Meeting of the Board of Directors Tuesday 26 May 2020 ...€¦ · Tahir Ahmed, Director of Estates & Facilities . Tina Benson, Chief Operating Officer . Linda Burke (NED) Dr Cathy

The Hillingdon Hospitals NHS Foundation Trust

Meeting of the Board of Directors

Tuesday 26 May 2020 Public part of the meeting 11.00 – 12.30pm

Via MS Teams

AGENDA

Items which have gone through a Board Sub Committee are marked with an *

Item Business Items Lead Format Indicative Timing

Business Matters

1. Welcome and Apologies for Absence Chair Verbal 11.00

2. Declarations of Interest Chair Verbal

3. Minutes of the meeting held on 28 April 2020 Chair Minutes

4. Matters Arising/Action Log Chair

5. Chair’s Report Chair Report 11.05

6. Chief Executive’s Report (to cover CQC update)

CEO Report 11.10

Quality 7. Patient/Staff Story CN Verbal For

information and

discussion

11.20

8. COVID-19 Update* MD/CPO Report

For information

and assurance

11.30

9. Quality and Safety Committee Chairs report

Committee Chair Report

For assurance

and Information

11.35

10. Integrated Quality & Performance Report *

MD/DPO /COO/CPO Report

For information and brief

discussion

11.40

11. Serious incident Summary Report MD Report For

information 11.45

Trust Board meeting: 26 May 2020 Page 1 of 130

Well-Led/Governance 16. Audit and Risk Committee

Chair’s Report – will be shared post 21 May 2020


For information

and decision

12.20

17. Use of Trust Seal TS Report For noting

Other Matters

None

Questions from the Public 12.25 Exceptionally, and until further notice, due to the Covid-19 situation, members of the public have been asked to submit questions in writing to the Trust Secretary in advance of the meeting as the Board will be convening by teleconference.

Date of Next Meeting: Tuesday 30 June 2020

Note – there will be a Part II private part to the agenda – for items which are commercial in confidence

Performance Matters

12. People Committee Chairs report


For assurance

and Information

11.50

13. BAME update (includes appendices a – e) CPO Report

For information

and discussion

11.55

14. Finance and Performance Committee Chairs report


For assurance

and Information

12.05

15. Finance Report (Month 1, April 2020)* FD Report

For information


1

Present: Sir Amyas Morse (Chair) Professor Lis Paice (Deputy Chair) Sarah Tedford, Chief Executive Tahir Ahmed, Director of Estates & Facilities Tina Benson, Chief Operating Officer Linda Burke (NED) Dr Cathy Cale, Medical Director Janet Campbell (NED) Catherine Jervis Justine McGuiness, Director of Communications Simon Morris (NED) Ema Ojiako, Interim Director of People & OD Jason Seez, Deputy CEO Richard Whittington (NED/SID) Camilla Wiley, Chief Nurse In Attendance: David Meikle, Interim Director of Finance Sue Smith, Chief People Officer (Designate) Interim Trust Secretary: Michael Wood 1. Welcome and Apologies for Absence 1.1 The Chair welcomed all to the meeting. No apologies for

absence were received. 2. Declarations of Interest 2.1 There were no Declarations of Interest.

THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST

DRAFT MINUTES OF THE BOARD OF DIRECTORS

Tuesday 28 April 2020

Via Teleconference


2

3. Minutes 3.1 The Minutes of the meeting held on 24 March 2020 were approved as an accurate record of the meeting. 4. Matters Arising & Action List 4.1 There were no matters arising.

5. Chair’s Report 5.1 The Chair wished to record his continuing thanks to the Executive for the way in which they were leading the Trust in difficult times. It was noted that NEDs were equally supportive with feedback being sent to the CEO. 5.2 The proposal to put in place streamlined governance procedures whereby FPC, QSC and the People Committees were to be combined into a single meeting from May, but with the Audit & Risk Committee meeting as normally to provide independent assurance, was agreed. It was noted that there may need to be rapid decision-making in between formal meetings which would subsequently be reported to the Board. 6. Chief Executive’s Report 6.1 The Chief Executive reported on the following developments:

• the new Chief People Office, Sue Smith, would start on 1 June 2020;

• a meeting had been held with the CQC Chief Inspector on 31 March but no date had yet been set for the Trust’s inspection;

• the Trust had achieved its £12.7m out-turn for 2019/20;

• NEDs had been updated separately on current Covid-19 and preparations were being made for Divisions to resume normal operations as soon as possible;

• the new Trust Secretary, Deborah Lawrenson, would start on

1 May, thanks being extended to Michael Wood (Interim Trust Secretary) and Mike Weaver (Secretariat Support) for their work to date.


3

7. Covid-19 Report 7.1 The Medical Director presented a report on Covid-19. It was commented that the Trust had been very challenged in recent weeks but capacity had been maintained, due to flexibility of team working across different disciplines. 7.2 In respect of a question from the public related to lessons learned and PPE stockpiling, it was commented that the Trust had been advised not to stockpile (which had been extended to drugs). In the Trust’s experience, the sector had worked well in distributing PPE. 7.3 A further public question was asked in respect of tactical planning preparations for a possible second wave of Covid-19. In response, it was noted that North West London NHS FT (as the STP) had a key role to play in forward planning involving all local trusts. The CEO commented that planning was wider than the second wave in that the Trust needed to look at different ways of working (eg virtual clinics) and that this would form part of a major communications strategy. The Board noted the report. 8. Integrated Quality & Performance Report 8.1 The Chief Nurse referred to the Quality section of the Performance Report for March 2020, it being noted that the number of reported pressure ulcers had fallen, as had complaints (due to the fall in patients, although overall trends remained the same). Several complaints could not be progressed since complainants had requested face-to-face meetings. The Board was pleased to note that the Trust’s Friends & Family Test results for inpatients, outpatients and maternity were better than the London average. 8.2 The Chair of QSC commented that staff could be encouraged to complete historic discharge summaries where there was capacity at the present point in time. It was noted that a question from the public related to when the Trust was going to address the current discharge summary situation.

Action - The Chair commented that he would write to the CEO on the on-going matter of discharge summaries as the issue needed to be resolved.

8.3 The COO presented highlights from the Performance Report,


4

commenting that the Trust was using Royal College of Surgeons’ guidance with regard to RTT safety issues. It was noted that A&E performance was still below the target (despite fewer admissions) due to staff being re-deployed to different areas. Establishing a consistent daily rhythm within A&E was deemed essential moving forward. The Board noted the report. 9. Clinical Services Strategy 9.1 The Deputy CEO introduced discussion of the updated Clinical Services Strategy (CSS) commenting that the CSS arose out of the publication of the Long-Term Plan in 2019 to inform the planning for a new hospital build. Board approval of a refreshed clinical services strategy is one of the early milestones in the Trust’s re-development programme: a key recommendation from the Gateway Review conducted by NHSE/I in summer 2019. 9.2 The Board further noted that the Strategy reflected the presentation given at the Trust Board seminar in February 2020 and as subsequently reviewed by the CSS Steering Group, the Re-Development Programme, the Trust Management Executive and at meetings of the Finance and Performance Committee held on 25 February 2020, 17 March 2020 and 21 April 2020. 9.3 The Board noted that the FPC had recommended approval of the clinical services strategy, in the context this will continue to evolve in the light of the on-going development of the outer North West London strategy (including a focus on the elderly); further patient and public engagement and business case development process for the new build. The Board approved the Clinical Services Strategy. 10. Nursing Staff Establishment Review 10.1 The Board noted the six-monthly Establishment Review, as presented by the Chief Nurse. Arising out of NED discussion, it was commented that there would be a need for a review of safer staffing principles and protocols post Covid-19 (ie ICU staffing). 11. CQC Update


5

11.1 The CEO commented that whilst the CQC visit had been postponed, it was important for the Trust to maintain momentum in delivering improvements through the Hillingdon Improvement Plan. This was supported by the Board. 12. Financial Report 12.1 The Chair of Finance & Performance Committee (FPC) commented on the meeting of the Committee held on 21 April, at which the positive result in relation to delivering the Trust’s control total was discussed, together with consideration of exceptional Covid-19 costs. The Committee received an update on the Digital Care Record, the fact that NHSE/I had approved the outline business case being welcomed. In respect of estates, Members noted good progress across a range of fronts in challenging times. 12.2 The Interim Director of Finance presented the a Month 12 Report, commenting that £8.1m had been achieved in respect of the Cost Improvement Programme and a gain of £2.5m arising out of adjustments in the re-valuation reserve. 12.3 The Chair stressed that there was a need for the Trust to understand historic deficiencies in the run-rate in order not to repeat them. In response, the Director of Finance advised that improvements were being sought from the Trust’s forward plan with a view to a report being considered at the next FPC meeting. NEDs requested that the long-standing issue of patient repatriation from out of the Borough needed to be addressed which was accepted. 12.4 The Director of Finance presented the Financial Plan, 2020/21 it being reported that a cost pressure reserve of £4.6m had been created, in addition to a £1m uncommitted reserve. A Cost Improvement Programme of £12.1m had been agreed and the deficit of £20.3m would be substantially funded by the Centre. The Chair commented that the Plan was not without risk given a reliance on re-valuation and having a low reserve. Strenuous efforts must, therefore, be made to contain costs throughout the year. The Board noted the reports.


6

13. Estates Report 13.1 The Director of Estates & Facilities presented his report to the Board, it being noted that in response to the unprecedented Covid-19 situation theatres had had to be re-configured for ICU purposes with oxygen safety and a supply of medical gases being prioritised. With regard to supporting the well-being of staff, 1000 free meals per day were being provided. Free car parking was also being provided. 13.2 The Board learned with great sadness that a member of the Estates team had died from Covid-19 and sincere condolences had been passed to their family by the CEO. 13.3 The Board approved the appointment of ME Construction following a lift modernisation tender process as reported to FPC. 13.4 The Chair, on behalf of the Board, wished to record his thanks to the Director of Estates and his team at this challenging time. The Board noted the report. Report from Audit & Risk Committee 14.1 The Chair of the Audit & Risk Committee commented on the meeting of the Committee held on 23 April at which the Interim Report from the External Auditors was considered, in addition to reports from Internal Audit (including a review of the BAF) and other internal reports. The Committee considered a draft Covid-19 Board Assurance and Control Desk Risk Register from which reasonable assurance was taken in terms of the Trust’s capacity to manage risks at a high level based seven key assurance prompts aligned local system plan; implementing finance, workforce and communication plans. The Committee also noted that the timescale for the production of the Annual Report & Accounts was on schedule. 14.2 In response to a question from the public in relation to residual Covid-19 risks and what impact this might have on overseas nursing recruitment, it was commented that the situation still remained fluid at the present point in time, although there had been a notable increase in nursing


7

applications nationally which may mitigate against any shortfalls in overseas recruitment.

15. Use of Trust Seal

15.1 The Interim Trust Secretary advised of a use of the Trust Seal in respect of deed transfer and property purchase.

In respect of the purchase of the RAFT Building at Mount Vernon and a question from the public, it was noted that the building had been purchased for £350k and that the building would be used as an investment property as part of the Trust’s wider estates strategy.

16. Any Other Business

16.1 The CEO commented that a more detailed report on People matters would be presented at the next meeting.

16.2 Chair stressed that papers needed to be produced in good time in advance of the next meeting in order for the agenda to be circulated in a timeous manner.



TRUST BOARD PART 1 ACTION LOG – 26 MAY 2020

Minute ref Agenda item DETAILS OWNER DATE DUE PROGRESS UPDATE

8.2 INTEGRATED PEFORMANCE REPORT

The Chair commented that he would write to the CEO on the on-going matter of discharge summaries as the issue needed to be resolved.

Chair 26 May 2020 Completed action closed



1

Meeting of the Board of Directors 26 May 2020

Agenda item 9

Title Chief Executive’s Report

Report author Sarah Tedford with input from Executive Team Report sponsor Sarah Tedford, Chief Executive

Status of Report Public Private Internal X ☐ ☐

Purpose of Report For Decision For Assurance For

Information ☐ X X

Summary The Board is asked to note the update provided.

Impact

Quality and Safety X

Legal X

Financial X

Human Resources X Equality and Diversity X

Engagement and communication X

Sustainability X

Chief Executive’s Report

1. Covid-19

The Trust has continued to work to support the large numbers of patients who havebeen seen in our emergency department or admitted with COVID-19. This hasrequired different ways of working for teams and individual staff members, and wehave been consistently impressed by the willingness of all staff to step outside theircomfort zones.

We have re-purposed a number of our clinical areas, including expanding our ICUinto the theatres on the Hillingdon site and opening a joint medicine and ICUrespiratory support unit on our acute medical unit for patients requiring non-invasive


2

ventilation to manage their COVID-19 illness. We have been able to provide both ward based and intensive care for all patients who presented to us; and we have worked as a system across North West London to ensure that we retained ICU capacity throughout the surge of COVID-19 cases.

We are particularly grateful to colleagues at Royal Brompton and Harefield who accepted and treated a significant number of our ventilated patients. The numbers of COVID-19 patients have decreased slowly in May, but we still need to maintain our standards of isolation of patients with and without COVID. Testing of all admitted patients from early May has enabled us to safely manage all patients. We have been working with teams, and as part of the NWL system, to plan for safe resumption of elective activity in coming weeks.

The staff in the organisation are still having to continue changing clinical capacity to meet the needs of all our patients, those with suspected Covid and those coming in with non Covid related illnesses, there has been a significant change over the past few weeks in the profile of this activity and this has caused challenges to our emergency flow both in the Emergency department and in the ward areas. It is key that we continue to risk manage this dynamically to protect both our staff and our patients. Having said this our current 4 hour performance is lower than we would expect and the COO and the senior ED leadership team are meeting weekly and providing hourly updates to drive performance and improve the quality of care to our patients. The leadership team are empowering the clinical staff to work with the speciality teams and wards to ensure streamlined transition to the next place of care.

As the number of Covid positive patients reduces across London we have started, as part of the NWL ICS, to work together to plan the restart of elective surgery; diagnostics and lastly specialist consultations. This is happening with great care and detailed planning due to the need to ensure we have Covid protected pathway for both staff and patients. This includes testing, PPE, staffing levels, equipment and physical space for social distancing and excellent infection control practices. We on the 19th May 2020 started Endoscopy at Mount Vernon and this will be soon followed by Imaging, we were able to accelerate these as our services at Mount Vernon are Covid protected. Across NWL we are expecting to start surgery during June on some sites, and again we will start at Mount Vernon.

2. Sickness absence The effects of COVID-19 on staff attendance continue to be felt during the month of April as the Trust saw sickness absence levels increase month on month to 11.6% in April from 7% in March. This unprecedented level of absence was mirrored across the North West London sector as all Trusts have seen sharp increases in absence driven by COVID-19 since the onset of the pandemic.

The Trust is undertaking concerted work to support individuals who are sick, particularly those who have been away from the Trust for longer periods of time. Testing is offered for staff and household members who are symptomatic and regular


3

welfare calls are made to individuals who are unwell. These colleagues are also offered psychological support where appropriate as the organisation notes that there is a need for greater wellbeing resources at this time.

3. The North West London Health and Care Partnership

The NHS Plan (published January 2019) detailed the central role Integrated Care Systems (ICSs) would have in the delivery of the NHS Long Term Plan – with the ambition that by April 2021 ICSs would become established across England.

The expectation was for the forty four Sustainability and Transformation Partnerships (STPs) which were established in 2016, to evolve in delivering an Integrated Care System model. For North West London, the finalised ‘draft North West London Health and Care Partnership, Five year strategic plan’, was submitted to NHSI/E in November 2019. In response to the COVID-19 pandemic, the North West London Health and Care Partnership, has also developed a ‘ICS Draft Plan, North West London ICS – 11th May 2020’.

The Trust continues to work closely with Hillingdon Health and Care Partners (our local authority, primary and community care, and third sector partners in Hillingdon), and London North West University Healthcare NHS Trust (our neighbouring acute hospital provider) and regional leads, in ensuring we deliver the best health and social care services to our local population as part of a vibrant wider integrated care system.

4. New Hospital Development Programme

A key national and North West London priority is the building of a new Hillingdon Hospital.

Work has now begun on the business case for a new Hillingdon Hospital. The first stage of the business case process is the development of a Strategic Outline Case and work is underway to support completion of this by July 2020. This will be followed by an Outline Business Case and then a Full Business case.

Governance arrangements have been established to support this process including a Programme Board chaired by the Chief Executive and monthly updates are provided to the Finance and Performance Committee. The first meeting of the Partnership Board with key stakeholders was held at the beginning of May 2020. Partners were supportive of the programme and the approach being taken to develop the Strategic Outline Case. Regular meetings are also underway with NHSE/I and the DHSC to review progress.

Further discussions are planned with commissioners and the Local Authority during May and June on the approach to public involvement in the development of the plans. Good engagement with patients and the public will be very important in informing the future development of the hospital and plans are being developed to support this.

5. Transformation and Improvement Programme


4

The Transformation and Improvement Programme (TIP) is the Trusts programme of work to deliver large scale transformational change across the Trust. The programme consists of six workstreams to deliver the transformation agenda and the £12.1m of efficiency savings required for delivery of the Trust’s 2020-21 year end control total. Work remains underway to validate all of the identified schemes as well as non-identified opportunities.

The TIP Board reporting to TME is responsible for overseeing implementation of the transformation agenda, the delivery of the efficiency savings programme, and the governance for the programme including Quality Impact Assessment (QIA).

The Transformation and Improvement programme is led by the newly appointed Chief Transformation Officer Belinda Norris, who has aligned the PMO, Transformation and CARES+ Teams to create one transformation resource for the Trust. The Transformation Team with aligned processes, personnel, aims and objectives working under the direction of the CTO; will provide the programme support required to deliver an ambitious trust-wide transformation agenda.

The six workstreams cut across the organisation and include the ambitious Outpatients transformation programme where building on innovations post Covid-19 recovery we are seeking to embed progress made to date on delivering a virtual outpatients model. This includes the roll out of digitally enabled processes which improve ultimately will improve safety and provide a more agile delivery model for those clinically assessed as being suitable for this interface.

6. Finances

In Month 1 the Trust achieved a break-even position as required by the interim financial regime for the period April to July 2020, as per the instructions of, and in line with, the plan from NHSI. This plan is based on average income and expenditure patterns in 2019/2020, with a flexible income top up to ensure that the Trust’s overall position is in balance.

In comparison with the Trust’s operating plan there is a favourable variance of £1.1m, which is driven by greater income than originally planned.

The Trust’s pay run rate of £15.4m contains circa £650k of COVID-19 expenditure, with a number of areas of underspend due to less planned activity. Therefore, comparison with the Trust’s planned pay expenditure would show a marginal underspend when these factors are taken into account.

The Trust’s non pay run rate of £7.8m contains £1.23m of COVID-19 expenditure. Comparison with the Trust’s planned non pay expenditure would show that the Trust’s non pay costs were on plan if these costs had been excluded.

The Trust closed the month with a bank balance of £27m as a result of the income phasing from the commissioner re the above COVID support, in addition to the capital loans drawn down in March 2020. This will be reduced as capital creditors are paid in the next three months. However, in the meantime the Trust has taken the opportunity to reduce its creditors commitment.


5

7. Corporate Governance

The newly arrived Trust Secretary is undertaking a review of our internal committee structure and processes and engaging with colleagues across the Trust in this, with a view to putting in strengthened processes and arrangements in the coming months.

8. Communications and Engagement

During April 2020 significant energy has been put into developing employee engagement, this has included twice weekly live CEO Q&A sessions for staff, in addition to twice daily all staff Covid 19 e-newsletters and other regular communications to staff. The monthly Team brief was held virtually and will be held virtually in May. Through April, work started on improving our external communications and I anticipate a fuller report to the Board in the future.



Agenda Item: 8 Board of Directors: 26th May 2020

Title COVID 19 UPDATE

Report author Report sponsors

Report sponsor Dr Cathy Cale Medical Director, Camilla Wiley Chief Nurse, Ema Ojiako Chief People Officer, David Meikle Director of Finance

Status of Report Public Private Internal

☐ x x

Purpose of Report For Decision For Assurance For Information

☐ x x

Summary

This report provides a summary of the actions the Trust has taken to ensure that we were able to respond to the COVID-19 pandemic. Plans have been made in line with national and regional guidance, and with the welfare of our staff and patients at their heart. The number of patients being admitted with COVID-19 has now plateaued, both in THHT and across NWL and London. Planning is therefore underway to resume limited amounts of elective work.

