meeting, I am delighted that a number of governors joined us on a number of Go-See visits to wards on Denmark Hill. There is no doubt that governor involvement brought a different dimension. 6. Financial Performance

In summary, at the end of month 12 (March) the consolidated financial position of the Trust across all sites and services of the Trust had an operational deficit position of £3.161m, against a planned year to date surplus of £6m. This is an adverse variance from plan of £9.161m but a better than expected year-end position due to an increase in completed tertiary activity during the final months of the year. Monitor’s continuity of service risk rating (CSRR) is intended to flag the risk of insolvency over the next 12-18 months on a scale of one to four, with the lowest rating signifying the highest level of concern. At month 12 the Trust has been rated 3, which is in line with the CSRR forecast in the annual plan. There are several reasons behind the adverse financial position and these are closely linked to clinical and operational strategies. One key driver is the high level of spending on temporary staff throughout 2013/14. Where there is high demand for services there is a corresponding demand for qualified, trained staff and as the organisation has expanded it has been necessary to fill gaps, particularly where there are long-standing vacancies. A recruitment drive for nursing staff is under way, with a focus on increasing establishment at the PRUH, and further campaigns will run in 2014/15. | Review of the Last Quarter

Throughout the year members of the Board are pleased to attend the various events held here to engage members, staff and the local community with our work. We also spread the word through the wider media. These are a few of the highlights from the past two months: Following the Council of Governors meeting on Wednesday, 05 March, the second community event was held at Bromley Central Library as part of consultation and engagement in relation to the annual planning process. Unprecedented numbers of members attended to hear about plans for the future and to participate in round-table discussions about key issues facing the Trust which have fed into our strategic thinking. Dignity Month 2014 culminated with the Dignity Awards on Monday, 17 March. Palliative Care won the award for their work in delivering dignified, compassionate care to patients with palliative care needs. The Chairman, George Alberti, hosted the event and presented the awards assisted by Mrs Cecilia Anim, the Deputy President of the Royal College of Nursing.

Enc. 2.3


Friday, 28 March - The BBC reported on news that King’s, along with nearly two thirds of England's major A&E departments, missed the waiting time target of seeing 95% of patients within four hours during winter 2013/14.

Wednesday 10 April - The Nursing Times and local press in Bromley reported on the large nursing recruitment drive being undertaken at the PRUH. The articles detailed plans to attract 250 new members of staff, including both senior and newly qualified nurses, as part of a £3.5 million investment.

Friday 04 April - King’s celebrated the official unveiling of Howard Ward, a liver ward situated in Cheyne Wing. Professor Ted Howard was in attendance and formally opened the ward and a function in the Boardroom was held to commemorate the event. Professor Howard was a leading paediatric surgeon at King’s, who helped establish the liver service at the hospital.

Helipad appeal 02 May We need to raise £3.5 million for the helipad, which will be built on top of the Ruskin Wing at our Denmark Hill site enhance our ability to provide life-saving care for patients transferred to us by helicopter from across London and the south east. Governors, patients, staff and members are called upon to spread the word and help King’s raise the necessary funds.

On Friday 09 May the National Institute of Health Research and Wellcome Trust Clinical Research Facility will officially be opened by Professor Dame Sally Davies DBE, Chief Medical Officer. The Clinical Research Facility is a pioneering collaboration involving the NHS (King’s College Hospital NHS Foundation Trust and the South London and Maudsley NHS Foundation Trust), academia (King’s College London) and the pharmaceutical industry, to support world leading research across physical and mental healthcare.

Finance Report

Month 12 (March) 2014/15

Council of Governors

15 May 2014

Page 2

Report to: Council of Governors

Date of meeting: 15 May 2014

Subject: Finance Report – Month 12 (March 2014)

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

Presented by: Simon Taylor, Chief Financial Officer

Sponsor: Simon Taylor, Chief Financial Officer

History: Finance and Performance Committee & Board on 29 April 2014

Status: Information

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

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

2. Action required The Council is asked to note the Finance Report

Legal: Reporting to Monitor and Commercial Bank

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

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

from financial targets.

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

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

Clinical: There is no direct impact on clinical issues

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

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

Limits.

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

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

vacancies.

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

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

information to support the quarterly Monitor Return.

Other:(please specify) None.

3. Key implications

Page 3

Page 4

Month 12 Executive Financial Summary

Financial Key issues:

The Trust is reporting an operating deficit of £3.146m year to date excluding the asset impairment of £2.6m. The Continuity of Service Risk

Rating is 3.

The operating deficit reduced in month 12 by £2.8m (from £5.9m to £3.1m) as a result of the following income and expenditure movements:

accounting for the stock increase as at 31st March 2014 at a value of £3.959m.

additional work in progress income as at 31st March 2014 amounting to £2m. This is a result of additional patient incomplete spells

in hospital at year end (particularly additional critical care patients and elderly patients with a long length of stay).

commissioner contract income over-performance of £2.4m (DH) and £1.5m (PRUH) including year-end estimates for un-coded

activity.

final allocation of emergency recovery income from CCG/NHSE Commissioners (£5.5m).

These positive movements were consequently off-set by over-spends on pay and non-pay expenditure budgets primarily in the following

areas : TEAM (£2m), Surgery (£2.8m), Critical Care (£1.6m), Neurosciences (£2m) and Facilities (£1m -patient transport usage, utility costs

and PFI cleaning contract variations). Further details are provided on pages 23-24.

The Trust has managed to maintain a Monitor CSR financial rating of 3; despite the high emergency activity attendances/admissions,

operational capacity restrictions and staffing cost pressures. This financial position has been achieved through material non-recurrent

funding such as emergency recovery plan funding (£8.6m) and project diamond support (£2.6m); plus the PRUH transactional support.

The financial challenge for 14/15 will be to ensure these non-recurrent funds are once again provided by the CCG/NHSE Commissioners.

The reduced transactional support has to be covered by the Cost Improvement Programme (CIP); on top of the national 4% efficiency

target. A £53m CIP plan for 14/15 is being developed into detailed action plans for monthly monitoring (see page 11).

Annual Budget YTD Budget YTD Actual

Month 12 YTD

Variance

Month 11 YTD

Variance

Movement in

Month

£'000 £'000 £'000 £'000 £'000 £'000

Income (excluding off Tariff Drugs) 801,137 801,137 836,625 35,488 21,935 13,553

Off Tariff drugs Income 45,122 45,122 54,182 9,060 7,635 1,425

Pay (471,731) (471,731) (499,270) (27,539) (22,428) (5,111)

Non-Pay (excluding off tariff drugs) (283,419) (283,419) (296,875) (13,456) (12,502) (954)

Off Tariff Drugs Expenditure (45,122) (45,122) (54,182) (9,060) (7,635) (1,425)

Capital Charges, Interest and Dividends (44,987) (44,987) (44,670) 317 1,803 (1,486)

Surplus from Subsidiaries & Associates 1,000 1,000 1,044 44 0 44

Consolidated Operating Surplus/(Deficit) 2,000 2,000 (3,146) (5,146) (11,192) 6,046

Impairment Expense (8,000) (8,000) (2,648) 5,352 0 5,352

Consolidated Annual Surplus/(Deficit) (6,000) (6,000) (5,794) 206 (11,192) 11,398

Gain on Transfer by Absorption 0 0 68,461

Reported Surplus/(Deficit) (6,000) (6,000) 62,667

Page 5


Draft Annual Accounts

The Trust’s draft annual accounts were submitted on 22 April 2014 and in line with DoH/Monitor deadline.

The transfer of services from SLHT has been accounted for by use of absorption accounting in line with the Treasury Financial Reporting

Manual (the FReM). The gain resulting from the transfer of assets and liabilities from SLHT has been recognised in the Statement of

Comprehensive Income, and disclosed separately from operating costs.

The stock increase has been noted and the other material increase is NHS receivables and accrued income. The increased outstanding

debt sits with NHSE (£11.6m transactional support and £22m contract over-performance).

The Trust has also raised invoices to the SLHT legacy office/TDA for £1m which relate to costs not disclosed in the transactional business

case. They include prepayments charged to KCH prior to 1ST October, additional PDC dividend and Jr Dr rota payments. Additionally, there

are still unresolved un-budgeted cost pressures relating to the PRUH pathology service (contracted out to Lewisham Hospital); and the

Women’s & Children’s service which were not reflected in the transaction agreement and need to be recovered through the TDA.

The balances transferring from SLHT are also reflected in the draft accounts based on the accounts submitted by SLHT legacy office on

17TH April 2014, although King’s has not included the negative cash balance of £2.645m which SLHT is using to zero out the net working

capital position (inventories, total receivables, total payables and total provisions). This difference was not notified until the 17th of April and

this cash balance needs to be underwritten by the TDA as the Trust was not anticipating any cash impact of working capital liabilities. The

potential impact would be to increase debtors and reduce the net transfer of services from SLHT.

Land and building asset valuations were undertaken as at the valuation date of 31 March 2014. The revaluation resulted in an increase of

£4.253m in the value of land owned by the Trust and an overall increase to buildings and dwellings net book value of £53.142m.

A net impairment amount of £2.648m has been charged to the Statement of Comprehensive Income. This is as a result of an impairment of

buildings totalling £4.043m, offset by the reversal of prior year impairments of £1.395m where building values has increased in 2013/2014.

The buildings which decreased in value include CDU Modular building (£650k), Infill Block 4 (£769k), Cheyne Wing Block 4 (£1.403m),

Denmark Wing (£476k), Unit 8, KCH Business Park (£587k) and other buildings (£158k).

The actual impairment value was below budget due to the increased property valuation indices used by the District Valuer and the reversal

of previous impairments.

Page 6


Contract income over-performance

As at month 12, the LSL contract over-performance position is £17.7m, BBG over-performance position is £13.3m and the NHSE over-

performance position is £25m. The BBG CCG’s contract income level is capped for the PRUH and a financial control total regarding

income over-performance has been agreed with LSL CCG’s. The Trust has received confirmation of the Project Diamond funding

(£2.6m) and the R&D MFF income (£0.7m). This is transitional funding and the proposal is for this income stream to be wrapped up in

PbR prices for 15/16.

The number of elective patient spells are still above last years phased outturn; which are partly driving the income over-performance

(see page 20). However the medical outliers are still adversely impacting on the potential income of the Trust (see pages 21-22). The

Trust is potentially under performing against income by £1.8m per year due to General Medicine patients outlying in other wards.

Operating Expenses

Medical and Nursing staff costs are still over-spending due to locums and agency staff to cover vacancies and to meet the increasing

patient activity levels, patient acuity and vacancies.

TEAM, Critical Care, Liver, Surgery , Neurosciences are the key areas of concern regarding agency and locum spend (see pages 25-

26). There is still an upward trend despite the recruitment plans.

Year-to-date Trust-wide expenditure for off-site working is £6.1m.

The drugs expenditure is £13m over-spent to date and there has been a steep increase in usage since July (see pages 27-31). This is

due to additional off-tariff drug expenditure of £7.6m and a greater usage in general drug expenditure across all divisions. A concerted

effort to improve the drug expenditure reports with activity data will commence in 14/15 in order to challenge the Division’s, who all

have dedicated pharmacy support.

Cost improvement Programme

The overall achievement to date is 73% against plan. The CIP value achieved to date is £14m and income generation is £19m (see

pages 32-33). A contingency reserve was established to mitigate the KCH schemes and the remaining gap should be covered by

additional activity capacity coming on line. There are a number of PRUH schemes that have now been deemed unachievable by the

Division’s and this is a concern going into next year. This will put pressure on the Trust to achieve synergy CIPs earlier than planned

but this is very dependent on ICT implementation plans and service patient pathway reconfigurations.

Page 7


Capital and Cash

The capital plan for 13/14 was over-spent by £12.2m primarily due to the delivery of the Orpington Hospital development to meet the

capacity pressures (building works £1.8m and equipment & IT £2.3m). A further £1.7m re-phasing on the Energy Performance

Scheme, upgrading of Christine Brown ward (£1.3m), Infill Block 5 (£0.8m), site wide infrastructure projects (£6m) and general Medical

Equipment purchases and replacements (£1.8m) all contributed to the over-spend.

The 2 major capital development schemes impacting on the future capital plan are the new Helideck (£5m) and Infill Block 5 (£80m). A

business case will be submitted to the TDA in due course; now that the capital costs have been provided by the Estates Department.

The development will require £60m external borrowing from the FTFF and will require commissioner support. The capital charges and

the surplus contribution have been built into the 5 year plan.

Outstanding debts from NHS England currently total £33.6m (including £11.6m transactional support and £22m contract over-

performance). Outstanding CCG SLA and SLA over-performance debts total £25m; including emergency plan monies and maternity

pathway WIP. This will not impact on the risk rating but will generate a delay in payments to creditors.

The Trust has received the PRUH PDC transactional funding (£23m) and part payment of the revenue integration funding from NHSE

(£28.975m).

Page 8

Capital Plan Summary 2014-2016

Schemes

2014/15

£'000

2015/16

£'000

Critical Care Unit (Including new MRI build) 15,693 30,294

Unit 7 & 8 (TDA Building) 10,000 30,000

Site Wide Infrastructure 3,000 1,500

Helideck 5,000 900

Other Major Works 3,283 2,450

Orpington Hospital 1,460 250

PRUH Hospital 1,200 80

Minor Works (including PRUH & Orpington) 2,454 2,936

ICT 2,420 1,650

Medical Equipments 2,956 1,250

Integration Projects 6,370 1,200

Total Capital Budget Expenditure 53,836 72,510

CCU Capital Expenditure (Loan) 11,708 30,294

Unit 7 & 8 Loan (£40m) - 20,000

Net Spend after CCU and IB5 Loan 42,128 22,216

TDA Funding (£20m) 20,000 0

Donated - Equipment 250 250

Donated - Adult Cystic Fibrosis 0 430

Donated - Helideck 1,000 0

Safer Hospitals Safer Wards 920 0

Integration PDC Funding 1,600 900

Integration Funding Carried forward 5,770 300

Depreciation (Incl PRUH & ORP) 22,141 23,603

Total Funding 51,681 25,483

Additional Funding (Available) / Required (9,553) (3,267)

Page 9

Month 12 Capital Summary

Capital Plan

The annual budget for 2013/14 was reduced from £52.586m to £20,292m due to the re-phasing of the Critical Care Unit

(£31.966m) between 13/14 and 14/15. In 13/14, £3.365m for the Critical Care Unit was funded from the loan received from the

Foundation Trust Financing Facility.

£277k of the Capital Plan was funded by charitable donations, £3m is funded by an Energy Grant from the Department of

Health Energy Fund, with the remaining being funded by internal Trust resources e.g. Depreciation and surpluses. The £3m

budget for Orpington major works was funded by SLHT.

Actual Capital Expenditure

The actual capital expenditure for 13/14 was £12.232m above the Trust’s planned capital budget.

Below is the breakdown of the schemes contributing to the overall variance.

Revised Annual Actual Spend 2013/14

Scheme Plan - 2013/14 2013/14 Variance Comment

£'000 £'000 £'000

Maternity & Paediatrics 1,280 1,618 338

Additional costs for Fees and VAT, and project now incorporates the

refurbishment of Suites 4 & 7 in the Golden Jubilee Wing

Emergency Centre 1,279 684 (595)

Lease of a 2 storey Portakabin with CDU and Paediatric beds has reduced the

need for capital spend on this project.

Christine Brown Ward upgrade works - 1,274 1,274 Upgrade of Christen Brown to level 2 use

Sitewide Infrastructure - 5,954 5,954 Previously funded from CCU contigent fund

Infill Block 5 (Annie Zunz) 826 826 Previously funded from CCU contigent fund

Trundle Ward 750 178 (572) Scheme aborted

Energy Performance Contract 4,000 5,642 1,642 VAT excluded from initial estimate and payment to supplier has been re-phased

Ultrasound reconfiguration 700 58 (642)

Scope of project reduced due to design viability issue, remaining project to be

carried forward

CT Scanner Enabling Works - 85 85 Additional enabling works to install CT Scanner on ground floor of GJW

Diabetic Foot Clinic 300 13 (287) Project to be carried forward

Mortuary Expansion 300 - (300) Project delayed due to works been carried out on Infill Blk 5

Decked Car Park 500 20 (480) Project to be carried forward

Endoscopy 750 674 (76) Project underspend

Other major projects 2,056 1,867 (189) Project underspend

Minor Works 1,000 981 (19) Project underspend

Medical Equipment 1,165 2,855 1,690 Additional funding required for Infill Block 4 Equipments and ED CDU unit

IT & Intangible 3,212 3,425 213

Orpington Major Works 3,000 4,780 1,780

Overspend due to change in planned use of Orpington hospital resulting in

additional works been carried out.

Orpington Equipment & IT - 2,277 2,277 IT Infrastructure, theatre and therapies equipments for Orpington Hospital

Total - KCH 20,292 33,211 12,919

PRUH - Estate projects 1,954 1,954 Additional works due to integration of PRUH

Integration Project 3,313 672 (2,641)

Total - PRUH 3,313 2,626 (687)

Total capital budget/ forecast /

variance (+ over, - under spend) 23,605 35,837 12,232

Working Capital - Debtors

Page 10

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

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

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

£ £ £ £ £

NHS BodiesCCGs 25,645,711 16,645,759 1,082,037 738,912 7,179,003

NHS England 33,650,288 23,099,068 3,433,851 5,952,379 1,164,990

Department of Health 254,415 251,594 47 393 2,381

Provider Trusts 8,033,931 3,428,049 1,193,565 697,187 2,715,130

NHS Trade Debtors 67,584,345 43,424,470 5,709,500 7,388,870 11,061,504

Provision for Bad Debts (1,687,458) - - - (1,687,458)

NHS Bodies Total 65,896,887 43,424,470 5,709,500 7,388,870 9,374,046

Non NHS BodiesScottish, Welsh & Irish Health Bodies 1,107,441 240,913 (4,919) 117,537 753,910

King's College London University 2,927,215 335,014 508,918 168,546 1,914,737

King's Charitable Trust 138,205 1,748 23,054 6,590 106,813

Other Non NHS Bodies 3,598,407 (222,986) 1,751,136 204,628 1,865,629

Non NHS Trade Debtors 7,771,268 354,690 2,278,188 497,300 4,641,088

Provision for Bad Debts (336,294) - - - (336,294)

Non NHS Bodies Total 7,434,974 354,690 2,278,188 497,300 4,304,794

Total Accounts Receivable 75,355,613 43,779,160 7,987,689 7,886,171 15,702,593

% of Total Outstanding - Month 12 100% 58% 11% 10% 21%

Month 11 100% 26% 8% 29% 36%

Private Patients Accounts Receivable 5,035,947 1,521,185 705,528 614,758 2,194,476

Provision for Bad Debts (108,235) - - - (108,235)

Private Patients Accounts Receivable Total 4,927,713 1,521,185 705,528 614,758 2,086,241

Overseas Visitors Accounts Receivable 3,995,059 654,140 790,186 385,347 2,165,386

Provision for Bad Debts (2,381,011) (215,625) (2,165,386)

Overseas Visitors Accounts Receivable Total 1,614,048 654,140 790,186 169,722 0

Total PP & Overseas Visitors Accounts Receivable 9,031,006 2,175,326 1,495,714 1,000,105 4,359,863

Working Capital - Creditors

Page 11

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

£ £ £ £ £

NHS Bodies 6,932,247 1,857,048 3,392,458 412,212 1,270,529

Non NHS Bodies 25,347,512 7,478,272 13,106,004 966,767 3,796,468

Total 32,279,758 9,335,320 16,498,461 1,378,980 5,066,997

% of Total Outstanding - Month 12 100% 29% 51% 4% 16%

- Month 11 100% 16% 50% 10% 25%

Statement of Financial Position (Balance Sheet)

Page 12

Trade and Other Receivables includes NHS and Non-NHS debtors on page 38

Trade and Other Payables includes NHS and Non-NHS creditors on page 39

STATEMENT OF FINANCIAL POSITION AS AT

Consolidated

31 March 2013

Qtr 1

30 June

Qtr 2

30 September

Qtr 3

31 December

Consolidated

Qtr 4

31 March

Consolidated

Annual Plan

Forecast

2013 2013 2013 2014 31 March 2014

£'000 £'000 £'000 £'000 £'000 £'000

NON-CURRENT ASSETS

Intangible Assets 1,399 1,246 1,151 1,297 1,767 1,370

Property, Plant & Equipment 270,311 272,045 275,140 297,345 335,131 326,627

Investments in associates 816 816 816 816 3,598 1,749

On-Balance Sheet PFI 76,496 73,111 72,646 202,017 236,487 187,200

Trade and Other Receivables, Non- Current 3,834 3,834 3,834 4,865 4,167 4,865

Total Non-Current Assets 352,856 351,052 353,587 506,340 581,150 521,811

CURRENT ASSETS

Inventories 11,333 11,250 13,299 14,960 15,293 13,520

Trade Receivables 38,684 17,871 32,398 62,514 68,111 41,015

Other Receivables 1,968 19,257 26,679 26,886 18,349 5,968

Impairment of Receivables (4,666) (4,821) (6,067) (7,024) (7,576) (4,667)

Other Financial Assets 5,866 51,228 40,823 42,772 34,511 9,613

Prepayments 3,258 5,188 6,429 4,582 4,739 3,258

Cash & Cash Equivalents 40,502 16,028 11,200 41,317 54,535 67,397

Total Current Assets 96,945 116,001 124,761 186,007 187,962 136,104

CURRENT LIABILITIES

Borrowings (1,135) (629) (567) (62) (1,090) (1,091)

Deferred Income (5,552) (6,199) (7,635) (5,473) (9,989) (4,442)

Provisions (3,316) (3,181) (1,327) (1,694) (1,144) (1,087)

Current Taxes Payable (4,095) (8,173) (8,147) (10,938) (11,004) (4,400)

Trade Payables (32,908) (33,358) (27,222) (30,728) (43,672) (31,948)

Other Payables (14,958) (18,724) (19,640) (8,092) (9,117) (17,054)

Other Financial Liabilities (31,664) (36,691) (49,287) (99,509) (74,090) (32,336)

Total Current Liabilities (93,628) (106,955) (113,825) (156,496) (150,106) (92,358)

Total Assets less Current Liabilities 356,173 360,098 364,523 535,851 619,006 565,557

NON-CURRENT LIABILITIES

Interest-Bearing Borrowings (15,349) (21,249) (27,449) (25,755) (49,542) (49,590)

Provision (6,893) (6,893) (6,893) (8,504) (6,886) (6,734)

Other Financial Liabilities (75,583) (75,584) (75,584) (146,696) (156,748) (150,901)

Total Non-Current Liablilities (97,825) (103,726) (109,926) (180,955) (213,176) (207,225)

Total Assets Employed 258,348 256,372 254,597 354,896 405,830 358,332

Financed By (taxpayers' equity):

Public Dividend Capital 135,678 135,678 135,678 161,904 162,873 162,929

Revaluation Reserve 87,538 87,757 87,302 87,566 144,998 88,913

Income & Expenditure Reserve 35,132 32,937 31,617 105,426 97,959 106,490

Total Taxpayers' Equity 258,348 256,372 254,597 354,896 405,830 358,332

Glossary

Page 13

CIP – Cost Improvement Plan

SLA – Service Level Agreement

PDC – Public Dividend Capital

PSPP – Public Sector Payment Policy

Working Capital Facility - represents a sum of money reserved by the relevant bank for potential use

by the Foundation Trust

Asset - An asset is a resource controlled by the enterprise as a result of past events and from which

future economic benefits are expected to flow to the enterprise

Liability - an entity's present obligation arising from a past event, the settlement of which will result in

an outflow of economic benefits from the entity

Equity - the residual interest in the entity's assets after deducting its liabilities

EBITDA – Earnings before Interest, Taxation, Depreciation and Amortisation

EBITDA Achieved (% of Plan) – measures the achievement of earnings against plan

EBITDA Margin (%) – Measures Earnings as a percentage of total income indicating underlying

performance

Return on Assets excluding Dividends – Net surplus before Dividends as a percentage of average

assets indicating financial efficiency

I & E Surplus margin net of dividends – Net surplus as a percentage of total income indicating

financial efficiency

Liquidity Ratio (days) - The liquidity ratio (days) indicates the number of days that net liquid assets

can cover operating expenses without further cash coming from cash sales of fixed or long-term

assets.


1


15/05/2014

2013-14 Month 12

Performance @ Denmark Hill

Roland Sinker

Chief Operating Officer



Subject: Performance Report, Month 12 2013/2014 (Denmark Hill)

Author(s): Steve Coakley, Acting Associate Director of Performance and Contracts

Presented by: Roland Sinker

Sponsor: Roland Sinker

History: Finance & Performance Committee & Board of Directors on 29 April 2014

Status: For Information

2

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

Monitor Risk Assessment framework for the Quarter 4 position. It also contains an update on the Trust’s

contractual position with the CCG’s and NHS England at Month 12 including the latest position on CQUIN

agreements.

2. Action required The Council has asked to note the M12 performance reported against the governance indicators defined in the

Monitor Risk Assessment framework for the Quarter 4 position for Kings performance at the Denmark Hill site.

3

Legal: Statutory reporting to Monitor and the DoH.

Financial: Trust reports financial performance against published plan.

Assurance: The summary report provides assurance that the Trust has met the performance targets

as defined within the Monitor Risk Assessment framework for the Q4 position with the

exception of the RTT 18 Week Admitted target and the 4-hour Emergency Performance

target. Based on our Q3 position, Monitor has written to the Trust in March and advised

that their current governance risk rating for the Trust is “Considering investigation”.

Clinical: There is no direct impact on clinical issues.

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

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

indicators for the Q4 position as defined in the Monitor Risk Assessment framework, with

the exception of the RTT 18 Week Admitted target as planned and the 4-hour

Emergency Performance target.

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

Workforce: None.

Estates: There is no direct impact on Estates.

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

Other:(please

specify)

3. Key implications

4

Contents

•Executive Summary

•Trust Performance Summary

•Divisional Performance Summary

•Regulatory/Contractual Performance

• Monitor 2013-14 Q4 position

• Contractual 2013-14 position update

•Specific Performance Reports

• Key Areas of Concern

• Infection Control Plan

• ED Action Plan Update

• RTT Action Plan Update

5

Executive Summary (1/7)

1. Denmark Hill 2013-14 Key Areas of Performance for Month 12:

1.1 Good Performance

Access Targets – Cancer waiting time targets have been achieved for Q4, despite the pressures on

inpatient beds, and have therefore been achieved for each quarter in 2013-14. Referral to Treatment

(RTT) for non-admitted completed pathways and RTT Incomplete pathway targets have also been

achieved for March and Q4.

Length of Stay (LOS) – The Elective LOS target of 4.7 days was achieved again in March at 4.6 days,

with Surgery, Haematology, Gynaecology and Child Health specialties achieving their division targets.

1.2 Performance challenges – 6 Areas

RTT Admitted – The RTT Admitted pathway target of 90% was not achieved in March and performance

reduced further to 81.7% of patients admitted within 18 weeks, but consistent with the Trust plans

submitted to Monitor. There was a slight increase in the admitted backlog which is reported in the RTT

Incomplete pathway return for the March month-end position to 1771 patients, compared to the 1,700

patients waiting at the end of February. This position is higher than the year-end trajectory of 1,250

patients which was last shared with the commissioners, and significantly higher than the original year-end

trajectory of 550 patients.

Emergency Care Performance – Emergency Care 4-hour All types attendance performance worsened

from 93.9% in February to 92.2% in March. 93.0% was achieved for Q4 for all types performance so this

Monitor indicator was not achieved for the final quarter, which the Trust did highlight to Monitor as ‘at risk’

of not achieving in the Annual Plan. There were over 11,000 attendances in the ED in March, the highest

volume of attendances seen within a month since July last year. There were 482 attendances in ED on

Monday 17 March which is the highest daily attendance that we have recorded. There are a number of key

factors impacting on delivery of the 4-hour performance target on the DH site.

• Internal capacity: There has been an increase in emergency medical and more recently growth in

emergency surgery demand which has meant that the 75 additional beds are required to treat

emergency activity in 2013-14 compared to 2011-12. There has also been a 53% increase in demand

for emergency critical care demand over the last 2 years.

6


• External factors: The acuity of patients seen in the ED has changed with an 8% increase in patients

seen in ‘majors’ as well as an increase in the number of mental health patients seen who can block

cubicles in majors for long periods of time impacting on breach performance. Typically 30-40 beds are

‘blocked’ with repatriation patients, 8-10 beds ‘blocked’ due to delays in placing rehabilitation patients

and additional delays in the system managing transfer of care patients.

• Internal issues and discharge pathway management: The recent ECIS LOS review highlighted a

number of internal process issues including waits for diagnostics, variation in consultant ward rounds

and challenges managing outlier patients. It also identified the need for developing the system to

support the principle that decisions about long-term care are not made in hospital in the context of

delivering a ‘discharge to assess’ mind-set.

Health Care Acquired Infection (HCAI) – There were no further MRSA cases attributed to the Trust in

March, so 7 cases have been reported for 2013-14. There have been 5 c-difficile cases reported in

March, with 49 cases reported for the year. This is at the 49-case trajectory for the DH site, so this

Monitor target has been achieved for 2013-14. Concerns remain around the increase in CRE cases and

other multi-resistant organisms.

Finance – The year-end position reflects a £3.146m deficit for 2013-14 compared to the Trust target of a

£2m surplus. This gives a Monitor financial rating of 3.

Complaints – The number of complaints that the Trust management teams are handling since the

acquisition of the PRUH have doubled which has impacted on our ability to respond to them within 25

working days. Around half of the complaints received are categorised as ‘low’. 85 complaints were

received in March compared to 71 cases in February but the number of complaints rated high or severe

remained static at 10 cases in March. The number of responses that were either still open or not

responded to within the 25 day internal target increased from 51 cases in February to 83 cases in March.

HRWD - The overall section score for Environment survey questions fell by 1 point to 78 for March, below

the target of 79, whilst section scores for Care Perceptions and Patient Engagement continue to achieve

their target. However, the Friends & Family responder scores for Inpatients and ED worsened for March:

the inpatient score reduced by 5 points from February to March to 62, below the internal target of 68. The

ED score reduced by 8 points to 50 for March, also below the target of 61. At a divisional level, only

7


Surgery and Cardiovascular achieved the inpatient responder score target.

1.3 Actions – 5 areas

RTT admitted - The Trust's first waiting list priority is the reduction of the number of 52+ week wait

patients, and the number waiting at the end of March reduced to 82 admitted patients compared to the 104

patients waiting at the end of February. This end of year position is higher than the revised planned

position of having 50 patients waiting over 52 weeks, and behind the original plan of zero 52+ week wait

patients by year-end. The Trust will clear the 52+ week backlog by the end of June 2014.

The second waiting list priority is the reduction in the number of over-18 week patients which the Trust had

originally planned to reduce to 550 patients by the end of March. Continued pressure on beds and limited

off-site working has meant that the 18-week backlog position of 1,771 patients waiting is above the

expected position of 1,700 backlog patients for the year-end position. Trajectories have been set which will

reduce the 18-week backlog to 550 patients by the end of Q2. Day case backlog and inpatient backlog will

be reduced to sustainable levels by the end of Q2 with the exception of Bariatric Surgery, Neurosurgery

and HpB where detailed action plans are still being finalised. The Trust will reduce RTT day-case waiting

times by the end of Q2 in 2014-15.

The Director of Operations will be chairing weekly RTT meetings with each division to track progress

against action plans, and the COO will be invited to attend these meetings every 4 weeks. We are planning

to setup an Access Board which would review RTT, cancer and diagnostic waiting time performance, similar

to the ECB model. We are planning to introduce an RTT pathway tracking team, in line with the cancer wait

tracking teams that are in place across the DH and PRUH sites.

The Site Strategy Steering Group is meeting weekly to review immediate and short-term options for service

moves across the hospitals which will enable inpatient backlog reduction. As part of the Trust’s internal

audit plan, KPMG will be auditing our RTT reporting processes at the end of June 2014.

Emergency Care Performance – A range of initiatives are underway to enable compliance with the 4-hour

waiting time target.

• Internal capacity: Three phase 1 service moves have been identified and are being progressed to

manage the increase in emergency medical and surgical demand subject to process: transfer elective

8


Orthopaedic activity from Brunel ward to Orpington hospital, and move emergency female surgery

patients from Katherine Monk ward to the vacated Brunel ward. Katherine Monk will then be re-

designated as the acute surgical unit. 8-10 medical beds will be freed-up on Annie Zunz ward as these

surgical gastroenterology patients will be managed on surgical wards instead.

• External factors – An additional 40 mental health beds are planned to be commissioned although time-

scales are to be confirmed. The repatriation and rehabilitation delay issues have been escalated to NHS

England who are now leading on this.

• Internal issues and discharge pathway management – The Emergency Care Intensive Support

(ECIS) team have undertaken the 7-day LOS review at the beginning of April on the Denmark Hill site.

319 patients were reviewed and 152 patients deemed fit for discharge based on the ECIS coding

methodology used, and 167 unfit defined by ‘in need of care that can only be provided in the acute trust’.

Headline messages have been fed back to the Trust which identified a number of internal and external

pathway, process and interface issues. The Trust is proposing to develop a directorate that is focused on

admission/discharge pathway management.

Weekly Emergency Care Board (ECB) meetings are being held to review performance and progress against

the ED Action plan which is included later in this report. The ECB meetings are chaired by the Director of

Operations and the Chief Operating Officer (COO) will be invited to attend every 4 weeks. Daily Emergency

Department (ED) breach meetings are being held to review the 4-hour breaches.

The Trust is implementing its plans for 7-day working in medicine and the average number of weekend

discharges in medicine has improved from 12 to 35 weekend discharges in March. The Trust is being as

pro-active as possible in managing issues outside of the hospital with its external stakeholders; including

regular letter updates and requests, developing commissioning proposals and senior meetings reviewing

performance and action plans.

The Trust has already invited the Emergency Care Intensive Support (ECIS) Team to conduct a formal full

review of the emergency pathway, in particular the interface between ED and the Acute Medical Units. The

ECIS team will be on-site on Monday 28 April 2014 to commence this further review.

9


Health Care Acquired Infection (HCAI) – With the concerns around the increase in CRE cases and other

multi-resistant organisms, on-going focus must be given to increasing side room capacity as part of new

developments in the Trust. The latest HCAI Action plan is included later in this report.

Finance – Further details on key actions in relation to the financial position can be found in the separate

Finance paper.

Complaints – The Serious Complaints committee continues to meet which is chaired by one of the non-

executive directors and includes executive directors and senior clinicians. Jane Walters, Director of

Corporate Affairs and Judith Seddon, Associate Director of Governance & Assurance, attended a meeting of

the Performance Improvement Group on 15 April to brief divisional managers on complaints performance

and handling. The proposal is that ‘low’ category complaints will be signed-off by divisional managers with a

small additional resource in the Patient Complaints office to facilitate this process change. Divisional

managers will review their structures for managing other complaints and training will be provided to divisions

for improving the quality of complaints responses. Divisions will also provide a refresh of their points of

contact for use by the Patient Complaints and PALS offices.

HRWD – Inpatient HRWD survey scores and Friends & Family responder score performance will be picked

up in the divisional performance review meetings at the end of April.

2. Other areas of concern:

2.1 Diagnostic Waiting Times – There were 56 breaches of the 6-week diagnostic waiting time target

reported at the end of March, a decrease of 5 patients compared to the February position. This represents

1.2% of the diagnostic waiting list and is above the national target of 1%, where the key area of concern is

the backlog patients waiting in Paediatric Gastroscopy. All spare paediatric lists in the Day Surgery Unit are

being requested, including additional Saturday lists to maintain the current backlog position. A cost-benefit

analysis is being conducted into offsite or mobile endoscopy options to enable backlog clearance.

2.2 Tertiary transfers - Repatriation bedday delays have decreased from the 682 beddays in February to

442 beddays in February which still represents an average of 14 beds per day. 221 of the 442 bedday

delays are Neurosciences patients.

10


2.3 Red Shifts – The number of ward-based red shifts increased from 105 in February to 123 in March, with

81 red shifts reported in TEAM wards (including ED), 13 in Surgery wards and 8 in Child Health wards.

2.4 Red Adverse Incidents (AIs) – There were 10 incidents reported in March compared to 20 reported in

February, including 5 community acquired pressure ulcer cases which we are required to report. 4 of the

internal incidents were also pressure ulcer related (3 cases on medical and 1 case on a Cardiac ward).

2.5 Theatre Utilisation – Combined theatre utilisation for main and day surgery theatres reduced from 78%

in February to 76% in March, below the internal target of 80%. Theatres is one of the main productivity

projects that the Trust is driving across both the DH and the PRUH sites.

2.6 Vacancy Rate - Staff vacancy rate has reduced slightly from 13.0% in February to 12.6% in March,

above the target range of 5 - 8.0%.

2.7 Mandatory and Statutory Training - The overall index score for reporting staff who have attended

mandatory & statutory training courses has remained static at 71, below the expected index of 100. Further

focus on training is required in order to achieve the internal target of 95%.

3. Regulatory and Contractual Performance

3.1 Monitor

Monitor Q4 position - The Trust has achieved all the performance indicator targets in the Monitor Risk

Assessment Framework for Q4 with the exception of the RTT 18 Week Admitted target and the 4-hour A&E

performance target. A&E attendances and sustained emergency access pressures continued into March

and All Types performance of 92.2% was achieved for March and 93.0% for Q4.

3.2 Contractual

CQUIN 2013/14 – CCG Q3 update – The Trust has submitted its Q3 CQUIN scheme evidence and we are

anticipating achieving 99% compliance. The Trust is predicting a loss of £63k in Q3 CQUIN income due to

the Acute Surgical Unit not achieving the target for the Inpatient Patient Experience CQUIN.

11


CQUIN 2013/14 – NHS England Q3 update – The Trust received feedback for Q1–Q3 in March 2014, and

the Trust has achieved all CQUIN goals but will need to provide additionally requested information to NHS

England to confirm this.

4. Specific Performance Reports and other updates

This month’s report includes updates for :

4.1 Key Areas of Concern

Summary page to highlight key areas of concern on the Denmark Hill site under the categories of: Quality,

Efficiency, Finance and Strategy

4.2 Infection Control Action Plan Update

Further details on the enhanced actions for 2013-14 can be found in the HCAI Action Plan, provided later in

this report.

4.3 Emergency Department (ED) Action Plan Update

Further details on the additional action plans to manage the 4-hour emergency care performance target can

be found in the ED Action Plan update, provided later in this report.

4.4 RTT Performance Update

Further details on the revised trajectories and additional action plans to reduce the over 18 week backlog

can be found in the RTT Performance update, provided later in this report.


1


15/05/2014

2013-14 Month 12

Performance @ PRUH

Roland Sinker

Chief Operating Officer



Subject: Performance Report, Month 10 2013/2014

Author(s): Steve Coakley, Acting Assistant Director of Performance and Contracts

Presented by: Roland Sinker

Sponsor: Roland Sinker

Status: For Report

2

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

Monitor Risk Assessment framework for the interim Quarter 4 position. It also contains an update on the Trust’s

contractual position with the CCG’s and NHS England at Month 10 including the latest position on CQUIN

agreements for PRUH hospital only.

2. Action required The Council is asked to note the M10 performance report.

3


1. PRUH 2013-14 Key Areas of Performance for Month 10:

1.1 Good Performance

Patient Experience – All HRWD patient survey scores improved again in January, with the section score

targets for Care Perceptions and Environment being achieved. The recent CQC inspection report also

highlighted the real commitment from front-line and other staff in providing compassionate care to patients.

1.2 Performance challenges – 5 Areas

Referral to Treatment (RTT) – The RTT Non-admitted completed pathway target of 95% was achieved

for January with 95.0% of patients seen within 18-weeks in outpatient settings for the PRUH and Queen

Mary Sidcup hospitals. However, the RTT Admitted completed pathway target of 90% was not achieved

with 81.3% of patients admitted within 18 weeks, and the RTT Incomplete pathway target of 92% for

patients still waiting on an open pathway was also not achieved at 90.6%. This is consistent with our

plans set out with Monitor and reflects the multiple service moves that have been implemented since

October across the old SLHT hospital sites, and high medical demand leading to elective cancellations

during January.

Emergency Care Performance – The Emergency Care performance target was not achieved in January

for either the Type 1 A&E attendances at 67.1% or for all type attendances which includes the Urgent Care

centre (UCC) at the PRUH at 79.6%. Again, this is consistent with our plans set out to Monitor. Fragile

discharge processes and patient outflow issues continue to affect performance from the ED compounded

by staff capacity issues in relation to consultant cover and nursing staff shortages on the wards.

Health Care Acquired Infection (HCAI) – No MRSA cases have been attributed to the Trust since

October 2013 and this quality indicator is no longer assessed by Monitor in the Risk Assessment

Framework for Q3 onwards. There were 5 c-difficile cases attributed to the PRUH in January so 8 cases

have been reported for the cumulative position from October 2013 to January 2014 which would put the

PRUH above trajectory for the January position. However, 2 further cases have been reported to-date in

February so 10 cases have been reported in total which means the year-end trajectory has now been

reached. Any further cases will mean that this target will be breached in Q4.

4


Cancer Waiting Times - Cancer waiting time data is not yet available for January, but the Q3 position

reported that the 2-week wait time and 62-day time to first treatment cancer standards were not achieved

for Q3. This is consistent with our self-certification on cancer waiting achievement with Monitor.

Finance – Further details on the financial position will be picked up separately in the Finance paper.

1.2 Actions – 5 areas

RTT admitted – RTT Board meetings continue to take place on the PRUH site specific to services

provided from the PRUH and Queen Mary Sidcup hospitals, to which all divisions are required to send a

representative.

Emergency Care Performance – Daily operational site performance meetings are held at 10:30 to

highlight and review key areas of operational concern. The ED Action plan to improve 4-hour performance

is reviewed at weekly Emergency Care Board meetings at PRUH, and commissioners are also invited to

attend. Further work is underway to refresh the ED recovery plan following recommendations from the

NHSE visit, CQC report feedback as well as feedback from the DH Intensive Support Team.

A “Safer Faster Hospital” planned internal incident is scheduled to start from 8am on Friday 7 March to

1pm Friday 14 March at PRUH. The objective is to improve safety and flow through the PRUH site and

community colleagues have been briefed and are supporting the initiative. Community organisations

involved include the CCG, Bromley Health Services, Bromley Social Services, Continuing Health Care, St

Christopher’s, LAS, Oxleas Trust and Bexley Social Services.

The Trust has also invited the Emergency Care Intensive Support Team (ECIST) to work with our Director

of Therapies and Community partners to undertake an audit of patients in hospital for 7 days or more at

the PRUH earlier in February. ECIST are due to provide a report with feedback and recommended

actions.

Health Care Acquired Infection (HCAI) – Infection Prevention and Control (IPC) governance structures

are being re-instated at the PRUH and due to commence in February including an Environmental Action

Group and an Infection Prevention and Control Committee which is due to meet in March. Work is also

5


being undertaken with divisions to establish an IPC consultant lead role at the PRUH with a focus on

identifying candidates for this role. A baseline review of practice relating to IV lines has been completed

and an action plan is being implemented to standardise documentation and consumables, and to introduce

ANTT training.

Cancer Waiting Times – A Cancer Action Plan has been developed in response to the DH Intensive

Support Team visit earlier in the financial year.

Finance – Review meetings were held with each division from the week commencing 27 January.

2. Other areas of concern:

2.1 Diagnostic Waiting Times – The number of 6+ week diagnostic waiting time breaches at the PRUH

reduced slightly from 458 in December to 414 patients as at the end of January, and the national 1% target

for patients waiting over 6 weeks is not being achieved. Over half of the breaches are non-Obstetric

ultrasound tests which have increased due to clinician vacancies causing short-term capacity issues.

2.2 Red Adverse Incidents – the number of red adverse incidents increased from 26 cases in December

to 22 cases in January - 5 of these cases are internal with the other cases relating to community-acquired

pressure ulcers. All cases are the subject to a root cause analysis and will be presented to the Serious

Incidents committee.

2.3 VTE Assessments – The percentage of patients admitted who had a VTE assessment performed

decreased from 87% in December to 82% in January, and the position is still below the national target of

95%. Changes have been implemented with respect to the recording and reporting of VTE assessment

data at PRUH.

2.4 Complaints – The number of complaints received increased from 21 cases in December to 38 cases in

January, and the number of complaints rated high or severe increased from 4 to 6 cases. The number of

complaints that are still open or not responded to within the internal target of 25 days has improved from 21

cases in December to 12 cases in January.

6


2.5 Inpatient Cancellations – The number of inpatient operations cancelled on the day due to non-medical

reasons increased from 60 cases in December to 133 cases in January, with bed pressures being one of the

key reasons for cancellation.

2.6 Vacancy Rate – Figures are not yet available for January but the staff vacancy rate at PRUH was 16.1%

in December, above the target rate range of 5-8%.

3. Regulatory and Contractual Performance

3.1 Monitor

Monitor interim Q4 position – Only the RTT non-admitted pathway target was achieved at PRUH, as

neither the RTT Incomplete and Admitted targets were achieved for January, consistent with our plans to

Monitor.

A&E attendances and sustained emergency access pressures continued during January and PRUH did not

achieve the 95% 4-hour A&E performance target at 79.6% for All Type attendances in January.

5 C-Difficile case was reported in January with the Trust having 8 attributable cases since October 2013 to

January 2014. 2 further cases have been reported in February which means that that year-end trajectory of

10 cases has now been reached.

Cancer waiting time data for Q4 was not available at the time that this report was published.

The Trust is therefore reporting non-achievement of four targets for the interim Q4 2013/14 assessment due

to the RTT 18 Week Admitted completed and Incomplete targets as well as the A&E 4-hour target and c-

difficile trajectory not being achieved for January.

3.2 Contractual Update

CCG - Contracts have been novated to receivers, however, there is a contract variation required to move

Direct Access Pathology (£4m FYE) into the King’s Contract, and Queen Mary’s Sidcup Neurology

outpatients (£274k FYE) out of the King’s Contract. Receiver splits have been agreed and the Trust is

awaiting the final contract documentation from the Commissioning Support Unit to agree and sign.

7


NHS England – Contracts have been novated successfully with no issues outstanding to resolve.

CQUIN 2013/14: CCG Q3 update – The Trust has submitted its Q3 CQUIN return evidence and is waiting

feedback from CCG’s. A number of data recording and reporting issues have been found which we are now

improving which are having an adverse effect on compliance with targets based on previous SLHT-baseline

data.

CQUIN 2013/14: NHS England – The Trust has submitted its Q3 CQUIN return evidence and is waiting

feedback.

Specific Performance Reports and other updates

This month’s report includes updates for :

4.1 Key Areas of Concern

Summary page to highlight key areas of concern on the PRUH site under the categories of: Quality,

Efficiency, Finance and Strategy.

4.2 HCAI Action Plan Update

Further details on the enhanced actions for 2013-14 can be found in the HCAI Action Plan, provided later in

this report.

4.3 Cancer Action Plan Update

Further details on the action plan that has been developed to manage cancer pathways, incorporating

recommendations from the IST review earlier in 2013 can be found in the Cancer Action Plan, provided later

in this report.

4.4 RTT Performance Update

Further details on the action plans to manage 18-week pathways are provided later in this report.

8


4.5 Emergency Department (ED) Action Plan Update

Further details on the additional action plans to manage the 4-hour emergency care performance target can

be found in the ED Action Plan update, provided later in this report.

4.6 Learning Disability Action Plan Update

Further details on managing adult safeguarding issues and compliance can be found in the Learning

Disability Action Plan update, provided later in this report.

1

King’s Strategic Issues

Work in Progress Update

(5-year strategy)

Council of Governors 15 May 2014

Work in Progress

Enc. 2.6

• Integrated care and discharge management

• Safe care and patient experience

• NHSE specialised services strategy

• Development of tertiary clinical-academic peaks

2

Contents

Work in Progress

• We have carried out an assessment of the opportunities available to free up acute

hospital bed through integrated care schemes

• This work is the result of a triangulation of several reviews, assessments and

evaluations, including:

– ECIST (Emergency Care Intensive Support Team) review (319 patients with

LoS>7days)

– Internal review of 175 KCH patients focused on @Home and ERR eligibility

– Internal review of Orthopaedic pathways (trauma ward)

– National models

– Clinical / expert challenge

• We have focused on short term opportunities on discharge management, particularly,

and admission avoidance schemes

• We have developed a short term programme of work to add to the existing integrated

care portfolio, which will aim to free acute beds at Denmark Hill (PRUH work ongoing)

• Key driver for gains next year is driving existing integrated care schemes and processes

much harder rather than investing in new/alternative pathways or providers

• Main focus areas for impact are:

– Improvement of the management discharge processes and flows, particularly

internally

– Improvement of utilisation of growing / available @Home capacity

– Work with commissioners and community partners to develop new models of

discharge (discharge to assess / single point of access) and investing further in the

development of key community services (e.g. ERR, @Home)

Integrated care and discharge management:

Key emerging messages

Review of current

portfolio and

opportunity

identification

Development of

work programme

3 Work in Progress

Classification Service Provider Description

Ambulatory emergency pathway TALK (Telephone Advice

and Liason Service)

KCH 24 hour Senior Geriatric advice offered to GPs to hopefully prevent admission

Liaison and in-reach services for

older people under other specialties

KOPAL (King’s Older

People Assessment and

Liason)

KCH Inpatient advice and support to wards for geriatric patients (covers Acute Medicine,

General Surgery, Trauma and Orthopaedics).

Rapid access ambulatory clinics Hot Clinics KCH Urgent clinic slots for geriatric outpatients, diabetic foot, sickle cell and rapid access

chest pain clinics

Case management Community MDTs All (SLIC) Multi professional discussion around older people with complex issues referred in

Admission prevention hospital at

home - Virtual wards

@Home GSTT Virtual ward to prevent admission and enable early discharge. Medical, nursing and

therapy input.

Admission prevention hospital at

home - Virtual wards

Medihome Medihome Private run service provided to KCH as virtual ward. Takes a different cohort of

patients to @Home e.g. Long term IVABs

Home based rehab and reablement ERR (Enhance Rapid

Response)

GSTT For patients with hospital stay later than 72 hours, therapy, nursing, SW input and

consultant advice available. Often provide intense care packages for up to 6 weeks

Community hospital based rehab

and reablement

Lambeth Intermediate Care

Beds

Lambeth LA 20 bedded Ward based intermediate care, no medical cover

Care packages available to support

discharge

Ward Based Social

Workers

KCH Social workers based on geriatric wards to improve communication and hence

discharge process

Voluntary sector services providing

a ‘welcome home’ service

Red Cross and KCH

volunteer programme

KCH Volunteers providing support to patients on discharge. Red Cross from A+E, KCH

volunteers from wards. Cover issues such as taking patient home and turning

heating on etc, hope to reduce failed discharged and readmissions

Stroke Supported discharge Community based support

for stroke patients

GSTT SALT, physiotherapy and occupational therapists provided at home, at the gym, in

the park or at Pulross centre

Portfolio of current schemes

4 Work in Progress

Integrated care and Discharge management:

Short term impact programme of work (in progress)

Work Description / Focus

Improved management of

diagnostic pathways

• Quicker and more regular access to diagnostic tests

• More responsive medical reviews for patients in other specialty wards

Improved management of

discharge pathways

• Early senior assessment, assertive discharge planning and a clear focus on patient flow

• Improve flow through pathways, earlier identification of need, and decision making and

assessment eg. Discharge coordinators, front end geriatricians, therapies, ward based social

workers

Improved management

internal discharge referral

processes

• Improve administrative management of external referral processes eg. HNA completion, section

2s and 5s.

Orthopaedic pathways • Improved re-ablement pathways for Fractured Neck of Femurs and Non-Weight Bearing patients

Increase utilisation of @Home

service

• Improve awareness and confidence and more active presence of @Home staff at the acute

• Develop transparent utilisation / perf management tools and processes

• @Home to develop capacity as planned and expand scope of services

Partnership working to

simplify pathways and waits

• Need to work with Social Services and Community Services to agree new protocols, find ways to

reduce current paperwork requirements or processes

Reduce waits for community

services

• Work with community partners to increase capacity in out of hospital services to enable increased

speed and scope, eg. In ERR, community therapy, supported discharge and social care.

• More capacity should enable a speedier transfer of patients or prevention of admissions.

Single Point of Access /

Discharge to Assess Models

• Explore and develop the models with community partners

5 Work in Progress





6

Contents

Work in Progress

7

Issue and strategic framework

We need to improve quality and outcomes year on

year.

A substantial programme of work needed to

improve the experience of ALL patients

Getting capacity right and getting staffing right

• Acting on patient feedback through

review of PALS, complaints, HRWD etc

• Make more time to listen to patients

and act on their concerns

• Continue to build on our ‘Go See’

scheme

• Our strategy must be to reduce patient

dissatisfaction with services and

develop much more responsive services

• Continue to have commissioner

involvement in the Clinical Quality

Group where ‘never events and Serious

incidents are scrutinised

• More holistic approach to patient

experience

• More emphasis on patient experience

when we plan to grow a service

• Continue to encourage reporting of SI’s

and continue to scrutinise causes

Work in Progress

8

Issue

Action Status

Infection

Control

CRE increased Antibiotic resistant

organisms ( Fast growing problem)

Increased patient acuity = increased

infection risk

• Need to prevent because can’t treat

• Need more isolation rooms at DH

• look for opportunities to reduce

occupancy to allow for HPV cleaning (3-4

hours)

• Currently test in

haematology, liver and

Paediatric Liver

Increase in patients going home on

IVAB’s

KCH nurses to insert more PIC and HIC

lines

• Need more IV practitioners across

hospital and community with dedicated

microbiologists and pharmacists input

• Train patients to self manage and

community staff to problem solve

• Smaller team at the PRUH

• Very few patients go home

with IVABs at the PRUH

Outward facing care in the community

for patients with indwelling long term

devices

• Work with commissioners and community

teams to develop an effective service

• No community service so

patients come to ED

How we get more PRUH services

accredited

• Need to assess and scope requirements

• Working group to assess

and scope requirements

Require more infection control input to

deal with increasing satellite services

e.g. renal dialysis and dental

• Working group to scope this including

pharmacists and microbiologists

• No current input outside

PRUH and DH

Right staff,

right place

for Safe Care

Ensure safe staffing levels on the wards

to cope with rising acuity

• Measure and record patient acuity daily to

compare actual staffing numbers with

recommended levels

• Falls and pressure ulcers reviewed

• Agree format to display ward

staff levels to the public

across enlarged trust and

upload to NHS Choices

Improve recruitment and retention of

nursing staff

• Offer Band 6 leadership development

programme. Develop strategies to

encourage staff to stay a min term

• Return on investment could

be improved. Medium grade

nurses move on after short

term

Safe Care Programme

Work in Progress

9

Issue

Plan

CQUINs

Clinical Effectiveness

CQUIN National Patient Experience

Friends and Family Test

• Rollout to OP and DC Oct 14

• Rollout to all patients end of 2015

Need to improve patient experience

scores (also CQUIN target)

• Improve scores of Friends and Family Test for inpatients/ED

• Aspire to be in top 20% of London hospitals

Need to move towards increased

patient outcomes monitoring

• To drive through the value based healthcare agenda across all

clinical areas

• Focus on all Long term Conditions and preventable ill health

Patient feedback Historically patient concerns are high

at the PRUH

• Proactive PALS on PRUH site

• Offer range of opportunities for patients to feedback

• Improve staff responsiveness to dealing with concerns

• Staff training

• Links to culture change programme

Provide more realtime patient

feedback at the PRUH and other sites

• HRWD extended to the PRUH

• Support staff to make change based on ‘you said/we did’

Acting on patient feedback • Programme of work to enhance how we listen to patients and

act on their concerns

Improve communication and

engagement with stakeholders

• Provide rationale and information on service changes

• Engage with patients, the public , key stakeholders

Volunteering

1500 volunteers across the sites

Hospital to Home scheme

Improving health and wellbeing

• Scope for enhancing experience across all sites with

volunteers in every clinical area

• Hospital to Home scheme bridging hospital and community

• Development of Community Health Ambassadors

Patient Experience Programme

Work in Progress





10

Contents

Work in Progress

11

NHS

commissioning

budget

Other potential commissioning strategies?

Price competitive tendering

Price cuts/ efficiency savings

Transfer to/ share

responsibility with CCGs

Top-slicing CCG budgets

Rationing and referral

management

Refining scope of specialised

services

Commissioning Context

Consolidation strategy:

‘from 272 to 15 providers’

Strategy under review

Five year timeframe

Service specification compliance

process

Begin with low-hanging fruit

How will it save money?

Physical service moves or

subcontracts?

Work in Progress

Commissioning Context: Narrative

• NHS England funds 42% of KCH income post-merger

• Specialised services commissioners are under major financial

pressure and overspending by >3%

• NHS England intends to drive 9% QIPP and major

consolidation of specialised providers

• Current commissioning strategy in development

• Threat of losing minor specialised services due to consolidation

away from King’s

• More general threat from financial pressures in specialised

income and margins

12 Work in Progress

Risks and Opportunities for King’s

Risks

• Lack of clarity of NHS England specialised service strategy

• Loss of specialised services due to consolidation

• Additional capacity pressures

• Loss of income due to budget cuts

Opportunities

• Strengthening our major peak

• Acquisition of specialised service activity

13 Work in Progress

Strategic considerations

• Tertiary services are core business

– Teaching hospital “always aiming higher”

– Our specialised services should all aspire to world class status

• KHP strategic alignment

– Through collaboration and innovation we can achieve higher standards

in care, research and education

– Specialised service strategies developed by CAGs

• Capacity constraints

– Balance between specialised services

– Balance with local acute services

14 Work in Progress





15

Contents

Work in Progress

Issue and strategic framework

To be a vibrant partner in KHP and renowned leader

in healthcare provision / research / innovation, KCH

must:

• Operate a core portfolio of tertiary clinical-

academic specialties to international best-

practice standards

• Be nationally recognised as highly research

aware and effective across our wider set of sub-

specialties

• Develop a USP based on our strengths as a

Trust that crucially combines tertiary expertise

with a highly innovative approach to care and the

provision of comprehensive health services at

scale to a large and diverse population

Current state:

• Clinical-academic peaks are improving – but

each has specific areas needing attention

• Activity, outcomes, research and academic

profiles / infrastructures are variable in the wider

set of sub-specialities

• There are opportunities for KCH in Health

Services / Translational Research from our

combined role as local and tertiary provider, the

expanded patient base in Bromley and the policy

focus on developing new models of care

This paper sets out an emerging three point

strategy for developing King’s effectiveness

as a healthcare provider, educator and

researcher of national and international

repute:

1. Strategic developments in the clinical-

academic peaks to ensure their globally

leading positions

2. Generic infrastructure developments to

improve the variable performance in the

wider set of sub-specialities and nurture

emerging areas to excellence

3. The development of capability and

capacity to build an international USP in

Health Services / Bed–to-Bench / Care

Innovation and Adoption (including care

closer to home) research

16 Work in Progress

Research – a working definition

In thinking about our Research and development at KCH, we take a wider view

than simply work related to clinical trials

Source NIHR:

http://www.nihr.ac.uk/research/Pages/default.aspx 17 Work in Progress

Why R&D matters to patients and KCH

• Improves patient outcomes – safety, outcomes and

experience

• Develops innovative treatments and care models and raises

evidence-based best-practice standards

• Improves population health

• Rewards and incentivises bright and able employees

• Builds KCH reputation and brand

• Makes KCH attractive to: • Patients and their carers

• The most able and ambitious staff

• Commissioners

• Educational and training bodies

• International peers and those who want to learn from us

• Grant awarding bodies

• Industry and Pharma companies

• Expands and diversifies KCH income-base

Benefits to

patients

Benefits to

KCH

18 Work in Progress

Strategic considerations

• NHS policy re AHSCs – to lead research and

innovation in the NHS

• Global AHSC models (Boston, John Hopkins,

Virginia Mason, Karolinska)

• KHP Strategy and KCH role in it

• NIHR / DoH Research strategy and direction

of travel (money withdrawn form Trusts, more

centralised functions, process improvements)

• Translational research / service improvement

agenda (AHSNs, CLARHCs, KIS – new

models of care)

• Increasing commercial and industry co-

working opportunities

• Clinical and technical innovations trends and

opportunities

• Market share – research income / grants /

studies / recruitment / papers published /

innovations for NHS adoption –

• Finances Research and Development

makes a substantial financial contribution

to the Trust but management and

allocation of financial flows could be

improved

• Infrastructure, space and process

constraints

• Changes to CRN structures and functions

• Recruitment to studies

• Improve opportunities for funding – grants,

commercial work, PRUH

External Internal

KCH clinical/academic strategy must respond to changes and emerging trends

19 Work in Progress


Enc 2.7.1


Date of meeting: 15 May 2014 By: Geraldine Walters, Executive Director of Nursing

Jane Walters, Director of Corporate Affairs

Subject: Draft Quality Report 2013/14

Executive Summary The Quality Account is our annual report to the public about the quality of services we deliver. This third draft of the Quality Report is much advanced from the earlier version sent to governors on 17 April 2014. We have now received comments from some stakeholders and they have been incorporated in the document and a majority of the year-end data has been included. Key next steps include:

Draft and finalise CEO Statement – w/c 12 May

Final edits – w/c 12 May

Issue to Council of Governors (standalone document) for comment – 08 May (discussed at 15 May meeting)

Issue to Audit Committee (standalone document) for ratification – 13 May (discussed at 20 May meeting)

Incorporate report with Annual Report and Accounts – w/c 19 May

Issue to Board of Directors for final approval – w/c 19 May

Actions 1. The Council of Governors is asked to note the updated version of the draft of Quality

Account 2013/14; and 2. To provide any comments and feedback on the document.

EXPLANATION FOR THIS TEMPLATE:

BLACK Structure / skeleton of report

RED Core mandatory information – do not change

BLUE Content to be changed (last year’s report details included here to hold place and for comparison)

HIGHLIGHTED Section to be updated with more information or with year-end results/ further analysis

Enc 2.7.1

DRAFT Quality Account 2013/14

D1.2:18032014

King’s College Hospital NHS Foundation Trust

Quality Account 2013/14

Presented as part of the “Annual Report and Accounts 2013-2014” to Parliament pursuant to the Health Act 2009 and supporting regulations, e.g.

the National Health Service (Quality Accounts) Regulations 2010 and Amendments Regulations 2011, 2012 and 2013.

Enc 2.7.1

CONTENTS

Part 1: Statement of Quality from the Chief Executive, structure of report and CQUINs 4

Part 2: Priorities for improvement and statements of assurance from the Board 8

Our Quality Priorities and Objectives for 2013/14 8

Our Performance against Quality Priorities and Objectives for 2013/14 9

Clinical Effectiveness Priorities: 9

Patient Experience Priorities: 11

Safety Priorities: 15

Our process for developing the Quality Priorities and Objectives for 2014/15 19

Learning from the past 21

Our Quality Priorities and Objectives for 2014/15 22

Clinical Effectiveness Priorities: Plans for 2014/15 23

Patient Experience Priorities: Plans for 2014/15 26

Safety Priorities: plans for 2014/15 31

2a: Information on the review of services 33

2c: Information on participation in clinical research 57

2d: Goals Agreed with Commissioners: The Commissioning for Quality and Innovation

(CQUIN) framework 65

2e: Statements from the Care Quality Commission (CQC): 71

2g: Information Governance Toolkit attainment levels 73

2h: Clinical coding error rate 74

Part 3. An Overview of performance in 2012/13 against mandated national key standards

76

Appendix 1: Statements from Key External Stakeholders 84

Statement from Commissioners 84

Statement from Health and Adult Services Scrutiny Sub-Committee 88

Appendix 2: 2012/13 Statement of the Directors; responsibilities in respect of the Quality

Report 93

Glossary - to be updated when document finalised 99

Enc 2.7.1

Part 1: Statement of Quality from the Chief Executive, structure of

report and CQUINs

Statement from Chief Executive

‘Quality’, ‘safety’, ‘care and compassion’ are on everyone’s mind in light of the Francis Report

into the horrifying events at Mid Staffordshire NHS Foundation Trust. Looking back at my

statement in the introduction to last year’s Quality Account, I am pleased to see that those

words and phrases were on my mind then too.

We are still on a journey, and the entire leadership of King’s College Hospital is seized of the

importance of kind and compassionate care. It imbues all our values, and is a key plank in

the support we give to the nursing workforce in particular. They face huge challenges.

Regulation becomes ever more onerous and yet our patient cohort continues to be more

acutely unwell and more frail, and requires more one on one care. So we try to be innovative.

We are leading the way in becoming paperless, which is in part about releasing time to care.

We have centralised some of the processes so that direct patient care can be more efficiently

delivered, and again, this releases the nursing workforce to spend more time by the patient’s

bed-side. Having an electronic patient records system allows all the documents relating to

each individual patient’s clinical pathway and care plan to be accessed by all members of the

multidisciplinary team with ease. The unfolding of the patient’s clinical condition is captured

in a timely and contemporaneous manner and this allows for changes in the patient’s

condition to be detected earlier.

In 2013/14 we have made significant progress in reducing cases of MRSA bacteremia and

are in a much better place on other healthcare acquired infections, but we can never be

complacent. The results of our own patient satisfaction surveys are positive, but maintaining

the right atmosphere and environment for acutely unwell frail elderly people remains

challenging. This is an incredibly busy hospital; not always the most ideal environment for

patients and carers with difficult long term conditions. But they are our mainstay, and I am

delighted that they are reflected in this year’s quality priorities.

One of our values is ‘making a difference in our local community’, so the process of deciding

on our quality priorities is completely in keeping with that value. Stakeholder engagement

has been evident in the way those priorities have been set. And our volunteers continue to

make a difference. Feeding frail elderly patients is just one of the areas where they can

support the nursing workforce; they have more time, and because they are volunteers they

identify closely with the patients and the public and therefore add to the compassionate care

delivered by our professional workforce.

The feedback from our stakeholders and patients is pivotal to our continuing focus on service

improvement. Our nurses and other healthcare professionals live in close proximity to the

populations we serve. Our governors and non-executive directors give of themselves

unstintingly to make sure we stay true to our core purpose. Our commissioners, and

healthcare system partners, work tirelessly with us to help us deal with the pressures we

face.

The coming 12 months will probably see us change in many ways. We may well increase in

size by 30% by acquiring the Princess Royal University Hospital in Bromley. We may well

Enc 2.7.1

5

also decide to merge with Guy’s and St Thomas’, and SLAM. None of that is certain. But

what is certain is that our local patients will always be at the heart of everything we do. And I

hope that in 12 months’ time I will again be able to be proud about the kind and

compassionate care we provide to them.

We will have paid particular attention to six priorities, influenced by our stakeholder

consultation. Dementia and COPD are significant for our local patients, but we will also focus

on particular aspects of the outpatient and patient discharge processes. We will also be

safer and pay particular attention to the identification and escalation of deteriorating patients.

I hope you enjoy reading this report. It has been a collaborative effort, and it reflects much of

the progress we have made, and it doesn’t hide any of the issues we still face on our journey

to deliver first class care to our local population.

Enc 2.7.1

6

Quality Account and CQUINs

CQUINs are intended to reward excellence and encourage providers to drive a portfolio of

quality improvements on a continuous basis. Each year providers and commissioners come

together to agree the detail of how national priorities (e.g. Dementia screening) and local

priorities (e.g. public health screening & advice for patients) will be achieved and measured.

A series of milestones and targets are agreed in advance and each provider is required to

submit evidence to commissioners at regular intervals in order to secure the funding

associated with them.

The CQUIN framework contributes to the implementation of the National Institute of Clinical

Excellence (NICE) Quality Standards and Department of Health-led innovations as well as to

improving patient experience and outcomes. As a result, there is a natural overlap between

the objectives associated with Quality Account priorities and those contained in the Trust’s

CQUIN agreement. Where relevant, CQUIN evidence has been used throughout this

document to support the achievement of Quality Account priorities.

Structure of this report

The following report summarises our performance and improvements against the quality

priorities and objectives we set ourselves for 2014-2014. It also outlines those we have

agreed for the coming year (2014-2015).

We have outlined our quality priorities and objectives for 2014-2015 under the same

headings: patient safety, clinical effectiveness and patient experience. We have detailed how

we decided upon the priorities and objectives and how we will achieve and measure our

performance against these. The regulated Statements of Assurance are included in this part

of the report.

We have also provided other information to review our overall quality performance against

key national priorities and national key standards. This includes the 2014/15 requirement to

report against a core set of indicators relevant to the services we provide; using a

standardised statement set out in the NHS (Quality Accounts) Amendment Regulations

2012. We have also published the Statements from Clinical Commissioning Groups, NHS

England, Health Overview and Scrutiny Commit tees, and Healthwatch that outline their

response to this Quality Account.

To the best of my knowledge, the information contained in the following Quality Account is

accurate.

Timothy Smart, Chief Executive

Enc 2.7.1

7

Enc 2.7.1

8

Part 2: Priorities for improvement and statements of assurance

from the Board

Our Quality Priorities and Objectives for 2013/14

In February 2013, our Board of Directors chose the following six quality priorities taking

onboard feedback from external stakeholders, staff and governors.

Priority Key Objectives (Outline) Measure Rating

Cli

nic

al

Eff

ecti

ven

es

s

1. Care of

patients with

dementia

To improve the care of patients with

dementia by focusing on the detection of

undiagnosed patients admitted to acute care,

proving support for the carers of patients

with dementia and the level of staff with

specialised dementia training.

Process/

Outcome

Fully met

2. Chronic

obstructive

airway disease

To improve the self-management of

symptoms for patients with the long term

condition COPD and to improve community

support in a way that reduces acute COPD-

related readmissions.

Process/

Outcome

Fully met

Pati

en

t E

xp

eri

en

ce

3. Improve

outpatient

experience

To make focused specialty-specific

improvements, based on and measured by,

direct patient feedback from the Outpatient

‘How are we doing?’ survey.

Process/

Outcome

Fully met

4. Improve

patient

experience of

discharge

To implement key elements of the discharge

policy and deliver improvements to patient

satisfaction in relation to discharge

information.

Process/

Outcome

Not met

further

need

identified

Pa

tie

nt

Sa

fety

5. Management

of the acutely

unwell patient

To build on the work conducted in 2012/13 to

establish a consistent performance

framework for the identification and

escalation of acutely ill patients.

Process/

Outcome

Fully

Met:

further

need

identified

6. Surgical

Safety Checklist

To develop and implement a strategy to

ensure the Surgical Safety Checklist (SSC)

is integrated into the working practices of all

theatre/interventional teams.

Process/

Outcome

Partially

met

further

need

identified

Enc 2.7.1

Our Performance against Quality Priorities and Objectives for 2013/14

The Trust has been under immense pressure in what has been an extremely busy year including a significant organisational restructure.

Despite this these quality priorities have been the cornerstone of our operations and performance management during the year. The tables

below summarise the priorities, objectives and our performance against each of these priorities.

Clinical Effectiveness Priorities: Our Quality Priorities and why we chose them

What we aimed to do What we achieved

1. Care of patients with dementia1

Improve the detection of dementia for elderly people admitted to acute care: 90% of the emergency admissions aged 75 and older will be screened for dementia and 90% of patients with a positive dementia screen, who were not previously known to have dementia, will have an appropriate follow up in place before discharge. This outcome will be communicated to their GP.

Implement NICE guidance for the support and interventions for the carers of people with dementia: we will complete a monthly audit of carers of people with dementia to test whether they feel supported. These results will be reported to the Trust Board.

On the Denmark Hill site, we have ensured that 90% of emergency admissions aged 75 or over since June 2013 have been screened for dementia and delirium. Of those with a positive dementia screen, 90% have been assessed and referred if further action has been required. The Trust is working to ensure that this standard can be achieved at the PRUH site from March 2014. Training has been offered to the relevant staff groups, for example, all ward based nursing staff are provided with a 4-hour face to face dementia training session provided by a dementia and delirium clinical nurse specialist and all junior doctors are provided with clinical dementia training as part of their foundation course training modules. This is being delivered across both Denmark Hill and PRUH sites. In collaboration with the dementia team at Guy’s & St Thomas’s hospital, and in agreement with both Lambeth and Southwark commissioners, a carers survey has been designed. This has been delivered Trust-wide. The results of this are being fed back to the team, and this will continue into next year to ensure a robust set of data which can be used to target

1 King’s provides a dedicated Dementia and Delirium service, which supports patients with dementia and delivers its CQIN requirements for screening admissions and staff

training. Services are tailored to the individual person with dementia as far as possible, therefore multi-agency approaches can include input from South London &

Maudsley liaison psychiatry services and memory services (outpatients).

Enc 2.7.1

10

Our Quality Priorities and why we chose them


Develop and deliver an annual dementia training plan under the guidance of the Trust nominated Clinical Lead for dementia.

specific improvements in patient care. In addition to what was set out in the aims, we undertook a Dementia Day in May 2013 to publicise the developments for managing care of dementia patients across the Trust plus a new intranet page was launched. We developed new patient information booklets for dementia and delirium. Finally, a ‘dementia friendly hospital’ initiative was launched with the health and ageing wards. This focuses on the design of wards specifically to stimulate dementia patients. The success of the initiative is now influencing the design of other wards across the hospital.

2. Chronic obstructive pulmonary disease

Ensure that patients admitted with a COPD exacerbation are given a COPD care bundle during, or immediately following, their admission.

Roll out the COPD care bundle Trust-wide to include all patients with a confirmed diagnosis who are admitted with an acute exasperation of COPD.

Report figures for quarter 1 to our local commissioners and set improvement targets for quarters 3 and 4.

Achieve the quarter 3 and year end improvement targets for the percentage of patients who have received the COPD care bundle.

Measure the impact of the care bundle through a comparison of 2011/12,

We have developed a care bundle for COPD and ensured that patients are given the bundle during or immediately after admission. Information on the bundle is also sent to the GP, along with a letter, and followed up with a phone call discussing the patient’s exacerbation. This bundle was given to over 80% of applicable patients this year. When any patient with COPD is admitted via A&E an alert has been initiated to ensure that all patients are picked up early in their pathway. This has been strengthened with a 7 day a week presence among the respiratory team. There has also been a weekly consultant-led multi-disciplinary team meeting with GPs, community matrons and HomeWard (a ‘hospital-at-home’ initiative) to strengthen relations with primary care. Members of the integrated respiratory team now work in the hospital and in the community to ensure that the care bundle is delivered at home as well as in hospital. The team see patients at home post discharge, see housebound patients following GP referral, and support HomeWard with education and joint clinical reviews. The team also offers a home oxygen service to prevent inappropriate and wasteful oxygen prescription. We have has delivered virtual clinics in every GP practice in Lambeth and

Enc 2.7.1

11



2012/13 and 2013/14 attendance and readmissions data for this group of patients.

Southwark with the aim of supporting GPs and practice nurses with accurate diagnosis and good chronic disease management of COPD in the community and facilitating appropriate referrals. A smoking cessation programme has been launched with a hospital based advisor and training across both sites. This has the aim to reduce smoking in the local population and the long term prevalence of COPD.

Patient Experience Priorities:



3. Improve outpatient experience

Based on the Q4 2012/13 results identify a key specialty and agree which 5 questions are most in need of improvement within their area.

Develop action plans on how to deliver improvements in the 5 identified question areas.

Agree improvement target percentages for Q2, 3 and 4.

Improve response rates to provide robust feedback on patient experience.

Improve scores on the local ‘How Are We Doing?’ outpatient survey on

The results of the ‘How Are We Doing?’ survey in Suite 1 have improved by 7% across the 5 areas targeted for improvement. There have been a number of projects carried out in the Suite to improve patient experience. These have included:

A full redesign of the waiting area to increase the number of seats and improve the flow of patients through the department.

The numbers of nursing and admin staff have been increased to allow patients to have time with a nurse after consultation.

The link with x-ray has improved so patients who are waiting in x-ray are not worried they will miss their appointment.

Enc 2.7.1

12



questions targeted for improvement in specific areas.

Decrease the number of patient complaints relating to the outpatient department.

Ultimately, ensure that patients have a better experience of outpatients.

4. Improve patient

experience of

discharge

Implement the new Trust-wide discharge

policy

Roll-out the ‘Home for Lunch’ information

sheet across the Trust to improve the

standard of:

a. discharge planning; and

b. Information given to patients.

Improve Trust-wide patient satisfaction in

two key areas:

a. providing information about medication after

discharge; and

b. providing patients with information on what

to do and who to contact if they have a

concern after discharge.

Discharge policy is in place with associated audit standards.

Improvement in the following ‘How Are We Doing?’ survey questions,

representing overall satisfaction score for:

‘Did a member of staff tell you about medication side effects to watch for

when you went home?’

reached the target score of 73 in 6 out of the last 12 months – rated green

was one below target for 5 months – rated amber

below target for the remaining month – rated red

‘Did hospital staff tell you who to contact if you were worried about your

condition or treatment after you went home?’

reached the target score of 86 in 9 out of the last 12 months – rated green

was one below target for 2 months – rated amber

below the target for 1 month in 2013/14 – rated red

Enc 2.7.1

13



Improve patient

experience of discharge

(cont.)

There has been slight improvement in the Renal and Hematology wards in giving

information about medication side effects. However, more focus is required in

ensuring patients are given contact information if they are worried after leaving

hospital.

% increase from Quarter 1 to Quarter 4

Renal Surgery

Medication Side Effects 4% 7%

Contact information if worried -2% 0%

Scores for contact were 2% but March scores were very low which brought the

final % increase down.

Discharge leaflet to be launched by May 2014 giving clear explanations and

expectations for patients.

An audit took place in relation to the following criteria:

a) A copy of a patient’s discharge summary detailing the care and treatment

received and follow-up management plan.

b) Any appointments for follow-up where appropriate.

c) Discharge checklist utilization.

d) Relevant leaflets and information packs regarding their condition (where

appropriate).

e) Nursing transfer letter and wound care plan for the district nurse or care

Enc 2.7.1

14



Improve patient

experience of discharge

(cont.)

home if required.