Recommendations For information and discussion

Links to Corporate Objectives

All

Impact

Quality and Safety x

Legal

Financial x

Human Resources x

Equality and Diversity x Engagement and communication

Sustainability


1

COVID-19 Incident Management Update to Trust Board 26 May 2020

Purpose of Paper

The purpose of this paper is to provide a high level update on the steps that the Hillingdon Hospitals NHS Foundation Trust has made in line with national and regional guidance to manage patient care during the COVID-19 pandemic. This paper focuses on the elements that support the maintenance of quality of care (safety, effectiveness and experience) and provides an update on actions since the last report to TME, the Board Sub Committees and the Trust Board.

Background

The Hillingdon Hospitals NHS Foundation Trusts has worked with colleagues in the North West London Health and Care Partnership (NWL HCP) to plan for and work through the national requirements so that we can best manage the significant increase in caseload of COVID-19 patients. This has required rapid and significant transformation of services. The vast majority of elective services have been managed down, and largely paused (with the exception of some urgent time critical care). Plans have been made in line with national and regional guidance, and with the welfare of our staff and patients at their heart. The number of patients being admitted with COVID-19 has now plateaued, both in THHT and across NWL and London. Planning is therefore underway to resume limited amounts of elective work.

Summary

The descriptions below demonstrate the ongoing changes and the processes behind that to provide assurance that decision making is structured and within a governance framework.

For the organisation and our staff, COVID-19 presented huge challenges: this is a new disease and required new ways of working. The speed of learning and change has been rapid and all our staff are to be commended on the highly professional manner in which they have met the challenges. Our Chief Transformation Officer has been working with teams to capture the learning from the changes that we have made and either strengthen or maintain the positive changes. In tandem, we are working as part of the North West London ICS to plan for how we deliver care across the sector, and what the shape of our “new normal” NHS will be. Central to this is maintaining quality of outcomes, experience and maintaining patient safety.


2

Issue Action Monitoring and Governance

Compliance with national and regional guidance Services changed in line with guidance

Participation in regular NWL and London Calls

Service changes approved via daily execs meeting

Local guidance approved via Gold/Execs or normal governance routes and put on intranet

Signposting on intranet to national web sites

Ensuring appropriate management of the organisation during a national incident

Command and control structure from early March with gold, command centre (Silver) and area bronzes (clinical and management).

Twice daily meetings: Gold/Silver/Bronze

Review of command centre structures underway to maintain proportionate use of silver and bronze resource

Logging in line with good incident management practice

Action log maintained

Effective communication with staff to support effective two way flow of information

Twice Daily bulletin

Bronze structure in place to ensure key messages communicated to all areas

COVID-19 link on intranet

Executive visibility in ward areas

CEO Q&A sessions twice weekly

CEO/MD meetings with Clinical specialty leads/ DDs

Feedback from areas

Information via FTSUG

Planned work: requirement to reduce to manage increase in COVID-19 patients in line with national guidance

Elective and outpatient work scaled back over March in line with National and London guidance

Clinical stratification and review of booked patients to ensure urgent

Patient tracking mechanisms maintained

Clinician review of cases to ensure appropriate prioritisation


3

activity is maintained

Increased use of virtual consultation

Emergency work (including cancer and urgent surgery and some diagnostics) maintained to minimise adverse outcomes due to treatment delays for time critical cases, in line with national guidance

Clinical stratification and review of booked patients to ensure urgent activity is maintained

Access to independent sector for surgery for cancer patients in place

Access to independent sector to undertake urgent surgery (Prioritised as P1/P2)

Emergency endoscopy maintained

Urgent endoscopy restarting (in line with NWL)

Clinician review of cases to ensure appropriate prioritisation

NWL HCP MDs and CEOs sign off of requests to use independent sector to ensure equity of access.

Incident and SI trends monitoring

Outcomes monitoring via national audits

Requirement to increase ICU capacity in line with national and regional guidance and modelling including compliance with revised national (medical and nursing) staffing ratios

ICU expanded into theatres on Hillingdon site to increase from 9 beds to 17.

Risk assessed use of anaesthetic machines in line with national guidance

Creation of additional level 2 HDU for non-invasive ventilation (CPAP) on AMU: joint development by respiratory and ICU

Re-allocation of non-ICU staff (medical and nursing) to ICU to support care in line with national guidance on staffing ratios and training

Deployment of flexible work force via:

- use of volunteers (St Johns Ambulance) - Deployment of final year student nurses - Increase in staff bank capacity - Deployment of overseas nurses on the emergency register - Recruitment of return to practice nurses

Daily review of critical care usage

Submission of data to region/nationally


4

Deployment of staff from CCG and wider NHS network

Creation of increased numbers of general medical beds to ensure sufficient beds available and staffed.

All surgery combined on Kennedy ward

Work with CCG and community teams to discharge all medically optimised and DTOC patients, and maintain enhanced discharge processes.

Surgery, T&O, gynaecology and paediatric doctors (SHOs and below) released to work in medical teams, in line with HEE and GMC guidance and with training provided.

Medical teams re-structured as ward based teams, Junior medical teams constructed with a mix of seniority and specialty experience. Rotated on a weekly basis between higher and lower acuity areas.

Specialty medical consultants incorporated to support ward based care

Risk assessment for mixing of different types of surgical patients on single ward

Regular meeting with doctors to ensure they have sufficient support

Monitoring of bed capacity at bed meetings and against the national/regional modelling.

Risk managed placement of patients in line with COVID status (positive/negative/unknown)

Closure of ward areas to facilitate optimal staffing and enable planned re-escalation of activity

Cascade of wards to be COVID/non-COVID agreed with senior clinical leaders in conjunction with MD/CN and IPC. Ward allocation changed to accommodate risk assessment with introduction of testing of all non-elective admissions and in line with respective numbers of COVID and non-COVID patients

Closure of inpatient wards at Mount Vernon after appropriate discharge or transfer of patients and re-allocation of staff to Hillingdon Site

Creation of hot and cold zones and patient flows in ED to separate pathways. Move of hot and cold zones in line with numbers of patients attending

Plans signed off at execs

Monitoring of bed capacity at bed meetings and against the national/regional modelling.


Plan for resumption of elective activity in line with excellence in IPC

Working as part of the NWL ICS, we are planning for resumption of elective work. Sequencing based on clinical priority and managed risks in a COVID protected/COVID risk-managed environment.

Executives daily meeting, TME and Trust Board


5

Reviewing staffing models to enable staff availability to resume elective work

Reviewing PPE requirements to ensure that appropriate PPE is available in all settings

Ensure safe care provided to deteriorating patients

Maintaining safe levels of cover at Mount Vernon, including a consistent rota to provide ALS cover to the whole MV site

Implemented guidance from resuscitation council to ensure staff and patient safety during resuscitation.

Ward based medical teams enabled an already planned change to Amber NEWS calls process to ensure appropriate initial input provided by a registered nurse and ward based Dr.

Joint board round with ICU/medicine to identify patients of concern in place.

Risk assessment undertaken in conjunction with MVCC and resuscitation team


Ensure consistent and ethical Decision Making Treatment escalation plans (already developed and about to pilot) introduced across the Trust to support discussions with patients and their families about ceilings of treatment, in line with good clinical practice.

Clinical Decision Support group developed in line with London STPs guidance on ethical clinical decision making to provide additional support to clinicians in addition to normal MDT decision making processes

NWL HCP Ethics/Clinical decision support group in place collating information on local CDS panel discussions.

Ensuring appropriate provision of PPE in line with national guidance

The Trust has produced guidance on PPE in line with PHE guidance, and supported staff to understand and use PPE appropriately.

There is a daily PPE action group (chaired by the chief nurse) to monitor PPE supplies and issues.

Incident reporting and reports to FTSUG

Shortages flagged on daily MD calls with NWL and CEO calls where relevant.


6

There is an escalation framework to manage PPE shortages, should they arise

Procurement team have worked closely with NWL to ensure ongoing provision of PPE. Reports to twice daily silver meetings.

Shortages flagged on daily MD calls with NWL and CEO calls where relevant.

Escalation as required to NHS London

Staff well being (summary only) Staffing hub instituted in March to take sickness calls and signpost to advice.

Staff testing made available in line with national policy and regional capacity. Currently on site staff testing in sufficient capacity for staff who become symptomatic.

Free parking, meals and access to hotels and taxi services instituted for staff

Psychological support available on site, via partnership working and our existing wellbeing provision (Vivup), from the NW London sector, and from NHS Employers national Wellbeing support provisions

Nationally agreed framework for financial advice and support

Dedicated quiet / rest zones for staff

Online wellbeing portal for staff on Trust intranet

Chaplaincy support and guidance

Risk assessments and targeted action to support for Black, Asian and Minority Ethnic staff (BAME) and vulnerable staff groups

Increased senior nurse presence at weekends to support ward staff..

Comparative data from all NWL Trusts on sickness

Reports from FTSUG

Feedback via Staff forums and other channels.


7

Ensuring estates management appropriate and estates changes made in a timely manner to facilitate safe patient care

Changes of ward to “COVID wards” has required a large number of temporary estates modifications. This has principally been to provide identified donning and doffing areas and additional doors.

Estates has developed systems to ensure that we are able to model and monitor oxygen usage in line with national guidance

Incident and SI report trends.

Ensuring that governance systems for Quality are maintained

Normal incident reporting systems have remained in place, including daily escalation of any moderate and severe incidents to the medical director and chief nurse.

Incidents have continued to be investigated in normal timescales.

Incident reports mentioning PPE are reported to the infection prevention control team.

Measurement of other quality metrics (as per integrated quality and performance report) remain in place

Weekly Clinical Advisory Group in place from 30th April to provide

Daily Executive Team meeting

Monthly Trust Management Executive

Trust Board and subcommittees


1

Meeting of the Board of Directors

26 May 2020 Agenda item 9

Title Quality and Safety Committee Chairs report

Report author Deborah Lawrenson Trust Secretary Report sponsor Lis Paice, Chair of the Quality and Safety Committee


Purpose of Report For Decision For Assurance For Information ☐ X X

Summary

The attached report provides an update to the Board from the Chair of the Quality and Safety Committee for the meeting held on 19 May 2020.

The Board is asked to note the update provided.

Impact

Quality and Safety X Legal Financial X

Human Resources X Equality and Diversity X Engagement and communication X Sustainability

Report from the Chair of the Quality and Safety Committee The following items were received and discussed:

1. Update on Covid-19. This included detail which had been provided under one agenda item on the Combined Committees agenda and therefore included discussion on quality and people related issues, with finance issued outlined through the Month 1 finance report received at the Finance and Performance Committee.

Committee members asked for clarification on the following issues:

• Whether there were specific reasons as to why the Trust sickness rates were

higher in comparison with other Trusts in the sector. It was confirmed the Trust had peaked later in terms of Covid related sickness than other Trusts and that statistics across Trusts were falling in line with each other. It was


2

noted the Executive had asked for further work to take place at a more granular level on sickness.

• The extent to which staff are accessing psychological support. It was confirmed that support is available and staff had been made aware of this, data is being compiled to ascertain the level to which this is being accessed but it was noted this was more difficult to capture in terms of support provided through external bodies and programmes. It was confirmed staff are being reminded of the support available to them.

2. The Integrated Quality and Performance Report – Detailed discussion took place on the report and whilst the Executive were commended for including absolute data in the report it was noted reporting on trends on the previous period was becoming increasingly less meaningful given the current situation with regard to Covid-19. The committee asked that consideration be given as to how best to ensure meaningful data is collected to support decision making going forward.

In response to questions from the committee they were updated and assured

• on discharge process issues and it was confirmed a clear trajectory for managing these is in place with strong oversight at Executive level in place.

• support being provided to people attending services with Learning Disabilities (LD)

• on monitoring arrangements in place on performance in ED. • on the waiting list and planned next steps. It was noted further work is needed

on communications with patients to support them in being confident enough to start attending the hospital where appropriate, as there was some concern locally and nationally from patients about returning to hospitals. The committee was informed that in addition to local and national work underway on communications on this issue, Governors were being provided with a weekly update to support them in their onward engagement.

In summary key issues to be raised with the Board were agreed as:

• Communication planning required with the public to provide assurance about attendance at Hospital

• The need to give consideration to ensuring measurement of performance is meaningful post Covid to support decision making

• A request from the Committee for a report to be provided to the May Board outlining any impact from Covid on delivery of the four key clinical priorities agreed by the Board.


Board of Directors: 26th May 2020 Agenda Item: 10

Title Integrated Performance Report

Report author

Vikas Sharma – Assistant Director of Integrated Governance Dr Catherine Cale - Medical Director Camilla Wiley - Chief Nurse Ema Ojiako - Director of People and Organisational Development

Report sponsor Tina Benson – Chief Operating Officer


x ☐ ☐


☐ x ☐

Summary This report provides oversight to the Trust Board on progress against the performance standards the Trust seeks to meet as either national or local standards.

Recommendations The Board is invited to note the progress and assurance provided in the report.


All

Impact


Legal x

Financial x

Human Resources x

Equality and Diversity x

Engagement and communication x Sustainability x


1

Title Integrated Quality and Performance Report – April 2020

Report author

Vikas Sharma, ADIG

Dr Catherine Cale, Medical Director

Camilla Wiley, Chief Nurse

Ema Ojiako Deputy Director of People and Organisational Development

Report sponsor Tina Benson, Chief Operating Officer


☒ ☐ ☐


☐ ☒ ☐

Summary This report provides oversight to the Trust Board on progress against the performance standards the Trust seeks to meet as

either national or local standards.

Recommendations The Board is invited to note the progress and assurance provided in the report.

Links to Corporate

Objectives Links to objectives: Quality, Workforce, Performance, Money, Well led

Impact

Quality and Safety To continue to provide the best level of patient care and safety in delivering core constitutional standards

Legal

Financial

Human Resources To provide hospital services in the most efficient and effective manner

Equality and Diversity To provide and deliver services taking account of the requirements of diverse groups

Engagement and Communication To deliver nationally and locally set targets in terms of engagement, communication , listening and learning Trust Board meeting: 26 May 2020 Page 30 of 130

Page 1 of 26

Quality Summary

Summary:

Patient falls – o The total number of inpatient falls fell in April (39) from the previous month (51)– however the rate per 1000 bed days increased from 4.3 in March to 5.1 in

April. o The rate of inpatient falls exceeded the rate threshold for this month. o One fall resulted in patient sustaining a fractured neck of femur on AMU and a second patient fall on Hayes resulted in a facial fracture.

Hospital acquired pressure ulcers –

o The total number of pressure ulcers and moisture lesions decreased marginally in April 2020 to 13, compared to 15 in March 2020 o The rate on pressure ulcers category 2 + was 1.2 per 1000 bed days which is above the threshold limit of 1.0 incidents per 1000 bed days. o There were no Hospital Acquired Category 3, 4 but there was 1 Unstageable pressure ulcer in April 2020.

Infection control o MRSA – There have been zero MRSA BSI cases for April 2020, the threshold remains zero avoidable. The Trust reported one MRSA BSI for the year 2019/20.

o C. diff - There were zero cases (HOHA & COHA) of Clostridium difficile attributed to the Trust for the month of April 2020.

o E.coli – There were zero Trust attributed E.coli BSI cases for April 2020.

Complaints – o Performance in April 2020 was 37% against a target of 85%. 7 complaints were received in April 2020. o The Complaints Management Unit went into the new financial year with eight breaches from December 2019 and March 2020. Five of these have since been

closed but three remain outstanding.

PALS – o In April 2020 PALS received 43 negative contacts which demonstrated the continuing trend of a decrease of 45 contacts from the previous month which may be

attributed to reduced activity due to the Covid-19 outbreak.

Friends and Family Test (FFT) – o NHS England and Improvement has advised Acute Providers to stop carrying out the Friends and Family Test in order to reduce the burden on staff and release

capacity to manage the COVID-19 pandemic. There will be no penalties for not complying with any part of the FFT guidance during this period.

Discharge summaries – o There has not been a consistent improvement in the backlog for 2019/20 or the % timely completion. Completion within 24 hours of discharge remains at 4%

below target, and within 7 days 10% below target. Despite the work done, this has not significantly improved since May 2019. The improvement work stream in this area is being revisited and refreshed in May 2020.

Patient safety incidents – The total number of patient safety incident reported has reduced considerable in light of COVID-19, however the rate on incidents has

remained above the Trust target of >=35 @ 45 incidents per 1000 bed days compared to 39 incidents per 1000 bed days in Apr 2019.


Page 2 of 26

Serious incidents –

o 2 Serious incidents were declared for April 2020.

o The Trust continued to achieve 100% compliance against the serious incident framework timeframe of 60 days.

Medication safety –

o Due to the ongoing COVID-19 pandemic data on medicines reconciliation rate and omitted doses is not currently being collected.

Mortality –

o The Trust has been reviewing absolute numbers of deaths that are COVID-19 related. There are no published methodologies to derive Trust level data on crude or adjusted mortality from COVID-19. This is being addressed within NWL via ICHP.

o Mortality figures continue to be reviewed at the monthly Mortality Surveillance Group.


Page 3 of 26

Patient Falls **Rate per 1000 bed days # = fracture

No. incidents 41

Apr 2020

No. incidents 41

YTD

Lead: Vanessa Saunders – Deputy Chief Nurse

Rate 5.1 Rate actual 5.1 Executive: Camilla Wiley - Chief Nurse

Rate Threshold 4.6 Rate Threshold 4.6

Falls with # 1 Fall with # actual 1

Fall with # Threshold 10

Analysis of data

The total number of inpatient falls fell in April (39) from the previous month (51)– however the rate per 1000 bed days increased from 4.3 in March to 5.1 in April.

The rate of inpatient falls exceeded the rate threshold for this month.

One fall resulted in patient sustaining a fractured neck of femur on AMU and a second patient fall on Hayes resulted in a facial fracture.

The rate for all falls combined increased to 5.3 per 1000 bed days Themes and trends Inpatient falls: Highest incidence of falls in March were in: Stroke (8), Hayes (6), Grange, Bevan and Drayton (5). Of the 39 inpatient falls, 2 falls resulted in moderate harm, 7 in low harm, 30 in no harm Non-inpatient falls: 1 occurred in ED (Red Zone), and in MRI – both resulted in no harm.

Actions taken, have they worked? What is stopping actions progressing?

Beaconsfield East are now using falls sensors having purchased these with charitable funds.

Indicator Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov DecYTD

20/21Target SPC Trend

Patient falls

No. Inpatient falls 66 73 51 39 39 N/A Within control limit

Rate of inpatient falls (1000 bed days) 4.6 5.6 4.3 5.1 5.1 N/A

No. non-inpatient falls 13 2 6 2 2 N/A Within control limit

Rate of all patient falls (1000 bed days) 4.6 5.8 4.8 5.3 5.3 4.6

Falls with fracture 1 1 1 1 1 10

5.5 5.2

3.9 3.9

5.1

3.9

5.1 4.9 5.0 5.3

4.0

3.2

4.6

5.8

4.8 5.3

0

1

2

3

4

5

6

7

Jan

-19

Feb

-19

Mar

-19

Ap

r-1

9

May

-19

Jun

-19

Jul-

19

Au

g-1

9

Sep

-19

Oct

-19

No

v-1

9

Dec

-19

Jan

-20

Feb

-20

Mar

-20

Ap

r-2

0

Rate of Patient Falls per 1000 bed days

Threshold Rate


Page 4 of 26

What else needs to be done

Funding being sourced to purchase a supply of falls sensors for use across the trust where identified appropriate. Quotes have been received from an alternative supplier and discussions are ongoing to get optimal prices.

Development of robust, risk-based assessment process to identify which patients would benefit from use of falls sensors

Continuation of work with an independent IT company to explore the use of technology solutions for Falls assessments and interventions, Safe Steps– initial meetings are taking place to explore the needs of the trust and what they are able to offer to support this. Initial conversations began w/c 04/05/2020 with follow up meeting with interested parties to be arranged.

Closer work with therapy teams Trust wide to identify work patterns together to positively impact on falls rates.