The audit took place during January/February 2014 and was spread across the 3

healthcare aging wards. In summary,

The discharge summary was of a good quality overall but there was wide variation in the detail of clinical care and investigations evidenced on the forms.

The discharge checklist was poorly utilized and there was no evidence of any literature that may be given to patients in relation to their health needs.

Wound care plans, whilst completed, were not consistently being sent to the community services to evidence care given and wound progression/deterioration.

Enc 2.7.1

15



Audits from renal and surgical wards available end April 2014

Safety Priorities:



5. Management of the acutely unwell patient

Improve the identification, escalation and response to patient deterioration, more effective escalation of patient deterioration using formal communication protocols (e.g. SBAR), swifter escalation to the right person through clear local escalation policies

The iMobile critical care outreach team have been utilising Wardware, our electronic vital signs recording system, to proactively seek out patients who have reached the trigger threshold on their early warning score (EWS). Since the launch of the service in September 2013 10% of service activations were via the proactive route. The iMobile team has an open access referral system and encourage all

Enc 2.7.1

16



Management of the acutely unwell patient (cont.)

with clear alternatives when initial escalation isn’t successful.

Complete the roll out of Wardware and develop the reporting functionality to aid monitoring and management of observations and escalation; all areas able to demonstrate how they are using the data to identify improvement opportunities and corrective actions to improve patient safety.

Continue to develop the use of the new monthly patient-level divisional reports to ensure effective action plans are devised and implemented locally.

Build on the successful staff event of February 2013 to support penetration of key messages and actions to all staff.

Reference relevant national guidelines and standards and identify gaps and associated action plans and improved penetration and alignment with relevant national recommendations (NCEPOD, NICE).

An accessible central store of relevant information and data (on Kwiki) for all staff to access.

staff members to refer using SBAR, a safety standard communication tool. All preceptees attend the ALERT course during their preceptorship programme. During this one day study day we have a 30 minute session on communicating with the deteriorating patient where we discuss the use of SBAR in depth. The students are also expected to demonstrate the use of SBAR during assessed scenarios. The launch of the iMobile critical care outreach team has provided staff with an alternative route for escalation if they are faced with an initial escalation block. iMobile offers an open access referral system with calls being welcomed from all staff groups. Since the launch of the service in September 2013 there has been a steady increase in referrals from nursing staff and junior doctors. The service now receives 24% of its monthly referrals from nursing staff. iMobile is achieving a 15 minute response time from the time of referral to review of the patient. iMobile offers the following service for acutely unwell patients:

Outreach advice and education: iMobile are contactable via a mobile phone and staff can call at any time for advice about managing deteriorating patients. In addition to this the iMobile team has provided both formal and informal teaching sessions to the ward areas to help to improve staff knowledge, confidence and skill in managing unwell patients.

iMobile have been providing critical care treatments on the wards with dedicated critical care nursing and medical supervision. Patients are either treated as a ‘rapid response’ when the critical care bed is not immediately available, or as a ‘trial of treatment’ and will remain on the ward if they are responsive to treatment.

Rapid Response: In this instance there is no delay in the commencement of critical care treatments because the team is able to

Enc 2.7.1

17



deliver care at the patient’s bedside on the ward. Patients are admitted to the critical care units having receiving initial resuscitation and optimisation.

Trial of Treatment: The aim of this is to provide early optimisation to patients who are not yet requiring critical care admission or for those who respond to treatment is uncertain. In October 2013, 26 patients had a trial of treatment, 19 of these avoided critical care admission.

Critical Care Discharge Reviews: The team supports the service provided by the critical care matron. Patients are now seen 24/7 with most discharge patients receiving two reviews.

We have recognised key areas within the recent NCEPOD ‘Time to Intervene’ report [recommendations 2, 3, 9] and are building both interim and long term state of the art critical care facilities to enable it to meet the rising demands of its local and tertiary referral population. It has also moved to bridge the gap between the general wards, the specialty high dependency areas and the critical care service so that patients can benefit from an improved interface & experience, as well as expert consultation, even if they do not meet criteria for intensive care admission. We undertook a commitment to improve recognition and management of sepsis. The sepsis group launched a ‘Think Sepsis, Think Severity’ campaign. Posters were put in all wards, and Quick Reference Guides for ID holders were distributed to guide staff in the two stage approach or 60-minute resuscitation, and risk stratification for iMobile referral. Opportunistic education sessions were run on wards, and information was made available on Kwiki and Cliniweb to collate all the relevant sepsis guidance. We participated in the UK sepsis day on 06 March 2014, and launched at national initiative for cascade through champions from all disciplines.

Enc 2.7.1

18



6. Safer Surgical Checklist

Develop a strategy to ensure the Surgical Safety Checklist (SSC) is integrated into the working practices of all theatre/interventional teams; ensure all surgical procedures on an inpatient or day case basis which involve general or local anaesthesia or sedation use an approved version of the SSC.

Develop specialty-specific SSCs where appropriate, ensuring these comply with NPSA guidance.

Develop audit tool/s to assess the use and effectiveness of the SSC, and build these into audit programmes.

Develop measure/s to assess SSC impact on defined surgical outcomes.

Establish a Surgical Safety Checklist Improvement Group to help achieve the above.

Defined surgical outcome/s show improvement from baseline

Surgical Safety Improvement Group (SSIG) was set up and meets monthly. SSIG has approved 16 specialty-specific SSCs against a minimum dataset. SSC strategic action plan developed and Kwiki page available. Culture survey and mystery shopper audit completed. These showed: distractions/ interruptions are frequent; SSC routinely completed but quality of checks often sub-standard; staff need to be empowered to challenge SSC non-compliance. Surgical site marking and surgical count policies revised. A target of zero surgical Never Events was set. Since April 2014, 4 Never Events have been reported. Use of swab trays to provide additional visual cue for swab counts piloted in neurosurgery.

Enc 2.7.1

Our process for developing the Quality Priorities and Objectives for 2014/15

In a busy acute hospital like King’s, there are always several quality improvements going on

at any given time. The wider range of improvements to patient care happening across King’s

will not stop or slow down, but we have honed a clear set of priority objectives. These act like

a set of promises that everyone at King’s commits to meet or exceed this year. From our

various consultations, we know they are clear and meaningful to you as our key

stakeholders. We would like you to support our agenda for continuously improving our high

quality patient care, and to hold us to account.

On 01 October 2013, we became an enlarged hospital having acquired some sites form the

former South London Healthcare Trust that have been historically challenged in terms of

performance. Therefore in developing our quality priorities for 2014/15 we have considered

the needs of the enlarged communities we are now serving.

This section of the Quality Report summarises our patient safety, clinical effectiveness and

patient experience objectives for 2014/15, how these were developed, and how these will be

achieved and measured.

The process was as follows:

1. Reflected on our progress with the current year’s quality priorities (Apr-Nov 2013).

For example, we reviewed this at the Board Quality and Governance Committee, as well

as the Stakeholder Engagement Events on 10 January 2014 for Lambeth and Southwark

stakeholders and 17 January 2014 for Bromley stakeholders

2. A long-list of priorities was identified with the executive chairs and leads of each of

the committees which focus on the three dimensions of quality:

Patient Safety

Patient Outcomes

Patient Experience.

3. External stakeholders’ perspectives were collected in prioritising the long list of

potential areas for improving patient safety, clinical effectiveness and patient experience

(two stakeholder events on 10 and 17 January 2014 and an additional mail out to

individual stakeholder for further comment on 09 April 2014. We also attended the

parallel discussions at our Academic Health Science Centre partners: Guy’s and St

Thomas’ NHS Foundation Trust). This has involved discussions with the patients and

public who highlighted and helped select the Trust’s priorities.

4. Frontline teams/subject matter experts were consulted about the work planned to

meet these quality improvements, to shape feasible improvement objectives. The

Performance Directorate was closely involved to ensure alignment with the emergent

CQUIN framework. This has been through the key committees and forums outlined

below:

Enc 2.7.1

20

Summary of stakeholder engagement 2013/14

Groups Engagement Events

Commissioners,

governors,

Healthwatch,

OSCs

External Stakeholder Event 1 – Review of last 6 months progress, and early

discussion about 2013/14 priorities

External Stakeholder Event 2 – Review of last 6 months progress, and early

discussion about 2013/14 priorities

External Stakeholder Mail out – 2013/14 priorities (09 April)

Commissioners NHS SEL Clinical Quality Meeting – This group will meet monthly to discuss key

quality issues related to the Trust.

Governors Patient Experience & Safety Committee (11 February)

Council of Governors (05 March)

Staff

Frontline teams and subject matter experts

Quality & Governance Committee

Patient Safety Committee

Patient Outcomes Committee

Patient Experience Committee

Performance Directorate

King’s Executive

Enc 2.7.1

21

Learning from the past

We have also learnt that organisation-wide quality improvements may warrant the profile and

attention over a period longer than 12 months. We have therefore reflected on how we build

on our success to sustain and grow improvements. The diagram below summarises our

quality objectives and priorities over the last four years:

These are our priorities for quality improvement in recent years:

1

Pati

en

t S

afe

ty

Reduce hospital acquired infection

Pa

tie

nt

Ex

pe

rie

nc

e Improve the consistency

of positive inpatient

experience

Improve cleanliness of

the hospital environment

2011/12

Pa

tie

nt

Ou

tco

me

s

Improve end of life care

Improve diabetes care

Reduce avoidable death, disability, and chronic ill

health from venous thromboembolism (VTE)

Improve medication safety

Improve identification and escalation of acutely ill

patients

Minimise harm acquired in the hospital

Improve end of life care

Improve diabetes care

Improve responsiveness

to inpatients personal

need

Improve outpatient

experience

2012/13 2013/14

Management of the acutely unwell patient

Surgical Safety checklist

Improve outpatient experience

Improve patient experience of discharge

Dementia

Chronic obstructive pulmonary disease

2014/15

Reduction in falls

Surgical safety

Reducing mortality associated with alcohol &

smoking

Improve outcomes of patients with hip fracture

Improve experience of

cancer patients

Improve patient experience and

coordination of discharge

Enc 2.7.1

22

Our Quality Priorities and Objectives for 2014/15

On 25 February 2014 our Board of Directors provided final ratification on the recommended

six priorities for quality improvement over 2013/14 reflecting on the comments and feedback

we had from our governors, stakeholders and employees.

The table below summarises these safety, clinical effectiveness and patient experience

objectives and priorities.

Pati

en

t E

xp

eri

en

ce 3. Improving

experience and

coordination of

discharge: elderly,

renal and surgery

Denmark Hill:

Reduction in ‘unsafe’ discharges as reported by

primary care, community and social work

colleagues.

Improvement on 2013-14 discharge audit results

(elderly care, surgery and renal).

Positive qualitative feedback from stakeholders

N Outcome/

Process

Priority Key Objectives (Outline) CQ* Measure

Clin

ical

Eff

ecti

ven

ess

1. Working to

reduce

preventable ill-

health

Increase assessment of patients to identify whether

they want help with reducing the likelihood of harm

caused through smoking and alcohol.

Increase the number of staff trained to provide brief

interventions for smoking and alcohol.

Increase the number of referrals for specialist

smoking and alcohol support.

Increase the number of smoking ‘quitters’.

Identify opportunities to promote exercise and

healthy eating.

Y Outcome/

Process

2. Improve

outcomes of

patients following

hip fracture

Improve pain relief.

Reduce time before surgery.

Increase physiotherapy to help people recover

sooner.

Reduce length of stay in hospital.

Increase the number of patients who are

discharged to their own home.

Increase the % of patients who have a bone health

and falls assessment, and thereby reduce the

likelihood that patients will fall and incur further

injury in the future.

N Outcome/

Process

Enc 2.7.1

23

and users.

Increase of 5 points in ‘How are we doing?’ survey

combined scores for questions relating to

discharge and reduction in comments about the

discharge process.

Better experience for elderly and vulnerable

patients with timely discharges and more seamless

transfers and cross agency working.

Patients and their families receiving better

information and explanations in regard to the

discharge process, medications and any ongoing

concerns they may have.

PRUH

As above

4. Improving the

experience of

cancer patients

Increase the number of clinicians who have

undertaken the National Advanced Communication

Course across the organization.

Ensure patient have an Holistic Needs Assessment

(HNA) undertaken.

Patients are receiving appropriate information at

the right time.

More patients having improved access to the trust

e.g Cancer HelpLine.

Provide education for ward nurses to improve their

understanding of cancer patients’ needs.

N Process/

Outcome

Pati

en

t S

afe

ty

5. Improving the

identification and

management of

patients at risk of

falling in hospital

Reduction in falls with moderate and major to<3

per month.

Reduction in falls by age band.

Appropriately assessed pre fall.

Y Process/

Outcome

6. Safer surgery Zero never events.

Effective use of surgical checklist; completion &

situational awareness.

N Process/

Outcome

*CQ=Part of our CQUIN framework of national and locally agreed targets

Clinical Effectiveness Priorities: Plans for 2014/15

1. Working to reduce preventable ill health

There is a longstanding aspiration for the NHS to focus as much on promoting wellness as

managing poor health (NHS England).

Nationally, smoking leads to premature death in half of all smokers and half of all hospital

admissions are attributable to smoking (British Thoracic Society). Deaths from lung cancer

Enc 2.7.1

24

in Southwark and Lambeth are amongst the highest in England, and alcohol-specific hospital

admissions in Lambeth and Southwark are much higher than London average. Across all

King’s communities, premature deaths caused by smoking and alcohol are a key factor in

health inequalities and the reduction of unnecessary deaths is a priority for patients and

clinicians alike.

Many patients wish to take action to improve their own health and prevent future illness and

there is much that hospitals can do to support them.

Across all King’s sites there have been many initiatives to reduce smoking and harmful

alcohol use and to promote exercise and healthy eating over recent years. In 2014/15, we

will:

Review initiatives that have been successful, share good practice and extend roll-out

across new areas of King’s;

Ensure staff in key areas receive the training they need to support patients in reducing

smoking and harmful alcohol use;

Increase provision of advice and brief interventions relating to smoking and harmful

alcohol use;

Work to develop an electronic referral process into smoking cessation and alcohol

services across all King’s sites;

Increase referrals into smoking cessation and alcohol services;

Work with the providers of hospital food, both on the wards and in our cafes, to promote

and deliver healthier food;

Review ways in which King’s can increase promotion of exercise to improve health; and

Continue work to implement NICE public health guidance.

How will we monitor progress?

CQUINs will be agreed to support the monitoring of:

The identification of patients who smoke and/or are using alcohol in a harmful way;

The provision of advice to these patients;

Referrals made into specialist smoking (and alcohol?) services; and

The roll-out of training to staff.

In addition, over the year we will work to identify local measures of success, for example,

smoking cessation rates.

At the end of 2014/15, what will success look like?

A greater number of our patients will have received:

Advice on smoking and harmful alcohol use; and

Referrals into specialist services, where this is requested.

A greater number of our staff will have received the training that they need to offer evidence-

based advice and brief interventions relating to smoking and harmful alcohol use.

2. Improving outcomes for patients following hip fracture

Enc 2.7.1

25

Why have we chosen this is as a priority?

Hip fractures are cracks or breaks in the top of the thigh bone (femur) close to the hip joint,

and are usually the result of a fall. Hip fracture is usually extremely painful and most people

will require surgery to fix the fracture.

Around 500 patients a year are admitted to King’s sites following hip fracture and these

patients form one of our highest group of users of hospital beds (over 12,000 bed days each

year over the Denmark Hill and PRUH sites). Hip fracture is associated with increased age,

so the predicted increase in the number of elderly people across the area served by King’s

will lead to an increase in the number of patients with hip fracture in the future. It is therefore

crucial that we provide a first-rate service for these patients.

King’s currently provides excellent orthopaedic services through our recently redeveloped

facilities at Orpington Hospital and the geriatric/orthopaedic liaison service at Denmark Hill.

However, there are some identified areas in which we want to improve, including:

The proportion of patients admitted to orthopaedic care within 4 hours;

The process of booking hip fractures for surgery;

Pain relief, including the provision of pain relief earlier in the patient pathway;

Increasing the number of patients who receive pre-operative assessment by a

geriatrician, on all sites;

Early mobilisation of patients; and

Monitoring of patients’ mental health.

The development of seamless care between orthopaedic surgeons and care-of-the-elderly

doctors is a priority area and will not only improve the care of hip fracture patients but will

also benefit patients coming to King’s for elective hip and knee surgery.


The National Hip Fracture Database collects key data from all hospitals in relation to hip

fractures and will provide King’s with data that will enable us to compare our results over

time, and with other hospitals. In addition, a database has been set up to collect data within

King’s so that we can monitor our care against NICE guidance. Key outcomes that we will

measure include:

Length of stay in hospital;

Number of patients who are discharged to their own home;

Provision of pain relief in Emergency Department;

Time before surgery;

Provision of physiotherapy and mobilisation;

Proportion of patients who have a bone health and falls assessment; and

Assessment of patients’ mental status.


Our patients will:

Enc 2.7.1

26

Receive improved pain relief in the Emergency Department;

Receive the specialist care that they need in hospital, including support from care-of-the-

elderly doctors and a faster time to surgery;

Be fitter so that they can be discharged from hospital earlier and are more likely to be

going to their own home;

Receive preventative advice and treatment so that they are less likely to fall in the future,

or if they do fall they are less likely to incur a serious injury; and

Have improved mental health.

Patient Experience Priorities: Plans for 2014/15

3. Improving experience and coordination of discharge: All elderly care wards, renal

inpatient wards (Denmark Hill) and surgical wards:


Increased demand on our capacity urges us to ensure that our discharge coordination

provides a safe and positive experience for our patients and stakeholders. The real test

around discharge will be in areas of high patient turnover with often complex needs at

discharge such as healthcare of the aging unit areas where many of the more complex

patients require placement to care homes or large packages of care . Renal and surgery

wards have also been identified through ‘How are we doing?’ survey results and, at their

suggestion, a focus on discharge planning. In the areas of renal and surgery, this includes

our local population who return to utilize the service on a regular basis.

External stakeholders continue to describe concerns around medication information and

information on who to contact if complications arise after discharge. Feedback from patients

and GPs indicates that patient experience continues to be poor in this area due to the lack of

a well-planned and co-ordinated approach from ward to home. This includes discharges

made suddenly, long waits in discharge lounges, sometimes poor co-ordination with social

care/primary care and poor planning for medication on discharge. The aim would be a more

person-centred quality priority in this area, linking to the development of integrated care.

In order to demonstrate our plans for quality improvement we will:

Denmark Hill

Southwark & Lambeth Integrated Care: simplify discharge and continue the ongoing

project to refer elderly vulnerable patients to the Enhanced Rapid Response (ERR)

service to enable faster, safer discharge out to the community. Discharging patients to

assess them in the community as opposed to in hospital. This is taking place within

Medicine predominantly. Aim to see an increase in effective referrals.

o Ensure discharge processes that reduce duplication and deliver a clear

assessment of a person’s needs. Early multi-disciplinary assessment, including

social care that reflects the perspectives of all partners.

o Provision of the right service at the right time for a person being discharged from

hospital. Timely Transition Support with assessments being moved from the

Enc 2.7.1

27

acute to the community setting enhancing the capacity of the existing ERR team

in the community.

o Provision of clear information to people about the outcome of the assessment

process and the care pathway they will be following on discharge. Additional

support via Health Education South London funding.

Timely Transition Support aims to:

Make the process of passing a patient from one organisation to

another easier;

Allow the assessment process to take place at home;

Get people out of hospital faster; and

Identify patients who are in hospital but are medically fit who if

discharged would require additional supported home.

Hospital 2 Home project: aims to increase the number of volunteers working at King’s

with the specific aim of ensuring a safe transition to home from hospital including

accompanying patients home. This work is already being carried out in some of the

medical and surgical wards and aims to expand further to other wards.

Southwark Early Intervention project: early intervention social worker (SW) being ward-

based on the health and aging wards. The additional SW staff will attend the multi-

disciplinary meetings (MDMs) that occur on the Health and Aging Units (HAU) wards,

gather information relating to the community set up for patients and have access to

Southwark ICT systems to be able to feedback information to ward teams. They also aim

to commence joint assessing for patients that may require placement to improve on the

patient/relative experience around placement from hospital further funding dependent.

Homeless Team: this is project currently jointly funded between King’s and Guy’s and St

Thomas’s (GSTT). Consisting of a team that track and see homeless patients at King’s

that may require help regarding housing/hostels/SW/follow up clinics. This has just been

awarded funding into next year. Aim to see an increase in referrals with associated

positive feedback.

@Home service: this is a service run jointly between King’s and GSTT regarding the

expansion of Virtual Ward. There is now a clinical nurse specialist from the @Home

service based at King’s who is a face to face contact for the service that can help to take

patients out of hospital at an earlier juncture to receive both health and social care at

home.

Target work with ward based pharmacist and ward managers to improve information

around medications:

o Ensure a robust system is in place for auditing medication information at

discharge (currently not included in discharge audit tool and difficult to ‘prove’ it

has been done).

Target work/working group approach to improving discharge arrangements on the

specified wards; reviewing and improving processes, learning from areas that do well

(multi-disciplinary team).

Ensure discharge leaflets are given out from every ward and that there is a focus on the

supported carer when discharging a patient into a family member/partner’s care.

Increase effectiveness of discharge summaries: the first one goes to the patient with their

TTAs. The second one is signed by 2 registered nurses that the TTAs have been

checked as correct and discussed with the patient. This is then signed off and should be

filed in the patient notes as evidence.

Enc 2.7.1

28

PRUH:

Facilitate timely completion of key documents whilst supporting patients/families

through this complex process;

Discharge co-ordinators provide at least twice weekly support to board rounds;

Support family meetings for complex discharges;

Case manage complex patients as part of the multidisciplinary team; and

Introduce a rolling educational programme for nursing staff.


Progress will be monitored via ongoing audit cycles and adjusting action plans accordingly:

‘How are we doing?’ inpatient survey relating to discharge and number of patient

comments relating to discharge, monitoring improvement against question/s and national

survey results. These are routinely reviewed though the Trust Patient Experience

Committee;

Monthly review of complaints from users around discharge, action and evaluation;

Audit of patient note discharge summaries, correctly signed off and evidenced; and

Feedback in regular meetings with stakeholders: CQRG, Council of Governors GPs etc.


Denmark Hill:

Increase of 5 points for ‘How are we doing?’ combined scores for questions relating to

discharge and reduction in comments about the discharge process;

Better experience for elderly and vulnerable patients with timely discharges and more

seamless transfers and cross-agency working measured by decrease in quality

alerts/adverse incidents:

o 2014/15 Ensure robust reporting and monitoring system is in place for adverse

indent (quality alert) reporting and collation between community and hospital

(currently held at GSTT).

o 2015/16 Set target of reduction in quality alerts.

Patients and their families receiving better information and explanations in regard to the

discharge process, medications and any ongoing concerns they may have.

o Ensure a robust system is in place for auditing medication information at

discharge (currently not included in discharge audit tool and difficult to ‘prove’ it

has been done).

Improvements in discharge audit results. For 2014/15 we will use the same tool to be

able to see improvement but will plan to improve the audit tool to give more detail going

forward.

PRUH:

As above with relevant tools to PRUH

Enc 2.7.1

29

4. Improving the experience of cancer patients:


Following disappointing performance in the last two national cancer surveys, we’re

committed to improving the experience of our cancer patients. Patients have highlighted a

number of areas where we need to make improvements including:

How we communicate with patients;

The information that we give patients about both their clinical care and the support

available to them;

Involving patients in decisions about their care and ensuring that they understand

their care plan;

Lack of understanding from some staff about the needs of cancer patients;

Patients find it hard to get access to key staff such as the Clinical Nurse Specialist;

and

Poor patient experience of outpatient and day case visits.


Increase the number of doctors receiving advanced communication skills training;

Improve information provision for patients - carry out a Holistic Needs Assessment in

partnership with the patient to ensure that the patient understands their care and

treatment plan and provide them with information about the support available to

them. As part of this process, provide all patients with a patient held record;

Hold education sessions for ward nurses to improve their understanding of cancer

patients’ needs;

Extend the Macmillan Value Based Standard™ programme to additional non-cancer

specialist wards to improve the quality of care for all our cancer patients. The

Macmillan Values Based Standard™ aims to achieve a transformation in patients’

and families experience of care, through patients and staff co-designing solutions and

interventions that change behaviour;

Gather feedback from patient through qualitative methods such as patient stories to

get a better understanding of how our patients experience their cancer care.


Communication:

o Doctors attending communication skills training.

o Conduct a pre and post training evaluation to assess attitudes to

communication.

Information for patients:

o Audit to confirm that a Holistic Needs Assessment has been carried out – use

LCA baseline and aim for 5% increment each quarter across all tumour sites.

o Audit and improve the use and availability of patient hand held record.

Enc 2.7.1

30

o Survey of patients to assess satisfaction with the hand held record and

suggest improvements.

Contacting staff:

o Audit contacts to the King’s cancer help-line and the Macmillan Centre and

information stands.

Education:

o Audit numbers of nurses undertaking education sessions.

Pre and post staff survey on wards where the Macmillan Value Based Standard is

implemented

Overall performance in the National Cancer Survey for 2013/14

The use of patient stories for staff training.


Improvement in the 2013 /2014 National Cancer Survey;

Improved performance in the King’s How are we doing? inpatient and outpatient

surveys; and

Increased contacts with the helpline and Macmillan Centre.

Enc 2.7.1

31

Safety Priorities: Plans for 2014/15

5. Reducing the number of falls in hospital for patients


From April 2013 until the end of February 2014 there were 21 serious patient falls at King’s,

of which 15 resulted in a fractured neck of femur, 3 resulted in intracranial bleeding and 3

resulted in other fractures. This represents a significant increase in the number of serious

falls compared to the 2012/13 year when 6 serious falls were reported. Most of the serious

falls (17) have occurred on the Denmark Hill site, although patient harm from falls remains a

significant issue at the PRUH site as well, with 4 serious falls reported in year. The risk of

patient falls can be minimised by accurate and timely falls risk assessments which tailor the

care plan according to need.


Review the falls risk assessment documentation to ensure it is fit for purpose and that

the same approach to falls risk is followed across all sites;

Launch a falls awareness campaign to promote use of the standardised falls risk

assessments and other measures which have been shown to prevent falls;

Make falls prevention training mandatory for all nursing staff;

Extend pilot work on fundamentals of nursing care to more wards;

Progress in recruitment process of a pool of staff who will be available to provide

immediate 1:1 care to patients who are deemed at high risk of falls;

Develop falls metrics (such as injurious patient falls per 100 bed days by age range,

patient falls by ward by month) to enable tracking of performance at Trust, Divisional

and ward level; and

Review the root causes of moderate and serious patient falls at the Safer Care Forum

to identify common themes and develop safety improvements.


Monitor the number of injurious patient falls per 1000 bed days by age range;

Monitor the % of nursing staff who have in-date falls prevention training; and

Measure the number of serious falls in 2014/15.


Reduction in the number of injurious patient falls per 1000 bed days across each age

range compared to baseline;

Increase the % of nursing staff who have in-date falls prevention training compared to

baseline; and

Reduction in the number of serious falls in 2014/15 compared to 2013/14.

6. Safer Surgery


Enc 2.7.1

32

In 2008 the World Health Organisation (WHO) developed a core set of safety checks for use

in any operating theatre environment. The checks were designed to improve anesthetic

safety, avoid wrong site surgery and surgical site infections and generally improve

communication within surgical teams. A multi-site international study of almost 8000 surgical

patients showed that use of a checklist containing these core safety checks significantly

reduced death and complications. The WHO checklist was adapted and endorsed by the

NPSA in England in 2009.

King’s implemented the checklist in April 2009. In 2012/13 three retained swab incidents (and

one retained tampon) were reported at King’s - as a result this was identified as a safety

priority for 2013/14. However, despite the establishment of a Surgical Safety Improvement

Group, which focused on surgical safety and the implementation of a number of safety

initiatives, it has been recognised that further work needs to be done to create a safety aware

culture across all theatre environments. This is reflected in the fact that surgical Never

Events continued to occur in 2013/14 (1 wrong tooth extraction, 2 retained guide wires and 1

retained diathermy scratch pad).


Develop a standard operating procedure for Safer Surgery Checklist (SSC) use at King’s;

Develop an audit tool and audit programme to assess the quality of SSC use across all

surgical environments;

Conduct monthly audits of SSC compliance (as per audit tool and programme above) and

publish results on monthly divisional scorecards;

Extend audit tool for evaluation of pre-operative process (which has been successfully

trialled in vascular surgery) to other surgical specialties;

Develop a surgical safety website on Kwiki;

Continue to monitor surgical specialty compliance with SSC via presentation at the Safer

Surgery Improvement Group; and

Develop an electronic SSC on the theatre system (Galaxy) ready for pilot by the March

2015.


Ongoing monthly audits of SSC use will be conducted and results published in divisional

scorecards;

The number of surgical Never Events will be monitored through the Safer Surgery

Improvement Group; and

As a minimum each surgical specialty will attend the Safer Surgery Improvement Group

once a year where audit and outcome measures will be monitored.


Audit of SSC use indicates improvement in compliance from baseline; and

Zero surgical Never Events achieved in year.

Enc 2.7.1

33

2a: Information on the review of services

During the reporting period 01 April 2013 -31 March 2014 King’s College Hospital NHS

Foundation Trust provided and/or sub-contracted 9 relevant health services.

King’s College Hospital NHS Foundation Trust has reviewed all the data available to them on

the quality of care in all these relevant health services.

The income generated by the relevant health services reviewed in the reporting period 01

April 2013-31 March 2014 represents 100% of the total income generated from the provision

of relevant health services by King’s College Hospital NHS Foundation Trust for the reporting

period 01 April 2013-31 March 2014.

Enc 2.7.1

34

2b: Participation in Clinical Audits and National Confidential Enquiries During the reporting period 01 April 2013 to 31 March 2014, 43 national clinical audits and 4

national confidential enquires (National Confidential Enquiry into Patient Outcome and

Death, NCEPOD) covered relevant health services that King’s provides.

The breakdown over King’s main acute sites is as follows:

Relevant to services provided at Denmark Hill (DH) - 43 national clinical audits and 4

NCEPOD studies;

Relevant to services provided at Princess Royal Hospital, Bromley (PRUH) - 32

national clinical audits and 3 NCEPOD studies.

During that period King’s participated in 100% (43/43) of national clinical audits and 100%

(4/4) national confidential enquires in which it was eligible to participate:

The breakdown over the Trust’s main acute sites is as follows:

DH participated in 100% (43/43) of national clinical audits and 100% (4/4) of

NCEPOD studies.

PRUH participated in 94% (30/32) of national clinical audits and 100% (3/3) of

NCEPOD studies.

The national clinical audits and national confidential enquiries that King’s was eligible to

participate in during 2013/14, and those in which we actually participated in (with data

collection completed during 2013/14), are listed below alongside the number or registered

cases required by the terms of that audit or enquiry.

The following list is based on that produced by the Department of Health and Healthcare

Quality Improvement Partnership (HQIP):

NB: Data for the PRUH which is separate from South London Healthcare Trust (SLHT) for

several audits during this period is not available.

National Clinical Audit or Confidential Enquiry

Reporting period

Participation Participation rates

KCH (Denmark Hill)

PRUH

Acute

Case Mix Programme (CMP) ICNARC

01/04/13 – 31/03/14

Yes Yes Data submission and validation in process. To date:

KCH (DH) LITU: 100%.

KCH (DH) ICU: 100%.

PRUH ICU: 100%.

Emergency Use of Oxygen

15/08/13 – 01/11/13

Yes Yes Data collection complete:

KCH (DH): 100% (70 patients).

PRUH: 21 patients.

National Audit of Seizures in Hospitals (NASH)

01/01/13 - 15/09/13

Yes Yes Data collection complete:


PRUH: 97% (29 patients).

National Emergency Laparotomy Audit (NELA)

07/01/14 – 30/11/14

Yes Yes Data collection in progress - deadline 30/11/14.

Enc 2.7.1

35


Reporting period


KCH (Denmark Hill)

PRUH

National Joint Registry (NJR)

01/01/13 - 31/12/13

Yes Yes Data collection in progress - deadline 31/03/14. Participation rate will be included in the annual report, due to be published September 2014.

Paracetamol Overdose (Care Provided in Emergency Departments)

01/08/13 – 31/03/14

Yes Yes Data collection in progress - deadline 31/03/14. Participation rate will be included in the audit report, due to be published May 2014.

Severe Sepsis and Septic Shock

01/08/13 – 31/03/14


Trauma Audit and Research Network, TARN

01/04/13 – 31/12/13

Yes No Data collection complete:


PRUH: No data submitted. Action plan in progress.

Blood and Transplant

Audit of the Use of Anti-D

01/04/13 – 31/05/13

Yes Yes Data collection complete. Participation rate will be included in the audit report, due to be published spring 2014.

Audit of the Management of Patients in Neuro Critical Care Units

04/03/13 – 26/04/13

Agreed non-participation

Not applic-able

KCH (DH): Non-participation approved by the Trust’s Clinical Effectiveness Committee on the grounds that insufficient notice was provided by the audit supplier to enable participation. PRUH: Service not provided.

Audit of Patient Information and Consent

13/01/14 – 04/04/14

Yes Yes Data collection in progress - deadline 30/04/14. Participation rate will be included in the audit report, due to be published August 2014.

Cancer

Bowel Cancer (NBOCAP)

01/04/12 – 31/03/13

Yes Yes Data collection complete.


PRUH: SLHT data available only for this period.

Participation rate will be included in the audit report, due to be published July 2014.

Head and Neck Oncology (DAHNO)

Not applicable Service not provided at KCH. The service is centralised at Guy's and St Thomas' NHS Foundation Trust.

Lung Cancer (NLCA) 01/01/13 – 31/12/13

Yes Yes Data collection in progress - deadline 30/06/14. Participation rate will be included in the audit report, due to be published December 2014.

Oesophago-gastric Cancer (NAOGC)

01/04/12 – 31/03/13

Yes Yes Data collection complete.



Participation rate will be included in the audit report, due to be published June 2014.

Prostate Cancer Organisatio Yes Yes Data collection in progress.

Enc 2.7.1

36


Reporting period


KCH (Denmark Hill)

PRUH

nal audit: Oct 2013. Clinical audit: April 2014 onwards. PREM: April 2015 onwards.

Heart

Acute Coronary Syndrome or Acute Myocardial Infarction (MINAP)

01/04/13 – 31/03/14

Yes Yes Data collection in progress - deadline 31/05/14. Participation rate will be included in the audit report, due to be published September 2014.

Cardiac Rhythm Management (CRM)

01/04/13 – 31/03/14 (TBC)

Yes Yes Data collection in progress - deadline August 2014 (TBC). Participation rate will be included in the audit report, due to be published Autumn 2014.

Congenital Heart Disease (CHD)

01/04/13 – 31/03/14

Yes Not applic-able

KCH (DH): Data collection in progress - deadline 30/05/14. PRUH: Service not provided.

National Audit of Percutaneous Coronary Interventional Procedures

01/01/13 – 31/12/13

Yes Not applic-able

KCH (DH): Data collection in progress - deadline 31/03/14. Participation rate will be included in the audit report, due to be published October 2014. PRUH: Service not provided.

National Adult Cardiac Surgery Audit

01/01/13 – 31/12/13

Yes Not applic-able

KCH (DH): Data collection in progress - deadline 30/06/14. PRUH: Service not provided.

National Heart Failure Audit

01/04/13 – 31/03/14

Yes No Data collection in progress - deadline 02/06/14. PRUH: Non participation for 2013/14 period. Actions in place to ensure successful participation 2014/15.

National Vascular Registry - Carotid Interventions Audit (CIA)

1/10/12 – 30/09/13

Yes Not applic-able

KCH (DH): Data collection in progress - deadline 31/03/14 (TBC). Participation rate will be included in the audit report, due to be published September 2014. PRUH: Service not provided.

National Vascular Registry - National Vascular Database

01/01/13 – 31/12/13

Yes Not applic-able

KCH (DH): Data collection in progress – continuous data collection. PRUH: Service not provided.

National Cardiac Arrest Audit (NCAA)

01/04/13 – 31/03/14

Yes No Data submission and validation still in process. To date KCH (DH): 100%. PRUH: No previous participation in the audit. Data submission due to start April 2014.

Enc 2.7.1

37


Reporting period


KCH (Denmark Hill)

PRUH

Pulmonary Hypertension Audit

Not applicable Service not provided at KCH.

Long term conditions

National Diabetes Adult (NDA)

01/01/12 – 31/03/13

Yes Not applic-able

KCH (DH): 100%. PRUH: PRUH does not provide an outpatient diabetes service.

National Diabetes Inpatient Audit (NADIA)

16-20/09/13 Yes Yes Data collection complete:


PRUH: 43 patients.

Pregnancy Care in Women with Diabetes

01/07/13 – 31/01/14

Yes Not applic-able

KCH (DH): Data collection complete. Participation rate will be included in the site specific report, due to be published August 2014. PRUH: Pregnant women with diabetes are managed by Bromley Health Care.

National Paediatric Diabetes Audit (NPDA)

01/04/12 – 31/03/13


Inflammatory Bowel Disease (IBD) (Adult and Paediatric patients)

01/01/14 – 31/12/13

Yes - adult and paediatric cases

Yes - adult cases only

Data collection complete. Participation rate will be included in the annual report, due to be published June 2014. PRUH: Not eligible to participate in the paediatric component of the audit due to small patient numbers.

National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme

1/2/2014 - 30/4/2014


Paediatric Bronchiectasis

01/10/13 – 30/11/13

Yes Not applic-able

KCH (DH): Data collection in progress - deadline 07/02/14. PRUH: No patients diagnosed with bronchiectasis during the audit period.

Renal Registry 01/01/13 – 31/12/13

Yes Yes Data collection in progress – deadline 31/05/14.

Rheumatoid and Early Inflammatory Arthritis

01/02/14 – 31/01/15 (and follow up data by 30/04/15)

Yes Yes Data collection in progress – deadline 30/04/15. Participation rate will be included in the site specific reports, due to be published June 2015.

Mental Health

Mental Health Clinical Outcome Review Programme: National Confidential Inquiry into Suicide and Homicide for people with Mental Illness (NCISH)

Not applicable Service not provided at KCH. The recommendations produced by the study are, however, reviewed for relevance to the Trust.

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38


Reporting period


KCH (Denmark Hill)

PRUH

National audit of schizophrenia (NAS)


Prescribing Observatory for Mental Health (POMH)


Older People

Falls and Fragility Fractures Audit Programme (FFFAP) – National Hip Fracture Database

01/04/13 – 31/03/14.

Yes Yes Data collection in progress – deadline 13/04/14. Participation rate will be included in the audit report, due to be published September 2014.

Sentinel Stroke National Audit Programme (SSNAP)

01/04/13 – 31/03/14.

Yes Yes Data collection in progress – deadline 03/02/14 (Q3, 2013/14 data).

Other

National PROMs Programme

01/04/2012 – 31/03/2013

Yes Not avail-able

Data collection complete:

KCH (DH): 48.3% (provisional data published December 2013).