E-learning and face to face packages for falls management to be explored and options identified following initial approval from Chief Nurse

Actions paused due advent of COVID-19 crisis include:

Work with communication team to produce visual falls prevention campaign for staff, patients and relatives

Trajectory for improvement

Performance metrics and targets for 2020/21 are currently under review


Page 5 of 26

Hospital Acquired Pressure Ulcers/Moisture Lesions **Rate per 1000 bed days

No. incidents 13

Apr 2020

No. incidents 13

YTD

Lead: Vanessa Saunders – Deputy Chief Nurse

Category 3+ 0 Category 3+ 0 Executive: Camilla Wiley - Chief Nurse

Rate Cat 2+ 1.2 Rate Cat 2+ 1.2

Rate Threshold 1.0 Rate Threshold 1.0

Analysis of data

The total number of pressure ulcers and moisture lesions decreased marginally in April 2020 to 13, compared to 15 in March 2020

The rate on pressure ulcers category 2 + was 1.2 per 1000 bed days which is above the threshold limit of 1.0 incidents per 1000 bed days.

There were no Hospital Acquired Category 3, 4 but there was 1 Unstageable pressure ulcer in April 2020.


Matron IPADS are enabled to photograph pressure ulcers as integral part of assessment and evaluation. Next step is to enable uploading of images to HCR.

Process to alert Matrons re Category 3, 4 and unstageable pressure ulcers implemented in January, with expectation of same day review and update of report where indicated.

Band 6 TVN is now in place (part time), and a bank band 7 TVN continues to support the

service.

Recruitment is ongoing into the band 7 role – with further funding agreed to increase the

service and offer further support to the hospital.



Hospital Acquired Pressure Ulcers/Moisture Lesions

No. HPAU/Moisture Lesionsincidents 41 14 15 13 13 N/A Within control limit

Rate of HPAU/Moisture Lesions incidents (1000 bed

daysCat 2+)1.4 0.6 1.3 1.2 1.2 1

No. Category 2 pressure ulcers 19 8 15 9 9 N/A Within control limit

No. Category 3 & 4 pressure ulcers 1 0 0 0 0 N/A

No. Unstageable pressure ulcers 1 1 0 1 1 N/A


Page 6 of 26


Band 7 TVN’s to be recruited.

The service will run at an increased capacity once in post, enabling comprehensive improvement programme to be driven in 2020/21

Progression of training and education programme commenced in 2019/20

Identification of an e-learning programme and review of statutory and mandatory training requirements for tissue viability

Implementation of learning from RCAs

Ongoing need to review air mattress use, ensuring that these are reviewed regularly.

Review of the referral process to ensure the TVN service receive effective referrals to allow prioritisation of workload

Explore the option of a trial of SEM scanners (handheld electronic devices which help to identify the risk of pressure ulcers) – procurement are liaising with the team to investigate the viability of a trial. Trial locations to include an area with Covid-19 positive patients and a rehabilitation area

Explore the option of a wound mapping device to be trialled by the TVN team for complex wound management once the app has approval by the IT department

Exploring information sharing between our inpatient TVN service and the community TVN service to improve working patterns.


Performance metrics and targets for 2020/21 are currently under review


Page 7 of 26

MRSA No. 0 Apr 2020

No.

YTD

Lead: Glenda Shadford – Lead Nurse Infection, Prevention & Control

Threshold 0 Threshold 0 Executive: Camilla Wiley - Chief Nurse

Indicator Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD

20/21 Target unavoidable

MRSA (trust attributed) 0 0

MRSA (Bacteraemia): There have been zero MRSA BSI cases for April 2020, the threshold remains zero avoidable. The Trust reported one MRSA BSI for the year 2019/20.


A vascular access / OPAT CNS nurse visited the Trust upon request on 10 February 2020 to review current line management across the Trust with regards to VIP and PICC line care a summary of findings was received


● Task and finish (T&F) group planned March 2020 to address lack of guidance for the care and management of intravascular lines. This has been delayed due to COVID-19

● The VIP tool requires updating as part of work for T&F group, ● Re-establish MRSA screening surveillance through informatics support whilst awaiting ICnet (earliest June 2020) ● MRSA discharge letter produced to be used for patients discharged with a positive MRSA screen- currently under review by Infection Control Doctor.


Zero MRSA Bloodstream Infections in the financial year 2020/21.


Page 8 of 26

Clostridium difficile Cases HOHA/COHA

0

Apr 2020

Lapses in care

0

YTD


Threshold HOHA/COHA

0 Executive: Camilla Wiley - Chief Nurse

Indicator Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD

20/21 Ceiling target

C.diff cases HOHA (Hospital onset hospital acquired) 2 0 0 0 0 *

C.diff cases COHA (Community onset hospital acquired) 0 0 1 0 0 *

Overall Total YTD 0

Overall Total YTD 20/21

C. diff lapses in care 0 0 0 0

* awaiting threshold for 2020/21

Analysis of data

Clostridium difficile (C.diff) cases: There were zero cases (HOHA & COHA) of Clostridium difficile attributed to the Trust for the month of April 2020, this is much improved when compared with April 2019 when five cases where reported. In addition, there were no further HOHA cases in February and March, as a result the Trust recovered from an escalation in cases earlier in the year. The Trust closed the year 2019/20 on the threshold of 24 HOHA and 7 COHA totalling 31 cases. In previous years, the CCG have actively monitored all C. diff cases to identify any ‘Lapses in care’ however during 2019/20 this has ceased. The Trust however continues to undertake Root Cause Analysis (RCA) investigations which are still being shared with CCG for transparency and learning for assurance. If any lapses in care /learning is identified this is addressed through robust action plans which are also recorded on GiveMeData to ensure follow up and closure. The majority of lapses in care for 2019/20 included poor antimicrobial prescribing, lack of antimicrobial documentation, poor hand hygiene and poor environmental cleaning audit (QQA) all of which had improvement action plans in place and have now been closed.


Actions taken: ● Weekly C. difficile/antimicrobial ward rounds continued with a review of all C. difficile toxin and C difficile PCR positive in-patients being seen – when required. This

includes re-admitted previous positive cases. This action has been successful and will continue into 2020/21. ● Several antimicrobial guidelines were revised and ratified during 2019/20 and appear to be working. ● ‘Smarten and Clean’ programme was successful in the planning of the decant ward which was on site as planned by end of March. The plan is the Trust will now have

decant capacity to enable deep cleans and repairs to the aging Estate. Progress needs to be made and shared as to the use of this facility. ● The review of cleaning provision and need for increase in some areas has been agreed in principle and funding is planned to start from April 2020- awaiting

confirmation this is going ahead. ● UVL procured


Page 9 of 26

What else needs to be done?

● Compliance to the revised Isolation Policy needs to be audited Trust Wide- was planned for March but however was delayed due to the fast-moving Coronavirus situation and other priorities superseding it – planned for w/c 18 May 2020.

● Review, agree, and finalise Bowel Management Chart. ● Finalise quality contract performance with the CCG for 2020/21.


There continues to be an inherent aspirational target to keep the number of C difficile cases below the objectives set out by the NHSE/I. The Trust is considering the quality contract performance criteria for 2020/21 with the CCG which remains outstanding due to the COVID19 pandemic.


Page 10 of 26

E.coli Blood stream infections (BSIs) Infections 0*

Apr 2020

Infections 0*

YTD


Threshold N/A Threshold N/A Executive: Camilla Wiley - Chief Nurse

Indicator Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD 20/21

E. Coli 0* 0

*Data not yet reconciled

Analysis of data

E.coli Bloodstream infections (BSIs) – No threshold set but the Trust continue to aspire to reach a 50% reduction in gram-negative BSIs by 2020/21. There were zero Trust attributed E.coli BSI cases for April 2020. The Trust reported 24 cases of E. coli BSI in 2019/20. This halted an annual increase in numbers when compared to previous years furthermore reflecting a 32% reduction when compared to 35 cases for the same period in 2018/19. The CCG have reported 202 cases for the same period, showing an 8% increase when compared to the same period in 2018/19. Source of: THH IP&C Data


The Gram-negative BSI working group was put on hold whilst the Trust awaited the CCG plans on improving a whole system approach strategy to achieve this ambitious reduction; this has not progressed during 2019/20. Needs to be re-established in 2020/21.


● Development of guidelines for the insertion and management of intravenous lines which includes care plans, following recommendations from Vascular access Nurse (see MRSA).

● Perform Post Infection Reviews of all Trust attributed GNBSI. ● Await CCG to arrange and attend whole system approach meetings. ● IPCT to undertake a roadshow to share updates from the revised Blood Culture Protocol.

Education and Training to incorporate Blood culture taking training into phlebotomy and other teachings incorporating ANTT.


Achieve a 10% reduction from 2019/2020.


Page 11 of 26

Complaints Performance %

37 Apr 2020

Performance % 37

YTD

Lead: Lynne Simpson – Complaints Manager

Target 85% Target 85% Executive: Camilla Wiley - Chief Nurse

Complaint theme (Top 5) 2020/21

Communication/ Information to Patients 4

Clinical Care Nursing Staff 3

Clinical Care Medical Staff 3

Discharge 3

Attitude (Medical Staff) 1

Complaint theme (Top 5) 2019/20



Clinical Care Nursing Staff 74

Attitude (Medical Staff) 54

Attitude (Nursing Staff) 50

Analysis of data

Performance

The Complaints Management Unit (CMU) went into the new financial year with eight breaches

from December 2019 and March 2020. Five of these have since been closed but three remain

outstanding.

Incoming complaints were significantly down (presumably because of reduced activity with Covid-

19) but the number due for response was at its highest level in five years.

Key indicators for April 2020 are shown below:

There were seven new complaints received in April 2020

All complaints received were acknowledged within three working days

There were 46 complaints due for response in April 2020. Almost half of these sat within

Medicine and 41% within Surgery.

37% compliance was achieved for response within the agreed timeframe. Divisional

performance was widely different.

Eight complaints have breached and a further 21 are still open. The target for performance

is 85%.

No complaints triggered duty of candour investigations in April 2020 but two were reopened.



Patient experience

Complaints received 17 46 23 7

% Compliant performance 85.7 50 60 37 85

Reopened complaints 1 1 0 1 N/A


Page 12 of 26

Themes

With only seven complaints received in the month, it would be unwise to draw any particular

conclusions from such a small data sample.

Ombudsman investigations

PHSO has paused its work on health investigations and is not accepting new cases or progressing

existing ones. This is to relieve pressure on the NHS as it deals with the pandemic.


The coronavirus pandemic has impacted on staff being available to investigate complaints and this

has been most problematic in the Division of Medicine. At the end of April, a nurse who is not

currently able to work clinically has been undertaking complaint investigations for the division. A

former employee is also assisting with investigations on alternate weeks. Their focus is on

complaints that have not breached.

The Complaints Manager met with the new Lead Nurse in the ED and went through all outstanding

ED complaints, discussing what is still required. Further information is awaited from the division on

who has been assigned as lead investigator on AMU and ward-based complaints. 27 complaints

remain open for Medicine.

The Complaints Manager continues to have discussions with the Surgery Divisional Director, who is

managing the division’s complaints, based on the weekly hotlist. Only four complaints remain open

for Surgery.

One member of staff in CMU is shielding for 12 weeks.


The end to end review of complaints was not undertaken in March due to the Coronavirus

pandemic and will be rescheduled with the deputy chief nurse, Head of PPE, divisional staff

from Medicine, Surgery, CMU and PALS. The purpose of the meeting will be to map the


Page 13 of 26

current process, identify bottle necks and agree, if possible, solutions to address these.

Medicine process review to be completed to remove dependence on one or two people to

manage everything.

Divisional teams need to ensure a lead investigator is assigned to each complaint and

advise CMU accordingly.

GiveMeData logins and training need to be rolled out across the Trust


2020 to 2021 – to achieve 85%


Page 14 of 26

PALS Contacts 50

Apr 2020

Contacts 50

YTD

Lead: Sally Taylor – PALS Manager

Concerns 43 Concerns 43

Threshold N/A Threshold N/A Executive: Camilla Wiley - Chief Nurse

PALS Top 5 Themes 2020/21


Patients Property 9

Information (Internal) 6

Discharge 4

Compliments 3

PALS Top 5 Themes 2019/20

Appointments (OPD&A&E) 509


Admissions 98


Information (Internal) 53

Analysis of data

In April 2020 PALS received 43 negative contacts which demonstrated the continuing trend of a decrease of 45 contacts from the previous month which may be attributed to reduced activity due to the Covid-19 outbreak. In comparison to the same period last year, April 2019, there were 80 negative concerns. The top two themes for this time period were 17 contacts recorded for “Communication/Information to patients” and 23 contacts recorded for “Appointments”. The current situation within the hospital of outpatient appointments being deferred and decreased activity within A & E for non Covid patients has had an impact on the top five themes. In April 2020 the top theme remained as Communication/Information to patients with 14 contacts recorded but patient property became the second top theme with PALS having received concerns from relatives chasing for lost/missing items. PALS have been working closely with the Bereavement Office and have been in receipt of e-mails from companies offering PPE, donations and kind offers of support which have been forwarded on appropriately. PALS work closely with relevant operational staff to answer patients concerns and seek resolution informally and promptly, where possible preventing a formal complaint from being logged. From the 43 concerns only 5 were referred on to the Complaints Management Unit and this hopefully demonstrates the positive impact of the PALS Service. The majority of PALS concerns are very individual and when resolved they do not require a change in practice.

PALS activity is reported to the Patient Experience and Engagement Group a well- attended group with representation from all divisions, public governors, and lay members which is held on a bi-monthly basis. This activity has currently been put on hold.



PALS contacts 122 160 99 50

PALS concerns 113 150 88 43 N/A


Page 15 of 26

Friends and Family Test

Lead: Catherine Holly - Head of Patient and Public Engagement

Executive: Camilla Wiley - Chief Nurse

Indicator Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 YTD 20/21 Target

Patient experience

A&E

% Response rate 11 13 N/A 20

% Recommended 74 78 N/A 96

Inpatient



Maternity All



Outpatients



Analysis of data

NHS England and Improvement has provided the following high-level advice about reducing burden and releasing capacity to manage the COVID-19 pandemic: During March 2019 the Trust received notification from NHS England and Improvement to stop carrying out the Friends and Family Test and that there would be a temporary suspension of submission of FFT data to NHS England until further notice. In addition, there will not be a need to keep a count of responses collected during the suspension. There will be no penalties for not complying with any part of the FFT guidance during this period. The measures are intended to allow for staff resources to be diverted towards more immediate priorities during the COVID-19 pandemic. It remains as important as ever to continue listening to patients and enabling them to raise concerns about the services they are using. Patients may still want to give feedback about their experience, and it is important they still have this opportunity. FFT could still be a route for them to do this, as can PALS, or other collections that may be ongoing at this time but you should avoid any methods that have a risk of infection such as feedback cards or tablets. Any feedback collected may be useful locally, but there will be no national submission until further advice is published later in the year.


Page 16 of 26

Overall summary of FFT for 2019/20 Inpatients, Outpatients and Maternity achieved their response targets; Inpatients and Maternity achieved their 96% target for % recommended while outpatients fell just below % recommended throughout the year. A&E unfortunately ended the year at 13% response rate which is below the 20% response target set. It also fell well below the 96% target achieving only 81% recommending the service. Prior to the introduction of SMS texting A&E was achieving their 96% recommending the service but only had a response rate of 6%. This would indicate that while the introduction of SMS texting has more than doubled the response rate, it is providing a more honest representation of service delivery and patient satisfaction. THH FT comparison to London Trusts – November 2019 (most recently published data)

A&E London Trusts (average)% THH %

Positive recommendation % 83 74

Response rate 15 11

Inpatients


Response rate 28 37

Maternity touchpoint 2 (Labour)


Response rate 65 72

Outpatients


Response rate 9 7


Introduction of SMS texting

A&E – The increase in response rate has resulted in the A&E and Minor Injuries Unit receiving a larger amount of qualitative feedback which will help managers to understand what is working well and what needs to be improved. All comments are provided to the senior managers in A&E and Minor Injuries for dissemination and discussion with departmental staff.

A&E response rate has improved since the introduction of SMS texting. The number of responses however show that a large number of patients who receive a text failed to respond. Minor Injuries continue to give out paper surveys which helps maintain a response rate of 11% overall.


Page 17 of 26

Outpatients – All radiology patients receive a text message within 48 hours of their appointment which has contributed to an improved response rate.

Each area has been asked to continue to offer paper surveys to patients as not all patients will have a mobile phone or wish to use technology to complete a survey.


Later in the year when NHS England and Improvement give instruction to restart submission of FFT data, the Head of Patient and Public Engagement Trust will roll out the new process for capturing FFT feedback. The following is a summary of the key changes:

Mandatory question for all surveys Thinking about (x setting) overall, how was your experience of our service. There will be six possible responses: very good, good, neither good or poor, poor, very poor and don't know.

Changes to recommended free-text question Providers are still required to include at least one free text question alongside the standard fixed question and can choose locally what question or questions to ask. There is opportunity for additional questions but not too many.

Response rates Response rates are no longer possible because there is no limit on how often or when a patient or service user can give feedback. Response rates will no longer be calculated or published. Providers will be still required to submit monthly numerical FFT data for national publication based on the six response categories.

Changes to timing requirements In all settings, patients should be able to use the FFT to give feedback when they want to i.e. during admission or after discharge. Antenatal patients will be offered the opportunity to provide feedback at any time during their antenatal care. It is recommended that providers wait until two weeks after childbirth before collecting feedback about childbirth itself.


To achieve targets during 2020/21


Page 18 of 26

Discharge Summaries

Actual 112

833 ↓

279 <->

2020/21

2019/20

2018/19

Lead: Nikki Jackson, Divisional Director

for Women & Children

Threshold Executive: Cathy Cale – Medical Director

Analysis of data

There has not been a consistent improvement in the backlog for 2019/20 or the

% timely completion. Completion within 24 hours of discharge remains at 4%

below target, and within 7 days 10% below target. Despite the work done, this

has not significantly improved since May 2019.


The discharge summary improvement group has not been effective in driving

improvement.


A proactive system needs to be in place within each division to ensure that completion is actively driven, at service level. Divisional management teams have been engaged in developing this. The improvement work stream in this area is being revisited and refreshed in May 2020.



Discharge summaries not issued

2020/21 (cumulative) 112 112

2019/20 (cumulative) 869 974 947 833 833

2018/19 (cumulative) 281 281 280 279 279

Within 24 hours (post discharge) 84.10 86.00 83.40 74.70 90

Within 7 days 90.50 91.40 83.40 84.80 100

112

869 974 947

833

0

200

400

600

800

1000

1200

Jan

Feb

Mar

Ap

r

No

. su

mm

arie

s n

ot

issu

ed

(C

um

ula

tive

)

Month

Discharge Summaries - Not Issued Monthly Cummulative Trend

2020/21 2019/20 2018/19


Page 19 of 26


The Discharge Summary Improvement Group will oversee continuous

improvement and embedding of processes.

84.10 86.00 83.40 74.70

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

Jan

Feb

Mar

Ap

r

% issued within 24 hours

Within 24 hours Target

90.50 91.40

83.40 84.80

40.00

50.00

60.00

70.00

80.00

90.00

100.00

Jan

Feb

Mar

Ap

r

% Issued within 7 days

Within 7 days Target


Page 20 of 26

Patient Safety Incidents (PSI) **Rate per 1000 bed days

No. PSI incidents 282

Apr 2020

No. PSI incidents 282

YTD

Lead: Vikas Sharma – Assistant Director of Integrated Governance

PSI Reporting Rate 45 PSI Reporting Rate 45 Executive: Cathy Cale - Medical Director

PSI Reporting Threshold

>=35 PSI Reporting Threshold >=35

Overdue (all incidents)

FY 2020/21 (1.29%)

Overdue (all incidents)

FY 2019/2020 641 (9.49%)

YTD

Analysis of data

The total number of patient safety incident reported has reduced considerable in light of COVID-19, however the rate on incidents has remained above the Trust target of >=35 @ 45 incidents per 1000 bed days compared to 39 incidents per 1000 bed days in Apr 2019.

6 Patient safety incidents were graded as moderate and above harm in April 2020

3 of the 6 incidents have been declared a serious incident. One occurred on 30/04/2020 and was therefore reported to the CCG in May.

2 of the 6 incidents has been declared an internal investigation.

1 of the 6 incidents is undergoing a local Datix investigation.



Patient Safety Incidents

Patient Safety Incidents 624 641 440 282N/A

Below lower control

limit

Reporting rate of patient safety incidents (KH03) 50 57 43 45 >=35

No. patient safety incidents graded Moderate + 13 7 9 6 N/A Within control limit

Rate of patient safety incidents graded Moderate + 1.0 0.6 0.9 1.0 <3.5

47 45 39 39 39 41

47 44

51 49 50

43

50 57

43 45

0

10

20

30

40

50

60

Jan

-19

Feb

-19

Mar

-19

Ap

r-1

9

May

-19

Jun

-19

Jul-

19

Au

g-1

9

Sep

-19

Oct

-19

No

v-1

9

Dec

-19

Jan

-20

Feb

-20

Mar

-20

Ap

r-2

0

Reporting rate of Patient Safety Incidents

Reporting rate of patient safety incidents Min Threshold


Page 21 of 26


Overdue Incidents (Incidents reported before 31st March 2020 @ 7th May 2020

Open Incidents by Division Total

Medicine 367

Other/Corporate Services 70

CCSS 0

WC 73

Surgery 94

Grand Total 673

ED 107

Overdue Incidents FY 2020/21 @ 7h May 2020

Open Incidents by Division Greater 14

days

% All incidents overdue

Medicine 77 1.58

WC 32 1.32

CCSS 3 0.33

Surgery 10 0.72

Other/Corporate Services 8 2.12

Grand Total 130 1.29

ED 26 1.58

The Trust Incident policy sets a threshold for overdue incidents at < 10% which is monitored via Divisional Governance boards and the Patient Safety Committee. All Division are within the Threshold. The Patient Safety team will continue to support the divisions. Incident managers receive a bi-weekly email reminder from the Datix system alerting of any


Page 22 of 26

overdue incidents for action. Monthly Divisional Governance reports provide visibility on overdue incident position by number, location and allocated manager.


Overdue Incidents Divisions to continue monitoring and ensure accountability when this indicator is at risk. Governance systems team and Patient safety team are continuing to work with the Ward Managers to ensure that the incident management can be shared within teams, instead of a single allocated manager per area (All areas already have multiple Datix trained incident managers).


Overdue Incidents The 30 day threshold for incident has been reduced to 14 calendar days which went into effect from 1st November 2019. Serious incidents 60 working days (no change) and internal investigations 30 working days (previously Duty of Candour Incident Investigations 45 working days) timelines for these incidents will not form part of this indicator and will follow their own timelines.


Page 23 of 26

Serious Incidents and Never Events (NE)

No. SIs Incl. NE

2

Apr 2020

No. SIs Incl. NE

0

YTD

Lead: Vikas Sharma – Assistant Director of Integrated Governance

NE 0 NE 0 Executive: Cathy Cale – Medical Director

Performance % 100% NE Threshold 0

Overdue SIs 0

SIs Declared by Category Dec-19

Jan-20

Feb-20

Apr-20

2020/21 YTD

Pressure ulcer meeting SI criteria 4 1 2 0 0

Diagnostic incident including delay meeting SI criteria (including failure to act on test results)

0 0 1 0 0

Sub-optimal care of the deteriorating patient meeting SI criteria

0 0 1 1 1

Treatment delay meeting SI criteria 0 0 2 0 0

Slips/trips/falls meeting SI criteria 0 1 1 1 1

HCAI/Infection control incident meeting SI criteria

1 0 0 0 0

Maternity/Obstetric incident meeting SI criteria: baby only (this include foetus. neonate and infant)

0 0 0 0 0

Maternity/Obstetric incident meeting SI criteria: mother and baby (this include foetus. neonate and infant)

0 1 0 0 0

Analysis of data

2 Serious incidents were declared for April 2020. 1 serious incident was reported for a fall with fracture 1 serious incident was reported for the suboptimal care of a deteriorating patient. Performance The Trust continued to achieve 100% compliance against the serious incident framework timeframe of 60 days. There is however more improvement required ensuring the timely implementation of actions and dissemination of learning. Backlog/overdue SIs There are no overdue serious incidents. Themes There were 2 thematic reviews carried out for 2019/20: -Delayed diagnosis of cancer serious incidents - Deteriorating patient serious incidents There are currently no thematic reviews scheduled for 2020/21




Serious Incidents and Never Events

SIs declared (reported to StEIS) 3 7 0 2 N/A

Never events 0 0 0 0 N/A

SI performance 100 100 100 100 N/A


Page 24 of 26

Medication incident meeting SI criteria 0 0 0 0 0

Operation/treatment given without valid consent

0 0 0 0 0

Surgical/invasive procedure incident meeting SI criteria

0 0 0 0 0

Maternity/Obstetric incident meeting SI criteria: mother only

0 0 0 0 0

Grand Total 5 3 7 2 2

Daily review of moderate and above incidents is now embedded into practice within the Patient Safety team. These are reviewed, cleansed and sent daily (with audit trail) to the Chief Nurse and Medical Director to prompt early escalation and instigate action.

Email reminders and hotlist of SIs sent to investigating officers, Divisional leads, and line managers.

Weekly SI review meetings with Divisional leads

Weekly SI scope meeting with the Medical Director and Divisional Directors to agree the terms of reference for each case and confirm the duty of candour details.

The revised SI process has been implemented.

Monthly learning summits in place.

Monthly HILHS newsletters to share learning from serious incidents. Backlog of serious incidents cleared.

Revised Incident and SI Policy to reflect and changes in process has been ratified,

published and disseminated to staff.

Serious incident investigator training booked for 28/05/2020 and 12/11/2020 to

increase the pool of lead investigators.


Focus on improving the quality of reports first time.

Focus on strengthening action plans and embedding them within the Trust.

Implement a structured and effective process of disseminating and sharing the learning.

Focus on closing the backlog of overdue actions from Sis.


The aim is to continue to achieve 100% compliance against the 60 working day timeframe or agreed extension.

Completion of overdue action plans. The Divisions have been instructed to provide a trajectory date for completion of all overdue actions


Page 25 of 26

Medication Safety

No. Incidents 28

Apr 2020

Lead: Andrew Caunce – Chief Pharmacist ** Reconciliation rate % N/A

Reconciliation threshold >70

** Omitted dose % N/A Executive: Cathy Cale – Medical Director

Omitted dose threshold <18

Analysis of data

Due to the ongoing COVID-19 pandemic medication safety data is currently suspended as this is collected manually on wards.


A task and finish group has been set up to discuss omitted doses with ward managers, MSO and lead nurse quality and clinical standards.


Electronic Prescribing and Medicines Administration (EPMA) – national funding has been secured to implement jointly with London North West Healthcare NHS Trust.

Consistent spot checks by ward managers/matrons continue.

Review of all drug charts before each shift change by nurses.


Medicines reconciliation rate and omitted doses is in line with national benchmarks and the Trust target.



Medication Safety

No. medication incidents 81 83 52 28 N/AApproaching lower

control limit

** % medicines reconciliation started within 24

hours of admission70.7 77.4 >70

** % omitted dose in the last 24 hours 13.7 13.6 <18

53

66 75

101

62

76

62

90 86 82 86

56

28

0

20

40

60

80

100

120

140

Ap

r 2

019

May

20

19

Jun

20

19

Jul 2

01

9

Au

g 2

019

Sep

20

19

Oct

201

9

No

v 2

01

9

Dec

20

19

Jan

20

20

Feb

20

20

Mar

20

20

Ap

r 2

020

SPC: Medication Incidents

Data

Mean


Page 26 of 26

Mortality Lead: Emma Babski – Patient Safety and Clinical Risk Manager

Executive: Cathy Cale – Medical Director

COVID-19: The Trust has been reviewing absolute numbers of deaths that are COVID-19 related. There are no published methodologies to derive Trust level data on crude or adjusted mortality from COVID-19. This is being addressed within NWL via ICHP.

Mortality figures continue to be reviewed at the monthly Mortality Surveillance Group.

Outlier procedure reviews to be completed as required


Core Skills Training Compliance

• Core Skills compliance decreased for the third consecutive month to 93.0% (-1.3%) reducing overall performance to

the average level for past 9 months. All courses continue to remain within their respective targets except DSP which

has reduced further to 91.0% from a target of 95%.

• CCSS maintain the highest compliance rate at 97.4% (-0.1%), followed by W&Cs directorate at 94.7% (-0.3%).

• Surgery and Corporate services experienced the greatest reductions in compliance at -1.3% to 92.3% (Surgery) and

-4.1% to 90.8% (Corporate).

• Medicine division reduced compliance by -0.3% to 90.5% with 3 subjects under target; DSP 89.7%, IPC L.2 88.3%

and SGC L3 78.5%. .

• The Medical staff group remains the lowest of the staff groups at 89.4% (-0.2%) with 3 subjects non-compliant; DSP

(87.1%), IPC L.2 (88.4%) and M&H L.2 (64.0%). Trust Board meeting: 26 May 2020 Page 57 of 130

Core Skills Training Compliance

Course Clinical Support Services Division

Medicine Division

Surgery Division

Women's & Children's Division Corporate Services Temporary Staffing Grand Total

Adult Basic Life Support Level 1 [Once Only], 80% target 100.0% 99.0% 97.5% 100.0% 98.2% 93.6% 98.1%

Adult Basic Life Support Level 2 [1 Year], 80% target 91.5% 81.2% 86.3% 86.1% 82.4% 91.4% 85.9%

Blood & Blood - Transport Only [1 Year], 80% target #DIV/0! #DIV/0! #DIV/0! #DIV/0! 100.0% #DIV/0! 100.0%

Blood & Blood [2 Years], 80% target 91.8% 89.2% 92.2% 93.7% 85.9% 93.1% 91.2%

Conflict Resolution [3 Years], 80% target 98.4% 94.0% 95.9% 97.0% 93.1% 95.1% 95.4%

Data Security & Protection [1 Year], 95% target 97.0% 89.7% 90.3% 93.4% 85.7% 91.9% 91.0%

Equality & Diversity [3 Years], 80% target 98.6% 94.7% 96.4% 98.1% 93.5% 95.7% 95.9%

Fire Safety Level 1 [1 Year], 80% target 97.3% 82.4% 81.1% 84.9% 84.8% 89.8% 85.7%

Fire Safety Level 2 [1 Year], 80% target 90.0% 81.6% 87.1% 84.8% 71.1% 89.0% 85.1%

Health, Safety & Welfare [3 Years], 80% target 99.1% 93.4% 95.6% 97.0% 93.5% 95.9% 95.4%

Infection Control Level 1 [3 Years], 90% target 98.8% 96.7% 95.5% 100.0% 90.3% 93.3% 93.1%

Infection Control Level 2 [1 Year], 90% target 97.9% 88.3% 92.8% 93.1% 93.3% 93.8% 92.5%

Moving & Handling Level 1 [3 Years], 80% target 99.1% 87.0% 97.0% 92.9% 91.2% 93.4% 92.9%

Moving & Handling Level 2 [2 Years], 80% target 97.5% 90.0% 84.0% 94.3% 86.0% 93.2% 90.6%

Safeguarding Adults Level 1 [3 Years], 90% target 99.2% 93.7% 94.4% 97.5% 92.2% 95.3% 95.1%

Safeguarding Adults Level 2 [3 Years], 90% target 97.5% 93.0% 94.5% 97.0% 90.2% 96.4% 94.7%

Safeguarding Children Level 1 [3 Years], 90% target 98.3% 94.6% 94.9% 98.9% 91.3% 95.7% 95.3%



Safeguarding Children Level 4 [3 Years], 90% target #DIV/0! #DIV/0! #DIV/0! 100.0% #DIV/0! #DIV/0! 100.0%

Grand Total 97.4% 90.5% 92.3% 94.7% 90.8% 94.1% 93.0% Trust Board meeting: 26 May 2020 Page 58 of 130

Time to Recruit (non-medical)

• Time to recruit crept up to 35.7 (+0.3) working days for April as recruitment activity levels increased

to 71 starters (+18); 46 external and 25 internal.

• Three divisions exceeded the 33-day target; Corporate services (39.3 days) with lengthy

recruitments across all recruitment campaigns, Surgery (38 days) and Medicine (37 days).

• The remaining divisions were within target; CCSS at 32.7 and W&Cs at 31.9.

• Four of six staff groups were over target; AHPs at 42.8, Estates & Ancillary at 40.3, A&C at 36.8

and N&M at 35.6. Trust Board meeting: 26 May 2020 Page 59 of 130

Voluntary Turnover

• Voluntary turnover has continued to reduce throughout April to 12.2% (-1.1%) as is now the lowest level since August 2018.

• Statistically there has been a shift in past two months from sustained under performance (orange points on graph) to an improvement

that now exceeds the upper end of expected high performance.

• All clinical divisions reduced voluntary turnover during April; Surgery 8.8% (-1.4%), CCSS 15.2% (-1.3%), W&Cs 11.9% (-1.0%) and

Medicine 13.0% (-0.7%).

• Estates & Ancillary and Healthcare Scientists staff groups remained relative static at 6.6% and 7.3% respectively with reductions seen

in A&C staff 12.8% (-1.3%), AHPs 20.3% (-4%), Medical 7.6% (-1.5%) and N&M 13.1% (-1.4%). However a slight increase was seen

in Additional Clinical Services 14.6% (+0.2%) and a greater increase in Additional Professional Scientific & Technical staff at 14.3%

(+1.1%). Trust Board meeting: 26 May 2020 Page 60 of 130

Substantive Vacancies

• The April vacancy rate continues to improvement by reducing for the first time to within target at 9.9% (-1.7%) due to a reduction in

overall substantive budget from 3556fte to 3492fte (-64fte) coupled with an overall increase in staff-in-post numbers to 3148fte

(+4fte) helped by a steadily reducing voluntary turnover rate.

• Both Medicine and Surgery had notable decreases in vacancy levels with Medicine having the greatest reduction to 5.3% (-9.9%)

as large numbers of staff moved into the division, and Surgery at 10.1% (-1.1%) with a slightly lower intake of staff. W&Cs

increased to 7.6% (+2.1%) and CCSS by +0.6% to 10.7%.

• Corporate services continued to increase in April by +4.2% to 15.9% as Operational Services and Estates & Facilities had vacancy

increases.

• Of the staff groups N&M made the greatest improvement at 6.2% (-9.3%) with a vacancy level of 67fte. However Additional

Clinical Services increased to 14.4% (+4%) with vacancy FTEs increasing by over +20fte to 82.8fte. The remaining staff groups

were relatively static part from Estates & Ancillary staff increasing by almost +5% to 18.6%. Trust Board meeting: 26 May 2020 Page 61 of 130

Sickness Absence

• The effects of Covid-19 continue to be felt during April as the sickness absence level increased further to another highest level at

11.6% (+4.6). This unprecedented level has pushed the estimated cost of sickness to over £1m for the month for the first time with

over 10.8k fte days lost. The short-term/long-term split moves closer to a 50/50 split from the normal 2/3s long-term sickness.

• All areas have been heavily impacted by Covid-19 as absences have in many areas doubled since March. Facilities has increased

to 16.9% from 10.3% in March and 7.2% in Feb. Medicine and Surgery divisions were the most affected of the clinical areas with

Medicine increasing 15.0% (+8.2%) reaching 19.2% in the wards, and Surgery at 12.4% (+5.2%) easily exceeding 20% in Theatres.

• Of the remaining divisions W&Cs is at 8.2% (+1.4%) with CCSS at 8.0% (+1.6%) and Corporate at 11.7% (+4.0%).

• The staff groups have clear outliers in Additional Clinical Services at 16.8% following an increase of +8.3%, Estates & Ancillary at

16.4% increasing by +6.4% and Nursing & Midwifery at 14.6% (+7.3%), all doubling sickness levels from last month. However the

Medical and Dental staff group appears to have remained relatively unaffected, in fact sickness reduced by -0.2% to 3.3% for April. Trust Board meeting: 26 May 2020 Page 62 of 130

Agency Spend

• April saw a further reduction in agency spend by -£211k to £556,886k.

• Divisional spend:

– Medicine, £169.570 (-£235.4k)

– Corporate, £150,462 (+£55.4k)

– Surgery, £121,702 (-£1.2k)

– CCSS, £117,104 (+£7.1k)


Executive Summary: Operational standards (1/2)

2

Commentary A&E Emergency Department (ED) four hours’ wait: In April 2020 performance against the A&E performance was 81.0%. Performance for March 2020 was 81.5%. The national average in March 2020 was 84.2%, the London average was 84.7%. The total number of All Type attendance for April was 4937, which is 9053 patients less than April 2019. The reduction in attendance numbers is as a direct result of the impact of Covid 19.

RTT Performance continues to deteriorate in Month 1,this is expected as a result of the current Covid19 pandemic and may continue to deteriorate however we are seeing a reduction in the total waiting list size as result of referring back routine referrals as per sector and national guidance. Sector wide plans are being developed to recover performance

Cancer Performance has deteriorated in month 1 as a result of the Covid19 pandemic, this is likely to deteriorate as we are limited to what cancer activity can be currently undertaken.

DM01 Performance has significantly deteriorated in Month 1, however this is expected as a result of the current Covid19 pandemic and may continue to deteriorate as there is no routine diagnostic work currently being undertaken however sector wide plans are being worked through.

Summary of performance against constitutional standards

Note: 1Cancer validation takes c 1 month so current month reported position is unvalidated and likely to be subject to change Conditional formatting indicates achievement of monthly target/ trajectory Source: I-Reporter; Planning Submission

Standard Target Feb-20 Mar-20 Apr-20

A&E Performance (All

Types)

Target: 95%

Trajectory: 81.9%82.0% 81.5% 81.0%

RTT PerformanceTarget: 92%

Trajectory: 86.9%66.0% 58.1% 47.2%

RTT Total Waiting List 25,052 34,756 31,536 25,525

Cancer 2 Week Wait

Performance93% 77.9% 82.2% 73.6%

Cancer 62 Day Treatment

Performance85% 71.7% 87.6% 60.3%

Diagnostics Performance 99% 98.71% 85.45% 34.61%


A&E Performance Executive Summary: Operational

standards (2/2)

3

Commentary There were 4937 All type attendances in April 2020. 2,858 of these attendances were type 1 activity. Attendances are 9053 patients less than April 2019. The reduction in attendance numbers is as a direct result of the impact of Covid 19. Patients with a length of stay of 7 days and over has reduced down to 83 (From our average of 173). This is due to several factors: seven day working with each patient have a review by a clinician on the weekend and therapy over the weekend, and accelerated discharge pathways. London Ambulance Service (LAS) handover There were 5 x 60 minute breaches reported in April, a decrease of 6 when compared to the previous month.

A&E Performance Overview

Note: Conditional formatting indicates achievement of monthly target/ trajectory Source: Informatics

Standard Plan: Apr-20 Feb-20 Mar-20 Apr-20

A&E Performance (All Types) 81.9% 82.0% 81.5% 81.0%

A&E Performance Trajectory

(All Types)n/a 90.7% 91.6% 81.9%

A&E Performance (Type 1) 54.9% 59.3% 59.3% 67.2%

A&E Attendances (All Types) 13,990 13,180 9,527 4,937

A&E Attendances (Type 1) 5,372 5,279 4,246 2,858

A&E Attendances Plan (Type

1)n/a 5,564 5,948 5,372

Ambulance Arrivals n/a 2,260 1,994 1,597

A&E Type 1 Admission Rate n/a 32.0% 33.4% 33.5%

A&E Decision To Admit

Delays - 4 hrsn/a 507 287 43

Stranded Patients 7+ Days n/a 187 109 83

DTOCs - Days Delayed n/a 140 n/a n/a

Ambulance Handover 60 min

Delaysn/a 11 11 5


A&E Performance- Type 1 split (2/7)

4

Commentary Admitted performance was 45.8%, which was an improved from the March position by 9%. The additional capacity and beds within the system has enabled flow for admitted patients to flow. Some of the challenges have been around critical care capacity and time to be seen by specialty in the Covid areas of ED. Non admitted performance was 77.8% - which is an improvement of 7% from the previous month, The ED teams have adapted quickly to the continuous changes of flow that have to occur to ensure we segregate Covid and non Covid patients.