Women’s & Children’s Health

Child Health Clinical Outcome Review Programme (CHR-UK)

01/06/12 – 31/03/13

Yes Yes Data collection complete – participation rate not provided by Royal College of Paediatric and Child Health (RCPCH).

Epilepsy 12 Audit Clinical Audit: 01/02/13 – 31/10/13 Organisational Audit: 01/01/14

Yes Yes Data collection in progress – deadlines:

Clinical audit and organisational audit mid May 2014. PREM: 31/03/14.

Maternal, Newborn and Infant Clinical Outcome Review Programme (MBRRACE-UK)

10/04/13 - Continuous

Yes Yes Data collection in progress – continuous. 100% participation.

Moderate or Severe Asthma in Children (Care Provided in Emergency Departments)

01/08/13 – 31/03/14


National Neonatal Audit Programme (NNAP)

01/01/13 – 31/12/13

Yes Yes Data collection in progress – continuous.

KCH (DH): 100%.

PRUH: 100%.

Paediatric Asthma 01/11/13 – 30/11/12

Yes Yes Data submission deadline 28/02/14.

Paediatric Intensive Care Audit Network (PICANet)

01/01/11 – 31/12/13

Yes Not applicable

Data collection in progress – continuous.

KCH (DH): 100%.

PRUH: Service not provided.

Enc 2.7.1

39

In addition, King’s participated in the following NCEPOD studies:


Reporting period


KCH (Denmark Hill)

PRUH

Acute

Tracheostomy Care 25/02/13 – 12/05/13

Yes Yes 83% (insertion questionnaires) 73% (critical care questionnaires) 72% (ward care questionnaires) 100% (patient notes) 100% (organisational questionnaire)

Lower Limb Amputation 01/10/12 – 31/03/13

Yes Not applicable

Data collection in progress – participation rates to date: 33% (clinician questionnaires) 33% (patient notes) 100% (organisational questionnaire)

Subarachnoid Haemorrhage

01/01/13 – 30/04/13

Yes Yes 80% (secondary clinician questionnaires) 81% (tertiary clinician questionnaires) 60% (secondary patient notes) 100% (tertiary patient notes) 100% (organisational questionnaire)

36 national clinical audit reports were reviewed by King’s in 2013/14. The actions King’s intends to take to improve the quality of healthcare are provided below: Key

Symbol Definition

* Highest result nationally

+ Above the national average

= Similar to national average

- Below the national average

N/A Not applicable – national average comparable data not available

National Clinical Audit and Confidential Enquiry

Headline results and/ or actions taken KCH (DH) Rating

PRUH Rating

Acute

Adult Community Acquired Pneumonia (British Thoracic Society) Published: June 2013 Audit Period: 01/12/12 – 31/01/13 Sample Size:

KCH (DH): 100% (108 patients)

PRUH: Part of SLHT during audit period. PRUH did not participate in this audit.

The audit shows that the death rate within 30 days of discharge from KCH (DH) is lower than national average (2.1% compared to 3.4%). KCH (DH) performed at or above national average for 9/11 audit standards and has improved since 2012 for 6 of the 7 criteria re-audited. Re-admission rate, however, is higher than national average and is currently under investigation by the audit lead. Action is being taken to ensure that antibiotics are prescribed in line with local community acquired pneumonia guidelines and that data is recorded correctly through the e-prescribing work.

+ N/A

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PRUH Rating

Adult Critical Care (Case Mix Programme – ICNARC CMP) Published: Quarterly reports available Audit Period: 2012/13 Sample Size:

KCH (DH): 100% (775 - 825 patients)

PRUH: Part of SLHT during audit period and PRUH data not available.

The ICNARC confidential comparison of Intensive Care Unit (ICU) shows that mortality at KCH (DH) is below expected and is comparable to Trusts with a similar casemix.

+ N/A

Adult Critical Care (Case Mix Programme – ICNARC CMP) Published: Quarterly reports available Audit Period: 01/01/13 – 31/03/13 Sample Size:

KCH (DH): 100% (200 - 250 patients)

PRUH: Not applicable – service not provided.

The ICNARC confidential comparison of Liver Intensive Care Units (LICU) shows that mortality at KCH (DH) is below expected and is comparable to Trusts with a similar casemix.

+ N/A

Emergency Use of Oxygen (British Thoracic Society) Published: November 2013 Audit Period: 15/08/13 – 01/11/13 Sample Size:


PRUH: 21 patients.

In line with the national picture, the Trust had mixed results for the audit compared to the national average at both KCH (DH) and PRUH. Following the 2012/13 audit KCH (DH) implemented a detailed action plan that included the development of local guidelines, electronic flagging and a staff training programme. As a result KCH (DH) performance has improved for all key criteria compared to the previous round including for patients currently using oxygen with a prescription or bedside order, percentage of signatures to rounds, percentage of observations to rounds and patients with SpO2 within target range at last assessment. A trust-wide (KCH (DH) and PRUH) action plan is in development to support further improvement.

= -

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PRUH Rating

National Audit of Seizure Management (NASH) Published: February 2014. Audit Period: 01/01/13 – 15/09/13 Sample Size:


PRUH: 97% (29 patients).

KCH (DH) performed at or above the national average for 28/31 criteria and is similar to or better than 2011 performance for all criteria re-audited. PRUH performed at or above the national average for 21/31 criteria and in line with or better than 2011 performance for 15/25 criteria re-audited. A detailed action plan has been implemented at KCH (DH) to improve patient management further. This includes the implementation of a care pathway for adult patients with established epilepsy presenting in the ED with seizures and detailed patient information. The implementation of a Rapid Access Clinic and appointment of an additional Epilepsy Nurse is under investigation and work is in progress to improve further the liaison between the ED team and the Epilepsy Specialist Nurses and ensure all patients receive the best quality service. A PRUH action plan is currently in development.

+ +

National Joint Registry (NJR) Published: September 2013 Audit Period: 01/01/12 – 31/12/12 Sample Size:

KCH (DH): 372 patients

PRUH:150 patients

Both KCH (DH) and PRUH are within expected range for mortality following hip and knee replacement and revision surgery. Both sites are also rated ‘green’ for consent, an improvement from ‘amber’ on both sites in the previous report.

+ +

Orthopaedic Surgery: National Joint Registry (NJR) (Surgeon-level data) Published: June 2013 Audit Period: 01/01/12 – 31/12/12 Sample:

KCH (DH): Data published on 8 consultants.

PRUH: Data published on 7 consultants.

KCH (DH): No non-consenters, all surgeons within expected range. PRUH: No non-consenters, all surgeons within expected range.

+ +

Non-invasive Ventilation (NIV) - Adults (British Thoracic Society) Published: June 2013 Audit Period: 01/02/13 – 31/03/13 Sample Size:


PRUH: Part of SLHT during audit period. PRUH did not participate in this audit.

The audit identifies KCH (DH) as performing at or above national average for 15/19 audit criteria. KCH (DH) experiences a higher length of stay for ventilated patients than the national average (17 days compared to 13 days). Below national average performance was recorded for 3 standards relating to planning in case of NIV failure. An action plan, that includes the development of a flow chart for NIV and a review of the prescription of oxygen across the Trust, is being implemented by the Integrated Respiratory Team to address these issues. How to improve referral for sleep study for obese patients is under review by the audit lead - performance against this standard was poor nationally.

+ N/A

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PRUH Rating

Trauma Audit and Research Network (TARN) Published: Data available [on-line], current as of 09/04/14.

The TARN data demonstrates that more trauma patients admitted to KCH (DH) are surviving compared to the number expected based on the severity of their injury. Rate of Survival at KCH (DH): Between January 1st

2011 and December 31st 2013

+ N/A

Cancer

Bowel Cancer (NBOCAP) Published: July 2013 Audit Period: 01/04/11 – 31/03/12 Sample Size:



KCH (DH) adjusted mortality for bowel cancer is better than national average at 30 days, 90 days and 2 years. A high proportion of KCH (DH) patients undergo laparoscopic surgery (72%; national average = 40%). Three areas of underperformance relate to data recording: CT scans, MRI scans and pre-operative radiotherapy. All areas have improved since 2012 and continue to be addressed.

+ N/A

Colorectal Surgery: Surgeon-level data Data taken from: Bowel Cancer (NBOCAP) Published: June 2013 Audit Period: 01/04/10 – 31/03/12 Sample:

KCH (DH): Data published on 6 consultants

PRUH: Surgeon-level data not provided.

KCH (DH): No non-consenters, all surgeons within expected range.

+ +

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PRUH Rating

Lung Cancer (NLCA) Published: December 2013 Audit Period: 01/01/12 – 31/12/12 Sample Size:



KCH (DH) performed in line with or above the national average for 7/13 standards. PRUH data is currently being extracted from SLHT data, and once available a joint action plan for the audit will be developed across all sites.

= N/A

Oesophago-gastric Cancer (NOGCA) Published: June 2013 Audit Period: 01/04/11 – 31/03/12 Sample Size:

KCH (DH): >80% (36 patients)

PRUH: 60-80% (99 patients).

KCH (DH) has significantly improved its case ascertainment from <25% in 2012 to >80% in 2013 and was rated ‘green’ for the first time. KCH (DH) is rated green for percentage of patients with planned intent (i.e. a plan in place for the approach to treatment - curative or palliative) and planned modality (i.e. a plan in place for the treatment to be given, e.g. surgery, chemotherapy, radiotherapy) and red for percentage of patients for recording of ‘M-stage after CT’ (i.e. presence or absence of metastases). The ‘red’ rating for percentage of patients with M-stage after CT is a data completeness issue and has improved over the past year. Actions continue to ensure that after CT scans all M-stages are recorded on the multi-disciplinary meeting proformas. PRUH was part of SLHT during audit period and PRUH-specific data against standards of best practice is not available.

+ N/A

Heart

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PRUH Rating

Acute Coronary Syndrome or Acute Myocardial Infarction (MINAP) Published: October 2013 Audit Period: 01/04/12 – 31/03/13

KCH (DH): 823 patients

PRUH: 70 patients

KCH (DH), which is a Heart Attack Centre, performed at or above the national average for 9/11 audit criteria of best practice. PRUH performed in line with or above the national average for 4/5 criteria (6 criteria applied to Heart Attack Centres only). KCH (DH) and PRUH performed below national average for nSTEMI patients admitted to cardiac unit or ward:

KCH (DH) = 41.8%, PRUH = 28.8% and national average = 52.6%.

At KCH (DH) these patients are routinely admitted under General Medicine. Additional capacity has recently been achieved for cardiology patients and the issue remains under review.

At PRUH this is a data submission issue and actions are in place to improve data quality.

KCH (DH) performed above the 75% target for patient receiving primary percutaneous coronary intervention (PCI) within 150 minutes of calling for help, however performed below 75% for patients receiving primary PCI within 120 minutes of calling for help. In 2013 the KCH (DH) cardiology team completed a detailed local audit of the causes of delay, which were found to be primarily inter-hospital transfers. As a result:

Work is underway to engage DGH A&E departments to streamline the inter-hospital transfer process.

A new internal acute coronary syndrome referral pathway has been developed to facilitate transfer from KCH (DH) A&E to cardiac care.

Re-audit is planned for 2014.

+ +

Adult Cardiac Surgery: Surgeon-level data. Data taken from: Adult Cardiothoracic Surgery. Published: June 2013 Audit Period:01/04/09 – 31/03/12 Sample:



KCH (DH): No non-consenters, all surgeons within expected range.

+ +

Congenital Heart Disease Published: Available on-line Audit Period: 01/04/11 – 31/03/12 Sample Size:

KCH (DH): 29 procedures*


* 2012/13 data to be validated on 13/03/14.

No mortality reported at 30 days or at 1 year post procedure.

+ +

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PRUH Rating

Heart Failure (HF) Published: November 2013 Audit Period: 01/04/12– 31/03/13 Sample Size:

KCH (DH): 31.2% (157 patients)

PRUH: 256 patients (case ascertainment provided for SLHT only)

KCH (DH) performed at or above the national average for 10/11 best practice criteria. Performance was variable at PRUH, which met or exceeded the national average for 3/11 audit criteria. KCH (DH) performed below national average for 1 criteria – heart failure patients treated under Cardiology. At KCH (DH) these patients are cared for under General Medicine. An acute heart failure pathway is in place for the care of these patients, with the audit demonstrating that 94.8% of heart failure patients receive specialist cardiology input. An additional cardiology ward was made available in February 2014, with dedicated heart failure beds. PRUH performance was affected by poor data submission against key fields so is not an accurate reflection of clinical practice. A detailed action is in place to improve data submission.

+ -

Interventional Cardiology: Surgeon-level data. Data taken from: National Audit of Percutaneous Coronary Interventional Procedures. Published: June 2013 Audit Period:01/01/12 – 31/12/12 Sample:



KCH (DH): No non-consenters, all surgeons within expected range, data does not include any comparison to national average.

+ +

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PRUH Rating

National Vascular Registry - Carotid Interventions Audit (CIA) Published: October 2013 Audit Period: 01/10/2011 – 30/09/12 Sample Size:



KCH (DH) performed at or above the national average for all 7 standards of best practice. In particular more patients at KCH (DH) are undergoing surgery within 7 days of referral compared to the national average.

+ N/A

Vascular Surgery: Surgeon-level data. Data taken from: National Vascular Registry. Published: June 2013 Audit Period:

Elective abdominal aortic aneurysm repair, 01/01/08 – 31/12/12

Carotid endarterectomy, 01/10/09 – 30/09/12

Sample:



KCH (DH): No non-consenters, all surgeons within expected range, with excellent unadjusted mortality below the national average.

+ +

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PRUH Rating

National Cardiac Arrest Audit (NCAA) Published: June 2013 Audit Period: 01/04/12 – 31/03/13 Sample Size:

KCH (DH): 100% (167patients)

PRUH: Part of SLHT during audit period. PRUH did not participate in this round of the audit.

KCH (DH) is within the expected range for survival after cardiac arrest. Survival to hospital discharge by shockable presenting/ first documented rhythm Survival to hospital discharge by non-shockable presenting/ first documented rhythm

+ N/A

Long Term Conditions

National Diabetes Audit (Adult) (NDA) Published: October 2013 Audit Period: 01/01/11 – 31/03/12 Sample Size:

KCH (DH): 100% (5220patients)

PRUH: Part of SLHT during audit period and did not participate in this round of the audit.

KCH (DH) performed below the national average for patients receiving all 8 care processes recommended by NICE and above the national average for 4/7 treatment targets achieved. Patient care has, however improved for 10/15 care processes and treatment targets compared to the 2010/11 data, and is better than peer. Performance improvements include the measurement of cholesterol, serum creatinine and BMI as well as the provision of foot surveillance and smoking cessation advice. The Trust’s Clinical Effectiveness Committee has planned a focused review of diabetes care in May 2014, across all KCH sites and taking into account the results of all national audits as well as local data on patient experience and patient safety. An action plan will be developed as a result.

- N/A

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PRUH Rating

National Diabetes Inpatient Audit (NADIA) Published: March 2014 Audit Period: 16 – 20 September

2013

*1 day snapshot audit during audit

period.

Sample Size:


PRUH: 43 patients

KCH (DH) continues to perform well in comparison to the national average for the clinical aspects of the audit, performing in line with or above national average for 26/29 criteria, and improving for 9 out of 10 of the patient experience criteria since 2012. PRUH performed in line with or above national average for 18/28 criteria with performance improving across the board, compared to 2012 and in particularly for medication safety, where performance has exceeded the national average . The Trust’s Clinical Effectiveness Committee has planned a focused review of all the diabetes audit results across all KCH sites (see above).

+ +

National Diabetes Inpatient Audit (NADIA) Published: March 2013 Audit Period: 17/09/12 – 23/09/12 Sample Size:


PRUH: Part of SLHT during audit period.

Overall KCH (DH) results for this audit were mixed,

however performance has improved compared to 2011

results and compared to the national average, indicating

safer patient care. PRUH was part of SLHT during this

cycle of the audit and PRUH-specific data is not

available.

+ N/A

National Diabetes Inpatient Audit (NADIA) data, 17/09/12 – 23/09/12

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PRUH Rating

Diabetes (Paediatric) (NPDA) Published: December 2013 Audit Period:01/04/11 – 31/03/12 Sample Size:

KCH (DH) 100% (159 patients)

PRUH: Part of SLHT during audit period. PRUH did not participate in this round of the audit.

In line with the national picture, KCH (DH) patients had slightly higher blood glucose levels than national average but this reflects KCH’s local population and, on detailed review by the Clinical Effectiveness Committee, was not found to be an indicator of poor quality care. A comprehensive action plan is in place to increase staff numbers (psychological, medical and nursing staff); to improve service provision across sites with the implementation of Young Diabetes Connections, peer review and common guidelines for working practices; and improve data submission with the introduction of the TWINKLE database system. To improve further the services offered at KCH (DH), the paediatric diabetes clinic and MDT have been re-structured in line with feedback provided by families of patients.

= N/A

Renal Registry Published: December 2013 Audit Period: 01/01/12 – 31/12/12 Sample Size:


PRUH: Part of SLHT during audit period and did provide a renal service at that time.

KCH (DH) has the highest rate in England of patients starting on renal replacement therapy (RRT) who have diabetes, at 39.2% (national average = 25%), however survival for patients on RRT is very similar to national average (KCH adjusted (to age 60) 1year after 90 day survival and national average = 90.9%). Compared to the 2011 data patients presenting to a nephrologist less than 90 days before RRT initiation has improved from 21.9% to 18.8% at KCH (DH) and is now better than the national average. This has been achieved through the introduction of the renal e-mail helpline, renal services at PRUH, joint referral guidelines between KCH (DH) and Guy’s and St Thomas’ Hospital and the Clinical Commissioning Groups as well as the GP liaison team. Patients on home dialysis continues to exceed the NICE target of 15% at 16.1%, and total infections recorded (01/05/11 – 30/04/12) are all below the national average. Time on waiting list for kidney transplant not reported this cycle. An action plan is currently being developed across sites.

+ N/A

Renal Registry Published: May 2013 Audit Period: 01/01/11 – 31/12/11 Sample Size:


PRUH: Part of SLHT during audit period and did provide a renal service at that time.

KCH (DH) has a similar proportion of patients starting on renal replacement therapy to peers (139 per million population; peer range 90-164). KCH (DH) has the highest rate nationally of patients starting on renal replacement therapy who have diabetes, at 41% (national average = 24.8%), however survival for patients on renal replacement therapy is similar to national average (KCH (DH) adjusted (to age 60) 1year after 90 day survival = 88.3%; national average = 89.6%). KCH (DH) home haemodialysis rate is 17.1%, exceeding the NICE target of 15%. Median time to wait listing for a kidney transplant is 635 days at KCH (DH) (peer range 120-1197 days). The decision-making process is under review to identify opportunities to reduce delays.

+ N/A

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PRUH Rating

Older People

Hip Fracture Database (NHFD) Published: September 2013 Audit Period: 01/04/12 – 31/03/13 Sample Size:


PRUH: 91.1% (346 patients)

Both KCH (DH) and PRUH performed in line with national average for surgery within 48 hours, bone health medication and falls assessment. Both hospitals performed below national average for time taken to orthopaedic care, pre-operative assessment by a geriatrician. Actions are in place, led by the newly-established Hip Fracture Forum, to drive improvement in these areas and, whilst performance demonstrates improvement in 2013-14, the area remains under close internal scrutiny and is a Trust quality priority topic for 2014/15.

= +

National Audit of Dementia (NAD) Published: March 2013 Audit Period: 17/09/12 – 23/09/12 Sample Size:

KCH (DH): 102.5% (41 Patients)


KCH (DH) performed in line with or above the national average for 80% of the applicable criteria audited across 6 domains. An action plan is in place to improve patient management

further. This includes the development of a care pathway

and guideline for patients with delirium and dementia, an

improved discharge planning process formalised in the

Trust’s Discharge Policy, and improved training on the

assessment and documentation of delirium and

dementia. Dementia was a 2013-14 Quality Priority at

KCH (DH).

+ N/A

Sentinel Stroke National Audit Programme (SSNAP) Published: February 2014 Audit Period: 01/07/13 – 29/09/13 Sample size:

KCH (DH): 205 cases (≥90%)

PRUH: 207 (80-89%)

KCH (DH) achieved an overall SSNAP level of B (70 - <80%), higher than all London HASUs and nationally the joint highest routinely admitting unit. The Denmark Hill site also performed at or above the national average for 22/24 criteria and in line with or better than previous performance (April - June 2013) for 18/23 criteria. PRUH achieved an overall SSNAP score above the national average, and performed in line with or above the national average for 17/24 criteria and in line with or better compared to previous performance (April - June 2013) for 22/23 criteria. An action plan to continue to drive improvement is currently being developed across sites.

+

*

+

Women’s & Children’s Health

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PRUH Rating

National Neonatal Audit Programme (NNAP) Published: August 2013 Audit period: 01/01/12– 31/12/12 Sample Size:


PRUH: 100% (324 patients)

The audit identifies KCH (DH) as one of the best performers nationally for the second year running, performing in line with or above best practice for all audit criteria. PRUH performed at or above national average for 4 of the 5 criteria. KCH (DH) performance has improved since 2011 for antenatal steroids and consultation with senior member of the team within 24 hours of admission. At PRUH one criteria is below the national average - provision of retinopathy of screening in accordance with guidelines. Action has already been taken to address this issue and a local audit is planned for early 2014. PRUH’s performance has improved since 2011 for babies receiving mother’s milk at discharge and consultation with a senior member of the team within 24 hours of admission.

+ +

Paediatric Asthma (British Thoracic Society) Published: February 2013 Audit Period: 01/11/12 – 30/11/12 Sample size



KCH (DH) performed in line with or above the national average for 13/19 criteria including: initial assessment, treatment, prophylaxis reviewed at discharge and information provided at discharge.

A local audit of data to assess correct patient management will be completed and work will be undertaken with ED staff to reduce unnecessary investigations and prescriptions of antibiotics.

+ N/A

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PRUH Rating

Paediatric Intensive Care (PICANet) Published: September 2013 Audit Period: 01/01/12 – 31/12/12 Sample size



The audit identifies the mortality rate at KCH (DH) as being one of the lowest nationally, and comparing very favourably with peer trusts. KCH (DH) and Great Ormond Street have the lowest rate of emergency admissions of all peer Trusts.

+ N/A

Paediatric Pneumonia (British Thoracic Society) Published: April 2013 Audit Period: 01/11/12 – 31/01/13 Sample size



KCH (DH) performed in line with or above the national average for 7/11 criteria, including admission tests, provision of oxygen, method of administering oxygen, avoidance of nasogastric feeding tubes (KCH (DH) = 0%), provision of oral antibiotics and hospital follow up arranged.

The data indicates that KCH (DH) is treating patients with a higher severity of pneumonia compared to the national average. A clinical review of the data concluded that, whilst the Trust is performing more tests and interventions (c-reactive protein, chest physiotherapy and chest x-ray) than the national average, these were clinically appropriate and the results are a reflection of severity of pneumonia due to KCH (DH) tertiary status.

+ N/A

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53

In addition, the reports of 26 Trust priority clinical effectiveness audits were reviewed in 2013/14 and the following actions will be taken to improve the quality of healthcare provided:

Local Clinical Audit Headline results and/ or actions taken

UK Liver Transplant Audit Published: May 2013 Audit Period: 01/10/11 – 30/09/12 Sample Size:

KCH (DH) Adults: 131

KCH (DH) Paediatrics:37


KCH (DH) has the joint lowest 90 day mortality in the UK for:

All adult patients who received a first liver transplant as super-urgent.

All adults who received a first liver transplant as elective (risk-adjusted).

The audit also shows that for paediatric cases mortality at KCH (DH) is below national average.

Potential Donor Audit Published: June 2013 Audit Period: 01/04/12 – 31/03/13 Sample Size:

KCH (DH): 100% (all relevant patients are reported in the potential donor audit and to the UK Transplant Registry)

PRUH: Part of SLHT during audit period and PRUH data not available

The number of organ donors at KCH (DH) increased from 13 in 2011/12 to 35 in 2012/13, and the total number of patients whose lives were saved through receiving a transplanted organ from donations at KCH rose from 45 in 2011/12 to 105 in 2012/13.

Bariatric Surgery: Surgeon-level data Data taken from: National Bariatric Surgery Registry. Published: June 2013 Audit Period:01/04/012 – 31/03/13 Sample:


PRUH: Consultant-level data not listed for PRUH.

KCH (DH): No non-consenters, no outliers identified.

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Urological Surgery: Surgeon-level data Data taken from: The British Association of Urological Surgeons – Nephrectomy Outcomes Data Published: June 2013 Audit Period: 01/01/12 – 31/12/12 Sample:


PRUH: Part of SLHT during audit period. No data returned to the BAUS audit for 2012.

KCH (DH): No non-consenters, no outliers identified.

Audit of NICE derogation CG122 ovarian cancer

An audit on gynaecological cancers including ovarian cancer and rapid access service is performed annually. Audit results will be available to demonstrate KCH (DH) compliance with the NICE guidance in 2014.

Audit of NICE derogation CG154 ectopic pregnancy and miscarriage

The Early Pregnancy Unit audits its outcomes on an annual basis including outcome of management options. The data generated from this informs the continuous updating of the unit management protocols.

Audit of NICE derogation CG95 chest pain of recent onset

Attendance, investigation and outcomes are audited for all patients who are managed in the rapid access chest pain clinic. Results expected April 2014.

Audit of NICE derogation CG112 sedation in children and young people

A retrospective analysis of case notes and EPR clinical notes of 99 consecutive paediatric patients sedated for painless and painful procedures at KCH (DH) has been completed. The audit demonstrated a high-level of compliance with the paediatric sedation protocol. Sedation for painful procedures was successful for all patients, whilst 10% (6/60) failed sedation for painless procedures. This was due to the child waking up in 4/6 cases. The audit identified several areas for improvement in the quality of documentation. This is currently being addressed by the Division.

Audit of NICE derogation CG144 venous thromboembolic diseases

Audit in progress to provide assurance of high quality clinical outcomes and processes. Results expected September 2014.

Audit of NICE derogation CG149 antibiotics for early onset neonatal infection

Audit in progress to provide assurance of high quality clinical outcomes and processes. Results expected March 2014.

Audit of NICE derogation CG151 neutropenic sepsis

Routine audit is in place to assess the number of cases of neutropenic sepsis presenting to KCH (DH) and the door to needle time in minutes. Audit results are reviewed by the Acute Oncology Service Committee monthly. Any issues such as delay between prescription of antibiotics and administration are discussed with the ED team. PRUH is planning to adopt the derogation by April 2014 and the neutropenic sepsis audit programme will incorporate PRUH sites in due course.

Audit of NICE derogation IPG149 division of ankyloglossia (tongue-tie) for breastfeeding

An outcome audit was carried out in 2013 to examine the breastfeeding difficulties following frenulotomy and parents’ feedback. The results were reviewed by the Trust Evidence-Based Practice Committee and it was agreed that the tongue-tie clinic is a successful service with good outcomes. Work has begun to improve the referral pathway from the Trust’s post-natal ward and neonatal unit, including staff training in assessment of tongue tie, and for community practitioners post frenulotomy wound care.

Enc 2.7.1

http://guidance.nice.org.uk/CG122

http://guidance.nice.org.uk/CG122

http://guidance.nice.org.uk/cg151

http://guidance.nice.org.uk/cg151

http://guidance.nice.org.uk/ipg149



55


Annual Audit of Modified Early Obstetric Warning Score (MEOWS)

The audit demonstrated documentation needs to be improved and the MEOWS chart has been amended as a result, including clarification of the escalation process and the addition of bleep numbers for key contacts. Training in the use of the new charts is in progress and re-audit is planned.

Surgical Safety Checklist (SSC) In response to the publication of the NPSA Alert 0861 Surgical Safety Checklist, 2009 and the incidence of Never Events at KCH (DH) 2012-13, a number of actions have been taken to improve compliance with the SSC. These include the development of an SSC audit tool used to review completion rates and the quality of SSC completion; all staff informed of SSC expectations; formal launch across all KCH sites, including training sessions and communication strategy, baseline audit to be undertaken across all sites, the swabsafe box introduced to all areas where appropriate and efforts taken to reduce avoidable interruptions in theatre.

Oral/Nasogastric Feeding Tubes Following the publication of the NPSA Alert 1253 Reducing the harm caused by misplaced nasogastric feeding tubes in adults, children and infants, (2011) and an adverse incident in 2013 at KCH (DH) a number of steps have been taken to improve patient care in relation to nasogastric feeding tubes. A routine audit programme is currently in development to monitor compliance with best practice, due to start March 2014.

High Risk Medical Equipment Audit conducted to assess the number of high risk medical devices are in use without planned maintenance contracts. All devices identified will be added to maintenance contracts.

Infection Control Audit Programme

KCH (DH): Routine audit is in place to assess compliance with infection control standards. A hand hygiene tool recommended by the Department of Health is fully operational and an audit management system is in place to facilitate routine data entry, analysis and dissemination at all levels of the organisation, with results incorporated in the Trust scorecard KCH (PRUH and other sites): Routine audit, monitoring and reporting is in place to assess compliance with infection control standards. There are plans in place to roll out the KCH Infection Control Audit Programme to all newly acquired sites in 2014.

Line Flushing and Peripheral Line Insertion Audit

Audit to monitor compliance with the clinical guideline Flushing Intravenous Lines in the Immediate Post General Anaesthesia period in Operating Theatres. The audit demonstrated good performance for hand over between theatre and recovery (75%) and excellent performance for handover between recovery and ward (100%).

Risk Assessment Model for Venous Thromboembolism (VTE) in Hospitalised Medical Patients

VTE is monitored through a CQUIN and KCH (DH) is compliant with all external requirements. KCH (DH): Monthly audit takes place to ensure VTE is compliant with the Quality Standards set by NICE. An electronic audit tool is set up to facilitate data entry and analysis. Hospital associated thrombosis cases are audited by the VTE Clinical Nurse Specialists with root cause analysis completed for all. Results of the audit are disseminated to all levels of the organisations. KCH (PRUH and other sites): Compliance with the NICE VTE Quality Standard is audited bi-annually. Results are disseminated at all levels throughout the organisation. A VTE risk assessment tool based on the tool recommended by the Department of Health is in use at PRUH and continuous audit is in place to assess compliance with its use.

Enc 2.7.1

56


Annual Audit of Physiological Observation Track and Trigger System (POTTS)

POTTS charts are routinely used across KCH (DH). POTTS will be replaced with the National Early Warning Score via Wardware implementation, with Wardware to be implemented in all adult wards at KCH (DH) by March 2014. Actions are being developed across KCH (DH) to address training needs and to raise awareness and improve responsiveness. Action plan implementation to be monitored via the Trust’s Deteriorating Patients Committee.

Blood Sampling and Labelling Audit

KCH (DH) audits blood sampling and labelling on a monthly basis using electronically gathered data. Results are fed back to the Divisions and are reported into and monitored by the Patient Safety Committee.

Blood Wastage and Tag Compliance Audit

KCH (DH) audits blood wastage and tag compliance on a monthly basis using electronically gathered data. Results are fed back to the Divisions and are reported into and monitored by the Patient Safety Committee.

In addition to this priority audit programme, many hundreds of audits are undertaken at specialty and Divisional-level. These are appropriately managed within Divisions and not centrally-reported.

Enc 2.7.1

57

2c: Information on participation in clinical research

The number of patients receiving health services provided or sub-contracted by King’s that

were recruited to participate in National Institute for Health Research (NIHR) portfolio

badged research approved by a Research Ethics Committee, during the period 1 October

2012 – 31 September 2013 was 4834. These patients were recruited to 197 NIHR adopted

studies. This is an 18% decrease in recruitment from 2011/12. Additionally, King’s was

involved in over 600 non-commercial studies, and over 200 commercial clinical research

studies during the same time period, for which further patients cohorts were recruited.

Nationally, King’s has the 2nd highest number of commercial trials (223), and the 4th largest

number of complex trials (145).

Over 400 Principal Investigators across 26 different specialities participated in research

during 2013. These staff were a mix of scientists, clinical staff (medical, nursing,

physiotherapy, pharmacy, dietetics and many others) and support staff, demonstrating the

successful integration of research into all clinical areas with associated benefit to patients,

and staff.

There were over 850 publications involving King’s staff or patients during 2013.

Investigators across King’s have been successful in securing grant awards in excess £8.8

million. Additionally, NIHR Clinical Research fellowship awards were received by 2

Physiotherapists.

As a world renowned research institution, King’s College Hospital aims to integrate clinical

research into the daily care our patients receive, with all staff being either directly aware of

the opportunities for patients to participate or who they should talk with to obtain relevant

information. Taking part in transitional, clinical, or health services research, or being treated

by a team who are research aware, offers the best opportunities for treatment, investigation,

and support for our patients, ensuring that they enjoy an optimal experience & clinical

outcomes. We are committed to improving the quality of care we offer, and to making our

contribution to wider health improvement.

Our commitment to driving research that will lead to improvement in patient outcomes and

experience across the NHS can be demonstrated through the investment the trust has made

in research and the outcomes this has driven.

In 2013, we became involved in 2 exciting new collaborations that are designed to take

research findings and implement into clinical practice as rapidly as possible, addressing the

needs of the local community. The first, Kings Improvement Science (KIS), brings together

clinicians, patients, researchers and health care managers, to solve problems to improve

healthcare. King’s is hosting the Collaboration for Leadership in Applied Health Research

and Care (CLAHRC), which is closely linked with KIS. It is concerned with late stage applied

research, supporting projects that will allow improved understanding of disease as it affects

the local community, how best to solve identified issues, and then to address how findings

can be implemented.

Enc 2.7.1

58

The NIHR Wellcome Trust Clinical Research Facility (CRF) is now fully operational, with

over 100 studies being supported by the CRF, ranging from mental health disorders to

physical health problems such as diabetes and renal. The specialised facilities within the

CRF include the functional 3T MRI scanner, EEG suite, Virtual Reality suite. The

Experimental Medicine Facility within the CRF is currently working towards gaining

accreditation for Phase I trials with the Medicine Health Regulatory Authority (MHRA). The

Cell Therapy Unit is also fully functional and operational and working under HTA

accreditation for sample collection and storage. Currently the CTU is undergoing the

process to gain its MHRA licenses to fulfil the legal requirements of being a GMP licensed

facility with the function of being able to transplant stem cells in to patients. We anticipate the

continued growth and expansion of translational and experimental research with in the CRF

for 2014.

Involving our local population in the development of new projects has proven to be valuable

and rewarding. There are a number of groups across King’s, comprising of clinicians,

patients and carers, who regularly meet and contribute to new and ongoing projects. Notable

groups include Renal, Critical Care, Neurosciences, Liver and Sexual Health/HIV.

Additionally, King’s Patient Governor groups have been engaged in conversation with R&D

to better inform them of the value of research to improving health car, and to involve them in

making change.

Other highlights include commendation by NIHR as an example of good practice for the

research section of the website.

The breadth and depth of clinical research at King’s has been again recognised this year by

the large number of a number of new clinical professorships that have been awarded and

the appointment of a third NIHR Senior Investigator (Professor Anne Greenough).

We have picked some headline examples of the research being conducted within the Trust,

to give a flavour of the how it impacts and benefits our local community as well as nationally.

Gerontology

The department has been undertaking a Research for Patient Benefit funded pilot study

investigating a multi-factorial intervention to prevent falls in older people with cognitive

impairment living in residential care. During 2013 this study has recruited to time and target

and is due to be completed in 2014. Julie Whitney was awarded a 4 year NIHR Allied Health

Professional Clinical Lectureship which will start in 2014. A randomised controlled trial to

determine the efficacy of an exercise programme for walking frame users to prevent falls will

be conducted as part of the lectureship.

Cardiac

The Cardiac Research Department has enrolled patients into over thirty different studies

through the course of 2013, a number of which have offered groundbreaking treatments.

King’s was the first UK centre to enrol a patient into the BioVentrix study, in which a suture

and anchor system allows major reconstruction of the left ventricle on a beating heart.

Cardiology and Neurosurgery worked together on the NECTAR-HF study to investigate the

potential effect of vagus nerve stimulation on chronic heart failure.

Enc 2.7.1

59

Professor Ajay Shah heads the internationally renowned academic research centre,

providing a strong link between KCL and the clinical cardiology service. He leads a team

which employs an integrative multidisciplinary approach to address questions surrounding

the development of cardiac hypertrophy, failure and vascular dysfunction. They utilise

molecular, cellular, biochemical, physiological and clinical techniques with a strong emphasis

on carefully phenotyped relevant gene-modified models, several of which have been

generated within the group.

Haematology

The Sickle Cell Department has been undertaking several clinical trials of novel

investigational medicinal products for both the chronic treatment of sickle cell disease and

the acute treatment of sickle cell crisis. They have recently successfully completed an

industry led, Phase I, first in human, clinical trial to treat acute sickle cell crises, and the

results of the investigations were presented at the annual American Society of Haematology

Conference in Dec 2013. They are also collaborating with Quintiles Clinical Research

Organisation in identifying and recruiting patients to an industry led, Phase II/III, clinical trial

of a novel investigational medical product for the chronic treatment of sickle cell disease.

They continue their ground-breaking research into the genetics of sickle cell disease with the

initiation of a King’s lead, multi-centre, observational study of 475 patients, investigating the

ability of genetic variants associated with Foetal Haemoglobin to predict fetal haemoglobin

levels de novo and disease severity. This study is looking to recruit well above the initial

recruitment target. The study has led to 2 publications on genetic associations of SCD

severity, one with Duffy Antigen Receptor for Chemokines (DARC) and the other, with

Telomere Lengths.

Very few research projects have been undertaken during an acute sickle cell crisis. The

Sickle Cell Department is proud to be collaborating with King’s Emergency Department in

initiating an observational study looking at the changes in biomarkers during an acute sickle

cell crisis.

Neurosciences

Worldwide validation and use of KCH led (Non motor group led by Prof K Ray Chaudhuri

and colleagues using an European (EUROPAR) and international network ) development of

the non-motor symptoms questionnaire (NMSQuest), the Non-Motor Symptoms Scale

(NMSS) and the Parkinson’s Disease Sleep Scale (PDSS). Non-motor symptoms in

Parkinson’s disease are key determinants to quality of life in this condition, yet prior to KCL

work, there were no bedside tools to specifically address the overall impact of such

symptoms in Parkinson’s disease, no tools to allow self-declaration of symptoms or any

grade-rating tools for overall non-motor symptom scoring. The tools from part of mandatory

national audit in Parkinson's in the UK as well as non-motor measurements in clinical

practice which forms part of best practice tariff criteria of UK Department of Health.

Additionally, other highlights have included the pioneering trials of DC Vaccine led by Mr K

Ashkan and full validation and publication of the first ever patient related outcome tool (PRO-

APD) in Parkinson's disease by Dr P Reddy, supported by the movement disorders team at

Kings funded by a research initiative grant from Kings R&D department. King’s Staging

System for the management of ALS is now in fairly widespread use and the subject of two

Enc 2.7.1

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grants, including an EU/MRC Joint Programme on Neuro Degeneration and a World

Federation of Neurology Task Force, as well as being under review by a number of

pharmaceutical companies.

Stroke

In October 2013, King’s College Hospital was commended as “NIHR Stroke Research

Network Team of the Year” and received the SRN awards for 'The top recruiting network in

the UK for patients to stroke studies' and the “Best Hyper-acute Site in England”. For

2013/2014, the annual SRN target for KCH was already exceeded by 33% in December

2013. We have also outperformed the 2014 NIHR Performance targets for Hyper-acute

Stroke Research Centres by attracting a portfolio of 6 industry sponsored studies (including

2 “first in man” stem cell modulation studies) and recruiting 59 hyper-acute patients up to

December 2013, exceeding the aspirational HSRC target of 40 patients set by the NIHR by

48%."

Liver

In 2013, the Dr Antoniades was awarded in excess of £1.4 million from the MRC/Charitable

bodies to investigate the role of monocytes/macrophages in patients with acute liver failure.

This project is now forms the infrastructure of a research network between three of the most

academically productive liver units in the UK (KCL, Imperial College and University of

Birmingham) that will enable the development of novel therapeutic strategies to will reduce

the burden of infection and premature death in patients with liver disease. This work having

recently received media attention following publication in Hepatology Journal Reuters:

http://www.newsdaily.com/health/b0cfcad2937cf6b1c1243eb9e0901765/serine-protease-

inhibitor-may-predict-infection-in-acute-liver-failure)

Radiology

Continuing the innovative work on imaging modality to improve diagnosis of breast cancer,

the addition of 3D has great potential for improving specificity in a screening programme by

allowing radiologists to avoid recalling false negatives. The study has shown that the

performance of 2D with 3D is better than 2D alone in terms of specificity with a marginal

improvement with sensitivity. The study study was recognised for a prestigious award by

Radiological Society of North America, and discussed in 2 press releases:

Digital Breast Tomosynthesis Offers Superior Pre-surgical Staging,

http://rsna2013.rsna.org/dailybulletin/index.cfm?pg=13mon07.

Tomo is accurate in measuring invasive breast cancer

http://www.auntminnie.com/index.aspx?Sec=road&sub=wom_2013&pag=dis&itemId=10532

5

Professor Paul Sidhu developed an imaging technique for children which is radiation-free

and, thus, reduces the likelihood of developing cancer (http://www.bbc.co.uk/news/health-

25052955

Dental

The CBT service for individuals with dental fear and anxiety has been identified as a model

of excellence in the care of patients with dental anxiety by the Department of Health. The

team has developed training materials and courses in order to be able disseminate this best

Enc 2.7.1

http://www.newsdaily.com/health/b0cfcad2937cf6b1c1243eb9e0901765/serine-protease-inhibitor-may-predict-infection-in-acute-liver-failure

http://www.newsdaily.com/health/b0cfcad2937cf6b1c1243eb9e0901765/serine-protease-inhibitor-may-predict-infection-in-acute-liver-failure

http://rsna2013.rsna.org/dailybulletin/index.cfm?pg=13mon07

http://www.bbc.co.uk/news/health-25052955

http://www.bbc.co.uk/news/health-25052955

61

practice to other settings. To date similar services have been commissioned in Sheffield,

Northampton and Edinburgh based on the KCL model.

A research team led by Professor Marie Therese Hosey have developed an online resource

for children who are scheduled to undergo dental treatment under general anaesthesia. The

aim of the resource is to reduce the child's anxiety upon admission for the general

anaesthesia and at induction. The resource was developed in collaboration with parents

attending the service.

Dermatology

The dermatology team has increased recruitment from zero to over 200 patients to CLRN

studies. We are partaking in BADBIR, a national registry for patients receiving biological

agents for the treatment of psoriasis. As these agents come in to increasing usage, the

monitoring of patients receiving these drugs, for side effects and adverse incidents becomes

increasingly important. We have contributed patients with acne to a study examining the

genetic determinants of this disease; an abstract of this paper is currently in press with

Nature Genetics. We have enrolled a number of paediatric dermatology patients to a study

examining the interaction between food allergy and eczema. This is an important area of

emerging research in paediatric eczema.

Ophthalmology

This year has been a real success for Ophthalmology as we received provisional funding for

3 NIHR grants worth a total of £5 million in collaboration with Kings CTU to evaluate novel

treatment options for diabetic retinopathy and age-related macular degeneration. The

vitreoretinal research team, in collaboration with Oxford Eye Hospital, led a pioneering trial of

subretinal implantation. This involved insertion of a photodiode under the retina, to provide

‘artificial vision’ to totally blind patients with retinitis pigmentosa. The operations were the first

in the UK, lasted 9 hours, and involved a team of maxillofacial, ENT and ophthalmic

surgeons. This was widely covered by media in the UK and internationally, and was to sight

what the first cochlear implants were to hearing.

Palliative Care

The Cicely Saunders Institute, the world’s first Institute for palliative care, continues to grow

and thrive. Locally, its programmes are improving palliative care, highlights include: the

development and evaluation of improved care for patients with advanced stage renal

disease, support for psychosocial care and communication in intensive care following a joint

project with intensivists, resulting in a new communication aid called PACE, and the

implementation of improved systems of assessment and evaluation. Patients and families in

our area have achieved the highest numbers in the UK being offered the opportunities to

engage in research. Globally, the Cicely Saunders Institute team have programmes linking

across the UK, many other European countries, the USA, Australia, and Africa, where their

research is studying better ways to improve and control symptoms, support patients and

their families, improve communication and dignity, address spiritual needs and reduce

inequity. The team have published over 60 papers in top quality peer reviewed journals,

including the Lancet, PLOS Medicine and BMC Medicine, as well as specialist journals.

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Rheumatology

The department is headed by Professor David Scott, who is the chief investigator for the

NIHR programme grant TITRATE. This grant is supporting a body of work exploring

treatments and outcomes for people with rheumatoid arthritis. In particular the grant focuses

on patients with 'moderate disease activity'. Whilst we have clear therapeutic paradigms for

people at the extreme ends of the spectrum (highly active disease and remission), in fact the

majority of our patients end up in the moderate activity cohort - and there is currently no

evidence base to direct practice. TITRATE aims to address this knowledge gap through a

multicentre RCT, with the first patients due to enrol next month. In addition to TITRATE, the

trials team continue to deliver a broad portfolio of research, with the aiming of offering

patients the broadest access to research. We are currently set to commence recruitment to a

high intensity mode of action phase 2 trial of a novel therapeutic in rheumatoid as part of the

NOCRI Translational Research Partnership scheme in collaboration with other experimental

medicine teams around the UK.

Diabetes

One of the many trials the Diabetes team has been working on this year is a hypoglycaemia

unawareness pilot study, which is looking to restore their brain's warning symptoms of very

low blood sugar levels.

The intervention was a 6 week group programme incorporating education around

hypoglycaemia unawareness and what maintains the problem and incorporated

psychological techniques (including motivational interviewing and cognitive behavioural

therapy) to support patients in making the behaviour changes necessary to minimise

problematic hypoglycaemia. The pilot study involved 24 patients and demonstrated a

significant reduction in severe and moderate hypoglycaemia and a significant improvement

in awareness of hypoglycaemia warning signs at 12 month follow up. The study was

published in Diabetes Care. 2013 Dec 6. [Epub ahead of print] and there are plans to extend

this pilot into an RCT.

Professor Francesco Rubino was appointed as the first established chair of bariatic and

metabolic surgery in the UK, potentially globally. KCH is following its own tradition –

Professor Stephanie Amiel was appointed to the first Chair Diabetic Medicine in the UK.

Critical care

2013 has been a strong year for critical care, building on previous success. The research

group again was successful in attracting both NIHR and industry research grants and began

supporting MRES and PhD students for the first time in parallel with strong CRN portfolio

participation, including in-house projects. Submissions from projects funded by NIHR

research for patient benefit grants were accepted to high impact journals and two NIHR

funded projects completed on target. The group started their first single site interventional

randomised controlled trial. Again several awards for recruitment to portfolio projects were

gained including funding for a nurse to attend and present at ESICM in Paris. By February,

2014, the combined Emergency Department, Critical Care and anaesthetics CRN group, the

largest of its type in London, had been established. Finally, 2013 was an important year for

the Critical Care Group as we jointly hosted the annual speciality group meeting at KCL, with

strong inter-professional representation.

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Sexual Health & HIV

King’s is an internationally recognised centre for HIV-associated kidney disease, and work

continues to focus on kidney disease progression, end-stage kidney disease and kidney

transplantation in HIV positive patients. Sexual health research is focused on developing an

evidence base for sexual health service development and service improvement that reflects

the needs of local population. The group has recruited some 1700 patients in portfolio-

adopted studies, and was recently awarded a £4,000,000 programme grant to develop and

evaluate online sexual health services for South East London.

Child health

The Lung Biology group led by Anne Greenough (PI in the MRC/Asthma UK Centre for

Allergic Mechanisms in Asthma) has completed a number of important projects. The UKOS

follow up study supported by NIHR HTA has been completed to time and target (n=319)

demonstrating extremely prematurely born infants supported by high frequency oscillation

rather than conventional ventilation have been lung function and neurological outcomes at

11-14 years (the manuscript has been accepted for publication in March 2014). Children

born at term have also now been recruited to time and target and their results will further

inform an understanding of the severity of the problems suffered by the UKOS children. A

series of studies have been completed in sickle cell patients showing that in both children

and adults, vascular abnormalities contribute to their lung function abnormalities. With our

collaborators at the University of Kingston (Jamaica) we have shown asthma and smoking

increases the risk of dying in young adults with SCD. With collaborators in Utrecht we have

shown that prematurely born infants have a genetic as well as a functional predisposition to

RSV infection and the associated chronic respiratory morbidity. Our collaborative work with

Professors Nicolaides and Davenport have highlighted that very premature delivery (<33

weeks gestation) after FETO in CDH patients is associated with a very poor outcome

emphasising research is needed to reduce premature delivery following the FETO

procedure. In addition, we have demonstrated routine neuromuscular blockade in the labour

suite of infants with CDH is disadvantageous.

Anaesthetics

The research group in anaesthesia and peri-operative medicine at King's College Hospital

has continued recruitment and follow-up of ongoing portfolio trials in 2013, including

postoperative outcome studies ENIGMA2, the ERICCA trial in collaboration with the

cardiovascular division and the TITRE2 trial. This has been supported by R&D funds. In

addition recruitment and follow-up for the proof-of-concept Whipple's trial and the

postoperative cognitive dysfunction trial have been carried out successfully. Several

abstracts have been presented at National and International meetings, and the research

group was awarded an abstract prize at the National meeting of the Association of

Cardiothoracic Anaesthetists in June 2013 for a presentation about depth of anaesthesia

and postoperative cognitive dysfunction.

Renal

Professor Macdougall is the UK lead for the ongoing PIVOTAL trial, a randomised controlled

trial in over 2000 dialysis patients across over 40 sites in the UK, which is investigating the

optimum amount of intravenous iron dialysis patients should be given -- this trial secured

£2.5 million of funding from Kidney Research UK. In early 2013, he published two papers in

the prestigious New England Journal of Medicine on the theme of anaemia in kidney failure,

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and more recently he was successful in an NIHR HTA bid for £2.1 million of funding to

conduct another randomised controlled trial in dialysis patients investigating the possible

benefits of regular cycling on exercise bikes during dialysis (the PEDAL study). Other

successful active research in the renal department includes Dr Claire Sharpe's involvement

as a principal investigator in the eGFR-C study, Helen MacLaughlin's research into

measures to combat obesity in chronic kidney disease, and Sharlene Greenwood's NIHR-

funded research into the effects of exercise post-kidney transplantation.

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2d: Goals Agreed with Commissioners: The Commissioning for Quality and

Innovation (CQUIN) framework

A proportion (2.5%) of King’s College Hospital NHS Foundation Trust contract income in

2013/14 was conditional upon achieving quality improvement and innovation goals agreed

with both NHS South London Commissioning leads & NHS England specialist services as

part of the Commissioning for Quality and Innovation (CQUIN) payment framework. This

equated to a total of £10.5m in 2013/14. When the Trust acquired the PRUH in October

2013/14 it also inherited additional CQUINs, the income of which equated to £3m.

Please see the tables below for the detailed report of performance as measured for our

CQUIN indicators in 2013/14 for both our Denmark Hill & PRUH sites. King’s has delivered

significant quality improvements under the CQUIN schemes as shown.

The following table indicates the goals & achievement for CQUINs on the Denmark Hill site:

Goal Number National CQUIN Indicators Q4 target Q4 Actual

1 - VTE Prevention

1a Assessment of patients at risk of VTE 97% 98.8%

1b Root case analysis of patients with VTE 80% 100%

2 – Friends &

Family

2a Roll out of Friends & Family in Maternity NA NA

2b Response rate for Friends & Family 20% 25.8%

2c Staff survey – increased satisfaction NA NA

3 -NHS Safety

Thermometer

3a Completion of data NA NA

3b Reduction of pressure ulcers

Multiple NA

4 - Dementia

4a Find, assess & refer patients 90% 90%

4b Clinical leadership & staff training NA NA

4c Supporting of careers of people with

dementia NA NA

5 – Alcohol

5a Screening of alcohol use & provision of

brief advice 80% 84%

5b Staff training 70% 70%

6 – Patient

Experience 6a Improving outpatient experience: Suite 1 72% 72%

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6b Improving inpatient experience: MAU &

ASU 82% 87%

7 - COPD

7a Provision of bundles 75% 92%

7b Care planning 75% 91%

8 – Choose &

Book

8a Increased number of directly bookable

clinics 50% 50%

8b Additional specialist clinics 5 5

9 – Cancer 9a End of treatment summaries 50% 70%

10 – Highly

Specialist

Services

10a Presentation of data & analysis NA NA

11 – Clinical

Quality

Dashboards

11a Provision of data NA NA

12 – HIV

12a Annual communication with GPs 95% 98%

12b Increased use of home delivery 70% 74%

12c Move from branded to generic drugs 80% 100%

13 - BMT

13a Information – UK vs US / European

donors NA NA

13b Information – CT / ET tests per patient NA NA

13c Information – Number of searches per

transplant NA NA

13d Information – Turnaround times for

search request to delivery report NA NA

14 - NICU 14 Improved access to breast milk in

preterm infants 73% 82%

15 - PICU 15 Information – unplanned readmissions NA NA

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The following table indicates the goals & achievement for CQUINs on the PRUH site:


1 - VTE Prevention

1a Assessment of patients at risk of VTE 92% 96%

1b Root case analysis of patients with VTE NA NA

2 – Friends &

Family

2a Roll out of Friends & Family in Maternity NA NA

2b Response rate for Friends & Family 20% 30%

2c Staff survey – increased satisfaction NA NA

3 -NHS Safety

Thermometer

3a Completion of data NA NA

3b Reduction of pressure ulcers

NA NA

4 - Dementia

4a Find, assess & refer patients 90% 98%

4b Clinical leadership & staff training NA NA

4c Supporting of careers of people with

dementia NA NA

5 – Stroke

5a Improve discharge 90% 100%

5b Development of service NA NA

6 – Smoking 6a

Roll out of screening of patients who

smoke & provision of brief advice NA NA

7 - Safeguarding

7a

Safeguarding training 50% 40%

7b Children’s social care referrals 20% 90%

7c Review of safeguarding NA NA

8 – Alcohol 8a

Roll out of screening of patients who

smoke & provision of brief advice NA NA

9 –

Transformation 9a Service redesign: Cardiology NA NA

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9b Audits: Dermatology & Gynecology NA NA

9c Service Redesign: Urgent Care Centre NA NA

9d Provision of information: Pathology NA NA

9e Service Redesign: Step up services NA NA

9f Service Redesign: Diabetes NA NA

10 – PALs

10a Root Cause Analysis Training NA NA

10b Serious Incident Action Plans NA NA

10c Sharing of Learning NA NA

12 – Clinical

Quality

Dashboards

12a Provision of data NA NA

13 - NICU

13a Improved access to breast milk in

preterm infants NA NA

13b Improved use of TPN in preterm infants NA NA

King’s is currently in discussion with both the South London Clinical Support Unit and NHS

England Specialist Commissioning (SCG) to develop CQUIN schemes for 2014/15. As in

2013/14, 2.5% of King’s contract income will be allocated to this CQUIN payment

framework. This is estimated to be a value of £20m across 35 Quality improvement areas.

Three areas of these areas have been identified nationally and will apply to both the CCG &

Specialist contracts. These are expansion of the Friends and Family test, data collection

through the NHS Safety Thermometer and to improve the diagnosis and care of patients with

Dementia.

The list below outlines the proposed goals and descriptions to date for 2014/15. Further

details of the targets agreed with commissioners for the following 12 month period are

available on request from our website.

Enc 2.7.1

69

National CQUIN: Goal Name Description of Goal

1 NHS Safety Thermometer (National

CQUIN) Reduction in falls and pressure ulcers.

2 Dementia: Diagnosis (National CQUIN) Improve awareness and diagnosis of dementia, using risk assessment, in

an acute hospital setting.

3 Patient Experience – Friends and

Family Test (National CQUIN)

Increased response rate, roll out of survey to staff, outpatients &

daycases.

CCG CQUIN: Goal Name Description of Goal

4 Smoking Screening To ask patients if they smoke and offer very brief advice

5 Alcohol Screening To ask patients if they drink and offer very brief advice

6 Medication Reviews To conduct comprehensive reviews of medication of patients in Geriatric

beds

7 Care Planning Not yet agreed

8 Communications Not yet agreed

9 Emergency Standards To improve compliance with London Emergency Standards

NHS England CQUIN: Goal Name Description of Goal

13 Dashboards Provision of data for national dashboards

14 Highly specialist services Meeting & joint annual review of services

15 Endocrine Coding Provision of additional data

16 Cardiac Surgery To admit patients within 7 days

17 Patient held records cancer To provide patients with their own records

18 Specialist Orthopedics To provide MDTs for this service

19 NICU Improve Retinopathy of prematurity (ROP) screening

20 Renal Dialysis Provision of information

21 HIV Telemedicine To provide telemedicine for patients with HIV

22 National CQUIN supporting QIPP Awaiting details from NHS England

23 Clinical Utilization Review To participate in a national system for neuro bed availability

24 Tertiary level Foetal medicine To see all patients within 2 days of referral

25 Local CQUINs for development Awaiting details from NHS England

26 Severe Endometriosis Awaiting details from NHS England

27 Breast screening: Smoking Cessation To refer patients for smoking cessation

28 Breast screening: Increased uptake To increase the uptake of breast screening

29 New born blood spot screening: LEAN To conduct a LEAN review of the service

30 Eye screening No details provided yet

31 Cervical Cytology No details provided yet

32 Dental information To record and provide additional information

33 Havens – operational efficiency Improve response times for statements

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34 Havens – quality & patient experience Implement a set of clinical outcome measures

35 HIV drug trials Participation in drug trials

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2e: Statements from the Care Quality Commission (CQC):

Care Quality Commission

King’s College Hospital NHS Foundation Trust (the Trust) has been registered with the Care

Quality Commission (CQC) since April 2010. As part of the acquisition of services and

locations following the dissolution of South London Healthcare Trust, the Trust registered the

following locations with the Care Quality Commission (CQC) on 1 October 2013:

Princess Royal University Hospital (PRUH),

Beckenham Beacon,

Orpington Hospital,

Sevenoaks and

Queen Mary Sidcup.

As of 31 March 2014, the Trust’s current registration status is without any condition for all

locations.

The CQC inspected the PRUH in December 2013 juts 2 months following acquisition. The

inspection report did not highlight any issues that the Trust had not previously found through

its clinical due diligence exercise. The report was published on 6 February 2014 on the

CQC’s website.

The CQC requires the Trust to improve the PRUH’s performance and quality against the

following compliance actions:

Improvements to the Emergency Department Pathway (Regulation 9: Care and

Welfare).

Better availability of beds, improved discharge planning, management of outpatient

clinics and planning for children’s elective surgery (Regulation 9: Care and

Welfare).

Embedding effective systems in place to monitor the quality of the services

provided (Regulation 10: Assessing and monitoring the quality of service

provision).

Consistent use of infection control procedures amongst all staff and improved

provision of alcohol dispensers (Regulation 12: Cleanliness and Infection Control).

Improvements to availability and quality of medical records (Regulation 20: Records).

Improved staffing levels to provide enough qualified, skilled and experienced staff

(Regulation 22: Staffing).

Improvements to arrangements to ensure that all staff have appraisals, supervision

and training (Regulation 23: Supporting Workers).

The Trust submitted an action plan to the CQC on the 28 February 2014 to demonstrate how

the Trust will improve compliance with the regulations.

The CQC actions plans will be implemented by the divisions and relevant corporate teams,

the monitoring of progress against actions will take place within the existing integration,

performance and quality governance infrastructure. Progress against the plan will also be

monitored by the CQC.

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72

Developments to improve quality assurance in line with CQC quality standards

During 2013/14 a trust-wide quality monitoring process was developed in collaboration with

senior nursing and divisional staff to enable a consistent and systematic approach in

assessing compliance with CQC and other national specialty-related standards. The process

was tested in October/November 2013 at the PRUH to establish a baseline of quality and

safety. Tools were developed and tested to cover a range of specialties and modalities at the

different locations. These tools will be used as part of a rolling program of self-assessments

and peer-review. Each inspection of safety and quality consists of:

Observation of practice

Review of documentation (including patient records)

Interviews with people who use the service

Staff interviews

Feedback and recording of findings

Compliance rating

Development of action (plans) to improve quality and address issues and gaps in assurance

Reporting into the performance and governance framework for assurance purposes.

Linkages to risk and performance management are being established. It is planned that the

quality monitoring framework is rolled out across all services and Trust locations in 2014/15.

In additiona Quality Summit was held with all stakeholders invited

SUMMARY:

CQC inspection at The PRUH 2 months after acquisition, no new issues

highlighted since due diligence exercises therefore action plans already in place

Trust wide quality monitoring processes in place and robust governance

frameworks in place which include external stakeholder input

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2g: Information Governance Toolkit attainment levels

The King’s Information Governance Assessment Report overall score for 2013/4 was 62%.

This is lower than the previous year as we have re-evaluated the evidence we have

previously provided as much of it was out of date or no longer appropriate. As a result, there

are eleven areas where our scores are below the required satisfactory score of 2. These

include

Information Governance awareness and mandatory training procedures are in place and all staff are appropriately trained.

A formal information security risk assessment and management programme for key Information Assets has been documented implemented and reviewed.

Business continuity plans are up to date and tested for all critical information assets (data processing facilities, communications services and data) and service - specific measures are in place.

All information assets that hold, or are, personal data are protected by appropriate organisational and technical measures.

Procedures are in place for monitoring the availability of paper health/care records and tracing missing records.

On a positive note the Trust has improved in two areas including scoring level 3, the highest

level possible, in the requirement that “There are approved and comprehensive Information

Governance Policies with associated strategies and/or improvement plans” demonstrating

our commitment to developing a high quality and robust approach to Information

Governance. As part of this strategy the Trust has appointed an Information Governance

Manager who carried out this thorough evaluation exercise and identified where and how we

should be able to achieve the satisfactory scores we aspire to in the coming year. As a result

of having responsibility for the IG Toolkit sitting with a single IG Manager, the process of

completion has been significantly more rigorous than in previous years.

SUMMARY:

11 areas below satisfactory score of 2

Improvement in 2 areas

Thorough evaluation exercise performed and confident we should be able to meet

required levels for 2014/15

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2h: Clinical coding error rate

Clinical coding is the translation of medical terminology, as written by clinicians to describe a

patient’s complaint, diagnosis, treatment or reason for seeking medical attention, into a

nationally recognised code. Coding is important because it generates information that can

aid service improvement and clinical research, and because it determines how much the

Trust is paid for an episode of care through a national set of rules called ‘Payment by

Results’.

Kings was not subject to a PbR Audit in 2013/14, however, for Trusts that did have a PbR

audit in 2013/14, the national average coding error rate identified in the Data Assurance

Framework was 8% for inpatients.

King’s was subject to the annual mandatory Coding Audit for Information Governance

Standards during the 2013/14 financial year. The audits were completed bi-monthly by

accredited external coding auditors, and a total of 550 episodes were audited across 12

specialties.

The findings of the final report submitted to the Trust for the reporting period 2013/14, found

that the overall coding inaccuracy rate of 5.2 per cent is lower than the national 7.0 per cent

average error rate as identified in the Payment by Results Data Assurance Framework

2011/12. This audit has reviewed an increase of 43% more diagnosis codes and 10.8%

more procedure codes than the audit of 2012/13 indicating more depth of coding.

The Trust should be commended for maintaining the quality of the coding during a year

when many changes have occurred. There has been general re-organisation and the initial

effect on the clinical coding department has allowed the creation of specific training and

audit teams of nationally qualified staff across both sites to further support the improvements

in data quality.

Regular audit of clinical coding data improves accuracy and consistency and allows

identification and resolution of issues before they become problematic. Kings College

Hospital NHS Foundation Trust maintains a robust audit cycle continually monitoring data

quality and providing feedback both to coders and clinicians on areas for improvement. In

the last year the Trust has continued the established external audit programme focusing on

specific areas of concern. The process allows early identification of error and subsequent

revision of the coded clinical data prior to final submission to the Secondary Uses Service

(SUS). These processes have a positive impact on data quality and in turn Trust income and

allow targeted training to be undertaken in a timely manner.

SUMMARY :

2013/14 overall coding inaccuracy rate of 5.2 per cent is lower than the national

7.0 per cent average error

Kings College Hospital NHS Foundation Trust maintains a robust audit cycle

allowing early identification of error and subsequent revision of the coded clinical

data prior to final submission to the Secondary Uses Service (SUS)

Enc 2.7.1

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SUMMARY

From the above statements, assurance can be offered to the public that King’s has in

2013/14:

Performed to essential standards (e.g. meeting CQC registration), as well as

excelling beyond these to provide high quality care;

Measured clinical processes and performance to inform and monitor continuous

quality improvement;

Participated in national cross-cutting project and initiatives for quality

improvement e.g. strong and growing recruitment to clinical trials.

These statements are included in accordance with both Monitor’s NHS Foundation Trust

Annual Reporting Manual (5 March 2013) for the quality report, as well as the Department of

Health’s Quality Accounts Regulations (2012, 2011, 2010).

Enc 2.7.1

76

Part 3. An Overview of performance in 2012/13 against mandated

national key standards

From 2013/14 all trusts are required to report against a core set of indicators, for at least the

last two reporting periods, using a standardised statement set out in the NHS (Quality

Accounts) Amendment Regulations 2012. Only indicators that are relevant to the services

provided at King’s are included in the table below.

Indicator Data

Source Period 1 Value Period 2 Value

Actions taken to

improve the result

in year

Summary

Hospital

Mortality Index

(SHMI)

NHS IC Jul 11 - Jun

12

88.7

Below

average

Jul 12 - Jun 13

The Trust discusses

these results monthly

with the divisions at a

special executive

committee. Follow up

actions have led to

an improvement in

scores.

Palliative Care

Indicator: % of

patient death

with palliative

care coding.

NHS IC Jul 11 - Jun

12

46.3%

Higher

than

average

Jul 12 - Jun 13

The Assistant

Medical Director has

audited a sample of

patients to ensure

that palliative care

coding was

appropriate and that

the patients were in

receipt of expert

palliative care

intervention

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Indicator Data


Actions taken to

improve the result

in year

Readmissions 28 day

Patients aged 0-

14

CHKS Apr to Dec 12

3.8%

Apr to Dec 13

Data is analyzed monthly

to look for trends. Any

issues are acted upon &

raised to executives and

commissioners where

appropriate. In 2013/14

the Trust conducted an

emergency readmissions

audit with a GP and this

will be repeated in

2014/15.

Patients aged

15+

CHKS Apr to Dec 12 4.5%

Apr to Dec 13

Trust responsiveness to the personal needs of patients

Q32 Were you

involved as much

as you wanted to

be in decisions

about your care

and treatment?

CQC KCH 2012/13

7.3

KCH 2013/14

Divisions are tasked

with developing action

plans to address issues

raised by patients.

These are monitored

through the Patient

Experience Committee

and through Divisional

performance meetings.

Examples of

improvement work

include:

The Trust dignity

month which

highlights innovative

projects across the

trust to improve

patient dignity

Introduction of

patient and relative

diaries in the Frank

Cooksey

Rehabilitation Unit to

improve

communication,

particularly out or

hours and at

weekends.

In Haematology, patients are now offered a pre-transplant

Q34 Did you find

someone on the

hospital staff to

talk to about your

worries and

fears?

CQC KCH 2012/13

6.01

KCH 2013/14

Q36 Were you

given enough

privacy when

discussing your

condition or

treatment?

CQC KCH 2012/13

8.47

KCH 2013/14

Q56 Did a

member of staff

tell you about

medication side

effects to watch

for when you

went home?

CQC KCH 2012/13

4.8

KCH 2013/14

Q62 Did hospital

staff tell you who

to contact if you

were worried

about your

condition or

treatment after

you left hospital?

CQC KCH 2012/13

7.6

KCH 2013/14

Enc 2.7.1

78

information session which has been well received by patients. Development of new

Discharge Policy to

improve the

discharge process

for patients and

improve the

information that they

receive

Patient stories and

patient video stories

on our wards to

gather qualitative

feedback to support

service improvement.

Family & Friends Test

How likely are

you to

recommend our

ward to friends

and family if they

needed similar

care or

treatment?"

Trust KCH 2012/13

Data not

available

2013/2014 Inpatient

average

FFT score

for DH Site

= 62

ranging

from 61 -

68

Target FFT

score for

inpatients

is 68 to

place

King’s on

top 20% of

London

trusts

Divisions have

developed action

plans to address

issues raised by

patients who

would not

recommend

King’s

Response targets

linked to CQUIN

were met

How likely are

you to

recommend our

A&E department/

to friends and

family if they

needed similar

care or

treatment?"

Trust KCH 2012/13

Data not

available

2013/2014 Emergency

average

FFT score

for DH Site

= 45

ranging

from 40 -

59

PRUH Site

= 43

ranging

from 10 –

79

A wide ranging

improvement

programme is

underway to

improve the

patient

experience of the

ED on both sites

Enc 2.7.1

79

Target FFT

score for

inpatients

is 61 to

place

King’s on

top 20% of

London

trusts

Workforce

% of staff

employed who

would

recommend the

Trust as a

provider of care to

their Family or

Friends

NHS IC KCH 2012/13

4.05

KCH 2013/14

We have focused on

improving

communications with

staff in year, and this

work has been reflected

in our improved score in

the survey.

Patient Safety

% of patients

admitted who

were risk

assessed for VTE

NHS IC KCH 2012/13

96.3%

KCH 2013/14

The specialist team

monitors this on a

regular basis. This

ensures Kings remains a

national leader in this

field.

C-difficile

infection rate per

100,000 bed days

NHS IC KCH 2012/13

Reportable cases

Rate /100,000 bed

days

54

18.56

KCH 2013/14

Reportable cases

Rate /100,000 bed

days

The following actions

have been taken to

review CDIFF in

2013/14:

Implementation of

the DH’s two stage

testing methodology

Multidisciplinary

review of all cases

to identify lessons to

be learnt

An increased focus

on cleaning

standards including

the secondment of

the senior IC nurse

Introduction of hydrogen peroxide vapour technology as an enhanced cleaning technology

Much stronger focus on antibiotic prescribing including monthly antibiotic stewardship audits.

Introduction of

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80

* These figures accurately reflect data currently held by the NRLS on patient safety incidents at KCH, and discrepancies may

exist with data previously published by the NRLS. Further information on the total number of incidents reported to the NRLS

(which includes October 2012-March 2013 information) is yet to be published but is expected to report 8749 patient safety

incidents for 2012/13 of which 34 (0.39%) resulted in death or severe harm.

**These figures are those published by the NRLS at a point in time, which have subsequently been adjusted to the figures

marked with one asterisk.

hydrogen peroxide vapour technology as an enhanced cleaning technology Much stronger focus on antibiotic prescribing including monthly antibiotic stewardship audits.

Indicator Data


Actions taken to

improve the result

in year

Patient safety

incidents reported

to the National

Reporting and

Learning Service

(NRLS)

NRLS April 12 – Sept 12 3595*

3215 **

April 13– Sept 13 5323*

5206**

This is monitored

through the quarterly

safety report.

Patient safety

incidents reported

to the National

Reporting and

Learning Service

(NRLS), where

degree of harm is

recorded as

‘severe harm’ or

‘death’, as a

percentage of all

patient safety

incidents reported

Rate per 100

admissions

(published)#

NRLS April 12 – Sept 12 0.42%*

(15)

1%

(33)**

5.7**

April 13 – Sept 13 0.65%*

(34)

0.88%

(46)**

8.78

This figure is in line with

that of other large acute

teaching hospitals.

All incidents were fully

investigated and subject

to a detailed root cause

analysis.

The current reporting

rate is one of the highest

amongst acute teaching

hospitals and reflects

the positive reporting

culture at King’s

Enc 2.7.1

81

Patient safety incidents resulting in severe harm or death

The National Reporting and Learning Service (NRLS) was established in 2003. The system

enables patient safety incident reports to be submitted to a national database on a voluntary

basis designed to promote learning. It is mandatory for NHS trusts in England to report all

serious patient safety incidents to the Care Quality Commission as part of the Care Quality

Commission registration process. To avoid duplication of reporting, all incidents resulting in

death or severe harm should be reported to the NRLS who then report them to the Care

Quality Commission. Although it is not mandatory, it is common practice for NHS Trusts to

report patient safety incidents under the NRLS’s voluntary arrangements.

As there is not a nationally established and regulated approach to reporting and categorising

patient safety incidents, different trusts may choose to apply different approaches and

guidance to reporting, categorisation and validation of patient safety incidents. The

approach taken to determine the classification of each incident, such as those ‘resulting in

severe harm or death’, will often rely on clinical judgment. This judgment may, acceptably,

differ between professionals. In addition, the classification of the impact of an incident may

be subject to a potentially lengthy investigation which may result in the classification being

changed. This change may not be reported externally and the data held by a trust may not

be the same as that held by the NRLS. Therefore, it may be difficult to explain the

differences between the data reported by the Trusts as this may not be comparable.

The data provided above represents the most up-to-date data held by the NRLS on patient

safety incidents in KCH, but for the reasons above differences may exist with data previously

published by the NRLS.

The Table below details the information the Trust is required to submit on PROMS over the

last two available reporting periods. Higher scores represent better reported outcomes.

Area Measure KCH Adjusted

Health Gain 11/12

KCH Adjusted Health Gain

12/13

National Adjusted

Health Gain 12/13

Hip

EQ-5D 0.5

EQ-VAS 13.3

Oxford Hip Score 21.5

Knee

EQ-5D 0.3

EQ-VAS 4.6

Oxford Knee Score 14.8

Varicose Veins

EQ-5D 0.1

EQ-VAS 0.0

Aberdeen Varicose Vein Score -5.6

Groin EQ-5D 0.1

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82

Hernia EQ-VAS -2.2

Over 70% of patients asked have responded to both pre and post operation surveys looking

at their health and quality of life. In two of these quality of life indicators,

Oxford knee and EQ-VAS for groin hernias, there has been an improvement in patient

reported outcomes.

Enc 2.7.1

83

Performance against key national priorities

As at quarter 4 the Trust self-certified a performance rating of ‘risks identified’ for 2013/14

against the Monitor Compliance Framework for Denmark Hill. This equates to a Monitor

governance risk rating of ‘risks identified’ which is in line with the planned trajectory.

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Appendix 1: Statements from Key External Stakeholders

In March the Trust shared the draft Quality Accounts for 2014/14 with its key external

stakeholders, External stakeholders were given three weeks to review and provide comments

and formal statements on the draft document.

This section includes the statements received from external stakeholders. These statements

have been unaltered, with the exception of any minor typographical errors. Where the Trust

could and felt appropriate it has responded to particular queries from stakeholders by either

amending/appending to the quality report or annual report.

The following stakeholders did not respond:

Lambeth Clinical Commissioning Group

Lewisham Clinical Commissioning Group

NHS England

Statement from Health and Adult Services Scrutiny Sub-Committees

Statement from Commissioners

Southwark Clinical Commissioning Group

Response to Kings College Hospital NHS Foundation Trust Draft Quality Accounts 2014/15

Thank you for sharing the KCH Quality Accounts with us and inviting us to comment on the

draft document. I am able to set out below a summary of feedback from Southwark and

Lambeth CCGs. I understand you have received a separate document from Bromley CCG

and so have received comment from all major commissioners of service.

Some commissioners, including Southwark and Bromley CCGs, participated in the

stakeholder events you ran earlier in the year and are pleased to recognise some comments

have been taken on board as the document has evolved from early thoughts to final draft.

The NHS Southwark CCG Integrated Governance and Performance Committee, a

committee of the Governing Body, received the draft Kings College Hospital Quality Account

last week and were supportive of the priorities you have identified. The committee agreed

that your priorities are broadly in line with our own and asked for two comments to be

passed on:

It was suggested that reducing cancelled operations for cancer patients be added as

a priority for cancer care

The committee queried if the audit info could be presented in a more accessible way

for a public facing document

I note that you have responded to us with your feedback on how you intend to address this.

We have also received some feedback from NHS Lambeth CCG which I am able to pass

onto you.

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Falls reduction – given the increased number of falls resulting in serious injury the

CCG believe the actions you are planning via your Quality Accounts will help to

address this issue. We are interested to hear whether any environmental issues

need to be taken into account that may reduce incidences and type of injury

sustained, and whether, given the level increase over the past year, you have

considered identifying a lead at senior level with responsibility for falls.

Management of hip fractures – with regard to level of ambition for this initiative we

recommend you look to best performance elsewhere as identified in the national hip

fracture audit and be more specific about what your aspirations regarding to time to

surgery, LOS etc.

Discharge management – we note the current review of the Southwark and

Lambeth Integrated Care programme simplified discharge work and caution that

some of your plans may be subject to change depending upon the outcome of that.

More specificity such as time of discharge e.g. how many discharges will take place

in the morning, and the level of information given when patients are discharged to

care homes would be beneficial.

We look forward to receiving the final version of your Quality Accounts and to hearing of the

impact of the actions you plan to implement in 2014/15.

Jacquie Foster

Head of Governance and OD

NHS Southwark CCG

30 April 2014

Bromley Clinical Commissioning Group

Thank you for the opportunity to comment on King’s quality account for 2013-14. Acute

services within Bromley transferred to King’s from the 1st October 2013, following a process

put in place by the Trust Special Administrator to dissolve the South London Healthcare Trust

(SLHT). The former SLHT services within Bromley have historically faced significant

challenge. Bromley CCG have welcomed the open approach from King’s to understanding

those services, the issues that they have faced, and in beginning to address difficulties

identified. Bromley CCG recognise that the process of change now underway within King’s

services in Bromley is designed to ensure that they meet the needs of Bromley residents

and that standards of quality are excellent.