Performance – Type 1 Admitted

Source: ED Trajectory v3; Integrated EC Performance Pack

Performance – Type 1 Non Admitted

45.8%

30%

35%

40%

45%

50%

55%

60%

65%

70%

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

2020/2021 2019/2020 Trajectory

77.8%

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%


2020/2021 2019/2020 Trajectory


A&E Attendances by Type (5/8)

5

Commentary There were 4937 All type attendances in April 2020. 2,858 of these attendances were type 1 activity. Attendances are 9053 patients less than April 2019. The reduction in attendance numbers is as a direct result of the impact of Covid 19.

Source: Informatics; Plan Submission

Attendances – All Types

Attendances – Type 1 Only

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

Ap

r

Ma

y

Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Ma

r

Ap

r

Ma

y

Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Ma

r

Ap

r

Ma

y

Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Ma

r

2018/2019 2019/2020 2020/2021

A&E Attendances (All Types) Plan

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Ap

r

Ma

y

Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Ma

r

Ap

r

Ma

y

Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Ma

r

Ap

r

Ma

y

Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Ma

r

2018/2019 2019/2020 2020/2021

A&E Attendances (Type 1) Plan


Discharge Improvement (7/7)

6

Commentary Delayed Transfers of Care: A new Discharge Co-ordination Centre set up at the on the second week of March 2020, as national mandated for management of discharges during the Covid outbreak, has seen a significant reduction in delayed transfers of care and in extend stay patients.

Long and Extended Stay Patients

Source: i-Reporter

Weekly Delayed Transfers of Care (DTOCs)

0

20

40

60

80

100

0

50

100

150

200

250

21

+ D

ays

7+

Da

ys

Stranded Patients 7+ Days Stranded Patients 21+ Days

0

2

4

6

8

10

12

14

0

10

20

30

40

50

60

70

80

Spe

lls

Da

ys D

ela

yed

DTOCs - Days Delayed DTOCs - Spells


RTT Performance Overview (1/2) Commentary This indicator remains a significant challenge for the Trust due to the Covid19 Pandemic and postponement of all routine elective activity. April saw a significant deterioration in performance, which does result from a reduction in new referrals and patients waiting over 18 weeks continue to rise whilst plans to restart elective activity are worked through.

Source: Infomatics

18 Weeks Performance and Trajectory

Over 18 Weeks

Actions taken since last meeting. Have they worked or is there a barrier to progress? Sector wide discussions are being developed around PTL management and elective recovery.

7

47.2%

0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


2020/2021

RTT Performance Trajectory Standard

13,469

25,525

0

5,000

10,000

15,000

20,000

25,000

30,000


2020/2021

18 Week Waiters 18 Week Trajectory Total Waiting List Total Waiting List Trajectory


RTT Performance Overview (2/2) Commentary Speciality performance has deteriorated as expected due to the covid19 pandemic and the need to reduce/postpone elective routine activity. T&O, Pain, Oral surgery, ENT, Allery and Neurology have been affected the most.

Note: Table cut to reflect nationally reported dataset; June data unvalidated Source: Informatics

RTT Incomplete and PTL by Service

18+ Week Waiters by Service

Actions taken since last meeting. Have they worked or is there a barrier to progress? Clinical reviews of all urgent and cancer activity completed. Divisions have completed an assessment of what activity can be completed virtually as well as what could be done at Mount Vernon. The Trust is working with the CCGs to set up advice and guidance ‘clearance’ hubs, which will be ready to implement once there is an agreement from the sector to restart routine activity.

8

What further actions are required? What is the trajectory for improvement? Sector wide response to recovery will help provide guidance on priorities, options and trajectories.

PTL Last

Period

PTL This

Period

RTT 52

Weeks

RTT 40

Weeks

RTT 18

WeeksDec-19 Jan-20 Feb-20 Mar-20 Apr-20

(110) Trauma & Orthopaedics 6,008 4,597 71 674 2,831 63.8% 59.6% 56.4% 50.1% 38.4%

(130) Ophthalmology 3,775 3,005 1 126 1,581 80.9% 75.8% 69.4% 61.0% 47.4%

(100) General Surgery 2,972 2,483 22 189 1,272 72.2% 70.4% 64.5% 60.0% 48.8%

(191) Pain Management 2,146 1,653 96 426 1,319 48.6% 46.5% 43.2% 38.5% 20.2%

(301) Gastroenterology 1,897 1,649 7 130 822 67.5% 65.0% 64.9% 58.1% 50.2%

(330) Dermatology 1,706 1,613 19 108 649 77.2% 72.2% 70.3% 68.6% 59.8%

Other 1,981 1,477 0 28 510 81.2% 78.4% 75.6% 73.2% 65.5%

(101) Urology 1,409 1,266 4 91 595 76.7% 71.3% 68.5% 61.5% 53.0%

(140) Oral Surgery 1,579 1,176 0 67 836 79.2% 74.2% 68.0% 50.3% 28.9%

(120) ENT 1,622 1,030 1 44 725 82.5% 79.4% 76.2% 46.5% 29.6%

(502) Gynaecology 1,295 994 0 1 241 93.7% 90.7% 88.1% 82.5% 75.8%

(420) Paediatrics 963 901 0 0 125 97.3% 94.1% 90.5% 92.1% 86.1%

(410) Rheumatology 906 808 0 16 419 63.7% 61.8% 60.4% 54.5% 48.1%

(320) Cardiology 999 807 0 1 265 81.7% 80.7% 76.8% 74.8% 67.2%

(400) Neurology 902 767 0 24 584 61.4% 49.9% 44.7% 32.7% 23.9%

(317) Allergy Service 532 544 10 146 402 42.6% 38.9% 37.3% 34.0% 26.1%

(340) Respiratory Medicine 534 435 0 2 129 86.6% 80.8% 78.0% 75.1% 70.3%

(257) Paediatric Dermatology 310 320 2 26 164 68.0% 62.9% 62.9% 58.7% 48.8%

Total 31,536 25,525 233 2,099 13,469 72.7% 69.2% 66.0% 58.1% 47.2%

(317) Allergy Service

(110) Trauma & Orthopaedics

(330) Dermatology

(100) General Surgery

(191) Pain Management

(301) Gastroenterology

Other


Cancer Performance (1/2) Commentary 2WW performance deteriorated further for the Trust due to the Covid19 Pandemic related delays both patient initiated and hospital initiated.

Note: Validation for Cancer lags 1 month so last reported period is unvalidated Source: NHS Digital Cancer Dataset (via internal Informatics team)

2 Week Wait Performance (all tumour sites)

Actions taken since last meeting. Have they worked or is there a barrier to progress? Tumour sites have now agreed their 2WW pathways and 2WW referral data and performance continues to be monitored through the Covid19 elective recovery board

9

What further actions are required? What is the trajectory for improvement? PTL meetings to restart with divisional representation to ensure patients are being fully tracked and progressed through pathways. Restart of some Endoscopy Cancer work will also help with diagnosis and then developing treatment plans.

2 Week Wait Performance by Tumour Site

937 950 944

11631057

968 1014 990 977 984910

794

329

0

200

400

600

800

1,000

1,200

1,400

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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

2019/2020 2020/2021

Tota

l See

n

Per

form

an

ce

Total Seen Performance Target

Jan-20 Feb-20 Mar-20 Apr-20 Jan-20 Feb-20 Mar-20 Apr-20

Suspected skin cancers 176 167 122 96 86.4% 91.0% 93.4% 37.5%

Suspected breast cancer 143 118 132 61 98.6% 98.3% 99.2% 95.1%

Suspected head and neck cancers 109 100 84 42 90.8% 73.0% 95.2% 90.5%

Suspected gynaecological cancers 85 107 82 41 98.8% 97.2% 100.0% 95.1%

Suspected urological cancers (excluding testicular) 63 66 63 20 90.5% 89.4% 87.3% 90.0%

Suspected upper gastrointestinal cancers 83 62 53 18 72.3% 87.1% 58.5% 83.3%

Suspected lower gastrointestinal cancers 234 207 173 17 64.1% 36.2% 49.1% 23.5%

Suspected lung cancer 51 23 38 13 76.5% 82.6% 86.8% 100.0%

Suspected children's cancer 13 23 19 7 100.0% 95.7% 78.9% 100.0%

Suspected haematological malignancies excluding acute leukaemia13 20 16 6 100.0% 100.0% 93.8% 100.0%

Suspected brain or central nervous system tumours 7 12 10 5 85.7% 91.7% 100.0% 100.0%

Suspected testicular cancer 7 5 2 3 100.0% 80.0% 100.0% 100.0%

Suspected sarcomas 0 0 0 0 - - - -

Other suspected cancer 0 0 0 0 - - - -

Total 984 910 794 329 83.4% 77.9% 82.2% 73.6%

Total Seen Performance


Cancer Performance (2/2) Commentary April data is unvalidated however April saw a significant deterioration in 62 day performance across most tumour sites resulting in the Trust achieving the 62 day performance indicator. This is expected to continue as the impact of Covid19 has meant a delay in cancer diagnostics as well as some cancer treatments.

Note: Validation for Cancer lags 1 month so last reported period is unvalidated Source: NHS Digital Cancer Dataset (via internal Informatics team)

62 Day Performance (all tumour sites)

Actions taken since last meeting. Have they worked or is there a barrier to progress? Cancer surgery being prioritised and sent to the RM partners Cancer hub for treatment. 2WW and Urgent Radiology diagnostics have continued. Some Cancer diagnostics have been sent to the Independent sector for completion.

10

What further actions are required? What is the trajectory for improvement? Restart of cancer endoscopy at Mount Vernon. Sector wide plans for recovery of cancer operating.

62 Day Performance by Tumour Site

50

38

55 54

47

55 5448

43

58 6057

32

0

10

20

30

40

50

60

70

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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

2019/2020 2020/2021

Tota

l See

n

Per

form

an

ce

Total Seen Performance Target


Lower Gastrointestinal 9 7 4 6.5 55.6% 57.1% 50.0% 0.0%

Skin 15 18 17 6 93.3% 94.4% 100.0% 100.0%

Breast 8.5 9 13 6 88.2% 77.8% 92.3% 83.3%

Haematological (Excluding Acute Leukaemia) 5 2 0 3 60.0% 100.0% - 66.7%

Upper Gastrointestinal 1.5 4 2 2 100.0% 25.0% 100.0% 50.0%

Urological (Excluding Testicular) 13 15 13 1.5 73.1% 50.0% 84.6% 66.7%

Gynaecological 3.5 2.5 3.5 1.5 100.0% 80.0% 42.9% 66.7%

Lung 0 2 1 1.5 - 100.0% 100.0% 100.0%

Head and Neck 1 0.5 2 0.5 100.0% 100.0% 100.0% 0.0%

Sarcoma 0.5 0 0 0 100.0% - - -

Brain/Central Nervous System 0 0 0 0 - - - -

Testicular 1 0 1 0 100.0% - 100.0% -

Head & Neck 0 0 0 0 - - - -

Other 0 0 0 0 - - - -

Total 58 60 56.5 31.5 80.2% 71.7% 87.6% 60.3%

Total Seen Performance


Diagnostics Performance (DMO1 Standards)

Commentary As a result of Covid19 most routine diagnostic activity has been postponed resulting in the reduction in performance. The largest deterioration has been in Endoscopy and Cardiology.

Note: Most recently reported month is non validated Source: Informatics Team

Diagnostics Performance against DMO1 Standard

11

Performance by Modality

Actions taken since last meeting. Have they worked or is there a barrier to progress? Diagnostic recovery is being reviewed and actions agreed at a sector level. Divisions are working through internal plans to feed into those discussions.

What further actions are required? What is the trajectory for improvement? Sector wide plan on recovery will help guide prioritisation and inform trajectories.

99.9%100.0%100.0%99.8% 99.8%100.0%98.8% 99.0% 98.5% 98.2% 98.7%

85.4%

34.6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ap

r

Ma

y

Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Ma

r

Ap

r

Ma

y

Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Ma

r

2019/2020 2020/2021

Diagnostics Performance Target


Audiology - Audiology Assessments 343 370 98 29 100.00% 100.00% 100.00% 100.00%

Barium Enema 30 29 0 7 100.00% 100.00% - 100.00%

Cardiology - echocardiography 179 358 366 385 96.65% 100.00% 78.42% 14.81%

Colonoscopy 369 418 345 318 100.00% 99.52% 91.88% 13.52%

Computed Tomography 415 402 67 60 99.76% 100.00% 98.51% 95.00%

Cystoscopy 99 115 128 101 70.71% 82.61% 62.50% 40.59%

Flexi Sigmoidoscopy 75 63 58 47 100.00% 100.00% 94.83% 10.64%

Gastroscopy 305 348 290 220 100.00% 97.41% 82.41% 11.36%

Magnetic Resonance Imaging 580 535 30 20 100.00% 100.00% 100.00% 95.00%

Non-obstetric ultrasound 3270 3184 204 184 98.90% 99.37% 100.00% 86.41%

Urodynamics - pressures & flows 81 70 70 62 64.20% 64.29% 55.71% 87.10%

Total 5746 5892 1656 1433 98.24% 98.71% 85.45% 34.61%

Total Waiting List Performance


Date Source & Update Summary

12

Source systems and data extract dates of the constitutional standards performance figures

DatasetSource

SystemUpdate Comment

A&E PASReport data was updated on 07/05/2020. Data was extracted from

PAS on 06/05/2020.

RTT PASReport data was updated on 07/05/2020. The 30/04/2020 waiting

list snapshot was taken on 07/05/2020.

Open Exeter The latest published Open Exeter data available is for Mar-2020

SomersetReport data was updated on 07/05/2020. Data was extracted from

Somerset on 06/05/2020.

Diagnostics PASReport data was updated on 07/05/2020. The 30/04/2020 waiting

list snapshot was taken on 01/05/2020.

Cancer


1


Title Serious Incident Summary Report

Report author Emma Babski – Patient Safety and Clinical Risk Manager

Report sponsor Cathy Cale – Medical Director


x ☐ ☐


☐ x ☐

Summary

This is a Serious Incidents (SIs) reporting, investigation and learning and performance report which provides an overview of SIs (including never events) reported by the Trust for the period of 1st April 2020 – 30th April 2020

Recommendations

The QSC are asked to: • Note the Trust has achieved 100% compliance against the SI

framework and 60 working day timescale October 2019 - April 2020

• Note the ward governance training programme being developed • Note the 8th Hillingdon Hospitals Learning and Safety Bulletin

(Appendix 1)


Quality - We will deliver good care every day Workforce - We want empowered, committed people with the right skills and attitude Performance - We will deliver the right care at the right time for our patients


Legal

Financial

Human Resources

Equality and Diversity

Engagement and communication

Sustainability


2

Serious Incidents Summary Report

1. Introduction This is a Serious Incidents (SIs) reporting, investigation, learning and performance report which provides an overview of SIs (including never events) reported by the Trust for the period 1st April 2020 – 30th April 2020. 2. Serious Incident reporting The table below provides information on the numbers of SIs reported onto the Strategic Executive Information System (StEIS) by financial year (FY). Indicator 2018/19 2019/20 2020/21 All Serious incidents 76 75 2 Never Events (included with all serious incidents figure above)

3 1 0


3

2 SIs were declared in April 2020 compared to 5 reported in the same time period in 2019. All SI’s were reported onto STEIS within 2 working days. Performance against the 2 working day timeframe this FY 2020/21 is 100%.

The table below shows the type of incidents that have been declared in April 2020 and the themes of SIs declared in FY 2020/21.

Type of SI 2019/20 2020/21 YTD 04/2020 Sub-optimal care of the deteriorating patient meeting SI criteria 9 1 1 Treatment delay meeting SI criteria 9 Slips/trips/falls meeting SI criteria 10 1 1 Maternity/Obstetric incident meeting SI criteria: baby only (this include foetus, neonate and infant) 6

Surgical/invasive procedure incident meeting SI criteria 1 Diagnostic incident including delay meeting SI criteria (including failure to act on test results) 12

Pressure ulcer meeting SI criteria 17 Maternity/Obstetric incident meeting SI criteria: mother and baby (this include foetus, neonate and infant) 2

Maternity/Obstetric incident meeting SI criteria: mother only 0 Screening issues meeting SI criteria 0 Apparent/actual/suspected self-inflicted harm meeting SI criteria 0 HCAI/Infection control incident meeting SI criteria 6 Major incident/ emergency preparedness, resilience and response/ suspension of services 0

Medication incident meeting SI criteria 2 Operation/treatment given without valid consent 1 Total 75

3. Serious Incident investigation performance The chart below outlines the Trust performance and improvement trajectory. For April 2020, the Trusts performance was 100% for submitting serious incidents by the deadline date in comparison to 67 % performance for the same time period for 2019. Performance has shown significant improvement and continuity of consistently achieving 100% compliance with the submission deadline.


4

** Zero SIs were due in March 2020

4. Learning from SI investigations

4.1 SI action plans The table below highlights the current status of action plans.

There are currently 147 overdue actions; the Medical Director via the Patient Safety Group has instructed all divisions to provide a trajectory date for completion of all overdue actions. The overdue action are being monitored at the weekly SI review group (SIRG). The patient safety team are continuing to meet with action leads to support the timely closure and implementation of actions and updating the electronic record with evidence to support. The Trust records all SI action plans and improvements on the GiveMeData system which was launched in May 2019.

0 0

33

0 0

25 22 25

67 60 60

67 67 67

50 60

83.3 88.8 100 100 100 100 100 100

0

10

20

30

40

50

60

70

80

90

100Ap

r-18

May

-18

Jun-

18

Jul-1

8

Aug-

18

Sep-

18

Oct

-18

Nov

-18

Dec-

18

Jan-

19

Feb-

19

Mar

-19

Apr-

19

May

-19

Jun-

19

Jul-1

9

Aug-

19

Sep-

19

Oct

-19

Nov

-19

Dec-

19

Jan-

20

Feb-

20

Mar

-20

Apr-

20

SI Performance

Actual


5

To note since the systems inception in May 2019 legacy action plans which had not previously been tracked were uploaded onto the system. 684 actions were created between 1st May 2019 – 20th May 2020 and 472 (69%) actions were closed. Timely completion of action plans has shown limited improvement and further work is required to consolidate/triangulate similar actions and to ensure accountability. The progression and monitoring of SI action plans is now however visible and monitored via Divisional Governance meetings, the weekly SIRG, the Patient Safety Group and the Quality and Safety Committee. The table below highlights the number of Improvements recorded as a result of the SI process and implementation of actions between 1st May 2019 – 20th May 2020.

4.2 Sharing the learning from SIs

29 32

97

30 21

54

16

35

60

98

74 69 60 54

27 23 19

65 55

65

183

209

156

187

207

160 168 165

157 147

0

50

100

150

200

250

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

SI Action Plans

Closed Open in date Overdue


6

To support the sharing of learning from the investigations of SIs and Never Events across the Trust, a summary of each SI investigation report is circulated and discussed via Divisional Governance meetings, the Divisional Triumvirates and the Patient Safety Group. The seventh Safety Summit took place on 27th February 2020 and focused on the theme of following things through. 26 staff from across the Trust attended the summit and key learning points have been disseminated via the HiHLS bulletin.

The eighth monthly HiHLS bulletin was published in April 2020 to cascade learning across the Trust from incidents, SIs, complaints, claims, mortality reviews, patient safety alerts, clinical audit etc. A copy of the bulletin is provided in Appendix 2. The Safety Summits are currently on hold due to the Covid-19 pandemic however the Learning and Safety bulletin will continue to be published and shared with all staff across the Trust.

5 Thematic Reviews There are currently no thematic reviews scheduled for 2020/21. In 2019/20 two thematic reviews were completed:

• Deteriorating patients – completed in September 2019 and reported to the Quality and Safety Committee in October 2019

• Failure to follow up on Diagnostic results – completed in February 2020 and reported to the Quality and Safety Committee in March 2020

6 Trust wide training The patient safety team has developed an in house root cause analysis training programme for staff. Following staff receiving this training, they will have the skills to investigate serious incidents. The training will be carried out in May 2020 and November 2020. Communication has been cascaded via the weekly bulletin and the course can be booked via the GiveMeData system.