Clinical Quality Review Group

Bromley CCG has joined the existing Clinical Quality Review Group (CQRG) with Lambeth

and Southwark CCGs which meets monthly. Whilst the main CQRG remains the focus for

contractual quality monitoring, during the on-going transition period a separate Bromley

specific CQRG has been established on the Princess Royal University Hospital site. King’s

has engaged extremely well with Bromley CCG both within the main CQRG and the at the

Bromley focused meeting, providing high level senior clinical input through the Medical and

Nurse Directors as well as other senior staff. This meeting gives an opportunity to focus on

Enc 2.7.1

86

quality areas highlighted locally in addition to those identified as quality priorities and subject

to CQUINs, such as reduction in pressure ulcers.

Quality Improvement targets

Bromley CCG appreciates the partnership approach taken by King’s in agreeing quality

priorities for 2014-15, and found the engagement meeting with King’s as well as

representatives from Public Health and Healthwatch, which took place in January 2014, to

be a useful approach.

The CCG agrees with and supports the areas identified as targets for the coming year in the

areas of safety, clinical effectiveness and patient experience.

Safety

Bromley CCG agree that reducing the number of falls for in-patients is a valuable priority.

Bromley has a large elderly population and therefore the potential for harm caused through

falling in hospital is of concern. The safer surgery priority is an area which has been less

concerning for Bromley CCG. Nevertheless the focus on ensuring standardised processes is

welcomed.

Clinical Effectiveness

Bromley CCG supports King’s aim of promoting health and reducing harmful behaviours

through the use of brief interventions and onward referral for smoking and alcohol use, as

well as promotion of healthier lifestyles. Kings second clinical effectiveness priority of

improving outcomes for patients following hip fracture is again very relevant to Bromley’s

increasing elderly population. Improving care for this group of patients is viewed by the CCG

as an effective means of increasing satisfaction with care and treatment and enabling

recovery.

Patient Experience

Bromley CCG has raised concerns regarding the quality of discharge, and the impact of poor

discharge particularly in relation to communication with community based and primary care

services as a quality concern. We are therefore pleased that improving experience and

coordination of discharge has been agreed as a quality priority area and welcome

improvements in this area. Improving the experience of cancer patients is also an area that

the CCG endorses, particularly the focus on improved communication, information and

access to support.

Audits

The feedback from audit and confidential enquiries within the report highlights some

difficulties within Bromley services in that not all data has been submitted. A number of

action plans are in place as a result of audit and will support the general change and

improvement programme in place across King’s services in Bromley.

Consideration by Bromley CCG Quality Assurance sub –committee

The draft report has been considered by members of the Bromley CCG Quality Assurance

sub-committee. The committee acknowledges the challenges for King’s due to the legacy

Enc 2.7.1

87

issues in place within Bromley services. The committee also recognises that as Kings took

over services from October 2013 full information regarding quality is not as accessible for the

trust prior to this date. Bromley CCG appreciates that transition for king’s will be on-going

during 2014-15 to a trust on a number of sites, but expect that future quality accounts will

include increased detail from the trusts expanded services on all sites, and the CCG will

specifically focus on information regarding sites and services used mainly by Bromley

residents .

Sonia Colwill

Director of Quality, Governance and Patient Safety

April 2014

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Statement from Local Healthwatch Organisations

Local Healthwatch appreciates the opportunity to comment on the quality of the services provided by King’s College NHS Foundation Trust at the Princess Royal University Hospital (PRUH) and Denmark Hill (DH) Hospital site. We have compiled a joint response to the Quality Account this year using feedback from Healthwatch Bromley, Lambeth, Lewisham and Southwark due to the cross-over of services across boroughs.

1. Response to statement on quality of care from Chief Executive

The Chief Executive’s statement opened with the Francis report and KCH’s

commitment on “quality”, “safety”, “care and compassion”. We welcome this

commitment but would like to point out that “quality” and “safety" is built on a solid

foundation of “transparency” “openness”, continual learning and “listening to patients

and their family and carers”.

In the last Healthwatch response to KCH’s Quality Accounts, we commented that it

would be beneficial for Healthwatch to receive regular feedback on the Quality

Priorities throughout the year, and not just on annual basis when we are asked to

respond to the Quality Accounts. Some progress has been achieved last year but

further work is needed this year.

We are pleased that in preparation of the Quality Account, KCH has organised

engagement events with stakeholders to feed into the Quality Account and setting

next year’s quality priorities. However, the time allowed for Healthwatch to comment

on the quality account report is too tight. We would like more time to truly involve

patients in reviewing quality reports to ensure comments reflect their experiences.

We remain concerned over the 30% expansion of King’s College Hospital by

acquiring the Princess Royal University Hospital and we seek assurance that any

changes in the future, like the potential merger with South London and Maudsley and

Guy’s & St Thomas’ will still put patient safety and quality of care as the priorities for

local patients alongside international and specialised research.

2. Quality Priorities and Objectives setting

We welcome the opportunity to be involved in the setting of the priorities and were

pleased to contribute highlighting what we feel accurately reflects the issues that

matter to patients. We…

Appreciate the stated commitment to ‘meet or exceed’

Acknowledge this is an ongoing process year to year and that the process to

be ‘clear and meaningful’ to stakeholders is improving (following the

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engagement events which we were involved with in January and preparation

prior to this)

Appreciate that the Trust expects to be held to account

Acknowledges that during the last year the enlarged Trust with significant

additional sites and services means that ‘enlarged and different communities’

are being served with significant demographic and other differences which will

need to be addressed.

3. Performance against Quality Priorities and Objectives for 2013/4

On the agreed priorities for 2013/14 it was acknowledged in the report that further

improvement was required particularly in the areas of patient safety, and the patient

experience of discharge. We are pleased that the Trust ‘Fully met’ four of the six

priorities and that Discharge is carried over into this year where we hope to see

tangible outcomes for patients and carers. This is crucial to local Healthwatch as we

have collected people’s stories relating to the dissatisfaction felt around this issue.

On the issue of the Surgical Safety Checklist, again it is essential that this priority

was expanded upon for 2014-15 as the Trust must get to the position of having zero

Never Events.

We are concerned to see that under workforce, only 4.05 (not sure this is % or a

score out of 10) of staff employed would recommend the Trust as a provider of care

to their families or friends. We are also concerned that the action taken to improve

the result is through improved communication with staff. Has the Trust investigated

the causes for this poor performance?

4. Agreed priorities for 2014/15

We understand the rationale for the Trust choosing the priorities below and agree

with them and have written some comments regarding the priorities below:

Patient Safety

Reduction in falls and resulting injury to patients (KCH DH and PRUH)

Through our monitoring of services we have noted the amount of falls that

happen both within KCH and in community settings. This has also been an

issue at the South London Quality Surveillance Groups that we attend and

therefore welcome the attention being given to it.

Surgical safety We presume that this is for the KCH DH site only for this

period as changes at PRUH and new elective orthopaedic surgery at

Orpington Hospital are not currently in place but it would be important to have

assurances that this will be implemented across all sites.

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Patient Outcomes

Reduce mortality associated with alcohol and smoking (KCH DH and all sites)

As we know there is a very high prevalence of illnesses caused by these

within South East London we agree that this is a high priority.

Improve outcomes for patients with hip fracture (KCH DH and PRUH) It is

appreciated that this is an issue which is of importance to clinicians as

highlighted in the Quality Account engagement event which we also agree

should be a priority as it will produce a significant outcome for patients

Patient Experience

Improve experience for cancer patients (KCH) As we know that this is an area

of care that needs to be improved across the country and is not unique to

KCH. We look forward to better experience and outcomes for those patients

that will wait less time for appointments and treatment.

Improve experience and coordination of discharge (KCH) At a recent

Discharge engagement event attended by several local Healthwatch we

raised the issue of discharge and noted that this is a quality priority that was

not fully met from year 2012/13. We are pleased that patient’s experience on

discharge is still the quality priority for 2013/14 and the range of initiatives to

improve this area of work as it is disappointing that better results were not

shown during 2013/14. This is a crucial area to ensure that people have all

they need to go back to living in the community as well as it being key to

reducing re-admission.

Well planned and coordinated discharge has to involve patient’s family and

carers. These are the individuals who will be caring for the patients after discharge,

so it is important that they are involved and informed before discharge to ensure a

smooth transfer of care from hospital to home. As part of this it is crucial that there is

a named member of staff or team who is responsible for ensuring family and carers

are kept informed.

Recommendation: Clear named contact details of member of staff responsible for

enquiries about the patient by family and friends – to be verbally given on admission,

with clear written information about patient’s hospital stay within 24hrs to patient and

family. If patient is moved to a different part of the hospital, lead member of staff to

advise family within 1hr of move.

Healthwatch Bromley would be particularly keen to see improvements to achieve

well planned and coordinated discharge (including essential joint services with

community based health and social care services) extended to the PRUH. Good

practice needs to be extended from KCH around liaison/cross referral (e.g.

orthopaedic surgery and elderly care physicians, early identification of dementia and

multi-disciplinary/inter-agency working). On p.25 in terms of the key outcomes for

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monitoring the care of hip fracture, it would be useful if readmissions could be

measured too. In terms of improving the quality of care for cancer patients as

outlined on p29 ‘Increase the number of doctors receiving advanced communication

skills training’, it would be helpful if this was audited to check whether training had

been taken up.

Healthwatch Lambeth has received positive feedback on the @Home service,

particularly for patients who have high health and social care needs. The feedback

we received was that patients and families have quality time with the Doctor; it is

flexible, efficient and effective and caused no disruption to the care routine. We

would like to see this service expanded.

Healthwatch Lewisham identified that the Trust needs to improve communication around discharge procedures for patients from boroughs outside Southwark. Healthwatch Southwark would particularly request that some of the work discharge be focussed on patients who are in mental health distress in order to ensure that their discharge to mental health services within South London and Maudsley and the community is carried out in an effective way.

There are a number of ‘linked’ issues on patient experience:

Note on P. 66 that King’s intend to expand the ‘Friends and Family test’. On p.74

they highlight ‘Responsiveness to the personal needs of patients’ and on p.81 they

refer to their monitoring of Complaints and the current NHS review of complaints

procedures. This is an issue of particular concern at the PRUH given the history of

poor and delayed responses to complaints in the past.

Additional points:

Healthwatch Lewisham would like to see improvements in Day surgery appointments

for people in certain protected groups. A particular recent example highlights just one

of the issues relating to appointments: An older man with dementia has appointment

at day surgery at Kings College Hospital at 7.30 am which is too early for someone

in his condition. The hospital transport requires him to be ready 3 hours before which

means he is woken up at 4 am. Improvements need to be made when arranging

appointments for the elderly and also transport needs to be taken into consideration.

5. Availability of data

We recognise the inherited problems that the Trust took over since the acquisition in

October 2013 at the PRUH site. There was a significant lack of data available to

King’s about the quality and effectiveness of the care and treatment provided to

patients which was also acknowledged by the CQC during their inspections in

December 2013.

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The report notes that some data from clinical audits were not available at the PRUH

or are still awaited (p34-54) but KCH have put action plans in place across sites

where necessary to improve data collection and submission. It is important to note

that KCH intends to roll out their Infection Control Audit Programme across all sites

in 2014 (p 53).

6. Patient participation in clinical trials/research

The account of research developments/achievements at KCH is very positive and impressive that the Trust is drawing in large amounts of funding. It would be encouraging to know whether there are likely to be opportunities for PRUH patients to have the opportunity to participate in the future. We congratulate the Trust for performing above average on the National Neonatal Audit Programme for both the DH and PRUH sites (p49). There are some concerns that the results of the audit standards are so variable; either very high or very low.

CQC inspection of PRUH December 2013

According to KCH the CQC list of requirements were in line with issues they had already identified and highlighted. King’s submitted an action plan to the CQC on 28th February 2014. It would be useful if the report was broken down into hospital sites for both DH and the PRUH so that it is easier for a lay person to depict more borough specific issues. Whilst we are delighted that there was a good response to the CQC report there is some concern that there was so little data available from the PRUH. Having good data is essential to effective risk management. On the whole we would have liked more inclusion of quality issues relating to the new parts of the Trust. We look forward to continuing to work with the trust in the coming year to achieve

significant progress on the priorities identified.

Healthwatch Bromley, Healthwatch Lambeth, Healthwatch Lewisham and

Healthwatch Southwark

May 2014

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Appendix 2: 2013/14 Statement of the Directors; responsibilities in respect of

the Quality Report

The directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 to prepare Quality Accounts for each financial year. Monitor has issued guidance to NHS foundation trust boards on the form and content of annual quality reports (which incorporate the above legal requirements) and on the arrangements that NHS foundation trust boards should put in place to support the data quality for the preparation of the quality report. In preparing the quality report, directors are required to take steps to satisfy themselves that:

the content of the quality report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual;

the content of the quality report is not inconsistent with internal and external sources of information, including:

board minutes and papers for the period April 2013 to May 2014;

papers relating to quality reported to the board over the period April 2013 to May 2014;

feedback from the commissioners, dated 02 May 2014;

feedback from governors, dated 02 May 2014;

feedback from local Healthwatch organisations, dated 02 May 2014;

the trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, dated July 2013

the latest national patient survey, dated XX/XX/20XX;

the [latest] national staff survey, dated 25 February 2014;

the Head of Internal Audit’s annual opinion over the trust’s control environment, dated XX/XX/20XX;

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Care Quality Commission quality and risk profiles, dated 01 April 2013 to 31 March 2014;

the quality report presents a balanced picture of the NHS foundation trust’s performance over the period covered;

the performance information reported in the quality report is reliable and accurate;

there are proper internal controls over the collection and reporting of the measures of performance included in the quality report, and these controls are subject to review to confirm that they are working effectively in practice;

the data underpinning the measures of performance reported in the quality report is robust and reliable, conforms to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review; and the quality report has been prepared in accordance with Monitor’s annual reporting guidance (which incorporates the Quality Accounts regulations) (published at www.monitor.gov.uk/annualreportingmanual) as well as the standards to support data quality for the preparation of the quality report (available at www.monitor.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=3275).

The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the quality report. By order of the board Note: sign and date in any colour ink except black ..............................Date.............................................................Chair ..............................Date............................................................Chief Executive

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http://www.monitor.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=3275

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Independent Assurance Report Independent auditor’s report to the board of governors of King’s College Hospital NHS Foundation Trust on the quality report We have been engaged by the board of governors of King’s College Hospital NHS Foundation Trust to perform an independent assurance engagement in respect of King’s College Hospital NHS Foundation NHS Foundation Trust’s quality report for the year ended 31 March 2014 (the ‘Quality Report’) and certain performance indicators contained therein. Scope and subject matter The indicators for the year ended 31 March 2014 subject to limited assurance consist of the national priority indicators as mandated by Monitor: [Here, list the indicators and page numbers if necessary]. We refer to these national priority indicators collectively as the ‘indicators’. Respective responsibilities of the directors and auditors The directors are responsible for the content and the preparation of the quality report in accordance with the criteria set out in the NHS Foundation Trust Annual Reporting Manual issued by Monitor. Our responsibility is to form a conclusion, based on limited assurance procedures, on whether anything has come to our attention that causes us to believe that:

the quality report is not prepared in all material respects in line with the criteria set out in the NHS Foundation Trust Annual Reporting Manual;

the quality report is not consistent in all material respects with the sources specified in [here, include source or list]; and

the indicators in the quality report identified as having been the subject of limited assurance in the quality report are not reasonably stated in all material respects in accordance with the NHS Foundation Trust Annual Reporting Manual and the six dimensions of data quality set out in the Detailed Guidance for External Assurance on Quality Reports.

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We read the quality report and consider whether it addresses the content requirements of the NHS Foundation Trust Annual Reporting Manual, and consider the implications for our report if we become aware of any material omissions. We read the other information contained in the quality report and consider whether it is materially inconsistent with [either refer back to the specified documents in the guidance, or list those documents below:

board minutes for the period April 2013 to [the date of signing of the limited assurance opinion];

papers relating to quality reported to the board over the period April 2013 to [the date of signing of the limited assurance opinion];

feedback from the Commissioners, dated XX/XX/20XX;

feedback from local Healthwatch organisations, dated XX/XX/20XX;

the trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, dated XX/XX/20XX, dated XX/XX/20XX;

the [latest] national patient survey, dated XX/XX/20XX;

the [latest] national staff survey, dated XX/XX/20XX;

Care Quality Commission quality and risk profiles, dated XX/XX/20XX;

the Head of Internal Audit’s annual opinion over the trust’s control environment, dated XX/XX/20XX; and

any other information included in our review.] We consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with those documents (collectively, the ‘documents’). Our responsibilities do not extend to any other information. We are in compliance with the applicable independence and competency requirements of the Institute of Chartered Accountants in England and Wales (ICAEW) Code of Ethics. Our team comprised assurance practitioners and relevant subject matter experts. This report, including the conclusion, has been prepared solely for the Council of Governors of XYZ NHS Foundation Trust as a body, to assist the Council of Governors in reporting XYZ NHS Foundation Trust’s quality agenda, performance and activities. We permit the disclosure of this report within the Annual Report for the year ended 31 March 2014, to enable the Council of Governors to demonstrate they have discharged their governance responsibilities by commissioning an independent assurance report in connection with the indicators. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Council of Governors as a body and XYZ NHS Foundation Trust for our work or this report, except where terms are expressly agreed and with our prior consent in writing. Assurance work performed We conducted this limited assurance engagement in accordance with International Standard on Assurance Engagements 3000 (Revised) – ‘Assurance Engagements other than Audits

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or Reviews of Historical Financial Information’, issued by the International Auditing and Assurance Standards Board (‘ISAE 3000’). Our limited assurance procedures included:

Evaluating the design and implementation of the key processes and controls for managing and reporting the indicators.

Making enquiries of management.

Testing key management controls.

[Here, include analytical procedures].

Limited testing, on a selective basis, of the data used to calculate the indicator back to supporting documentation.

Comparing the content requirements of the NHS Foundation Trust Annual Reporting Manual to the categories reported in the quality report.

Reading the documents. A limited assurance engagement is smaller in scope than a reasonable assurance engagement. The nature, timing and extent of procedures for gathering sufficient appropriate evidence are deliberately limited relative to a reasonable assurance engagement. Limitations Non-financial performance information is subject to more inherent limitations than financial information, given the characteristics of the subject matter and the methods used for determining such information. The absence of a significant body of established practice on which to draw allows for the selection of different, but acceptable measurement techniques which can result in materially different measurements and can affect comparability. The precision of different measurement techniques may also vary. Furthermore, the nature and methods used to determine such information, as well as the measurement criteria and the precision of these criteria, may change over time. It is important to read the quality report in the context of the criteria set out in the NHS Foundation Trust Annual Reporting Manual. The scope of our assurance work has not included governance over quality or non-mandated indicators, which have been determined locally by XYZ NHS Foundation Trust. Conclusion Based on the results of our procedures, nothing has come to our attention that causes us to believe that, for the year ended 31 March 2014:

the quality report is not prepared in all material respects in line with the criteria set out in the NHS Foundation Trust Annual Reporting Manual;

the quality report is not consistent in all material respects with the sources specified in [here, include source]; and

the indicators in the quality report subject to limited assurance have not been reasonably stated in all material respects in accordance with the NHS Foundation Trust Annual Reporting Manual.

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Deloitte LLP

Chartered Accountants

St Albans

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Glossary - to be updated when document finalised

Amber Care Bundle A tool developed by Guy’s & St. Thomas’ Trust to help staff

identify the needs of patients whose life expectancy is

uncertain

AHSC Academic Health Science Centre

AHP Allied Health Professionals i.e. Physiotherapists, Occupational

Therapists, Speech & Language Therapists etc.

BHF British Heart Foundation

CQC Care Quality Commission

CLRN Comprehensive Local Research Network

CHD Congenital Heart Disease

CHR – UK Child Health Reviews in the United Kingdom

COPD Chronic Obstructive Pulmonary Disease

CQUIN Commissioning for Quality and Innovation

DAHNO National Head & Neck Cancer Audit

DoH/DH Department of Health

EoL End of Life

EoLC End of Life Care

FAST The Stroke Association’s acronym for diagnosing a the early

onset of a stroke – Face, Arms, Speech & Time

FY1 &FY2 Foundation Doctors in Years 1 &2

HF Heart Failure

HRM Human Resource Management

HTA Human Tissue Authority

HRWD Human Resources Workforce Development

HSJ Health Service Journal

IBD Inflammatory Bowel Disease

IGT Information Governance Toolkit

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Kwiki A website that allows its authorised users to edit & add

information pages

LCP Liverpool Care Pathway

MINAP The Myocardial Ischaemia National Audit Project

MEOWS Modified Early Obstetric Warning Score

MMC Mortality Monitoring Committee

MRSA Methicillin-resistant staphylococcus aureus

NAD National Audit of Dementia

NADIA National Diabetes Inpatient Audit

NAOGC National Audit of Oesophageal & Gastric Cancers

NASH National Audit of Seizure Management

NAPT National Audit of Psychological Therapies

NBOCAP National Bowel Cancer Audit Programme

NCDAH National Care of the Dying Audit

NCEPOD National Confidential Enquiry into Patient Outcome & Death

Studies

NCIS National Confidential Inquiry into Suicide & Homicide for

People with Mental Illness

NDA National Diabetes Audit

NHFD National Hip Fracture Database

NHIR National Institute for Health Research

NHS Safety Thermometer A NHS local system for measuring, monitoring, & analysing

patient harms and ‘harm-free’ care

NHSBT NHS Blood Transfusion

NICE National Institute for Health & Excellence

NJR National Joint Registry

NNAP National Neonatal Audit Programme

NPDA National Paediatric Diabetes Audit

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NPSA National Patient Safety Agency

NRAD National Review of Asthma Deaths

PbR Payment by Results

PALS Patient Advocacy & Liaison Service

PICANet Paediatric Intensive Care Audit Network

PEWT Paediatric Early Warning Tool

POMH Prescribing Observatory for Mental Health

POTTS Physiological Observation Track & Trigger System

PROMS Patient Reported Outcome Measures

Safety Express Dept. Health Safe Care Work Stream that links to the QIPP

(Quantity, Innovation, Productivity & Prevention programme)

SBAR Situation, Background, Assessment & Recognition factors for

prompt & effective communication amongst staff

SHMI Standardised Hospital Morality Index. This measures all

deaths of patients admitted to hospital and those that occur up

to 30 days after discharge from hospital.

SLAM South London & Maudsley NHS Foundation Trust

SSC Surgical Safety Checklist

SSIG Surgical safety Improvement Group

SSNAP Sentinel Stroke National Audit Programme

SINAP Stroke Improvement National Audit Programme

TARN Trauma Audit & Research Network

UKCRN United Kingdom Clinical Research Network

VSGBI Vascular Society of Great Britain & Ireland

VTE Venous-Thromboembolism

WHO World Health Organisati

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Report to: Council of Governors Date of meeting: 15 May 2014 Presenting: Jane Walters, Director of Corporate Affairs Author: Tamara Cowan, Board Secretary Subject: Governor Summer Elections 1. Summary This report provides information and the timetable for the forthcoming Governor elections. It also describes eligibility for election from the current Council of Governors and posts that are subject to re-election. The Governors’ Membership & Engagement Committee (MEC) considered this report at their meeting on 08 April 2014 and endorsed the proposed election timetable and engagement plan subject to expanding external stakeholder engagement to local Churches and organisations such as Millwall Football Club. The Board of Directors approved the timetable and election plan at their meeting on the 29th April 2014. 2. Council of Governors Structure In 2013, the Board of Directors and Council of Governors approved the adoption of the current Constitution, which sets out the structure of the Council of Governors (Table 1). Some of these changes included: 1. The addition of the Boroughs of Bromley and Lewisham as part of the Trust’s

constituencies. Four governors would represent the Bromley and one governor would represent Lewisham;

2. Creation of two interim staff governor posts to represent staff at the acquired sites; 3. Four governors would represent the Borough of Lambeth and four would represent the

Borough of Southwark. This change would take effect on 01 December and replace the previous arrangement with 6 governors in total representing the north (2), south (2) and central (2) groups of electoral wards in the Lambeth and Southwark constituencies;

4. Removing the support staff as a separate class within the staff constituency as this class

will be amalgamated with the Administrative and Clerical and Management Staff class; 5. Including new stakeholder governors for Bromley Council and Bromley CCG and

removing London South Bank University as a stakeholder ; 6. In addition, to create natural staggering on the Council of Governors so that all governors

were not subject to election at the same time, the following provisions were made: a. Bromley and Lewisham public governors were elected to serve 3 year terms from

31 January 2014; and

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b. The term of office a governor was able to serve was increased from the previous 6 years (2 three-year terms subject to re-election) to 8 years (2 three-year terms plus 1 two-year term also subject to re-election).

Council of Governors Structure as of 1 December 2014 No. of Governors

Public Constituency

Borough of Lambeth 4

Borough of Southwark 4

Borough of Bromley 4

Borough of Lewisham 1

Patient Constituency

Patient Governors 6

Staff Constituency

Medical & Dental Practitioners 1

Nurses and Midwives 2

Allied Health Professionals, Scientific and Technical 1

Administrative and Clerical and Management 1

Nominated Governors

Bromley, Southwark and Lambeth Council 3

Bromley, Southwark and Lambeth Clinical Commissioning Groups 3

King’s College London (University) 1

South London & Maudsley Hospital (KHP Partner) 1

Guy’s & St Thomas’ (KHP Partner) 1

Joint Staff Committee 1 Table 1: Council of Governors Structure as at 01 December 2014

Taking account of the other nominated governors the Council of Governors will have, as of 01 December 2014, 34 governors as opposed to 33 prior to the acquisition of the PRUH and other sites.

3. Elected Governors

The elected governors in post at the time of the PRUH acquisition started their first three-year term on 01 December 2011. With the acquisition of some sites, former South London Healthcare Trust (SLHT) the Trust also held elections in January 2014 for new public governors from Bromley and Lewisham and additional staff governors to represent nurses and doctors from the newly acquired sites. The Bromley and Lewisham public governors were elected for three-year terms. However, newly elected staff governors representing PRUH staff were elected to serve for an interim period. The end of their terms coincides with the end of the other staff governors on 30 November 2014. The current council of governors has 42 Governors (subject to vacancies).

Elected Governor Constituencies as at 31 January 2014 No. of Governors

Term Ends

Public Constituency (17)

Lambeth North 2 30 November 2014

Lambeth Central 2 30 November 2014

Lambeth South 2 30 November 2014

Southwark North 2 30 November 2014

Southwark Central 2 30 November 2014

Southwark South 2 30 November 2014

Borough of Bromley 4 31 January 2017

Borough of Lewisham 1 31 January 2017

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Patient Constituency (6)

Patient Governors 6 30 November 2014

Staff Constituency (8)

Medical & Dental Practitioners 1 30 November 2014

Interim New Sites (SLHT) Medical & Dental Practitioners 1 30 November 2014

Nurses and Midwives 2 30 November 2014

Interim New Sites (SLHT) Nurses and Midwives 1 30 November 2014

Allied Health Professionals, Scientific and Technical 1 30 November 2014

Administrative and Clerical and Management 1 30 November 2014

Support Staff 1 30 November 2014

Nominated Governors (11)

Bromley, Southwark and Lambeth Council 3

Bromley, Southwark and Lambeth Clinical Commissioning Groups

3

King’s College London (University) 1

London South Bank University 1

South London & Maudsley Hospital (KHP Partner) 1

Guy’s & St Thomas’ (KHP Partner) 1

Joint Staff Committee 1 Table 2: Current Elected Governors and End of Office

3. Summer Elections - current elected serving governors position In the summer, the Trust will have elections for all elected governors from the following constituencies:

Patient Constituency

Borough of Lambeth Constituency

Borough of Southwark Constituency

Staff Constituency:

Medical & Dental Practitioners

Nurses and Midwives

Allied Health Professionals, Scientific and Technical

Administrative and Clerical and Management Of the current serving governors:

Public (11)

8 current public governors elected 2011 will be eligible for re-election to serve a further 3-year term.

1 current public governor elected 2011 will be eligible for re-election to serve a further 2-year term.

2 current public governors who took up post to fill a vacancy mid-term will be eligible for re-election to serve a 3-year term.

Patient (5)

2 current patient governors elected 2011 will be eligible for re-election to serve a 3-year term.

2 current patient governors elected 2011 will be eligible for re-election to serve a 2-year term.

1 current patient governor who took up post to fill a vacancy in-term will be eligible for re-election to serve a 3-year term. Staff (7)

3 current staff governors elected 2011 will be eligible for re-election to serve a 3-year term.

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1 current staff governor who took up post to fill a vacancy mid-term will be eligible for re-election to serve a 3-year term.

2 current interim staff governors elected 2014 will be eligible for election to serve 3-year term.

GOVERNOR ELECTED 2011 ELIGIBLE TO STAND FOR:

GOVERNOR TAKING ON VACANT POST IN-TERM

ELIGIBLE TO STAND FOR:

INTERIM GOVERNORS

ELECTED 2014 ELIGIBLE TO STAND

FOR:

3-YEAR TERM 2-YEAR TERM 3-YEAR TERM 3-YEAR TERM

Borough of Lambeth

Fiona Clark

Nanda Ratnaval

Godwin Ubiaro

Chris North

Michael Robinson

Borough of Southwark

Barbara Pattinson Michelle Pearce Pam Cohen (Replaced Andy

Alatise)

Andrew McCall Jo Onabaworin (Replaced John

Henley)

Stuart Owen

Patient Governors

Patti Kachidza Tom Duffy

David Sullivan Jan Thomas Pida Ripley (Replaced Christine

Klaassen)

Staff Governors

Carolyn Campbell-Cole Nicky Hayes Mike Pedro (Replaced Brady Pohle)

Helen Mencia

Rachel Burman CV Praveen

Phyllis Barnet

Table 3: Current Governors Eligible for Re-election

4. Election Timetable To ensure that new governors are elected, inducted and trained by the 1 December 2014 it is proposed that the election process begin in May 2014. This will provide opportunities to use already planned engagement events to promote the elections before and after the official notice of election is issued. Table 4 below outlines the timetable for Election Awareness & Publicity Initiatives; Plans for Engagement, the planned official election period and the Governor Induction and Training Programme. Table 5 outlines some of the engagement and publicity activities that will be used during the election. Table 4: Timetable for governor elections - Summer 2014

TIMETABLE FOR GOVERNOR ELECTION SUMMER 2014

Events Notes Date

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Pu

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Election plan & engagement discussion at MEC

08 April 2014

Election plan agreement with ERS

09 April 2014

Draft election plan and early announcement at KE

14 April 2014

Members Seminar Prostate Cancer, Business Park Unit 4

28 April 2014 1.00-2.30pm

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Draft election plan and early announcement at BoD

29 April 2014

Copy and Data due MES to transfer relevant data to ERS Trust to provide any updates to nomination materials (cover letter text etc)

2 May 2014

Lambeth CCG Governing Body Meeting

Location: 336 Brixton Road, SW9 7AA Telephone 020 7274 2299 Pre-Meet – 12.00-1.00pm, Green Room Main Meeting –Main Room

07 May 2014 1.00pm – 4.00pm

Southwark CCG Governing Body Meeting

Cambridge House, 1 Addington Square, Camberwell, London, SE5 0HF

08 May 2014 2.00-5.30pm

Election special in @ King’s 09 May 2014 – Draft Content (for publication in June)

Final election plan and early announcement at CoG

15 May 2014

Ele

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Pe

rio

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Notice of Election ERS issue the notice of Election and nomination forms to be made available to Trust members.

No later than 40 days before the close of the poll Actual days allowed = 76 days

19 May 2014

Members’ Seminar Palliative Care Dr Rachel Burman, Business Park Unit 4

22 May 2014 1.00-2.30pm

Events Notes Date

Stakeholder Event Bill Whimster Suite – WEC KD, TS, GW

30 May 2014 10am-12pm

Stakeholder Event Bromley Library – Large Hall. MM & PC

02 June 2014 3:00-5:00pm

Governor Awareness Session 05 June 2014

Members’ Seminar Counter Fraud and Corruption in the NHS, Business Park Unit 4

16 June 2014 1.00-2.30pm

Lambeth CCG Governing Body Meeting

Location: 336 Brixton Road, SW9 7AA Telephone 020 7274 2299

02 July 2014 Pre-Meet – 12-1pm, Main Meeting, 1 – 4pm

Governor Awareness Session 04 July 2014

Ele

cti

on

Pe

rio

d

Governor information stands @ Trust Open Day

06 July 2014

Final day for receipt of nominations ERS to send final list of nominations for final validation by Trust(first check done by MES)

No later than 28 days before the close of the poll Actual days allowed = 46 Days

09 July 2014

Publication of nominated Statements ie List of

No later than the 27 days before close of the poll

10 July 2014

Enc 2.8

6

nominees ERS and Trust publish summary of nominated candidates upon validation.

Actual Days allowed = 44 Days

Election copy and data due MES to transfer data to ERS Trust to provide any cover letter text to ERS

10 July 2014

Final date for candidate withdrawal

No later than 25 days before the day of the close of poll Actual days allowed = 42 Days

14 July 2014

Uncontested report ERS to provide Trust with report for any uncontested constituencies

15 July 2014

Notice of Poll

No later than 15 days before the day of the close of poll Actual days allowed = 41

23 July 2014

Events Notes Date

Voting packs despatched by ERS to members

24 July 2014

Turnout updates [Trust to add in dates – otherwise weekly on Friday)

Reminder Mailing/email/sms 1 September 2014

Close of the poll By 5.00pm on the final day of the election

12 September

Report on Voting ERS to provide Trust with the report on voting

15 September 2014

ERS to send out letters to unsuccessful candidates

15 September 2014

Election Results in @ King’s August (for publication in September)

Go

ve

rno

r In

du

cti

on

s &

tra

inin

gs

Trust Governor Induction 1 Training/Induction 17 September

CoG & AMM Shadow period 25 September 2014

FTN Core Skills Training Training/Induction 06 October

FTN NHS Finance & Business Skills Training

Training/Induction 10 October

Public Board Shadow period 28 October 2014

Governor Committees Shadow period 30 October 2014

Trust Governor Induction 2 Training/Induction 12 November

Governor Workshop Shadow period 12 November 2014

Governor Development Day Shadow period 27 November 2014

Term of Office begins 01 December 2014

First CoG meeting 10 December 2014

Enc 2.8

7

Table 5: Governor Elections - Promotion initiatives Organisation Engagement

Internal Engagement

@King’s magazine

Spring Issue (Mid- June) – Elections special, information and timetable

Summer Issue (Mid – September) – Election results

KCH Website

Elections Page - Update and announce the election timetable on the Trust website

Membership Database

Targeted emails for those expressed an interest in standing as Governors and invite them to Governor Awareness Session (GAS) on 26 June 2014

Governors

Send all Governors 20 membership forms

Governors to stand on a number of nominated days for 2-hour slots at the OP clinics in the GJW & Hambledon

Governors to attend members events, community events, stakeholder events, Trust open day (06 July) and any other special information events to promote elections

Governors to take part in the Governor Awareness Session on 26 June

Stakeholders

Send out election information in the stakeholder news letters

Promote elections in the stakeholder events

Advertise in KHP electronic bulletins

GPs

Email to existing GP contacts

Promote in the GP electronic bulletins

Patients

Email to existing GP contacts

Promote in the GP electronic bulletins

Widespread leafleting in public areas such as canteen, outpatient clinics, receptions across all sites

Flyers via HRWD inpatient survey and other patients surveys

King’s Volunteers

Email information to volunteers database

Information Leaflets/flyers

Governor and Trust rep to speak at their meetings

Fundraising Send information with fundraising mailings

Friend of King’s

Email to database

Governor and Trust rep to speak at their meetings

Staff Engagement

Staff Engagement

Information on King’s Intranet

Regular information & updates in electronic staff bulletins

Information leaflets/flyers in canteens, wards, staff rooms across all sites

Hand out leaflets/flyers for staff groups at payslip collections in June, July and August

Current staff Governors and Trust lead to speak at relevant staff group meetings ie CDM, Divisional meetings etc

External Engagement

Lambeth & Southwark Clinical Commissioning Groups (CCGs)

Election information in electronic bulletins, which is circulated to wide network organisations, volunteers and individuals

Governor and Staff rep to attend the Lambeth CCG Governing Body Meeting on 07 May 2014 and 02 July to promote elections

Governor and a staff rep to attend the Southwark CCG Governing Body Meeting on 08 May 2014

Lambeth/Southwark Local Involvement Networks (LINKs)

Email election information to LINKs circulation

Identify any opportunity to attend a LINK steering group meeting or public meeting

Local Groups/Forums

SE5 Forum, Ruskin Park and other local community groups

Provide information and offer to attend meetings

Local Newspapers

Election information & ad in local newspapers including SLP, Southwark News, Lambeth Life

KCL mailing list/ Alumni? Email election information to KCL database

Young People

Promote elections in Charter School and Lambeth College (Sixth formers 16+)

Leaflets/ Flyers through youth councils

HR – work experience schools

London South Bank University & KCL

5. Recommendations The Council of Governors is asked to note the contents of the report the timetable.


Enc 3.2

Annual Plan 2013/14 Membership Report 1

King’s College Hospital NHS Foundation Trust

Annual Membership Report 2013-2014

Rachel Sugarman PPI and Membership Manager

Enc 3.2


1. Membership Report

Break down analysis of the current membership numbers, demographics and comparison to 2012/13.

Public constituency Last year (2012/13) Estimates for 2013/14 This year as of 20.03.2014 (2013/14)

Next year (estimated) (2014/15)

At year start (April 1) 4,255 4,276 4,276 7,884

New members 134 3,160 3,943 750

Members leaving 113 100 335 250

At year end (March 31) 4,276 7,336 7,884 8,384

Staff constituency Last year (2012/13) Estimates for 2013/14 This year as of 20.03.2014 (2013/14)


At year start (April 1) 7,169 7,225 7,255

New members 1,140 4,000 4,067

Members leaving 1,084 1,100 1,375

At year end (March 31) 7,225 10,125 9,947

Patient constituency Last year (2012/13) Estimates for 2013/14 This year as of 20.03.2014 (2013/14)


At year start (April 1) 3,894 4,157 4,157 3,142

New members 431 150 696 750

Members leaving 168 1,744 1,711 250

At year end (March 31) 4,157 2,563 3,142 3,642

Enc 3.2


Analysis of current membership*

Public constituency Number of

members 12/13

% of Membership

12/13

This year as of

20.03.2014 (2013/14)

% of Membership

13/14

Eligible membership

% of Eligible population

Age (years):

0-16 4 0.1 1 0.01 244,471 20.0

17-21 68 1.6 117 1.6 73,135 6.0

22+ 3,841 89.9 7,295 98 901,429 74.0

Ethnicity:

White 1,956 45.7 4,523 60.6 737,930 62.7

Mixed 179 4.2 259 3.5 72,307 6.1

Asian or Asian British 251 5.9 512 6.9 89,731 7.6

Black or Black British 1,527 35.7 2,059 27.6 249,681 21.2

Other 93 2.2 105 1.4 26,997 2.3

Socio-economic groupings*:

AB 2,592 60.6 2,276 29.0 123,066 30.0

C1 475 11.1 2,417 30.8 141,388 34.3

C2 764 17.9 1,215 15.4 59,549 14.4

DE 443 10.4 1,946 24.8 88,161 21.4

Gender analysis

Male 1,745 40.8 3,249 42.0 603,078 49.5

Female 2,454 57.3 4,507 58.0 615,957 50.5

Enc 3.2


Patient constituency Number of

members 12/13

% of Membership

12/13

This year as of

20.03.2014 (2013/14)

% of Membership

13/14

Age (years):

0-16 1 0.02 0 0

17-21 48 1.2 45 1.5

22+ 4,108 92.3 2,921 98.5

*Analysis excludes:

471 public members with no dates of birth

426 members with no stated ethnicity

128 members with no stated gender

176 patient members with no dates of birth

Suspended Members

Inactive Members

5.4 Membership Commentary

Membership Categories The trust has three categories of members: 1. Patient members Anyone who is 16 or over can join the Trust as a patient member if they:

live outside the Boroughs Lambeth, Southwark Bromley and Lewisham, and

have been a patient at King’s - or a carer of a patient - in the last 6 years

Enc 3.2


As shown in the graph below, the majority of our patient members live either in other London boroughs or the S E coastal counties such as Kent. However, there are patient members from across the country who may have been treated in our tertiary specialist services such as liver and bone marrow transplantation and neurosciences.

2. Public members 1 April - 30 September 2013 Up until 1st October 2013, people over the age of 16 years and resident in Lambeth and Southwark joined one of the six public constituencies:

Southwark North, Southwark Central and Southwark South

Lambeth North, Lambeth Central and Lambeth South

Enc 3.2


1) 1 October 2013 - 31 March 2014 Following the dissolution of South London Healthcare NHS Trust on October 1st 2014, King's acquired the Princess Royal University Hospital (PRUH), Orpington Hospital, as well as taking over services at other SE London sites. To ensure that local people were given the opportunity to have a say in the future of their hospital and to vote for Governors, the Trust's Constitution was changed to establish two new public constituencies of:

Bromley and

Lewisham

with four new Governors to represent Bromley and one Lewisham. 3. Staff members All staff that have employment contracts lasting more than 12 months are automatically opted into membership. They have the option to opt out should they so wish. Volunteers who work for the Trust and full time employees of King’s contractors are also eligible to become members, though they have to opt in to membership. There are six categories of staff membership with elected governors as follows for the Trust:

Following the acquisition of the Princess Royal University Hospital (PRUH) two additional Staff Governor positions were created, one for nursing and midwifery and one for medical staff / doctors. Two new PRUH Governors were elected in January 2104. These are transitional posts and will be dissolved prior to full Governor Elections scheduled for December 2014.

Enc 3.2


Pre-acquisition of

the PRUH Transition Period

Enlarged Organisation post elections Dec 2014

Medical and Dental 1 Governor 2 Governors 1 Governor

Nursing and Midwifery 2 Governors 3 Governors 2 Governors

Allied Health Professionals, Pharmacy, Scientific and Technical

1 Governor 1 Governor 1 Governor

Managerial, Administrative and Clerical 1 Governor 1 Governor 1 Governor

Support Staff 1 Governor 1 Governor

5.6 Engagement and Experience Strategy and Membership Development Strategy

a) Revised Membership Strategy

King’s Engagement and Experience Strategy incorporates the Membership Development Strategy and outlines our approach to ensuring that we have a membership that is reflective of our local communities, but also focusses on involving our membership in the work of King’s and on how the Trust can have a positive role in engaging with our local community. Prior to the acquisition of the PRUH, the Membership Development Strategy was revised to reflect the enlarged organisation and to include strategies to recruit members to the new public constituencies of Bromley and Lewisham. A key aim was to ensure that there was a large pool of members who were eligible to stand as new Public Governors in the elections and to vote in the elections. Targets were set to ensure as far as possible equity of membership across the three public constituencies of Lambeth, Southwark and Bromley, which have similar populations and will be served by four Governors each. The strategy set a target to have a membership of circa 2,000 for each of these three constituencies with an additional 1,000 members in Lewisham.

Recruitment targets were also put in place to recruit additional patient members as around 1,500 former patient members transferred to the new public constituencies of Bromley and Lewisham. Given that a lower percentage of patients of the PRUH are ‘out of area’, the plan proposed re-building patient numbers to circa 3,000 which will achieve better equity with the number of members represented by Governors in the public constituencies.

Enc 3.2


b) Membership Recruitment Overview Overall the patient and public membership has grown from 8,443 in April 2013 to 11,026 at the end of the year. This is an increase of 2,583 members or a percentage increase of 31%.

Enc 3.2


c) Pre and post-acquisition membership numbers April 2013 – September 2013 From April to September 2013, we continued to use cost neutral recruitment methods to ensure the membership grew incrementally and to replace any membership attrition:

Promoting membership as part of King’s “How are we doing?” patient feedback programme

The King’s website where people can sign up for membership

Promotion in the @Kings Magazine available across the hospital and sent to members to encourage friends and family to sign up.

Promotion via local stakeholder groups

Promotion via our Governors

The total number of patient and public members as of 30th September 2013 was 8,608, an increase of 175 members compared to the period 2012-2013.

We recruited 318 new members in the period, 112 of whom were public members and 206 patient members.

Membership from 1st

April 2013

New Members 1st April 2013 – 30th September 2013

New Members Deleted members Cumulative Total

Public Constituency 4276 112 61 4327

Patient Constituency 4157 206 82 4281

Total Membership (not Inc. staff) 8433 318 143 8608

October 2013 – March 2014 Leading up to the acquisition of the PRUH there was a large scale recruitment campaign focussing on recruitment to the new public constituencies. On acquisition, any current patient members resident in either Bromley or Lewisham were automatically transferred to one of the two new public constituencies. On October1st:

Enc 3.2


536 patient members from Bromley transferred to the Bromley constituency and

1,060 patient member from Lewisham transferred to the Lewisham Constituency The trust undertook a range of recruitment activities including:

stakeholder events held in Bromley

face to face recruitment and leafleting at the PRUH involving Governors

promoting membership at a number of road show events held in venues across the new constituency areas including supermarkets, railway stations and shopping centres

information online

promotion in @Kings Magazine

encouraging current members to recruit friends and family. The principal method used for recruitment was a mailing to current and past patients of the PRUH. A sample of 30,000 patients was drawn. To try to ensure that sufficient younger patients were recruited, the sample was weighted to include a larger proportion of younger patients. Member Engagement Services handled the mailing on behalf of King’s and a letter outlining the acquisition and inviting local people to become members was sent out in the autumn. The response was very positive:

Letters posted 29,763

Returned forms to MES 1,905

Returned forms to KCH 328

Total returned forms 2,233 (7.5%)

New Member Sign up 2,228 (7.48%)

Of the members who signed up from the recruitment mailing, the breakdown of location is shown below. As part of the membership application process, people were asked to state whether they had an interest in standing as a Governor. There was a very positive response with 19% of Bromley residents stating that they would like to stand and 18% in Lewisham.

Enc 3.2


d) A Representative Membership

We continue to work hard to ensure that our membership is representative of our local communities, and to take steps to ensure that membership is accessible to all who are eligible, irrespective of age, gender, race or social background. Our membership database allows us to monitor the demographics of the membership and to address any gaps with targeted recruitment. The acquisition of the PRUH and other SE London sites has had an impact on the overall demographic of our membership with the new public constituencies, and particularly Bromley, having a significantly different demographic profile to Lambeth and Southwark.

Enc 3.2


Age

We continue to be under-represented in the 0-16 year old category. The eligible population data includes all people from birth to 16 years. The fact that the minimum age for King's membership is 16 means that there will always be a disparity in these figures as the number of members who are aged 16 is very small.

We are over represented in the 60 and over category.

This follows trends across Foundation Trusts nationally. If we compare member age with the age of the local populations, the addition of the new public constituencies has had an impact with the 60-74 and 75 + age groups being significantly over represented in our membership compared to the local population. The trust will need to target its recruitment to begin to redress the balance and seek to recruit more members in the younger age groups, 22-29 and 30-39.

Enc 3.2


Socio Economic Groups

Last year the membership was largely representative in terms of socio-economic grouping, with the highest variance of 2% for the ABC1 category compared to the local population.

This year the largest variance is seen for the C1 category where there is a 3.6% difference and in the DE category where members are over-represented by 3.3%.

Ethnicity The establishment of new constituencies has seen our membership become more closely representative of our community in terms of ethnicity.

This year, we are over represented in the Black / Black British category by 6.4% compared with 10% last year. ‘White or White British’ are under-represented by only 2.1% compared to 17% over the last two years.

Enc 3.2


Gender

Women are over-represented by 7.5% which is a fall of 1.5% from the previous year. Men are under represented by 7.5% an improvement of 3.5% from last year.

This however follows national trends.

5.7 Membership engagement We have continued to build member engagement over the last year. The new membership database provided by Member Engagement Services (MES) provides us with effective tools to promote and manage member engagement.

a) Members’ Newsletter

Members News has been replaced by a new look magazine - @King’s. @King’s is designed for a wider audience including Members, stakeholders, the public and staff. The magazine is sent to all members via email or post four times a year. It provides members with information about King’s, our plans, topical stories, invitations to events We have also used the magazine to provide information for members to get involved in the work of the trust and this year successfully recruited members to become King’s volunteers and take part in a range of projects to improve the patient experience. b) Members’ pages on the website For those with internet access, there is a members’ section on the website, updating members on events and providing details of how they can contact Governors. The website also allows people to sign up for membership. Over the next year, King’s will be re-designing its website and this will provide us with an opportunity to update our membership pages and we will be engaging with our membership about what information they would like to see on the site.

Enc 3.2


a) Involving our Membership

The Trust is continuing to develop its programme of engaging and consulting with its membership. Below are some key highlights for the year. Community Events The Trust held two community events for members, one at Denmark Hill on 25th February and one in Bromley on 5th March. The response to these events was fantastic with over 180 people attending the two events. The core purpose of the events was to share the Trust’s strategic plans for the future with our members and give them an opportunity to share their views with us. This year, we again invited members to take part in discussion groups focussing on key topical issues. They discussed one of three questions;

What changes would you like to see in the way health services are delivered over the next 5 years ?

What can we all do to help prevent people going to A&E when it’s avoidable or unnecessary?

What are the pros and cons of centralising services on one site from a patient perspective?

The Annual Public Meeting The Annual Public Meeting again proved popular with over 200 members and members of the public attending. The evening began with health checks including Blood Pressure, Glucose and BMI. There was an opportunity to look at information stands on volunteers, fundraising, King’s Health Partners and King’s in Conversation.

Member Health Talks Over the course of last year the Trust continued its programme of Member Health Talks led by our Clinical Nurse Specialists and consultants. These have been held at both Denmark Hill and the PRUH. They have covered topics such as COPD, incontinence and diabetes. Member evaluation continues to be very positive with over 90% of members rating the talks as good. Members value the opportunity to interact with staff and also to learn more about medical conditions and treatments.

Enc 3.2


Involving members in improving the patient experience at King’s

Involving Members in improving King’s Patient Food Service Members have continued to play a role in improving the patient food service. For the last three years members have taken part in daily food service audits on our wards and talked to patients about all aspects of the food service. Involving members in this work has proved popular with staff and we are currently recruiting additional members to take part in this important project. Gathering patient feedback in outpatient clinics Members have also been involved in helping us to transform our outpatient service. An important aspect of this work is to ensure that service user views inform the changes being made and members have helped us to achieve that by conducting a patient survey about patient experience prior to their appointment. The results of this survey were used to inform the design of a new trust wide How are we doing outpatient survey which was launched in December 2012 and has already helped us to make improvements. We are continuing to recruit members to be involved in our outpatient improvement work to assist us by conducting surveys and carrying out observations in clinics.

Patient Led Assessments of the Care Environment (PLACE) The Department of Health and the NHS Commissioning Board recommends that all hospitals, hospices and independent treatment centres undertake an annual assessment of the quality of services and condition of their buildings. These assessments are referred to as patient-led assessments of the care environment (PLACE) and replace Patient Experience Action Team (PEAT) assessments in which Link members have been invited to take part in previous years. The assessments give patients and the public a voice that can be heard in any discussion about local standards of care, in the drive to give people more influence over the way their local health and care services are run.

Assessment teams are a collaboration between staff and patient assessors, therefore patients must make up at least 50 per cent of

the assessment team. Anyone who uses the service can be a patient assessor, including current patients, their family and visitors,

carers, patient advocates or patient council members. The only restriction is that current staff are not able to assess the hospital

they work at as a patient assessor.

Our Governors and Members were involved in this year’s PLACE assessments

Enc 3.2


Hands up for Volunteers King’s volunteers now number around 1,500 and are playing a key part in supporting our patients. We have continued to promote membership to our volunteers and involved members in a range of projects. The programme has been an excellent way for us to involve our membership, particularly for younger people as a large number of our volunteers are under the age of 25. Involvement going forward The Trust is developing a Membership Engagement Plan which will set out our plans and ideas for engaging with our membership and, importantly, providing opportunities for our Governors to link with the membership and local community. We propose to widen our programme of engagement to provide additional opportunities for our members to get involved with King’s. The Governors’ Membership and Community Engagement Committee will oversee this plan. The engagement plan will link appropriately with our strategic plans and stakeholder strategy, as well as key trust initiatives such as our cultural changer programme.


REGISTER OF GOVERNOR ATTENDANCE

(PUBLIC)

Enc. 4.1

CONSTITUENCY REASON FOR ABSENCE

1 2 3 4 5 6 7 8 9 10 11

Prof

SirGeorge Alberti Chair c c c c

May 2012: Sent apologies for absence - Unwell

Marc Meryon deputised. Sept

2012: Sent apologies for absence - unwell.

Graham Meek deputised.

Dec 2013: Sent apologies for absence - Overseas work

Marc Meryon deputised

March 2014: Sent apologises for absence - Marc Meryon

deputised

Mr Andy Alatise Southwark Central c c c c N/A N/A N/A N/A


Dec 2011: Sent apologies for absence - Out of the country.

Resigned

Ms Phyllis Barnett Allied Health Professionals c c c c c c cDec 2012 and May 2013: Reasons for absence personal and

notified to the Chair.

Ms Carol Bell Joint Staff Committee c c c N/A N/A N/A N/A

Dec 2012: Sent apologies for absence

Feb 2013: Sent apologies for absence: union commitment.

Resigned

Dr Rachel Burman Medical and Dentistry

Ms Carolyn Campbell-Cole Nurses and Midwives c c c

Dec 2011: Sent apologies for absence - Unwell.

Dec 2012: Sent apologies for absense

05 Sept 2013: Sent apologies for absence - Reasons Unknown

Ms Fiona Clark Lambeth North

Ms Pam Cohen Southwark Central N/A N/A N/A N/A N/A N/A c May 2013: Sent apologies for absence - Reasons Unknown

Mr Derek Cookson Patient c c c c c

May 2012: Sent apologies for absence - Unwell.


December 2013: Sent apologies for absence - Unwell

Cllr Jim Dickson Lambeth Council N/A N/A c c c c

Dec 2012: Sent apologies for absence - Urgent Council

Business



Dec 2013: Sent apologies for absence - reasons unknown

Mr Thomas Duffy Patient c c c

May 2012: Sent apologies for absence - On holiday

Sept 2012: Sent apologies for absence - On holiday

May 2013: Sent apologies for absence - Reasons Unknown

Mr Richard Gibbs Southwark CCG c c May 2013: Sent apologies for absence - On holiday

Ms Nicky Hayes Nurses and Midwives

Ms Sue Gallagher Lambeth CCG N/A N/A N/A N/A c c c Dec 2012: Sent apologies for absence - Work commitments

Ms Patti Kachidza Patient c c c c c

May 2012: Sent apologies for absence - Away

Sept 2012: Sent apologies for absence - work commitments

Dec 2012: Sent apologies for absence - work commitments



Ms Christine Klaassen Patient c c c N/AFeb 2012: Sent apologies for absence - On holiday.

Feb 2013: Sent apologies for absence - On holiday.

Mrs Phidelma Lisowska Joint Staff Committee N/A N/A N/A N/A N/A N/A N/A

Ms Madeliene LongSouth London & Maudsley NHS Foundation

Trust c c c c c c

Feb 2013: Sent apologies for absence - conflicting meeting

May 2012: Reason unknown

Feb 2012: Sent apologies for absence - Conflicting meeting.



Dec 2013: Sent apologies for absence - reasons unknown

Mr Andrew McCall Southwark North

Cllr Catherine McDonald Southwark Council N/A N/A N/A c c c

May 2013: Sent apologies for absence - On holiday



Mr Chris Mottershead King's College London c c c c

Feb 2012: Sent apologies for absence - Conflicting meeting

Dec 2011: Unknown

Dec 2012: Sent apologies for absence - Transportation

problems


Mr Christopher North Lambeth North

Mr Joe Onabaworin Southwark North N/A N/A N/A N/A N/A N/A c Feb 2013: attended meeting as an observer prior to taking up

role as governor

Mr Stuart Owen Southwark South c Feb 2012: Sent apologies for absence - Unwell.

Ms Barbara Pattinson Southwark Central c Sept 2012: Reason unknown

Mrs Michelle Pearce Southwark South

Mr Brady Pohle Administration and Clerical c N/A May 2012: Sent apologies for absence - Personal conflict

Mr Nandakumar Ratnavel Lambeth South

Mr Michael Robinson Lambeth Central c c cMay 2012: Reason unknown 18

Sept 2013: Sent apologies for absence - Reasons Unknown

Mr David Sullivan Patient c c c c c c c

May 2012: Sent apologies for absence - Reasons Unknown

Sept 2012: Sent apologies for absence - Reasons Unknown

Dec 2012: Sent apologies for absence - Reasons Unknown

Dec 2013: Absent - reason unknown

Ms Diane SummersGuy's & St Thomas' Hospital NHS Foundation

Trust c c c

Dec 2012: Sent apologies for absence

Feb 2013: Sent apologies for absence: union commitment

18 Sept 2013: Sent apologies for absence - Clashes with GSTT

Annual Meeting

Dec 2013: Attended Private session, apologies for Public

Session - Reason Unknown

NAME MEETINGS ATTENDED

Meeting Dates Key: (7) 15 May 2013 (8) 05 September 2013

(9) 18 September 2013 (10) 11 December 2013 (11) 05 March 2014

REGISTER OF GOVERNOR ATTENDANCE

(PUBLIC)

Enc. 4.1

Ms Jan Thomas Patient c c c c c

Feb 2012:Sent apologies for absence - On holiday.

Feb 2013:Sent apologies for absence - On holiday.


Dec 2013: Attended Private session - apologies for Public

session

Mr Ahmad Toumadj Support Staff c c c c

Sept 2012: Reason unknown


Dec 2013: Sent apologies for absence - reason unknown

Dr Warren Turner London South Bank University N/A N/A N/A N/A N/A c c 05 Sept 2013: Sent apologies for absence - Reasons Unknown

Mr Godwin Ubiaro Lambeth Central c c c

Dec 2012: Sent apologies for absence - Personal reasons

notified to the Chair. May

2013: Sent apologies for absence - Reasons Unknown

Mrs Alam Zabit Lambeth South c c c c N/A N/A N/A N/A

Sept 2012 - Hospital Appointment.


Feb 2012: Sent apologies for absence - Unwell.


Resigned 01 August 2013.

Mr Paul Corben Bromley N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Mr Alan Hall Lewisham N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A cMarch 2014: Work Conflict

Ms Eniko Benfield Bromley N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Ms Penny Dale Bromley N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Ms Helen Mencia Nurses and Midwives N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A cMarch 2014: Work Conflict

Ms Anoushka de Almeida-Carragher Bromley N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Mr CV Praveen Medical and Dentistry N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Meeting Dates Key: (7) 15 May 2013 (8) 05 September 2013

(9) 18 September 2013 (10) 11 December 2013 (11) 05 March 2014

Enc 4.2

1

1. Purpose NHS Foundation Trusts are required to make in-year submissions on a quarterly basis during 2013/14 which includes information on its financial performance, statements from the board certifying compliance with specific board statements including the underlying data that informs them where appropriate, any relevant exception reports and results of any governor elections. This report provides the details of the submission to Monitor for the Trust based on results/data in Quarter 4, January-March 2014. 2. Action Required

The Council is asked to note the Quarter 4 submission to filed with Monitor on 30 April 2014.

Report to: Council of Governors Meeting


Subject: Monitor Submission Quarter 4, 2013/2014

Author: Tamara Cowan, Assistant Board Secretary

Presented by: Tim Smart, Chief Executive

Status: For Information

Enc 4.2

2

1. Introduction

The Trust is required to summit quarterly reports to Monitor as part of its in-year reporting. The Trust is also required to submit monthly reports on performance to Monitor pertaining to the Princess Royal University Hospital. 2. Quarter 4 (Q4) – Board Certification

For finance Tthe Board approved Confirmed to governance statement 1 because the Trust has attained a CSRR of 3 in Q3 and it is anticipated this trend will continue to for next 12 months although the Trust faces significant challenges. For governance The Board approved Not Confirmed to governance statement 2 as the Trust failed to achieve the following targets and indicators as certified in its Annual Plan 2013-14:

18 week admitted referral to treatment targets (RTT)

Emergency Department (ED)

The Trust continues to work hard to achieve these targets and indicators but ED and RTT continued to be an area of great challenge in Q4 as was the case in Q3.

Otherwise

The Board approved Confirmed to governance statement 2 because there have been no exceptional matters or incidence arising in the Q4 which the Trust has not previously advised Monitor or self-certified. 3. Quarter 4 (Q4) – Key Returns

As part of the submission, the Board is noted the following key returns which will be submitted to Monitor for Q4.

Appendix 1: Continuity of Service Risk Rating and Financial Summary

Appendix 2: Declarations of risks against healthcare Targets and Indicators

Appendix 3: Governance Statement – Board Certification

Appendix 4: Quality Governance return which details executive director turnover in

Q3. As mentioned above this metric has been introduced with the implementation of

the RAF. Monitor wants to use this metrics as an indicator for quality governance

concerns, however the RAF provides for the use either patient metrics (satisfaction

surveys), staff metrics (sickness and absence rate, proportion of temporary staff,

staff turnover and high executive team turnover) and aggressive cost reduction

plans.

4. Board Action

On 29 April 2014 the Board: Approved the Trust declarations for the Q4 detailed in this report; and Authorised GA and TS to sign-off the final submission and the Governance Statements.

Worksheet "CoSRR"Click to go to index

Continuity of Service Shadow Risk Ratings (pilot indicators for 2013/14)

Historic Year to

31-Mar-13

Reported Quarter to30-Jun-13

Reported YTD to

30-Jun-13

Reported Quarter to30-Sep-13

Reported YTD to

30-Sep-13

Reported Quarter to31-Dec-13

Reported YTD to

31-Dec-13

Reported Quarter to31-Mar-14

Reported YTD to

31-Mar-14

Capital Service Cover

PDC dividend expense from SoCI (7.764) (1.950) (1.950) (2.050) (4.000) (2.663) (6.663) (3.532) (10.195)Interest Expense on Overdrafts and Working Capital Facilities from SoCI - (0.035) (0.035) (0.035) (0.070) (0.035) (0.105) 0.105 -Interest Expense on Bridging loans from SoCI - - - - - - - - -Interest Expense on Non-commercial borrowings from SoCI (0.578) (0.215) (0.215) (0.215) (0.430) (0.216) (0.646) (0.103) (0.749)Interest Expense on Commercial borrowings from SoCI - - - - - - - - -Interest Expense on Finance leases (non-PFI) from SoCI - - - - - - - - -Interest Expense on PFI leases & liabilities from SoCI (7.513) (1.860) (1.860) (1.860) (3.720) (3.871) (7.591) (4.722) (12.313)Other Finance Costs from SoCI (0.175) (0.042) (0.042) (0.040) (0.082) (0.037) (0.119) (0.046) (0.165)Non-Operating PFI costs (eg contingent rent) from SoCI (2.143) (0.622) (0.622) (0.622) (1.244) (1.609) (2.853) (1.144) (3.997)Public Dividend Capital repaid from SoCF - - - - - - - - -Repayment of bridging loans from SoCF - - - - - - - - -Repayment of non-commercial loans from SoCF (1.012) (0.506) (0.506) - (0.506) (0.506) (1.012) - (1.012)Repayment of commercial loans from SoCF (0.123) - - (0.062) (0.062) - (0.062) (0.061) (0.123)Capital element of finance lease rental payments - On-balance sheet PFI from SoCF (0.733) (0.201) (0.201) (0.201) (0.402) (0.599) (1.001) (1.004) (2.005)Capital element of finance lease rental payments - other from SoCF - - - - - - - - -

key to scoringRevenue available for Debt Service 35.451 7.739 7.739 8.304 16.043 10.758 26.801 14.828 41.629 Capital Service Cover 50%

Capital Service -20.041 -5.431 -5.431 -5.085 -10.516 -9.536 -20.052 -10.507 -30.559 Capital Service Cover metric 1.77x 1.42x 1.42x 1.63x 1.53x 1.13x 1.34x 1.41x 1.36x 4 3 2 1Capital Service Cover rating 3 2 2 2 2 1 2 2 2 2.5 1.75 1.25 <1.25

Liquiditykey to scoring

Cash for CoS liquidity purposes from SoFP -8.016 -2.206 -2.206 -2.361 -2.361 15.664 15.664 22.318 22.318 Liquidity 50%Operating Expenses within EBITDA, Total from SoCI -643.584 -166.490 -166.490 -181.262 -347.752 -244.752 -592.504 -258.604 -851.108 Liquidity metric -4.5 -1.2 -1.2 -1.2 -1.2 5.8 7.1 7.8 9.4 4 3 2 1

Liquidity rating 3 3 3 3 3 4 4 4 4 0 -7 -14 <-14

Continuity of Service Risk Rating 3 3 3 3 3 3 3 3 3

Enc 4.2 Appendix 1

Worksheet "Summary"Click to go to index

High level summary of financial plan of KINGS

Financial Summary Previous YE Current YTD FYActual Plan Actual Variance Plan Actual Variance Plan

Operating Revenue for EBITDA 678.1 243.1 272.1 28.9 853.0 891.3 38.3 853.0 Employee Expenses (374.1) (129.3) (150.2) (20.9) (466.6) (499.7) (33.1) (466.6)Drugs (67.9) (23.0) (26.2) (3.2) (80.6) (90.0) (9.4) (80.6)PFI operating expenses (26.4) (11.8) 0.0 11.8 (37.4) (27.1) 10.3 (37.4)Other costs (175.2) (65.7) (82.1) (16.5) (222.4) (234.3) (11.9) (222.4)

Clinical supplies (64.9) (21.9) (21.6) 0.3 (74.2) (79.7) (5.5) (74.2)Decrease (increase) in inventories of finished goods & WIP 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Vehicle Fuel costs (ambulance trusts) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Non-clinical supplies (35.2) (10.6) (14.8) (4.2) (38.4) (48.0) (9.6) (38.4)Cost of Secondary Commissioning of mandatory services 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Research & Development expense 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Education and training expense 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Misc. other Operating expenses (73.4) (33.2) (45.2) (12.0) (109.8) (103.6) 6.1 (109.8)

EBITDA 34.6 13.3 13.4 0.2 46.0 40.2 (5.8) 46.0 Donations of PPE & intangible assets 1.1 0.3 0.0 (0.3) 0.5 0.0 (0.5) 0.5 Depreciation and amortisation (14.7) (5.8) (5.1) 0.8 (18.1) (16.9) 1.2 (18.1)Impairment Losses (Reversals) net (on non-PFI assets) (9.1) (2.0) 3.1 5.1 (8.0) (2.6) 5.4 (8.0)Impairment Losses (Reversals) net on PFI assets 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Restructuring Costs 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Operating Surplus 11.9 5.8 11.5 5.7 20.4 20.6 0.2 20.4 Net interest (7.9) (4.3) (4.6) (0.3) (12.8) (12.9) (0.1) (12.8)

Interest Income 0.2 0.0 0.1 0.1 0.1 0.2 0.1 0.1 Interest Expense on Overdrafts and Working Capital Facilities 0.0 (0.0) 0.1 0.1 (0.1) (0.0) 0.1 (0.1)Interest Expense on Bridging loans 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest Expense on Non-commercial borrowings (0.6) (0.2) (0.1) 0.1 (0.9) (0.7) 0.1 (0.9)Interest Expense on Commercial borrowings 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest Expense on Finance leases (non-PFI) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest Expense on PFI leases & liabilities (7.5) (4.1) (4.7) (0.7) (11.8) (12.3) (0.5) (11.8)

Other Non-Operating items (9.8) (4.1) (14.5) (10.4) (13.6) 55.0 68.6 (13.6)Share of profit (loss) from equity accounted Associates, Joint Ventures, Total 0.7 0.3 1.3 1.0 0.6 1.3 0.7 0.6 Other Non-Operating income, Total (0.5) (0.0) (11.0) (11.0) (0.1) 68.0 68.2 (0.1)Other Finance Costs (0.2) (0.1) (0.0) 0.0 (0.2) (0.2) 0.0 (0.2)PDC dividend expense (7.8) (2.7) (3.5) (0.8) (9.4) (10.2) (0.8) (9.4)PFI Contingent Rent (2.1) (1.6) (1.1) 0.5 (4.5) (4.0) 0.5 (4.5)Other Non-Operating expenses (incl. Misc) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Income Tax (expense)/ income 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Net Surplus / (Deficit) (5.9) (2.6) (7.6) (4.9) (6.0) 62.7 68.7 (6.0)

EBITDA % Income 5.1% 5.5% 4.9% -0.5% 5.4% 4.5% -0.9% 5.4%CIP% of Op.Exp. less PFI Exp. 1.5% 2.2% 0.0% -2.2% 1.8% 1.1% -0.7% 1.8%Pay CIPs as % Pay Costs -1.1% -1.4% 0.0% 1.4% -1.0% -0.6% 0.4% -1.0%

Net Surplus / (Deficit) (5.9) (2.6) (7.6) (4.9) (6.0) 62.7 68.7 (6.0)Change in working capital 13.1 4.1 1.2 (2.9) (15.4) (27.7) (12.3) (15.4)

(Increase)/decrease in inventories (0.4) (0.1) (0.3) (0.3) (2.2) (4.0) (1.8) (2.2)(Increase)/decrease in tax receivable 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 (Increase)/decrease in NHS Trade Receivables (1.6) 3.0 (7.8) (10.8) (6.1) (54.8) (48.7) (6.1)(Increase)/decrease in Non NHS Trade Receivables (4.8) (1.0) (2.6) (1.6) 1.0 5.1 4.1 1.0 (Increase)/decrease in other related party receivables (1.0) (0.3) 2.8 3.0 (0.3) 2.8 3.0 (0.3)(Increase)/decrease in other receivables (1.0) 1.0 (3.6) (4.6) (1.0) (9.9) (8.9) (1.0)(Increase)/decrease in accrued income 2.5 7.0 3.7 (3.3) (4.0) (17.0) (13.0) (4.0)(Increase)/decrease in other financial assets 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 (Increase)/decrease in prepayments 0.6 2.0 (0.2) (2.2) 0.0 (1.5) (1.5) 0.0 (Increase)/decrease in Other assets 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Increase/(decrease) in Deferred Income (excl. Donated Assets) (0.6) (1.5) 4.5 6.0 (1.1) 4.4 5.5 (1.1)Increase/(decrease) in Deferred Income (Donated Assets) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Increase/(decrease) in Current provisions 2.3 0.5 (0.5) (1.0) (2.2) (2.5) (0.3) (2.2)Increase/(decrease) in post-employment benefit obligations 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Increase/(decrease) in tax payable 0.2 0.1 0.1 (0.0) 0.3 1.5 1.2 0.3 Increase/(decrease) in Trade Creditors 14.7 (2.8) 11.5 14.3 1.1 11.4 10.3 1.1 Increase/(decrease) in Other Creditors (3.8) 0.0 1.0 1.0 0.0 (0.4) (0.4) 0.0 Increase/(decrease) in accruals 5.9 (4.0) (7.2) (3.2) (1.0) 37.9 38.9 (1.0)Increase/(decrease) in other Financial liabilities 0.2 0.0 (0.3) (0.3) 0.0 (0.7) (0.7) 0.0 Increase/(decrease) in Other liabilities 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Increase/(decrease) in Non Current provisions 0.7 (0.7) 0.0 0.7 (0.2) 0.4 0.5 (0.2)

Non cash I&E items 41.4 15.6 19.6 4.1 51.7 (24.4) (76.1) 51.7 Tax expense/(refund) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Finance (income)/charges 7.9 4.3 4.6 0.3 12.8 12.9 0.1 12.8 Share of (profit)/loss from equity accounted investments net of cash distributions received 0.7 (0.2) (1.3) (1.0) (0.5) (1.3) (0.8) (0.5)Donations & Grants received of PPE & intangible assets (non cash) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Other operating non-cash (revenues)/expenses 0.2 1.5 10.6 9.1 3.0 (68.5) (71.5) 3.0 Depreciation and amortisation, total 14.7 5.8 5.1 (0.8) 18.1 16.9 (1.2) 18.1 Impairment losses/(reversals) 9.1 2.0 (3.1) (5.1) 8.0 2.6 (5.4) 8.0 Unrealised (gains)/losses on foreign currency exchange 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 (Gain)/loss on disposal of property plant and equipment 0.5 0.0 0.4 0.4 0.1 0.4 0.3 0.1 (Gain)/loss on disposal of intangible assets 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Share of (profit)/loss loss from investments 0.0 (0.3) 0.0 0.3 (0.6) 0.0 0.6 (0.6)PDC dividend expense 7.8 2.7 3.5 0.8 9.4 10.2 0.8 9.4 Other increases/(decreases) to reconcile to profit/(loss) from operations 0.5 (0.3) (0.2) 0.0 1.3 2.2 0.9 1.3

Cashflow from operations 49.3 16.4 13.2 (3.2) 30.1 10.9 (19.2) 30.1 Cashflow from investing activities (23.1) (16.7) (13.1) 3.6 (41.5) (37.1) 4.5 (41.5)

Property, plant and equipment - maintenance expenditure (1.1) (0.3) (0.3) 0.0 (1.1) (1.0) 0.1 (1.1)Property, plant and equipment - non-maintenance expenditure (18.3) (15.2) (12.6) 2.6 (35.9) (28.7) 7.2 (35.9)Plant and equipment - Information Technology (1.1) (0.6) (1.4) (0.8) (1.7) (3.7) (2.1) (1.7)Plant and equipment - Other (1.6) (0.5) 0.2 0.7 (2.6) (3.3) (0.7) (2.6)Property, plant and equipment - other expenditure 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Proceeds on disposal of property, plant and equipment 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Purchase of investment property 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Proceeds on disposal of investment property 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Purchase of intangible assets (0.6) (0.1) (0.1) (0.0) (0.3) (0.2) 0.1 (0.3)Proceeds on disposal of intangible assets 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Expenditure on capitalised development 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Increase/(decrease) in Capital Creditors (0.3) 0.0 2.6 2.6 0.0 1.3 1.3 0.0 Payments for other capitalised costs 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Other cash flows from investing activities 0.0 0.0 (1.5) (1.5) 0.0 (1.5) (1.5) 0.0

Cashflow before financing 26.2 (0.3) 0.1 0.4 (11.4) (26.2) (14.7) (11.4)Cashflow from financing activities (13.3) 4.7 13.1 8.5 41.3 40.2 (1.1) 41.3

Public Dividend Capital received 0.0 0.0 1.0 1.0 27.3 27.2 (0.1) 27.3 Public Dividend Capital repaid 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 PDC Dividends paid (7.8) (5.8) (5.6) 0.3 (9.4) (9.1) 0.3 (9.4)Interest (paid) on bridging loans 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest (paid) on commercial loans 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest (paid) on non-commercial loans (0.6) (0.2) (0.4) (0.2) (0.8) (1.2) (0.3) (0.8)Interest (paid) on overdraft and working capital facility 0.0 (0.0) 0.0 0.0 (0.1) 0.0 0.1 (0.1)Interest element of finance lease rental payments - other 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest element of finance lease rental payments - On-balance sheet PFI (7.5) (4.1) (4.7) (0.7) (11.8) (12.3) (0.5) (11.8)Capital element of finance lease rental payments - other 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Capital element of finance lease rental payments - On-balance sheet PFI (0.7) (0.6) (1.0) (0.4) (1.6) (2.0) (0.4) (1.6)Interest received on cash and cash equivalents 0.2 0.0 0.0 0.0 0.1 0.1 0.0 0.1 Drawdown of non-commercial loans 4.4 13.7 23.2 9.5 35.3 35.3 (0.0) 35.3 Repayment of non-commercial loans (1.0) 0.0 0.0 0.0 (1.0) (1.0) 0.0 (1.0)Drawdown of commercial loans 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Repayment of commercial loans (0.1) (0.1) (0.1) 0.0 (0.1) (0.1) 0.0 (0.1)(Increase)/decrease in non-current receivables (0.3) 0.0 0.7 0.7 (1.0) (0.3) 0.7 (1.0)Increase/(decrease) in non-current payables 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Other cash flows from financing activities 0.0 1.8 0.0 (1.8) 4.6 3.7 (0.8) 4.6

Net increase/(decrease) in cash 12.9 4.4 13.2 8.9 29.9 14.0 (15.9) 29.9

Cash at period end 40.5 67.4 54.5 (12.9) 67.4 54.5 (12.9) 67.4 Cash and Cash equivalents at period end 40.5 67.4 54.5 (12.9) 67.4 54.5 (12.9) 67.4

Enc 4.2 Appendix 1

Detailed Financial Summary Previous YE Current YTD FYActual Plan Actual Variance Plan Actual Variance Plan

Acute Ac Elective revenue 108.3 42.0 40.0 (2.0) 137.4 131.0 (6.5) 137.4 Ac Non-Elective revenue 126.9 50.6 44.0 (6.6) 156.2 144.1 (12.1) 156.2 Ac Outpatient revenue 88.4 31.8 36.8 5.1 111.1 120.7 9.6 111.1 Ac A&E revenue 16.0 5.8 6.8 1.0 20.6 22.4 1.8 20.6 Ac other revenue 232.2 66.4 99.1 32.7 276.6 324.6 48.0 276.6

Private patient revenue 13.2 4.0 4.6 0.6 14.4 14.9 0.6 18.0 Grants and donations in cash 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Other operating revenues 93.3 42.6 40.8 (1.8) 136.7 133.6 (3.1) 133.0

Total operating revenue for EBITDA 678.1 243.1 272.1 28.9 853.0 891.3 38.3 853.0 Grants and donations of PPE and intangible assets 1.1 0.3 0.0 (0.3) 0.5 0.0 (0.5) 0.5

Total operating revenue 679.3 243.5 272.1 28.6 853.5 891.3 37.9 853.5

Employee Expenses (374.1) (129.3) (150.2) (20.9) (466.6) (499.7) (33.1) (466.6) Drugs expense (67.9) (23.0) (26.2) (3.2) (80.6) (90.0) (9.4) (80.6) Supplies (clinical & non-clinical) (100.1) (32.5) (36.4) (3.9) (112.6) (127.7) (15.1) (112.6)

Clinical supplies (64.9) (21.9) (21.6) 0.3 (74.2) (79.7) (5.5) (74.2) Non-clinical supplies (35.2) (10.6) (14.8) (4.2) (38.4) (48.0) (9.6) (38.4)