The patient safety and governance systems team have commenced a ward based training programme and developed a governance booklet. The training includes duty of candour and serious incident awareness, incidents and near misses and risk management. The first phase of the training was carried out in February 2020 at the ward handovers. The second phase has been postponed until August 2020. The purpose of this training is to strengthen staff knowledge and awareness with governance systems and processes


Welcome to our eighth edition of the Trust’s Learning and Safety Bulletin. I hope that you are all finding these stories useful. Please ensure that you share the bulletin in team meetings to share the learning and put in place changes that will support patient safety. Everyone across the trust is encouraged to attend the learning and safety summit.

Patient Safety Summit - Process

Our monthly learning summit was held on 27th February with a large attendance of colleagues from all areas across the Trust. At the summit we talked through one serious incident and one complaint with a theme of following things through.

Case 1 – Delay diagnosis of cancer

In this case, a patient had a CT pneumocolon carried out to rule out bowel pathology. Scan showed a 36mm intrarenal abdominal aortic aneurysm (AAA) as well as a 15mm speculated nodule at the left lung base which was noted as being suspicious for an incidental pulmonary malignancy. A completion scan of the lung was recommended along with a referral to the chest team. The CT Pneumocolon results were not reviewed when the patient attended the follow up clinic in August 2015 or 2016. How are you alerted of results with untoward / significant findings? The patient returned in 2019 and had a CT scan carried out. The report made comparison to the CT Pneumocolon from 2015 and showed features of progressive left pulmonary malignancy with intrapulmonary metastases and local mediastinal adenopathy. The CT also made reference to a significant intrarenal abdominal aortic aneurysm. The disease was staged as advanced cancer. It is the requesting clinicians responsibility to check the results, however, how are you assured that results are checked if the requesting clinician is unavailable or was on call at the time of the request? Do you have a robust system in place in your area?

Case 2 – Failure to follow up with transport

A Plan for a patient that was fit for discharge was for them to be discharged with a discharge to access

team so that an assessment could be performed at the patient’s familiar home surroundings. Additional support could then be organised to meet his needs if required or to bring him back to hospital if that was felt necessary. How do you in each of your areas provide assurance that the discharge of a patient will go smoothly. How is the discharge plan communicated to the patient or next of kin? The process is for patient to be discharged by 14:00 so that the discharge to access team can attend that same day. This patient was collected at 14:35 by the transport team and the patient was taken home without the discharge to access team attending. The patient’s next of kin contacted an ambulance and the patient was brought back to Hospital as it was not safe for him to be at home alone. What could have been done differently to prevent this from happening? Discuss this complaint with your teams and ensure you have a robust discharge process in plan in your areas. Since this incident occurred, each ward now has a discharge co-ordinators to support the smooth running of discharges. Each area has it own challenges, by regularly

Infection, Prevention and Control

The learning and safety summits is currently cancelled due to

Covid19. We will continue to share the learning via our

monthly bulletin and we hope you will continue to discuss

these with your teams.

The next bulletins theme will be Infection, Prevention and Con-

trol. if there is anything particular you would like to be includ-

ed within the IPC bulleting please email Emma Babski, Patient

Safety Manager, [email protected]

I would like to thank you all of you for your continued hard

work, commitment and dedication during this difficult time.


This could be done by including the CURB-65

score to the medical booklet Performa.

This recommendation can help reduce the overuse

of broad-spectrum antibiotics when they are not

needed for the care of the patient.

If you would like to learn more about audits carried out at the trust, please contact Karin Dawson-Smith, Clinical Audit and Effectiveness Manager on 3787.

Learning from complaints and patient experience Repeat of blood tests A patient being tested for TB had to have 3 tests carried out due to time delay in processing each test . For the first test is was established that there was a delay from it going from phlebotomy to being receipted on the Hillingdon Pathology computer system of more than 24 hours therefore requiring a repeat. This was the same for the second repeat sample. A third test was processed and reported on. In light of these failings, actions have been identified to prevent recurrence. The following actions have been implemented as part of this investigation to mitigate the risk of a similar incident occurring: A recording log has been introduced in serology for the receipt of TB Eli spot samples. An audit of patient samples has been carried out to identify where there are delays in the process for the TB Eli spot. The Pathology Department has reviewed and shared the process. The request form now includes information relating to the sample processing time. Part of the complaints process is to ensure that we reflect on what has happened and learn as a

Claims and inquests - Indemnity cover

The Coronavirus Act 2020 provides the Secretary of State for Health and Social Care with powers to provide indemnity for clinical negligence liabilities arising from NHS activities carried out for the purposes of dealing with, or in consequence of, the coronavirus outbreak, where there is no existing indemnity arrangement in place. The Government has introduced the additional indemnity cover under the new Act for clinical negligence liabilities that arise when healthcare professionals and others are working as part of the Coronavirus response, or undertaking NHS work to backfill others as a consequence, and existing arrangements do not cover a particular activity. This additional indemnity cover will provide an additional safeguard, and is complementary to any existing indemnity provision already in place. The additional indemnity provided by the Coronavirus Act 2020 covers NHS services commissioned from non-NHS providers. These arrangements will therefore include healthcare professionals and others from the independent sector, working as part of the Coronavirus response, where there is no existing indemnity arrangement in place. Guidance has been set to reassure those working for the NHS that where they need to work in different ways, that they should be supported to do so; that the regulators will take extreme circumstances into account; and that the usual regulatory frameworks and the need to act in line with the principles of good practice set out by the regulators will apply. We can confirm that healthcare professionals and others carrying out NHS activities will continue to be covered for clinical negligence incidents if they have to work in different ways or locations – for example, advising more patients over the

Learning and improving from Clinical Audit Audit of antibiotics use in patients admitted with community acquired pneumonia This audit highlighted that the antibiotics guidelines for CAP is not always followed. It is seen that the common treatment is co-amoxiclav and clarithromycin even though the CURB- 65 score is not calculated. This raises the issue of antibiotics being used which are not necessarily needed and could create more to the worldwide issue of antibiotic resistance. The CURB-65 score should always be calculated to establish what the clinical severity of the condition is and what antibiotic choices they have.

For any further information, to give feedback or if you would like to contribute toward this bulletin please contact the Patient Safety Team on ext. 3993.

Edition: 8, March 2020


1

Board of Directors: 26th May 2020 Agenda item 12

Title People Committee Chairs report

Report author Deborah Lawrenson Trust Secretary Report sponsor Dr Linda Burke, Chair of the People Committee


Purpose of Report For Decision For Assurance For Information ☐ X X

Summary

The attached report provides an update to the Board from the Chair of the People Committee for the meeting held on 19 May 2020.


Impact

Quality and Safety X Legal Financial Human Resources X Equality and Diversity X Engagement and communication X Sustainability

Report from the Chair of the People Committee

The following items were received and discussed:

1. Integrated Quality and Performance Report – it was noted people related issueshad been reflected on the integrated report received for ease of reference in theQuality and Safety Committee part of the Combined Committee agenda; as hadCovid-related People elements such as sickness absence [see separate report fromthe Quality and Safety Committee Chair]

2. BAME update – Detailed discussion took place on the BAME report which outlinedwork underway including risk assessments, support being provided and howmanagement of issues raised were being responded to. It was noted this is also aspecific item on the May Board agenda.


2

In addition to the BAME report discussion took place on how staff are currently feeling, support being provided, progress with the operational restructure and safe management of this transition.

In summary key issues to be raised with the Board and to be received at the next meeting of the People Committee were agreed as follows:

• A report on the staff survey carried forward from the action log • A detailed report on the sickness and absence profile and how the Trust is

managing it • A report on support being given to staff regarding mental health and well being

including uptake of this • A report on our plans regarding recruitment & retention including potential

retirements, health and well being support, and students/ trainee retention • Safe staffing carried forward from the last meeting • A report on flexible use of the workforce - outlining how we have been

utilising staff flexibly (Trust, Students, voluntary, etc) including the numbers, the training provided, what has worked well, what we would do differently and what actions we are taking for the recovery phase and in preparation for the next potential wave of Covid-19

• Feedback from the risk assessment exercise


1

Board of Directors 26 May 2020

Agenda Item 13

Title Impact of COVID19 on BAME staff groups

Report Author Ema Ojiako Acting Director of People and Organisational Development

Status of Report Public Private Internal ☐ x ☐

Purpose of Report For Decision For Assurance For Information ☐ ☐ x

Summary

It has been widely reported in recent weeks that COVID19 has had a disproportionate impact on the BAME population, and specifically there have been a disproportionate number of staff deaths across the NHS and North West London Sector on BAME colleagues.

North West London sector data has highlighted that as at 27th April there have sadly been 21 deaths of NHS colleagues.

The breakdown by Trust and characteristic is detailed below:

The majority of these staff deaths have been female, all except three have been over 50 with the majority in the age range of 60 - 80, and the majority of those that have died have been BAME colleagues (67% BAME and 33% white). Seventeen of the staff that have died have been clinicians, mostly nurses and additional clinical staff (including HCA's) and three staff worked in administrative roles.


2

There has therefore been the requirement for targeted activity to be undertaken to address the potential risk factors that may impact BAME mortality within the workplace, and ensure the Trust has a taken adequate steps to risk assess and support BAME staff alongside all other vulnerable staff across the organisation.

The North West London sector is working collectively to engage with BAME network chairs to highlight and address issues that are affecting BAME staff, and Sarah Tedford together with Clare Murdoch chaired a meeting with BAME network chairs to further discuss these matters to. Based on this meeting an action plan (Appendix 1). has been produced that focuses on six objectives as detailed below:

- Risk Assessments to better protect BAME staff and other vulnerable high risk groups

- Supporting staff by creating open environments where they can raise concerns, knowing they will be addressed

- Creating a safe environment by ensuring physical spaces enable safe working

- Giving staff PPE they need to feel safe - Testing staff to enable them to have peace of mind and reduce

COVID19 spread - Engaging and communicating with staff with clear transparent

channels that share best practice and allow two way communication

The Trust now holds weekly meeting chaired by the CEO to progress local actions in line with this

In line with recent national guidance the North West London sector has also produced a refreshed risk assessment to be used for all BAME staff and other employees that will be classed as vulnerable to ensure that there is support for them in the workplace to minimise their risk of exposure to COVID19 (Appendix 2 and 3).

In addition to this communication has gone out to all staff, with particular emphasis on BAME colleagues asking them to self refer themselves directly to Occupational Health for risk assessments if they have not yet self identified themselves as potentially being considered a vulnerable person as per the Public Health England guidance (appendix 4 and 5).

Thus far the Trust has undertaken risk assessments for staff that are pregnant, over 70 and those with underlying health conditions and 229


3

members of staff have been risk assessed by occupational health and have had adjustments to their roles as a result of this; 102 of these individuals are from a BAME background. These assessments were based on individuals self identifying themselves as being vulnerable, however the intention moving forwards is that BAME and all other high risk staff will be proactively risk assessed by the Trust and contacted directly to facilitate this.

Recommendations The committee is asked to note the report and appendices.

Impact

Quality and Safety x Human Resources

Equality & Diversity x

Engagement and Communication x


OBJECTIVE SRO ACTION ACTION OWNER DUE BY

Write to all staff encouraging self-referral directly to OH for

any conditions that may deem them to be vulnerable;

letters to be distributed electronically and by hard copy to

ensure they reach all employees Ema Ojiako 01/05/2020

Implement NWL Sector refreshed staff risk assessments

across The Trust; all BAME staff to be prioritised for risk

assessments Jane Murphy 31/07/2020

Enhanced support to be put in place for BAME staff being

redeployed to working on frontline roles to minimise risk of

exposure Eileen Sullivan 30/06/2020

Regular CEO Q&A’s, virtual staff forums, and network

meetings for BAME staff to be held to support teams to

have open and sensitive discussions about concerns and

ways of working safely

Justine McGuiness / Asif

Bashir

Ongoing - regular plan of activity to

be presented and reviewed

Support all staff to be part of the union to enable them to

access further external advice and support Mark Handley



Regularly consult with local union representatives to

enable them to raise concernsMark Handley



Promote wellbeing services for BAME staff to support with

stress, anxiety and fearLindsey Waddell 15/06/2020

Training programme to be put in place for managers to

help them compassionately support staff and encourage

caring behaviours across the Trust Lindsey Waddell 30/06/2020

Encourage staff to contact the FTSU guardian to raise

concerns; FTSU guardian to link into BAME staff network Cherma Sinclair 19/06/2020

Regular meetings with the BAME network / senior

managers to be put in place in place to enable staff to raise

concerns, share experiences and seek solutions Asif Bashir


be presented and reviewed Collective advice on vitamin D deficiency, diet and exercise

to be issued in line with NW London sector Cathy Cale 26/06/2020

BAME network chair to run steering group to support with

the delivery of the work streams Asif Bashir


be presented and reviewed standard protocols for workplace risk assessments to be

developed Damian London 15/06/2020All work environments (offices, work stations, inpatient

settings) to be risk assessed to ensure social distancing is

optimised

Divisional Directors /

Damian London 31/07/2020

Ema Ojiako

Ema Ojiako

Camila Wiley / Tina Benson

Better Risk Assessment: Create

consistent, robust assessments that

work for all people.

Supporting Staff: Promote open,

supported environments where

staff raises concerns and fears,

knowing they will be addressed.

Creating a Safe Environment: Ensure

physical spaces enable safe working


Adequate supplies of hand sanitisers and cleaning supplies

to be available for all work spaces with protocol for use Steve Wedgewood 30/06/2020All areas to explore workable adaptions in work settings

and protocols to facilitate social distancing (i.e. online /

telephone handovers, virtual meetings, limited numbers in

offices at any one time) Divisional Directors 31/07/2020

NW London remote working policy to be agreed and

implemented Mark Handley 19/06/2020All areas to implement agile working where possible in line

with the needs of the service

Divisional Directors / Jane

Murphey 31/07/2020

Training to be provided to enable staff to use full system

functionality of online platforms Matt Kybert 30/06/2020

COMMs campaign to be run to encourage staff to voice

concerns about their own health, colleagues and IPC

practices to line manager, FTSU guardian, BAME network

chair or Staff side representative Justine McGuiness 15/06/2020

Line Managers to ensure good implementation of IPC and

PPE guidance

Divisional Directors / Jay

Dungeni 15/06/2020

All staff to receive PPE training and clinical practice checks

Divisional Directors / Jay

Dungeni 30/06/2020

Camila Wiley / Cathy Cale

Empower staff to voice concerns about PPE by directing

queries / concerns to dedicated point of contact and / or

line manager, FTSU guardian, BAME network chair or staff

side representative

Justine McGuiness / Jay

Dungeni 19/06/2020PPE queries line / FAQ's to be put in place to address staff

issues Jay Dungeni 12/06/2020

Ema Ojiako / Cathy Cale

Re-communicate protocols for staff testing or testing of

household members reinforcing that staff should self

isolate if they are symptomatic and full pay and support

will be received for time off

John Mitchell / Justine

McGuiness 12/06/2020Test programme for asymptomatic staff to be rolled out

across the Trust. BAME and other vulnerable staff groups

to be priority for testing. John Mitchell 12/06/2020

BAME network chair to connect with other network chairs

across NW London to share information, good practice,

concerns and challenges and seek common solutions Asif Bashir



Weekly CEO chaired meetings to be held to track progress

of action plan Sarah Tedford



Justine McGuiness Communication plan to be put in place to share good

practice and provide advice and support for BAME

colleagues; COMMS to be in line with NW London sector Justine McGuiness 15/06/2020

CEO Q&A and virtual forums to be scheduled with BAME

colleagues; themes to inform FAQ's Justine McGuiness



Engagement and Communications:

Creating transparent, open channels

that enable the sharing of vital best

practice and allow a two way

conversation

Camila Wiley / Tina Benson Creating a Safe Environment: Ensure

physical spaces enable safe working

PPE: Giving staff the equipment they

need to feel safe

Staff Testing: Helping staff have

piece of mind and reduce the spread

of COVID-19


HRD to link in with NW London / Pan London HRD's to

exchange information and best practice Ema Ojiako Ongoing

Trust to link into national workforce race equality work

streams / networks to implement and share best practice

quickly Ema Ojiako Ongoing

THH to invite BAME staff to join into sector webinars

providing guidance and support Justine McGuiness



Engagement and Communications:

Creating transparent, open channels

that enable the sharing of vital best

practice and allow a two way

conversation


1

Guidelines for individual staff risk assessment - Covid-19 This document should be read in conjunction with other advice regarding COVID-19 provided by the Trust. It is imperative to strictly adhere to infection control advice including hand hygiene and use of PPE. The aim of this process is to:

• Identify any staff that may be at increased risk due to COVID19; • Enable meaningful conversations between managers and potential staff at risk; • Identify actions to minimise and mitigate against any potential risk; • Take concerted actions to protect staff against any identified risk; • Review any actions in place currently to support vulnerable staff ; and • Ensure staff are aware and reminded of the support available to them via Occupational Health

& wellbeing work streams. Completing the risk assessment: This should be completed for all vulnerable staff, including those who are in the high risk groups, or considered vulnerable which includes those with underlying medical conditions, pregnant staff, or staff in certain ethnicity age groups.

1. The risk assessment should be undertaken by the line manager/supervisor, who can be supported by a designated senior manager.

2. The assessment should be completed jointly by the line manager and the member of staff identified.

3. Staff in a vulnerable group should aim to reduce the exposure as much as practicable, by reference to the key considerations in the protocol below.

4. Line managers should inform relevant Divisional Management Teams/Occupational Leads/ Directors, when staff at risk have been identified and informed of any actions agreed as part of this process.

5. All conversations should be held sensitively, maintaining confidentiality at all times, giving an opportunity for staff to raise concerns with their manager.

6. Conversations should be held on an on-going basis and risk assessments should be reviewed as needed.

Should further advice or guidance be required once completed, please contact the Occupational Health Department. Please ensure you keep up to date with all Trust communications and revisions of this document. Relevant Divisional Management, Clinical Lead or senior management should be notified of any adjustments made to support staff, particularly if staff are redeployed.

Step 1: How to determine Vulnerability Group Once line managers have identified which members of their team require a risk assessment, they should arrange a meeting as soon as possible with the member of staff to discuss potential risks and agree actions to mitigate and minimise these.


2

Staff who do not wish to disclose details of their current health conditions, should be made aware of the increased risks attached to not having the right support in place and this should be documented in section 4 of the risk assessment. The aim of the first step is to identify whether immediate actions are required i.e. if the member of staff is deemed to be in the ‘very high risk’ category. Staff in this group should have had a risk assessment in place already in conjunction with previous advice from Occupational Health. If staff are in this category, the NHS, their GP or specialist will have contacted them directly confirming that they fall into this ‘very high risk’ category. The initial list of diseases and conditions considered to be very high risk and therefore should be shielding included:

1. Solid organ transplant recipients.

2. People with specific cancers:

• people with cancer who are undergoing active chemotherapy

• people with lung cancer who are undergoing radical radiotherapy

• people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment

• people having immunotherapy or other continuing antibody treatments for cancer

• people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors

• people who have had bone marrow or stem cell transplants in the last six months, or who are still taking immunosuppression drug.

3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD.

4. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell).

5. People on immunosuppression therapies sufficient to significantly increase risk of infection.

6. Women who are pregnant with significant heart disease, congenital or acquired. They will have been provided with advice on more stringent ‘shielding’ measures that should be taken in order to keep themselves and others safe. Please to go to ‘step 4 – Agreed actions’ and provide details of current actions in place e.g. shielding and working from home. Staff in ‘at risk’ groups due to age, medical condition, ethnic background, gender and those pregnant less than 28 weeks without severe risk, should go to ‘step 2 – Define area of work’. The underlying health conditions for staff in the ‘at risk’ group are people with one of the following underlying health conditions:

• chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis

• chronic heart disease, such as heart failure

• chronic kidney disease

• chronic liver disease, such as hepatitis


3

• chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy

• diabetes

• problems with your spleen – for example, sickle cell disease or if you have had your spleen removed

• a weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets or chemotherapy

• being seriously overweight (a body mass index (BMI) of 35 or above) Amended from 40 or above

• Pregnant women

Guidance from the Royal College of Obstetrician and Gynaecologists emphasises the recommendations which are:

• Women over 28 weeks of pregnancy should self-isolate and work from home if possible • Women under 28 weeks of pregnancy with an underlying health condition should self-isolate and

work from home if possible • Women under 28 weeks pregnant with no underlying health condition can work in direct patient

facing role in a low risk areas if supported by a risk assessment, if she chooses to do so • Women under 28 weeks pregnant with no underlying health condition who following risk

assessment decides not to work in a direct patient facing role should be supported to find alternative duties e.g. telephone consultation, administrative duties either onsite or remotely.

• Hypertension (NEW category)

These staff groups are advised to be particularly rigorous in adhering to recommended infection control practice and where possible social distancing measures.

Step 2: Assessing risk levels, depending on vulnerability groups and ‘zones’ within the Trust The level of risk exposure in the Trusts varies, depending on the area/zone staff work and therefore the actions required to maximise protection for staff in identified vulnerable groups, vary depending on this. Wards and offices across the sites have labels on doors which identify whether they are Clean Zones, Green Zones or Red Zones:

• Clean Zone: Corridors, Offices, Public spaces, restrooms • Green Zone: Clinical areas where AGPs are not being undertaken • Red Zone: Aerosol Generating Procedures

Step 2a, 3 and 4: Risk levels and key considerations Depending on the area of work and vulnerability group/s selected, step 3 identifies whether staff fall within low, moderate or high risk categories. It is important that managers clarify and provide details of current mental and physical wellbeing offers available to staff when they carry out a risk assessment. Please note redeployment is not the only option and there are a number of considerations, additional checks and training that can be considered to support staff. These have been highlighted in the risk assessment in section 2 and 2A. If staff work in a clean zone and have selected one or more vulnerability groups, they are considered as ‘low risk’ and managers should consider the following:

• Whether public transport / rush hour can be avoided through adjustments to work hours


4

• Driving to work or travelling by taxi • Book accommodation in close proximity to the hospital • Enable remote working if possible

If staff work in a green zone and have selected one or more vulnerability groups, not including pregnancy or an underlying health condition, managers should check and confirm the following as per step 3:

• Staff Member is trained to use appropriate PPE • Staff Member is confident & competent in using appropriate PPE • If no consider re-training • Staff Member is fit tested if required • Appropriate PPE is available at all times • Plus key considerations listed above for staff working in blue zones

If staff work in a green zone and have selected more than one vulnerability group, including pregnancy or an underlying health condition they are considered to be at ‘moderate risk’. Managers should check and confirm the following as per step 3 and step 4:

• Referral to OH • Consider options such as redeployment to lower risk area • Staff Member is trained to use appropriate PPE • Staff Member is confident & competent in using appropriate PPE • If no consider re-training • Staff Member is fit tested if required • Appropriate PPE is available at all times • Plus key considerations listed above for staff working in blue zones

If staff work in a red zone and have selected one or more vulnerability groups not including pregnancy or an underlying health condition, managers should go to step 2A, and ensure advice on High Risk Aerosol Generating Procedures (AGPs) is followed:

• Check the AGP agreed list • For dentistry and post mortem, specific advice should have been provided to managers • Aerosolisation of blood and bone e.g. surgical drilling • Nebulisers are not AGPs • The 2m safe distance does not apply when performing AGP on respiratory system and

anyone in the room can be exposed • Plus key considerations listed above for staff working in blue zones, and actions identified

in step 3. If staff work in a red zone and have selected more than one vulnerability group including pregnancy or an underlying health condition, they are considered to be at ‘high risk’. It is important to ensure that the following are in place:

• Immediate agreed actions plans • Urgent OH referral • Immediate redeployment arranged until advice from OH is received • Reiterate details of current mental and physical wellbeing offers provided • Go to step 2A, and ensure advice on High Risk Aerosol Generating Procedures (AGPs) is

followed (as detailed above). How to arrange redeployment: Line managers should seek to arrange temporary redeployment until they receive advice from OH for staff in the red zones. Whilst all staff who should be shielding should have received a letter if the risk assessment identifies any-one in an extremely vulnerable group where shielding is required, following advice from OH, current process should be followed by contacting (insert Number)


5

If you require guidance on COVID19 related redeployment, please email (insert email) Additional guidance If you require additional guidance please contact the People Solutions Team on: Email: xxxxx Tel: xxxxx Once risk assessments have been completed, the agreed actions should be put in place as soon as possible. Risk assessments should be kept locally and a copy must be sent to: (Insert Email) If the outcome is moderate to high risk staff member the occupational health team will be in touch with you. Please outline in a covering email any specific questions related to this risk assessment. A detailed risk assessment carried out by the team will determine whether redeployment should be considered or whether additional specialist clinical advice is required to inform decision making.


Risk Assessment for High Risk and Vulnerable Staff Groups with potential work related exposure to COVID-19

Staff Member Name:

Staff Role: Date of Assessment:

Manager Name:

Location/Division: Date of Review (if applicable):

Step 1: Determine Vulnerability Group (Please Tick)

Vulnerable staff due to age 60+ (Ethnicity: BAME, Age: 55+) / underlying medical condition/Male Go to Step 2

Staff in the very high risk groups and pregnant women >28 weeks gestation Go to step 4

Step 2 – Define Area of Work

Clean Zone: Confirmed non-COVID wards, Corridors, Offices, Public

spaces, restrooms

Green Zone: Clinical areas where AGPs are not being undertaken however could still be treating

COVID patients

Red Zone: Aerosol Generating

Procedures Minimise people working in the

area

Clean Zone Vulnerability Group: Age 60+ [ ] Medical condition [ ] BAME 55+ [ ] Pregnant < 28 weeks without severe risk [ ] Male [ ]

Green Zone

Vulnerability Group: Age 60+ [ ] Medical condition [ ] BAME 55+ [ ] Pregnant < 28 weeks without severe risk [ ] Male [ ]

Red Zone

Vulnerability Group: Age 60+ [ ] Medical condition [ ] BAME 55+ [ ] Pregnant < 28 weeks without severe risk [ ] Male [ ]

If you have selected one or more

group/s, you fall into a low risk category.

Please review Key Steps 2A below

and then go to step 3

If you have selected any group you fall into a moderate risk category -

Go to 2A & 2B and then go to step 3

If you have selected any group you fall into a high risk category. Go to 2A, 2B & 2C and then go to Step 3.

2A Key Steps to put in place Whether public transport / rush hour can be avoided through adjustments to work hours or getting a taxi [ ] Drive to work [ ] Book accommodation [ ] Enable remote working if possible [ ]

2B Steps that must in place Check and confirm: Staff Member is trained to use appropriate PPE [ ] Staff Member is confident & Competent in using appropriate PPE [ ] If no consider re-training Staff Member is fit tested if required [ ] Appropriate PPE is available at all times [ ]

2C: Definition of High Risk Aerosol Generating Procedures (AGPs): Coronavirus is infectious spread through moisture droplets - Check the AGP agreed list - For dentistry and post mortem

specific advice should have been provided to managers

- Aerosolisation of blood and bone e.g. surgical drilling

- Nebulisers are not AGPs The 2m safe distance does not apply when performing AGP on respiratory system and anyone in the room can be exposed


http://gti.gstt.local/clinical/directorates/grida/directorate-services/infection/infection_prevention_control/wuhan-novel-coronavirus/personal-protective-equipment-ppe.aspx

Once completed provide a copy to the staff member [email protected]. It is the manager’s responsibility to keep this under review.

Step 3 Outcome:

Low Risk: Work in clean zones. Key considerations implemented and staff member works with adjustments in place

Moderate Risk: Selected one or two groups and work in green zones: Continue to work in Green Zone as long as steps in 2A and 2B have been implemented. Selected two groups or more (1 to include underlying health condition or pregnancy) and work in green zones: Complete risk assessment and send to email below for OH advice and consider options such as redeployment to lower risk area.

High Risk: Selected one or two groups and work in red zones: Continue to work in Red Zone as long as steps in 2A, 2B, 2C outlined have been implemented Selected two groups (1 to include underlying health condition or pregnancy) and work in red zones: Complete risk assessment and send to email below for OH advice but redeploy to a lower risk area whilst awaiting outcome.

Step 4 - Agreed Actions: Please specify

Manager Signature

Staff Member Signature

If you do not feel that reasonable steps have been made please contact staff side colleagues or HR for support

Date

Occupational Health Support

Please email the signed completed risk assessment to [email protected]. If the outcome is moderate to high risk staff member a member of our occupational health team will be in touch with you. Please outline in a covering email any specific questions related to this risk assessment


mailto:[email protected]

Dear Colleague, May I take a moment of your time? We are living through an extraordinary era. Every day, each of us is touched by Covid 19 in so many different ways. As the pandemic has developed it has become clear that some members of our community seem to be more likely to be effected and that there is a disproportionate impact of Covid-19 on our black, Asian and minority ethnic (BAME) communities. I know you, just like me, are concerned about your family, friends and colleagues. So that is why I am asking you to pause for a moment and do a personal 'check'. You may have already shared any anxieties that you have with your line manager. If you still have concerns, I ask you to complete the self-referral form (attached) and send it to our Occupational Health Team, who will support and advise you further. Your form will be treated in confidence. Sarah Tedford, our Chief Executive, has discussed the impact of Covid-19 on our staff with national colleagues. She and I are working with colleagues across North West London and the BAME network chairs to work out what additional steps we need to take to protect everyone who works at the Trust. We have set up a BAME working group, chaired by Sarah, which meets each week to make practical suggestions, while ensuring these measures are implemented. As the acting Executive Director responsible for People and Organisational Development, I want to make sure that we fully support people in the work place and, where appropriate, are making sufficient adjustments to roles and working environments to protect us all, as much as possible. I am keen to ensure that every member of staff who may be deemed to be vulnerable has been identified. May I take this opportunity to remind you of the guidance for employees who are in ‘vulnerable’ groups can be found on the Trust intranet: intranetthh.hilldomain.thh.nhs.uk/docs/dept/comms/Pubs/Covid_19/FAQs_staff.pdf Self-referral forms should be emailed to [email protected]. Please call 01895 279313 or ext. 3313 if you need any further help. There is also support for anyone who wishes to raise any issue, in confidence, about which they feel uncomfortable our Freedom to Speak Up Guardian, Cherma St Clair, who can be contacted on 0771 7881214 or at [email protected]. National guidance has also been issued by NHS England as to what measures Trusts can take to support BAME colleagues, and we will seek to implement these within the organisation. As a Trust we will continue assess and reassess staff who may be at increased risk. I would encourage staff from a BAME background to self-refer themselves to our Occupational Health department if they have any concerns about their health or well-being. I would like to take this time to thank you for you all your hard work and for taking the time to read this letter. Yours sincerely,


mailto:intranetthh.hilldomain.thh.nhs.uk/docs/dept/comms/Pubs/


mailto:[email protected].

COVID 19 EMPLOYEE OHA SELF REFERRAL FORM

This form has been created to allow staff who believe they may be classed as vulnerable as per the guidance from Public Health England to self-refer for assessment and support from the Trust’s Occupational Health Department; these are individuals that are pregnant, aged 70 or over and those with underlying health conditions.

If you believe you may be in this category please complete all section of this form and send to the Occupational Health Department on [email protected]. Please contact ext 3313 if you have any queries or need support completing the form.

Name:

D.O.B:

Occupation & Ward/Department:

Contracted working hours:

Home / Postal Address & Contact Telephone Number:

Email Address

Reasons for Self-Referral: (please tick reason for referral and provide further details as required)

Please provide details explaining the reason for the self-referral including

Condition Please tick

Further details

Pregnant (please indicate number of weeks)

Aged 60 or over

Underlying Health Condition(s)

Very High Risk / Shielded

BAME

BAME (Aged 55+)

Male

You will be contacted by the Occupational Health Department once they have reviewed this form. Please sign below to confirm that you have read and consented to the information below:

I confirm that I have outlined above the reasons for my self referral and I agree to attend

the Occupational Health department for an assessment if required.


https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19


I understand that both I and a relevant representative of the People and Organisational Development department will receive feedback from my referral / a copy of any associated report and may be in contact with me to discuss the content further.

Should it be necessary for the Occupational Health Department to contact my

GP/Specialist, this will only be done with my written permission.

I understand that feedback from my referral / a copy of any associated report will be fully

discussed with me and my line manager will be made aware of the outcome and any recommendations

Name:……………………………… Signed:…………………………… Date: ………………


1

Board of Directors: 26th May 2020

Agenda item 14

Title Finance and Performance Committee Chairs report

Report author Deborah Lawrenson Trust Secretary

Report sponsor Catherine Jervis, Chair of the Finance and Performance Committee


Purpose of Report For Decision For Assurance For

Information ☐ X X

Summary

The attached report provides an update to the Board from the Chair of the Finance and Performance Committee for the meeting held on 19 May 2020.


Impact

Quality and Safety Legal Financial X

Human Resources Equality and Diversity Engagement and communication Sustainability X

Report from the Chair of the Finance and Performance Committee The following items were received and discussed:

1. Capital Plan – Key elements from the plan were outlined and it was confirmed the Capital Plan had been taken through the Capital Group at the end of April. A final version will go to the Capital Group at the end of May, followed by Trust Management Executive and the Finance and Performance Committee in June.

2. Month 1 Finance Report – key elements of the report were outlined. The Trust is

monitoring its position both against its block contract with NHSI and its agreed Financial Plan20/21. The position at the end of month 1 was positive against plan


2

(insert Surplus). The Committee noted that it is difficult to understand the underlying financial position due to significant changes to both activity and funding.

Committee members asked for confirmation there will be an early focus in the financial year on the Transformation Improvement Planning to ensure the required level of savings are delivered. The committee was assured that key issues had been discussed at the Transformation Improvement Board and costed plans would be developed and signed off through governance processes in June. It was confirmed assurance was being provided to the Executive on control within all areas on pay and non-pay.

3. Medicine Division Deep Dive – the background to the deep dive undertake in

medicine was outlined. The outcome of this work will be brought to the next committee meeting.

4. The committee also received and approved a commercial in confidence item for receipt and final approval at the Board and received an update on the Hospital Redevelopment plans with further discussions on this planned to take place with the Governors in their next seminar session.

In summary key issues to be raised with the Board were agreed as:

• Month 1 position. • Process in place for the Transformation Improvement Programme to identify

schemes for discussion and approval through governance processes in June.


1

Board of Directors: 26th May 2020

Agenda Item: 15

Title Month 1 Finance Report

Report Author Stephen Jones (Deputy Director of Finance)

Report Sponsor David Meikle (Interim Director of Finance)

Status of Report Public Private Internal ☐ x

Purpose of Report For Decision For Assurance For Information X

Summary

This report provides oversight to the Trust Board, through the monthly Finance and Performance Committee, on the delivery of the financial position as at 30.04.20. The Trust is showing a breakeven position as required by the interim financial regime for the period April to July 20202 as per the instructions of and in line with the plan from NHSI. This plan is based on average income and expenditure patterns in 19/20, with a flexible income top up to ensure that the Trust’s overall position is in balance. In comparison with the Trust’s operating plan there is a favourable variance of £1.1m. The Trust delivered this target through a combination of: Receiving a block payment higher that the Trust’s planned income to cover the additional costs incurred under the Covi-19 situation. Accruing for the NHS Top-up payment to deliver a breakeven position as required under the NHSI interim financial arrangements. Due to the current Covid-19 situation normal operating activities have been significantly reduced across the Trust, with the resultant impact on the Trust’s cost base. The Trust’s pay run rate of £15.4m contains circa £650k of Covi-19 expenditure. Therefore, comparison with the Trust’s planned pay expenditure would show a favourable underspend if these costs were excluded. So although ahead of plan when the Covid-19 impact is removed you could expect even greater pay savings given the level of under activity. The Trust’s non-pay run rate of £7.8m contains £1.23m of Covid-19


2

expenditure. Comparison with the Trust’s planned non-pay expenditure would show that the Trust’s non-pay costs were on plan if these costs had been excluded. The attached report demonstrates that the transactional TIPs delivered savings of circa £50k and the transformational TIPs delivered £120k. The report presents an overall under performance in the TIP plan in month 1, however there is a need to review phasing of the plan, especially of the transformational TIPs, to show a more realistic phasing in Q2 and Q3. The Trust closed the month with a bank balance of £27m as a result of the income phasing from the commissioner re. the above Covid-19 support, in additional to the capital loans drawn down in March 20. This will be reduced as capital creditors are paid in the next three months. However, in the meantime the Trust has taken the opportunity to reduce its creditors commitment.

Recommendations


Impact

Quality and Safety

Legal

Financial x

Human Resources

Equality & Diversity

Engagement and Communication


Contents

1. Summary of Month 1 Financial Position: Income & Expenditure position

(a) Against Trust Plan (b) Against NHSI Plan

Highlight comments

2. Divisions: Summary Overall CIP position Surgery Medicines and Emergency Women & Children Cancer & Clinical Support Corporate

3. Financial reporting: Balance sheet Debtors & Creditors Cash flow Capital spend forecast

4. Appendices: Activity and income report I&E Restated (New structure) Covid - 19 Cost Summary

2 Trust Board meeting: 26 May 2020 Page 105 of 130

Summary of Month 1 Financial Position (Against Trust and NHSI Plans)

3

Trust Operating Plan NHSI PlanAnnual Plan Actual Variance Plan Actual Variance

Plan In Month In Month In Month In Month In Month In Month£m £m £m £m £m £m £m

Operating IncomeNHS Clinical Income - NWL Contract 177.43 14.27 14.81 0.54 19.19 20.77 1.58NHS Clinical Income - Non Contract 4.36 0.36 0.36 0.00 0.00NHS Clinical Income - Out of Area 17.81 1.43 1.43 0.00 0.00NHS Clinical Income - Other Income 7.19 0.56 2.95 2.39 0.00PbR Excluded Drugs & Devices 14.55 1.21 1.23 0.02 0.00Non-NHS Clinical Income 2.69 0.22 0.20 (0.03) 0.26 0.20 (0.06)Other Operating Income 24.73 2.05 1.83 (0.22) 4.67 1.83 (2.84)

Total Operating Income 248.75 20.10 22.80 2.70 24.12 22.80 (1.32)

Medical Pay (49.47) (4.19) (4.48) (0.29) (4.35) (4.48) (0.13)Nursing Pay (53.84) (4.56) (4.58) (0.02) (4.83) (4.58) 0.25HCAs & Other Support Staff Pay (21.32) (1.80) (1.93) (0.13) (1.95) (1.93) 0.02Other Staff Pay (53.64) (4.53) (4.47) 0.06 (4.46) (4.47) (0.01)

Employee Expenses (178.28) (15.08) (15.46) (0.37) (15.59) (15.46) 0.13

Drugs - PbR Excluded (12.30) (1.02) (0.80) 0.23 (1.03) (0.80) 0.23Drugs - In Tariff (5.27) (0.46) (0.34) 0.12 (0.51) (0.34) 0.18Clinical Supplies and Services (23.98) (2.04) (2.75) (0.71) (1.89) (2.75) (0.86)Other Operating Expenses (35.62) (2.97) (3.88) (0.91) (3.70) (3.88) (0.18)Total Non-Pay (77.16) (6.49) (7.76) (1.27) (7.13) (7.76) (0.63)

Total Operating Expenses (255.44) (21.57) (23.22) (1.65) (22.72) (23.22) (0.50)

EBITDA (6.69) (1.47) (0.42) 1.05 1.40 (0.42) (1.82)

Depreciation (10.27) (0.81) (0.76) 0.05 (0.74) (0.76) (0.02)Interest Income/Expense (2.40) (0.20) (0.18) 0.02 (0.20) (0.18) 0.02PDC Dividend Expense (5.49) (0.46) (0.46) (0.00) (0.46) (0.46) (0.00)Revaluation of Investment Property 3.00 0.00 0.00 0.00 0.00 0.00 0.00

Surplus(Deficit) before Exceptionals (21.85) (2.94) (1.82) 1.11 (0.00) (1.82) (1.82)

Financial Recovery Fund 20.27 1.69 1.69 (0.00) 0.00 1.69 1.69Marginal Rate Emergency Tariff 1.58 0.13 0.13 0.00 0.00 0.13 0.13

Surplus(Deficit) after Exceptionals (0.00) (1.11) (0.00) 1.11 (0.00) (0.00) (0.00)Trust Board meeting: 26 May 2020 Page 106 of 130

Highlight Comments on Month 1 Summary

4

Month 1 Financial Headlines As a result of Covid-19, amended financial arrangements for the NHS have been implemented. Under these arrangements all Trusts have been moved to block payments and top-ups ‘on account’ for an initial period of four months to 31 July 2020. In addition further top-up payments will be made to reflect the additional costs of Covid-19 sufficient to achieve a breakeven position for the Trust. Within the report the Trust is showing its I&E position against both the Trust’s plan and the interim NHSI plan. Under the Trust’s plan, there is a £1.1m in month favourable variance, compared to the NHSI plan which is showing a breakeven position as per the NHSI guidance. The overall position for month 1 under both the Trust’s plan and the NHSI plan incudes Covid-19 costs of £2.85m Income For the duration of the Covid-19 crisis, a simplified basis of contracting has been put into place. The Trust will receive block payments from 1 April 2020 to 31July 2020. Top up payments will be made in addition to the block contract value. The block payment is based on the previous years reported position. Normal contracting activity has ceased during this period, returns for SLAM will still be submitted, but with no commissioner challenges at this stage. In month, NHS Clinical Income is showing a £2.9m favourable variance to Trust plan. Of this, £1.9m is attributable to the NHSI top-up payment to bring the overall position to breakeven. Other Operating Income is £0.22m adverse to plan, reflecting the loss of car parking and catering income in April due to the impact of Covid-19. The Central Divisional budget is showing a favourable income variance on the NHSI Clinical Income line which is reflective of the Top-up payment received from NHSI and the balance of the monthly block payment not allocated to operating divisions.