PFI expenses (26.4) (11.8) 0.0 11.8 (37.4) (27.1) 10.3 (37.4) Other expenses (75.1) (33.2) (45.7) (12.6) (109.8) (106.6) 3.2 (109.8)

Decrease (increase) in inventories of finished goods & WIP 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Vehicle Fuel costs (ambulance trusts) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Cost of Secondary Commissioning of mandatory services 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Research & Development expense 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Education and training expense 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Misc. other Operating expenses (73.4) (33.2) (45.2) (12.0) (109.8) (103.6) 6.1 (109.8)

Total operating expenses within EBITDA (643.6) (229.9) (258.6) (28.7) (806.9) (851.1) (44.2) (806.9)

EBITDA 34.6 13.3 13.4 0.2 46.0 40.2 (5.8) 46.0 Depreciation and amortisation (14.7) (5.8) (5.1) 0.8 (18.1) (16.9) 1.2 (18.1)

Depreciation and Amortisation - owned assets (12.3) (5.3) (6.1) (0.8) (16.0) (16.4) (0.4) (16.0) Depreciation and Amortisation - assets held under finance leases (0.1) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Depreciation and Amortisation - PFI assets (2.3) (0.5) 1.0 1.6 (2.1) (0.6) 1.6 (2.1)

Impairments & Restructuring (9.1) (2.0) 3.1 5.1 (8.0) (2.6) 5.4 (8.0) Total operating expenses (667.4) (237.7) (260.6) (22.9) (833.1) (870.7) (37.6) (833.1)

Operating Surplus (Deficit) 11.9 5.8 11.5 5.7 20.4 20.6 0.2 20.4 Profit (loss) on asset disposal (0.5) (0.0) (0.4) (0.4) (0.1) (0.4) (0.3) (0.1) Net interest (7.9) (4.3) (4.6) (0.3) (12.8) (12.9) (0.1) (12.8) Taxation 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 PDC dividend (7.8) (2.7) (3.5) (0.8) (9.4) (10.2) (0.8) (9.4) Other non-operating items (0.5) (1.1) (10.5) (9.4) (3.6) 65.6 69.2 (3.6)

Net Surplus / (Deficit) (5.9) (2.6) (7.6) (4.9) (6.0) 62.7 68.7 (6.0)

EBITDA % of Op. revenue 5.1% 5.5% 4.9% -0.5% 5.4% 4.5% -0.9% 5.4%

EBITDA 34.6 13.3 13.4 0.2 46.0 40.2 (5.8) 46.0 Change in Current Receivables (8.5) 2.8 (11.2) (14.0) (6.3) (56.9) (50.6) (6.3)

(Increase)/decrease in tax receivable 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 (Increase)/decrease in NHS Trade Receivables (1.6) 3.0 (7.8) (10.8) (6.1) (54.8) (48.7) (6.1) (Increase)/decrease in Non NHS Trade Receivables (4.8) (1.0) (2.6) (1.6) 1.0 5.1 4.1 1.0 (Increase)/decrease in other related party receivables (1.0) (0.3) 2.8 3.0 (0.3) 2.8 3.0 (0.3) (Increase)/decrease in other receivables (1.0) 1.0 (3.6) (4.6) (1.0) (9.9) (8.9) (1.0)

Change in Current Payables 11.0 (2.6) 12.6 15.2 1.4 12.5 11.1 1.4 Increase/(decrease) in tax payable 0.2 0.1 0.1 (0.0) 0.3 1.5 1.2 0.3 Increase/(decrease) in Trade Creditors 14.7 (2.8) 11.5 14.3 1.1 11.4 10.3 1.1 Increase/(decrease) in Other Creditors (3.8) 0.0 1.0 1.0 0.0 (0.4) (0.4) 0.0

Other changes in WC 10.5 4.0 (0.2) (4.2) (10.5) 16.7 27.3 (10.5) Change in Non Current Provisions 0.7 (0.7) 0.0 0.7 (0.2) 0.4 0.5 (0.2)Other non-cash items 0.9 (0.4) (1.4) (1.0) (0.3) (1.9) (1.6) (0.4)

Cashflow from operating activities 49.3 16.4 13.2 (3.2) 30.1 10.9 (19.2) 30.1 Capital expenditure (accurals basis) 0.0 (16.7) (14.3) 2.4 (41.5) (36.9) 4.6 (41.5) Asset sale proceeds 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 other Investing cash flows (23.1) 0.0 1.1 1.1 0.0 (0.2) (0.2) 0.0

Cashflow before financing 26.2 (0.3) 0.1 0.4 (11.4) (26.2) (14.7) (11.4) Net interest (8.1) (4.3) (5.1) (0.8) (12.7) (13.5) (0.7) (12.7)

Interest (paid) on bridging loans 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest (paid) on commercial loans 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest (paid) on non-commercial loans (0.6) (0.2) (0.4) (0.2) (0.8) (1.2) (0.3) (0.8) Interest (paid) on bank overdrafts 0.0 (0.0) 0.0 0.0 (0.1) 0.0 0.1 (0.1) Interest element of finance lease rental payments - other 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest element of finance lease rental payments - On-balance sheet PFI (7.5) (4.1) (4.7) (0.7) (11.8) (12.3) (0.5) (11.8)

PDC dividends (paid) (7.8) (5.8) (5.6) 0.3 (9.4) (9.1) 0.3 (9.4) Movement in loans 3.3 13.6 23.1 9.5 34.2 34.1 (0.0) 34.2 PDC received/(repaid) 0.0 0.0 1.0 1.0 27.3 27.2 (0.1) 27.3 Donations received in cash 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 other financing cashflows (0.9) 1.2 (0.3) (1.4) 2.0 1.5 (0.5) 2.0

Net cash inflow (outflow) 12.9 4.4 13.2 8.9 29.9 14.0 (15.9) 29.9

Cash at period end 40.5 67.4 54.5 (12.9) 67.4 54.5 (12.9) 67.4 Cash and Cash equivalents at period end 40.5 67.4 54.5 (12.9) 67.4 54.5 (12.9) 67.4

Long form Acute Financial SummaryNon Safe Harbour Investments at period end 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Long form Mental Health Financial Summary

Enc 4.2 Appendix 1

Classified as Restricted per Monitor's Information Security Policy

Worksheet "Targets and Indicators"

Declaration of risks against healthcare targets and indicators for 2013-14 by King’s College Hospital

These targets and indicators are set out in the Risk Assessment Framework Key: must complete

Definitions can be found in Appendix A of the Risk Assessment Framework may need to complete

NOTE: If a particular indicator does not apply to your FT then please enter "Not relevant" for those lines. Quarter 1 Quarter 2 Quarter 3 Quarter 4

Actual Actual Actual Actual

Target or Indicator (per Risk Assessment Framework)

Threshold or

target YTD

Scoring

under

Compliance

Framework

Scoring

under

Risk Assessment

Framework

Risk declared at

Annual Plan

Scoring

under

Compliance

Framework Performance Achieved/Not Met

Scoring

under

Compliance


Scoring

under

Compliance


Scoring

under

Risk Assessment

Framework Performance Achieved/Not Met Any comments or explanations

Scoring

under

Risk Assessment

Framework

Referral to treatment time, 18 weeks in aggregate, admitted patients 90% 1.0 1.0 Yes 88.90% Not met 88.00% Not met 87.80% Not met 81.7% Not met January 87.8, February 83.6, March 81.7

Referral to treatment time, 18 weeks in aggregate, non-admitted patients 95% 1.0 1.0 No 97.10% Achieved 96.90% Achieved 97.30% Achieved 96.9% Achieved January 96.8, February 96.2, March 96.9

Referral to treatment time, 18 weeks in aggregate, incomplete pathways 92% 1.0 1.0 No 1 92.20% Achieved 1 92.10% Achieved 1 92.10% Achieved 1 92.1% Achieved January 92, February 92, March 92.1 1

A&E Clinical Quality- Total Time in A&E under 4 hours 95% 1.0 1.0 Yes 1 96.30% Achieved 0 95.10% Achieved 0 94.19% Not met 1 93.0% Not met 1

Cancer 62 Day Waits for first treatment (from urgent GP referral) 85% 1.0 1.0 No 85.50% Achieved 90.20% Achieved 88.50% Achieved 90.0% Achieved

Cancer 62 Day Waits for first treatment (from NHS Cancer Screening Service referral) 90% 1.0 1.0 No 0 96.60% Achieved 0 92.10% Achieved 0 93.50% Achieved 0 93.0% Achieved 0

Cancer 31 day wait for second or subsequent treatment - surgery 94% 1.0 1.0 No 98.10% Achieved 97.80% Achieved 96.20% Achieved 97.0% Achieved

Cancer 31 day wait for second or subsequent treatment - drug treatments 98% 1.0 1.0 No 98.30% Achieved 100.00% Achieved 100.00% Achieved 100.0% Achieved

Cancer 31 day wait for second or subsequent treatment - radiotherapy 94% 1.0 1.0 No0

99.20% Achieved 0

100.00% Achieved 0

98.60% Achieved 0

100.0% Achieved 0

Cancer 31 day wait from diagnosis to first treatment 96% 0.5 1.0 No 0 99.00% Achieved 0 98.20% Achieved 0 98.00% Achieved 0 98.0% Achieved 0

Cancer 2 week (all cancers) 93% 0.5 1.0 No 97.20% Achieved 96.80% Achieved 97.80% Achieved 97.1% Achieved

Cancer 2 week (breast symptoms) 93% 0.5 1.0 No0

98.90% Achieved 0

97.00% Achieved 0

100.00% Achieved 0

96.0% Achieved 0

Care Programme Approach (CPA) follow up within 7 days of discharge 95% 1.0 1.0 No 0.00% Not relevant 0.00% Not relevant 0.00% Not relevant 0.0% Not relevant

Care Programme Approach (CPA) formal review within 12 months 95% 1.0 1.0 No 0 0.00% Not relevant 0 0.00% Not relevant 0 0.00% Not relevant 0 0.0% Not relevant 0

Admissions had access to crisis resolution / home treatment teams 95% 1.0 1.0 No 0 0.00% Not relevant 0 0.00% Not relevant 0 0.00% Not relevant 0 0.0% Not relevant 0

Meeting commitment to serve new psychosis cases by early intervention teams 95% 0.5 1.0 No 0 0.00% Not relevant 0 0.00% Not relevant 0 0.00% Not relevant 0 0.0% Not relevant 0

Ambulance Category A 8 Minute Response Time - Red 1 Calls 75% 0.5 1.0 No 0.00% Not relevant 0.00% Not relevant 0.00% Not relevant 0 0.0% Not relevant 0

Ambulance Category A 8 Minute Response Time - Red 2 Calls 75% 0.5 1.0 No 0 0.00% Not relevant 0 0.00% Not relevant 0 0.00% Not relevant 0 0.0% Not relevant 0

Ambulance Category A 19 Minute Transportation Time 95% 1.0 1.0 No 0 0.00% Not relevant 0 0.00% Not relevant 0 0.00% Not relevant 0 0.0% Not relevant 0

Clostridium Difficile -meeting the C.Diff objective 0 1.0 1.0 Yes 1 8 Achieved 0 21 Achieved 0 40 Not met 1 49 Achieved January 2, February 2, March 5 0

MRSA - meeting the MRSA objective 0 1.0 N/A Yes 1 2 Achieved 0 2 Achieved 0 N/A N/A Not relevant No longer applicable under RAF

Minimising MH delayed transfers of care <=7.5% 1.0 1.0 No 0 0.00% Not relevant 0 0.00% Not relevant 0 0.00% Not relevant 0 0.0% Not relevant 0

Data completeness, MH: identifiers 97% 0.5 1.0 No 0 0.00% Not relevant 0 0.00% Not relevant 0 0.00% Not relevant 0 0.0% Not relevant 0

Data completeness, MH: outcomes 50% 0.5 1.0 No 0 0.00% Not relevant 0 0.00% Not relevant 0 0.00% Not relevant 0 0.0% Not relevant 0

Compliance with requirements regarding access to healthcare for people with a learning disability N/A 0.5 1.0 No 0 0.00% Achieved 0 0.00% Achieved 0 0.00% Achieved 0 N/A Achieved 0

Community care - referral to treatment information completeness 50% 1.0 1.0 No 0.00% Not relevant 0.00% Not relevant 0.00% Not relevant 0.0% Not relevant

Community care - referral information completeness 50% 1.0 1.0 No 0.00% Not relevant 0.00% Not relevant 0.00% Not relevant 0.0% Not relevant

Community care - activity information completeness 50% 1.0 1.0 No0

0.00% Not relevant 0



0.0% Not relevant 0

Risk of, or actual, failure to deliver Commissioner Requested Services N/A 4.0 Report by Exception No 0 No 0 No 0 No No

CQC compliance action outstanding (as at 31 Mar 2014) N/A special Report by Exception No No No No No

CQC enforcement action within last 12 months (as at 31 Mar 2014) N/A special Report by Exception No No No No No

CQC enforcement action (including notices) currently in effect (as at 31 Mar 2014) N/A 4.0 Report by Exception No No No No No

Moderate CQC concerns or impacts regarding the safety of healthcare provision (as at 31 Mar 2014) N/A special Report by Exception No No No No No

Major CQC concerns or impacts regarding the safety of healthcare provision (as at 31 Mar 2014) N/A 2.0 Report by Exception No 0 No 0 No 0 No No

Trust unable to declare ongoing compliance with minimum standards of CQC registration N/A special Report by Exception No No No No No

Results left to complete 0 0 0 0 -1

Total Score 4 1 1 3 2

Overide

Rating

(if any)

Enter the reason for any non-scoring

related rating override here

Compliance Framework Indicative Governance Risk Rating RED AMBER-GREEN AMBER-GREEN AMBER-RED AMBER-RED

Enc 4.2 Appendix 2

Classified as Restricted per Monitor's Information Security Policy

In Year Governance Statement from the Board of King’s College Hospital

The board are required to respond "Confirmed" or "Not confiirmed" to the following statements (see notes below)

For finance, that: Board Response

4

For governance, that:

11

Otherwise

Signed on behalf of the board of directors

Signature Signature

Name Name

Capacity [job title here] Capacity [job title here]

Date Date

3

Notes:

A

B

C

The board confirms that there are no matters arising in the quarter requiring an exception report to Monitor (per the Risk Assessment

Framework page 21, Diagram 6) which have not already been reported.

The board anticipates that the trust will continue to maintain a Continuity of Service risk rating of at least 3 over the next 12 months.

The board is satisfied that plans in place are sufficient to ensure: ongoing compliance with all existing targets (after the application of

thresholds) as set out in Appendix A of the Risk Assessment Framework; and a commitment to comply with all known targets going

forwards.

The board is unable to make one of more of the confirmations in the section above on this page and accordingly responds:

Monitor may adjust the relevant risk rating if there are significant issues arising and this may increase the frequency and intensity of monitoring for the

NHS foundation trust.

Monitor will accept either 1) electronic signatures pasted into this worksheet or 2) hand written signatures on a paper printout of this declaration posted

to Monitor to arrive by the submission deadline.

In the event than an NHS foundation trust is unable to confirm these statements it should NOT select 'Confirmed’ in the relevant box. It must provide a

response (using the section below) explaining the reasons for the absence of a full certification and the action it proposes to take to address it.

This may include include any significant prospective risks and concerns the foundation trust has in respect of delivering quality services and effective

quality governance.

Copy of KINGS 1314 Q4 in year reporting template (to issue) - Governance Statement

1 of 1 22/04/2014 17:26

Enc 4.2 Appendix 3

Worksheet "Quality Governance"Click to go to index

In Year Quality Governance Metrics of King’s College Hospital

Actual for Actual for Actual for Actual for

The Risk Assessment Framework (diagram 13) sets out that Monitor will use executive team turnover as one of the

potential indicators of quality governance concerns. Please provide the information requested below and ensure that

any changes are explained in your commentary: units

Quarter

ending 30-

Jun-13

Quarter

ending 30-

Sep-13

Quarter

ending 31-

Dec-13

Quarter

ending 31-

Mar-14

Executive Directors

Total number of Executive posts on the Board (voting) Posts 6 6

Number of posts currently vacant Posts - -

Number of posts currently filled by interim appointments Posts

-

1 -

Covering

substantive

non-voting

director

currently on

secondmen

t

Number of resignations in quarter Resignations -

Number of appointments in quarter Appointments

-

1 - Interim

to cover

substantive

non-voting

director

currently on

secondmen

t

Enc 4.2 Appendix 4


Enc. 4.3.1

1

Governors’ Membership & Community Engagement Committee Minutes of the meeting held at 14:00 on 23 January 2014 in the Dulwich Committee Room, King’s College Hospital

Members: Andrew McCall (AM) Committee Chair/ Public Governor Fiona Clark (FC) Public Governor Joe Onabaworin (JO) Public Governor In attendance: Prof Sir George Alberti (GA) Trust Chair Jessica Bush (JB) Head of Public & Patient Involvement Tamara Cowan (TC) Board Secretary Sally Lingard (SL) Director of Communications Leonie Mallows (LM) Corporate Governance Officer (minutes) Rachel Sugarman (RS) PPI and Membership Manager Jane Walters (JW) Director of Corporate Affairs Apologies: Faith Boardman (FB) Non-Executive Director Patti Kachidza (PK) Patient Governor Barbara Pattinson (BP1) Public Governor Christopher Stooke (CS) Non-Executive Director

Item

Subject

Action

14/01 Christine Klaassen AM proposed a vote of thanks to valued colleague Christine Klaassen. The Committee paid tribute to her as an energetic governor who acted as a role model to others and would be missed by this committee and the entire Council.

14/02 Welcome and apologies AM introduced himself as Committee Chair having taken over the position from Staff Governor Brady Pohle who left the Trust earlier this month. Apologies for absence were noted.

14/03 Minutes of the Previous Meeting The minutes of the meeting held on 16 October 2013 were accepted as a correct record.

14/04 Action Tracking Progress made on the action tracker was noted. HSB scheme at SLaM It was noted that there had been a delay to the launch of the Health Staff

Enc. 4.3.1

2

Item

Subject

Action

Benefits’ scheme for members by South London and Maudsley (SLaM). Once the scheme had been in operation for approx. 6 months, SLaM representatives would be approached to provide feedback to the Committee about the scheme’s progress.

14/05 Matters Arising LM to clarify with Angela Grainger the nature of the Trust’s involvement with universities and dates of the Disability Inclusivity Network/Group. Details of how to join the distribution list of the LGBt forum to be circulated to governors.

LM

LM

14/06 Committee Work Plan and Targets for 2014

AM presented the draft committee work plan including suggested targets for the committee as a whole. The Committee discussed the plan and the following key points were raised and noted:

Meetings will always include items under: o Membership engagement o Engagement with public o Governors in the community o Learning from other organisations

All these elements are important and reflect changes to the governor role brought about by the Health & Social Care Act 2012 and the remit of this committee;

An external perspective might be brought by other local membership organisations and their policy for reaching and communicating with members;

One method of creating ‘touch points’ between governors and members already planned for 2014 is using two of the four scheduled governor workshops to conduct membership ‘focus groups’;

The Trust will continue to provide opportunities, for example, through set-piece events such as listening events but governors should feel encouraged to create further ‘touch points’ by using their own networks and links with community organisations;

Governors provide a different perspective from that of the Trust which is valuable in itself;

In future, where opportunities for membership recruitment and/or raising awareness of the Trust have been identified and acted on, information about the outcome will be captured and presented to the Council in order to provide an example and encouragement;

Enc. 4.3.1

3

Item

Subject

Action

It would be desirable to have a committee member from amongst the newly elected Bromley and Lewisham governors;

RS is exploring the possibilities of introducing a ‘member ambassadors’ scheme which another foundation trust has implemented;

Patient journeys often begin with a GP and so there may be ways that the Trust and governors can link with GP surgeries to promote membership;

The programme of centenary lectures was well-attended. One way of offering something to members would be to launch a similar programme around ‘care and research at your local hospital’ to members and the general public; and

Two major events in the Trust calendar are the Trust Open Day and the Annual Members Meeting. Current thinking is to hold one event at the Denmark Hill site and one at the PRUH site, logistics permitting.

It was agreed that:

JB/RS would consider possible links with GP surgeries for a discussion at the next meeting;

SL/TC would report back on the location of the Open Day/AMM at the next meeting; and

The confirmed committee work plan for 2014 would be circulated to all governors with a note from AM encouraging more governors to join the committee.

JB/RS SL/TC AM

14/07 Membership Update RS presented a summary of membership numbers, changes and recruitment activity for the period 01 October 2013 to 01 January 2014. Key points included:

Overall the number of members has increased from 8,608 to 10,789;

The majority of new members were recruited via a direct mail sent to circa. 30,000 PRUH patients which resulted in a 7.48% recruitment rate;

Of these new members, 384 indicated interest in standing as a governor. This was converted into 48 nominations;

A large number of members were moved from the patient to the public constituency following the acquisition. There is a need now to replenish the patient constituency;

A lower number of members were deleted from the membership database due to a change of address;

Now that the Trust has met its targets for members in the new constituencies, the focus will be on:

Enc. 4.3.1

4

Item

Subject

Action

o consolidating the membership by offering more activities for members to get involved with;

o increasing work with schools and colleges e.g. Bromley College; and o collecting and promoting the use of email addresses.

AM congratulated JB, RS and their team for their work in recruiting members in the new constituencies and their continuing work with members.

14/08

Update on January and Summer Elections and New Governors’ Induction TC presented the update and tabled booklets containing the names and election statements of all candidates in the Bromley and Lewisham constituencies. The following key points were noted:

The voter turnout currently stands at 29% and 20.5% in Bromley and Lewisham respectively. This is around the average turnout for foundation trust elections;

Constructive feedback was received from the governor awareness session held on 28 November 2013. Participants particularly appreciated the honest depiction of the time commitment involved in being a governor;

Lessons learned from this process will be used for planning the summer election process. A timeline will be presented at the next meeting;

One aim will be to raise the level of staff engagement, particularly at the Trust’s newest sites;

The Trust intends to maintain contact with the 42 people who are not elected as governors. They may be good candidates for 'Member Ambassadors' or similar schemes in the future; and

One of the changes to the Trust Constitution made in 2013 was to offer existing governors a further 2-year term in order to stagger the terms of governors and thereby provide continuity.

A note inviting governors to be part of the buddying scheme will be

circulated to all governors.

TC/LM

14/09 Report on Community Engagement Activity AM introduced this item as a new, regular feature of the committee agenda for the following purpose:

Committee members will be able to report back on any engagement

Enc. 4.3.1

5

Item

Subject

Action

activity they have undertaken since the last meeting; and

These reports will be summarised and collated to form part of a wider report on governor involvement and engagement to be presented at each Council of Governors meeting.

AM reported that he and JB had attended a meeting at Southwark Healthwatch on 13 December 2013. Key points included:

The audience had been a small group of volunteer representatives who did not have an existing association with the Trust;

JB had updated the presentation on KCH, which is available to all governors to use for this purpose, and adapted it to suit the audience;

The ‘double act’ of a staff member and a governor had gone down well, the presentation had been well-received and pitched at the right level for the occasion;

It had been followed by a question and answer session; and

AM has two further visits planned in the coming months: Friends of Burgess Park and Southwark Cathedral.

The Committee discussed the best way of promoting engagement activity and how to encourage governors to take the initiative. The following points were raised and noted:

It’s easy;

Some governors are already doing it but perhaps don’t realise it e.g. attending the Integrated Care Citizens Board or talking informally with people they know in the community;

Support and presentation materials are available on request – governors just need to contact a member of the team for help; and

Community engagement is an essential part of fulfilling the governor duty to ‘represent the interests of members and the interests of the public’, as outlined under the 2012 Health & Social Care Act.

14/10 Community Events Planning SL presented an outline for two community events to be held on 25 February and 05 March 2014. Key points included:

The dates of the community events have been brought forward due to a change in Monitor’s reporting timetable for the annual plan;

Enc. 4.3.1

6

Item

Subject

Action

The events form part of the engagement around development of the Trust’s five-year strategy and will be led by the strategy team;

Discussion will be shared with other members via the @King’s magazine; and

Governors will be asked to attend to participate in the round-table discussions.

14/11 @King’s: Governor Contribution and Feedback SL presented an update on @King’s distribution and an outline of content for the spring 2014 edition. Key points included:

Copies of the autumn 2013 edition were distributed to all King’s sites. It was particularly popular at the PRUH and more stock has been ordered;

The spring 2014 edition will include features on Orpington and Beckenham Beacon and news stories from Queen Mary Sidcup and Beckenham Beacon. All ideas are welcome;

The summer 2014 edition (to be published in May) will include a piece on standing as a governor to link with the governor elections to be held this summer.

It was agreed that:

Governors would be asked via the CoG bulletin to suggest items for the summer edition; and

The suggestion to link the feature on standing as a governor to videos on the Trust website would be submitted to the Comms team for consideration.

LM LM

14/12 Any Other Business Members Survey RS and SL updated the committee on the progress to produce and roll out a survey of foundation trust members. Key points included:

It is important to consider the purpose of the survey and what we want to get out of it;

It is intended that this survey will link with the existing work of the Trust;

Question areas have been identified. Governors will be asked via the governor bulletin to send further suggestions to RS and then the draft survey will then be sent to all governors for comment.

The Committee thanked AM for taking up the position of Committee Chair following the former chair’s departure from the Trust.

LM/All

Enc. 4.3.1

7

Item

Subject

Action

14/13 Date of next meeting:

Tuesday 08 April 2014 14:00-16:00 in the Dulwich Committee Room


1

Enc. 4.3.2

King’s College Hospital Governors’ Strategy Committee

Minutes of the meeting of the Governors’ Strategy Committee held at 12.15 on Tuesday 11 February 2014 in the Dulwich Committee Room, King’s College Hospital, Denmark Hill. Members: Chris North (CN) Public Governor (Committee Chair) Tom Duffy (TD) Patient Governor Jan Thomas (JT) Patient Governor Michelle Pearce (MP) Public Governor Nanda Ratnavel (NR) Public Governor Joe Onabaworin (JO) Public Governor Carolyn Campbell-Cole (CC) Staff Governor Richard Gibbs (RG) Stakeholder Governor Phidelma Lisowska (PL) Stakeholder Governor In attendance: Prof. Sir George Alberti (GA) Trust Chair Pedro Castro (PC) Interim Director of Strategy Jane Walters (JW) Director of Corporate Affairs David Dawson (DD) Deputy Director of Strategy/Head of Change Leaders Team Joe Farrington-Douglas (JFD) Senior Strategic Advisor Leonie Mallows (LM) Corporate Governance Officer (Minutes) Apologies: Andrew McCall (AM) Public Governor Derek Cookson (DC) Patient Governor Jill Solly (JS) Head of Primary/Secondary Care Interface Sue Slipman (SS) Non-Executive Director Graham Meek (GM) Non-Executive Director Item

Subject Action

014/01 Apologies Apologies for absence were noted. It was also noted that governors are keen to have contact with non-executive directors but that, with the exception of GA, those due to attend governor meetings today had given apologies.

014/02 Approval of Minutes of the Previous Meeting The minutes of the meeting on 24 October 2013 were approved as a correct record.

014/03 Action Tracking The action tracker was noted. It was agreed that DD would approach KHP’s Director of Performance and Delivery, Jill Lockett, regarding the Organisational Health Index report.

DD

2

Enc. 4.3.2

Item

Subject Action

014/04

Matters Arising It was noted that the item on workforce culture and integration, which had been of interest to this committee, had been covered at this morning’s meeting of the Patient Experience and Safety Committee.

014/05

Trust-Wide Strategic Matrix 2013/14 Review of Q3 DD presented the Trust’s Strategic Matrix for quarter 3 which outlined Trust-wide and divisional strategic priorities. The following key points were noted:

The Trust held consultation events regarding selection of quality priorities for the year 2014/15;

Building on this year’s work and learning from patients who have experienced falls, a stretch target for reducing avoidable harm has been set as part of the 2014/15 quality priorities;

The Trust is currently operating at 95% bed occupancy;

Significant progress has been made with developing and implementing an evidence-based care bundle for the care of patients with Chronic Obstructive Pulmonary Disease;

RG reported that this is also a priority area for commissioners;

The Trust is acting as host for the Collaboration for Leadership in Applied and Health service Research and Care (CLAHRC) which aims to translate research into practical care models;

The research projects are a mix of social and clinical research and themes include ‘Palliative and End of Life Care’ and ‘Diabetes’, both of which are led by Trust clinicians;

Professor Irene Higginson has been appointed Assistant Director of Research and will be driving the CLAHRC and working to ensure that the Trust has a robust R&D strategy; and

The KHP alcohol strategy remains a priority area for Clinical Academic Groups and was referenced in KHP’s recent bid for accreditation as an Academic Health Sciences Centre.

In discussion, the following points were raised and noted:

Early intervention and addressing behavioural practices can be very effective when it comes to conditions associated with smoking and excessive alcohol consumption; and

It is also important that clinicians provide patients with full and clear information about the treatments available and what they entail and do not rely on the ‘nagging effect’.

3

Enc. 4.3.2

Item

Subject Action

GA provided an update on the discussions between the Trust and Guy’s and St Thomas’s regarding the configuration of vascular services. The following key points were noted:

The original agreement between the two trusts located all vascular services at the St Thomas’s site. This model is supported by national guidance;

The Trust is proposing a variation to the model which would see some services, which are integral to a whole pathway, retained at the Denmark Hill site on the basis that it would lead to better patient experience and outcomes;

There is disagreement over this proposed variation and communications between the two trusts have not reached a compromise to date;

It is important to resolve this matter before discussions about further KHP integration take place.

014/06 Strategic Issues JFD outlined current key issues for the Trust’s strategy. The following key points were noted:

For the first time the Trust will submit a five-year strategy to Monitor;

Part of preparing for this is revisiting major strategic issues in consultation with KHP organisations and colleagues in the local health economy (social care, local providers and commissioners);

There is a lack of clarity over the future of healthcare funding but projecting the Trust’s financial and operational needs over the next five years highlights the importance of making strategic decisions and possible alternative models of funding in order to bridge the funding gap; and

Whole pathway tenders and contracting for outcomes are examples of possible system change.

014/07 Strategic Planning for Change PC outlined the Trust’s process for strategic planning in 2014. The following key points were noted:

Monitor is encouraging all foundation trusts to think about long-term sustainability by changing from two to five-year plans;

In conjunction with this, and specific to the Trust, is the need to step back and refresh the strategic vision in the context of the acquisition and developments within KHP;

4

Enc. 4.3.2

Item

Subject Action

The Trust will conduct an internal assessment of its emergency and specialist services and commissioning contracts in order to develop a revised strategic vision;

System pressures and institutional changes will be taken into account, as will the ‘do nothing’ scenario;

Deliverables will include a transformational plan and process for achieving the vision;

Co-ordination with partner organisations and consultation with internal and external stakeholders will be part of the process. Various planning groups have been established;

The newly enlarged Trust and uncertainty around the future development of KHP present challenges, but also opportunities to lead service changes and make progress through existing structures; and

There is scope for governor involvement through community events, this committee and the Council of Governors.

014/08 Committee Work Plan 2014 CN presented the outline committee work plan for 2014 and asked for feedback and suggestions. In discussion, the following key points were raised and noted:

Development and monitoring of the five-year strategy should be a standing item for this committee with other related items flowing from it;

Integrated care is an important topic and is likely to feature prominently in the development of a five-year strategy – add to the July agenda;

Issues of public health and the role of local councils are also important – consider for either July or October agenda;

October would be an appropriate juncture to reflect on the progress of the integration programme (one year on from acquisition) plus developments with KHP/proposed service reconfiguration – add to October agenda.

014/09 Any Other Business There were no other items of business raised for discussion.

014/10 Date of next meeting: Thursday 10 April 12:00-14:00 in the Dulwich Room

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DRAFT Unconfirmed Minutes - Patient Experience & Safety Committee 11 February 2014

Governors’ Patient Experience & Safety Committee Minutes of the meeting held at 9.30am on 11 February 2014 in the Dulwich Committee Room, King’s College Hospital

Members:

Tom Duffy (TD) Patient Governor/ Committee Chair

Chris North (CN) Public Governor

Michelle Pearce (MP) Public Governor

Stuart Owen (SO) Public Governor

Joe Onabaworin (JO) Public Governor

Jan Thomas (JT) Patient Governor

Nicky Hayes (NH) Staff Governor

Carolyn Campbell-Cole (CC) Staff Governor

In attendance:

Fiona Clark (FC) Public Governor

Nanda Ratnavel (NR) Public Governor

Prof Sir George Alberti (GA) Trust Chair/ Non-Executive Director

Judith Seddon (JS) Associate Director of Governance

Jessica Bush Head of Public & Patient Involvement

Vanessa Sweeney (VS) Head of Nursing (TEAM)

Angela Huxham (AH) Director of Workforce Development

Mary Currie (MC) Associate Director of Workforce Planning

Helen Merati (HM) Engagement and Experience Manager

Kristen Nelson (KN) HR Consultant (KiC)

Tooba Ahmadi (TA) Corporate Governance Officer (minutes)

Apologies:

Patti Kachidza Patient Governor

Derek Cookson Patient Governor

Phyllis Barnett Staff Governor

Faith Boardman Non-Executive Director

Marc Meryon Non-Executive Director

Sue Slipman (SS) Non-Executive Director

Jane Walters (JW) Director of Corporate Affairs

Item Subject Action

014/00 Christine Klaassen TD recalled Christine Klaassen and her contributions to the Trust. The Committee paid tribute to her as an enthusiastic governor who acted as a role model to others and would be missed by this Committee and the entire Council.

014/01 Welcome and apologies

Apologies for absence were noted.

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Item Subject Action

014/02 Minutes of the meeting held on 22 October 2013

The minutes were accepted as a correct record of the last meeting subject to the following amendments:

Page 3, bullet point 2, last sentence – change to read The Trust can terminate the contract ‘if fail to meet contract or if fail any KPIs for any 3 months out of 6 or if VAT rules change’

Page 3, bullet point 4, amend ‘25 seats’ to ’13 seats’

014/03 Action Tracker/ Matters Arising

The Committee noted the progress on the action tracker.

014/04 Matters Arising

The following points were discussed and noted as additional matters arising.

Phlebotomy

The “demand analysis” report should be presented at a future PESC meeting;

It was agreed that JB would facilitate a meeting between SO, TD and Zebina Ratansi, Divisional Manager in Critical Care, Theatres & Diagnostics to further discuss the Phlebotomy issues in relation to waiting times and the methodology used for data analysis.

Pharmacy

JB to facilitate a meeting between MP, CC and Chris Barrass, Director of Pharmacy to further discuss Pharmacy issues in relation to seating space, ‘user review survey results’ and the staff queue.

014/05 Quality Report & Priority Development

JB presented the draft quality report which included a review of performance for the 2013/14 quality priorities and outlined the quality priorities for 2014/15.

It was noted that:

All the priorities for 2013/14 were achieved and on target apart from ‘surgical safety checklist’ and ‘improving patient experience of discharge’. These will be carried as priorities for 2014/15;

The Trust held 2 Stakeholder Events in Bromley and Lambeth/Southwark to invite comments and suggestions from the stakeholders on the 2014/15 priorities;

The following priorities have been proposed for 2014/15:

Improving the identification and management of patients at risk of falling in hospital;

Improving surgical safety checklist;

Improving experience and coordination of discharge;

Improving the experience of cancer patients;

Maximising King’s contribution towards reducing mortality due to use of alcohol; and

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Item Subject Action

Improve the experience of patients with hip fracture/ hip and knee replacement.

The draft report will be considered again by the Stakeholders and it will be presented at the next Council of Governors on 05 March 2014. The final report will be presented to the Board for approval in May 2014 as part of the Annual Report and Accounts before its submission to Monitor in June 2014.

The Committee noted the report and commented that ensuring different ways to measure improvements are essential.

014/06 Improving Patient Experience on the Acute Medical Unit (AMU)

Vanessa Sweeney, Head of Nursing for Acute Medicine updated the Committee on the Trust’s approach to improve patient experience in the Acute Medical Units (AMUs).

Key points included:

Following the review of patient experience in January 2013 and the analysis of various data, a number of initiatives and interventions were put in place to improve patient experience in acute wards;

These included a number of changes in the acute medicine pathway such as:

Introduction of patient experience CQUIN;

Using Volunteers to help capture real-time patient experience;

Revising pathways and streamlining the number of steps in patient journey;

Named nurses now on wards;

Ward round at the weekends;

24/7 presences of senior nurses on wards;

Supporting staff to deliver compassion in practice; and

Revising nursing levels in line with the increasing acuity and dependency of patients.

To improve on compassion in practice a number of development initiatives such as mandatory dementia training, delivering dignity and daily coaching with senior nurse were implemented;

Key outcomes included:

Reducing the number of steps in patient pathway;

Daily nursing rounds to maintain and deliver care with compassion;

Minimal ward moves for patients; and

Better quality of ward rounds with ward based consultants and senior admin support for junior doctors.

The committee commended all the improvement initiatives and highlighted that the outcomes from this review would be fundamental in improving patient experience. The Committee suggested that learnings from this review should be considered and rolled out in other areas around the Trust.

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Item Subject Action

014/07 Cultural Integration (incorporating King’s in Conversation)

Angela Huxham, Mary Currie and Kristen Nelson provided a detailed summary of the findings from the King’s in Conversation (KiC) and the Cultural Integration Programme across sites. Key points included:

Under the “all together better” banner there are 3 key projects, the King’s in Conversation (KiC), Cultural Integration Programme and the Staff Survey;

The KiC listening events included a number of round table discussions and pop-up sessions with staff and patients to have their say and raise issues;

Overall, staff are very proud to work in Denmark Hill and eager to do well for both patients and staff. Patients praised staff for kindness, taking time to listen, empathy, etc.;

The Cultural Integration Project involved undertaking a base line assessment of culture across all sites. 1500 responses have been received and the feedback has been shared with senior managers;

Additionally, a survey based on the national staff survey is also being launched at the PRUH site;

A number of opportunities for improvement were identified and categorised into 12 key themes, which are then split into granular level to plan and implement actions. Making patient care the number one target was one of the main areas to improve on across all sites; and

The 3 key areas of focus that has been identified by the Trust’s Board Integration Committee (BIC) and given priority are:

Doctors and managers working effectively together;

Promoting positive behaviour and performance; and

Empowering staff to take confidence in decisions.

The Committee noted the reports and suggested that a mechanism or an appropriate forum should be identified for Governors to continue their involvement in these initiatives.

014/08 Governor Involvement Updates

JB outlined continuing opportunities for Governor involvement and thanked those already taking part in various initiatives.

Governors are invited to be a patient assessor for this year’s Patient Led Assessments of the Care Environment (PLACE). This is an excellent opportunity for Governors to improve hospital environment. Interested Governors should inform JB in the first instance.

014/09 Trust Patient Experience Report – August 2013

The Committee noted the Patient Experience Report as of August 2013.

014/10 Trust Performance Report – Month 5

The Committee noted the month 05 Performance Report.

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Item Subject Action

014/11 AOB

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

014/12 Date of next meeting: Tuesday 10 April 9:30-11:30 in the Dulwich Committee Room


Documents

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