Pay Pay costs for April were £15.5m. This is £0.37m adverse to the Trust’s plan, but £0.13m better than the NHSI plan. Medical Pay is £0.29m adverse to the Trust plan, but additional Covid-19 medical pay costs of £0.37m have been incurred in April. The Trust’s expenditure on Agency staff has reduced by approximately £0.2m compared to last month due to the redeployment of substantive staff into those roles normally covered by agency, brought about by reduced levels of normal activity under the Covid-19 situation. Whilst the overall position on pay is showing £0.37m adverse this will be recovered under the top-up payment arrangements with NHSI. The Medicine division are undertaking a deep-dive exercise on pay costs and will be providing an updated report at next month’s FPC.

Non-pay In month non-pay costs were £7.76m, including £1.9m of additional costs related to Covid-19. This was £1.27m adverse to the Trust’s plan and £0.63m adverse to the NHSI plan. Drugs costs are favourable to both plans as a result of low levels of normal activity in month. Clinical Supplies & Services are £0.71m adverse to the Trust plan and £0.86m adverse to the NHSI plan. This includes additional Covid-19 costs of £1.1m. Other Operating Expenses are £0.91m adverse to the Trust’s plan and £0.18m adverse to the NHSI plan. This includes additional Covid-19 costs , for PPE, cleaning materials and software licences, held within the Central Divisional budget.


Divisions


Divisional Summary

6

Annual Plan Actual Variance Plan M1 M1 M1 £m £m £m £m

Surgery NHS Clinical Income 61.06 5.11 1.45 (3.66) Top Up Income - - 3.58 3.58 Other Income 2.72 0.23 0.27 0.04 Pay (38.66) (3.25) (3.37) (0.12) Non-Pay (14.63) (1.23) (0.60) 0.63 Total 10.49 0.86 1.34 0.47

Medicine and NHS Clinical Income 96.74 7.95 4.66 (3.30) Emergency Care Top Up Income - - 3.06 3.06

Other Income 2.64 0.22 0.19 (0.03) Pay (49.61) (4.13) (4.56) (0.42) Non-Pay (20.97) (1.75) (1.25) 0.49 Total 28.80 2.29 2.10 (0.19)

Women & Children NHS Clinical Income 47.10 3.44 2.85 (0.60) Top Up Income - - 0.61 0.61 Other Income 1.87 0.16 0.20 0.04 Pay (25.86) (2.17) (2.21) (0.04) Non-Pay (3.84) (0.32) (0.29) 0.03 Total 19.27 1.10 1.15 0.05

Cancer & Clinical NHS Clinical Income 11.83 0.97 0.37 (0.60) Support Services Top Up Income - - 0.62 0.62

Other Income 1.39 0.12 0.08 (0.04) Pay (27.32) (2.29) (2.27) 0.01 Non-Pay (4.65) (0.39) (0.43) (0.03) Total (18.76) (1.59) (1.63) (0.04)

Corporate NHS Clinical Income 0.01 0.00 0.00 0.00 Top Up Income - - - - Other Income 12.43 1.04 0.76 (0.28) Pay (33.14) (2.76) (2.75) 0.01 Non-Pay (30.05) (2.49) (2.51) (0.03) Total (50.75) (4.21) (4.51) (0.30)

Central Budgets NHS Clinical Income 26.46 2.16 5.39 3.23 Top Up Income - - 0.00 0.00 Other Income 6.37 0.52 0.53 0.00 Pay (3.69) (0.48) (0.30) 0.18 Non-Pay, Depn & Interest (18.19) (1.78) (4.08) (2.30) Total 10.95 0.43 1.55 1.12

Trust Summary NHS Clinical Income 243.19 19.64 14.72 (4.92) Top Up Income - - 7.87 7.87 Other Income 27.41 2.28 2.03 (0.25) Pay (178.28) (15.08) (15.46) (0.37) Non-Pay, Depn & Interest (92.32) (7.96) (9.16) (1.21) Total (0.00) (1.11) - 1.11

Month 1 2020/21

Each Division’s summary position has been expanded to reflect the constituent elements of their income make up between actual activity contribution and the NHSI Top-up element paid due to the current Covid-19 situation. The Central Budget is showing a favourable income variance on the NHSI Clinical Income line which is block funding above plan and the additional Top-up payment receivable from NHSI.


• The 2020/21 Transformation Improvement Programme (TIP) has a programme value of £12.1m.

• The programme is split between direct divisional schemes of £5.1m (43%) based on 2% of each division’s pay and non-pay costs and trust wide schemes of £7m (57%).

• It is proposed that Tip targets will be attributed to the Trust on the basis of 15% in qtr.1, 20% in qtr.2, 30% in qtr.3 and 35% in qtr. 4.

• As at month 1 the trust has identified £3.6m worth of schemes by work stream out of the target £12.1m.

• Month 1 TIP delivery by Divisions and Work streams:

Transformation Improvement Programme

Work Stream Target Plan Actual VariancePeople and OD 229,000 0 - 0Corporate Redesign 711,000 16,500 - (16,500)Improving Models of Care 1,525,000 116,667 116,667 0Outpatients - 0 - 0LNW Collaborative - 0 - 0Divisional 1,155,898 55,490 50,490 (5,000)

Unallocated TIP 8,463,102 415,544 - (415,544)Total 12,084,000 604,200 167,156 (437,044)

In Month £

7

Divisional Surgical DivisionMedical DivisionWomen & Childrens' DivisionClinical Support ServicesCorporateCentral Budgets

Unallocated TIPTotal

Plan Actual Variance1,085,015 237,463 (847,552)1,497,987 1,767,621 269,634

613,771 307,814 (305,957)662,974 363,000 (299,974)

1,268,000 694,500 (573,500)6,956,253 229,000 (6,727,253)

0 - 012,084,000 3,599,398 (8,484,602)

Forecast Outturn £

Divisional Target Plan Actual VarianceSurgical Division 1,085,015 54,251 3,865 (50,386)Medical Division 1,497,987 74,899 116,667 41,767Women & Childrens' Division 613,771 30,689 9,958 (20,731)Clinical Support Services 662,974 33,149 36,667 3,518Corporate 1,268,000 63,400 - (63,400)Central Budgets 6,956,253 347,813 - (347,813)

Unallocated TIP 0 - 0Total 12,084,000 604,200 167,156 (437,044)

In Month £


Divisional Summary (Surgery)

Surgical activity was significantly behind plan in month 1 due to cancellation of elective activity and lower emergency activity and outpatients activity as a result of COVID-19. However, the division reported a breakeven position on commissioners income due to the block contract.

Pay for April is £(118k) above plan mainly in Anesthetics medical staff £(99k) due to an increase in consultants PAs and on-call payments as a result of COVID-19 and HCA staff £(20k) due to additional bed capacity in ICU/HDU, short-term sickness due to COVID-19.

Non-pay for April is £630k below plan mainly in clinical supplies £355k, radiology recharges £187k, drugs £71k and other non-pay £17k due to lower levels of normal activity as a result of COVID-19.

TIP performance in month is £4k against a plan of £54k, this is reflective of a timing difference in the commencement of TIP schemes.

COVID-19 impact is £403k favourable due to significant underspend, predominantly in non-pay £670k across clinical supplies £392k, radiology recharge £187k, drugs £77k and general supplies £14k. SAU and Trinity ward closures £78k. This is partly offset by underperformance in PbR drugs/ devices income £(80k) and over in pay across medical £(180k), nursing £(59k), HCA £(15k), other staff £(11k).

Divisional TIP Annual YTD YTD YTD

Plan Plan Actual Var £m £m £m £m

Surgery

1.085 0.054 0.004 (0.05)

COVID-19 Analysis

Amount £m

Income (0.08) Pay (0.19) Non-Pay 0.67 Total (0.40)

Annual Plan Actual Variance Plan Actual Variance Plan M1 M1 M1 To-Date To-Date To-Date

£m £m £m £m £m £m £m

Surgery NHS Clinical Income 61.06 5.11 1.45 (3.66) 5.11 1.45 (3.66) Top Up Income - - 3.58 3.58 - 3.58 3.58 Other Income 2.72 0.23 0.27 0.04 0.23 0.27 0.04 Pay (38.66) (3.25) (3.37) (0.12) (3.25) (3.37) (0.12) Non-Pay (14.63) (1.23) (0.60) 0.63 (1.23) (0.60) 0.63 Total 10.49 0.86 1.34 0.47 0.86 1.34 0.47


Divisional Summary (Medicine)

9


£m £m £m £m £m £m £m

Medicine and NHS Clinical Income 96.74 7.95 4.66 (3.30) 7.95 4.66 (3.30) Emergency Care Top Up Income - - 3.06 3.06 - 3.06 3.06 Other Income 2.64 0.22 0.19 (0.03) 0.22 0.19 (0.03) Pay (49.61) (4.13) (4.56) (0.42) (4.13) (4.56) (0.42) Non-Pay (20.97) (1.75) (1.25) 0.49 (1.75) (1.25) 0.49 Total 28.80 2.29 2.10 (0.19) 2.29 2.10 (0.19)

At month 1 Medicine is reporting an adverse variance of £0.19m against plan. This is summarised as follows: Income is adverse to plan in month by £0.263m, of this variance £0.237m relates indirectly to COVID 19 which has had an adverse impact on activity. To highlight this Divisional NHS clinical income activity in month is 54% adverse, A&E as a subset of this is adverse 66%. Inpatients and outpatients respectively are 43% adverse. We have recognised the plan for clinical income on the basis that the CCG have agreed to pay us on our contracted position, this is in recognition of the impact of COVID 19. On an activity basis NHS clinical income is £3m adverse, which is important to recognise as it drives non pay variances. The reported income variance relates to excluded drugs driven by Haematology (£0.16m) and excluded devices adverse income driven by Cardiology (£0.046m). Non pay is £0.493m favourable to plan in month and year to date. Drugs (£0.248m) driven by Medical Haematology, other non-pay, supplies and clinical services account for a further £0.245m favourable performance. This is driven by the reduction in activity outlined above. Pay costs in month are £0.423m adverse to plan in month. However only £0.03m of this is attributable to Covid-19, as although there have been additional costs, particularly on medical staff there have been offsetting favourable variances associated with ward closures (Edmunds & Daniels). The main reasons for the adverse pay variance to plan in month are medical pay training bank (£0.11m) A&E, AMU and Elderly Medicine (£0.3m). It should be noted in pay that there is £0.23m unreleased budgeted cost pressure incurred in month which would bring our pay variance down to £0.193 adverse. Recognising this the overall position would be £0.04m favourable. The division is conducting a deep-dive review of pay costs and will be reporting back to next month’s FPC.



Medicine

1.498 0.075 0.117 0.042

COVID-19 Analysis

Amount £m

Income (0.230) Pay 0.030 Non-Pay 0.521 Total 0.321 Trust Board meeting: 26 May 2020 Page 112 of 130

Divisional Summary (Women & Children)

10

Divisional TIP

Annual YTD YTD YTD

Plan Plan Actual Var

£m £m £m £m

W&C

0.614 0.031 0.010 (0.021)

Gynaecology & Paediatric activity is significantly behind plan in month 1. Reduction in outpatient and elective activity is driven by operational pathway changes in managing patients away from the hospital due to Covid-19. Emergency activity, predominantly in Paediatrics is down by 73% compared to plan, with only severe cases (higher acuity) coming into the hospital. Neonatal Critical Care activity was also impacted, and fell by 14.5%. Maternity performance has shown an increase in antenatal bookings, where as births are 20 behind plan in month. Even though NHS clinical activity is below plan by £0.61m, it is protected under the block contract agreement with the commissioners and therefore does not represent a financial risk to the division. Pay for April is £36k adverse to plan. Medical pay in Obstetrics and Gynaecology, and Paediatrics is £23k more than plan, where as nursing pay is £14k over plan predominantly in maternity. The increase in medical and nursing pay costs are linked to covid-19 staffing issues caused by self isolation, and sickness. Non-pay for April is £33k below plan. The reduction in activity overall has decreased the demand on diagnostics, hence leading to £24k favourable variance on radiology recharges,£8k on clinical supplies and 4k on drugs offset by accommodation claim of £3k. TIP performance in month is £10k against a plan of £31k. COVID-19 impact on cost is £23k; medical pay - £26k, nursing pay - £22k, Health care assistant - £5k, admin & clerical - £2k, and accommodation costs - £3k, offset by reduced radiology recharges £24k, clinical supplies £8k and drugs £4k.


£m £m £m £m £m £m £m

Women & Children NHS Clinical Income 47.10 3.44 2.85 (0.60) 3.44 2.85 (0.60) Top Up Income - - 0.61 0.61 - 0.61 0.61 Other Income 1.87 0.16 0.20 0.04 0.16 0.20 0.04 Pay (25.86) (2.17) (2.21) (0.04) (2.17) (2.21) (0.04) Non-Pay (3.84) (0.32) (0.29) 0.03 (0.32) (0.29) 0.03 Total 19.27 1.10 1.15 0.05 1.10 1.15 0.05

COVID-19 Analysis Amount

£m

Income (0.00)

Pay (0.056)

Non-Pay 0.033

Total (0.023) Trust Board meeting: 26 May 2020 Page 113 of 130

Divisional Summary (CCSS)

11

At Month 1 CCSS is reporting an adverse of £40k against plan. This is summarised in the following categories: NHS Clinical Income produced a favourable variance of £20k against plan in month when adjusted by the NHSI top up income allowance. However this was offset by lower Non NHS Income where we saw lower (£15k) private patient & overseas income due to covid-19 and also lower (£24k) activity on the SLA to N&E Herts for DA patients. Pay as expected was lower this month by £14k against plan, due to the lower Agency, WLI and less recruitment of staff than in normal months. In pockets of higher spend we saw a Radiology Interventional consultant being hired to cover a vacancy. In addition the Radiology/X-Ray team, brought in agency staff to cover sickness. With Infection Control being a priority due to Covid-19, extra agency staffing was spent in Microbiology to cover the vacant posts 24/7 rota. Non pay reported a lower than normal month, although overspent £35k against budget. It has to be noted that due to a lack of X-ray’s & other modalities in the Radiology department the Radiology recharge reported a significant over-spend against budget of £359k. Areas to note, NWL Pathology due to covid-19, this saw large drop in patient activity by 50%, It reported a £189k under spend against budget. Alliance Mobile £60k, due to a lack of a signed contract, although not used this month was built into the position until the legal impact of this matter is understood. Other areas to note, Hearing Aids, lower by £19k due to lower than normal activity due to Covid-19 and lastly consumables including Blood, drugs and FP10’s were generally lower due for the same reason.


£m £m £m £m £m £m £m

Cancer & Clinical NHS Clinical Income 11.83 0.97 0.37 (0.60) 0.97 0.37 (0.60) Support Services Top Up Income - - 0.62 0.62 - 0.62 0.62 Other Income 1.39 0.12 0.08 (0.04) 0.12 0.08 (0.04) Pay (27.32) (2.29) (2.27) 0.01 (2.29) (2.27) 0.01 Non-Pay (4.65) (0.39) (0.43) (0.03) (0.39) (0.43) (0.03) Total (18.76) (1.59) (1.63) (0.04) (1.59) (1.63) (0.04)

Divisional TIP

Annual YTD YTD YTD

Plan Plan Actual Var

£m £m £m £m

CCSS

0.663 0.033 0.036 0.003


Divisional Summary (Corporate)

12

• Overall Corporate position is materially impacted by additional Covid costs in particular free car parking and staff meals. • Underlying bank and agency costs are contributing approximately £50k to the non-pay overspend. • TIP schemes are in development and the savings schemes will not come into effect until later in the year. • Underlying gap in the financial plan has been identified and actions to mitigate this are on-going. • Covid costs of £350K are made up of:

Income:£147k Car parking and £122k Retail. Pay: £35k Cleaning, £8k Portering , £10k Catering. Non-Pay: £24k Taxis, £2.5k Prof Fees Comms, £3k Catering Non Pay.



Corporate

1.268 0.063 0 (0.063)

Covid Costs

Income (0.27)

Pay (0.05)

Non-Pay (0.03)

Total (0.35)


£m £m £m £m £m £m £m

Corporate NHS Clinical Income 0.01 0.00 0.00 0.00 0.00 0.00 0.00 Top Up Income - - - - - - - Other Income 12.43 1.04 0.76 (0.28) 1.04 0.76 (0.28) Pay (33.14) (2.76) (2.75) 0.01 (2.76) (2.75) 0.01 Non-Pay (30.05) (2.49) (2.51) (0.03) (2.49) (2.51) (0.03) Total (50.75) (4.21) (4.51) (0.30) (4.21) (4.51) (0.30)


Financial Reporting


Balance Sheet as at 30 April 2020

14

Financial performance ratios M1

Prior Month Current Month

Current ratio 0.25 0.34 Cash/liquidity ratio 0.24 0.16

Explanations for principal movements The significant movements on the balance sheet requiring explanation relate mostly to the way in which all Trusts are currently being block funded following the impact of COVID-19, and changes to the NHS debt regime during the 2020-21 financial year. • Cash and cash equivalents is £27.2m at the end of the

month, and is therefore significantly higher than at any point in the last year. This is a temporary position caused by the current block funding arrangements. the Trust received April’s SLA payment on 1 April and May’s on 15 April. The Trust will be paid on the 15th of each month going forward, so (in a normal month) would expect to hold approximately £5-6m in cash at month end. However, this will not happen until the effect of front loading SLA income has unwound. The Trust is likely to be holding excess cash for at least until July.

• As May’s SLA was received in advance, it has to be reflected as a liability on the balance sheet – even if there is no risk of the Trust needing to repay it.

• The current borrowing (due within 1 year) figure reflects the fact that DHSC will replace £95m of the loans on the Trust’s balance sheet with Public Dividend Capital during 2020/21. The transfer will take place on 30 September 2020.

Statement of Financial Position 31/03/2020 30/04/2020 MovementActual Actual Actual£000's £000's £000's

Non-Current AssetsIntangible Assets 4,061 4,061Plant, Property and Equipment (Ow 160,056 161,477 1,421Investment Property 50,162 50,162Trade and other receivables 1,172 1,180 8Prepayments 810 810

Total Non-Current Assets 216,261 217,690 1,429

Current AssetsInventories 3,167 3,115 -52NHS Trade Receivables 8,252 7,150 -1,102Non-NHS Trade Receivables 4,711 6,160 1,449Prepayments and Accrued Income 10,430 13,093 2,663Cash and Cash Equivalents 9,791 27,205 17,414

Total Current Assets 36,351 56,723 20,372

Total Assets 252,612 274,413 21,801

Current LiabilitiesTrade Payables 2,451 3,256 805Capital Payables 8,117 6,101 -2,016Other Payables 9,653 7,592 -2,061Accruals and Deferred income 18,480 19,555 1,075Provisions 158 158Other Liabilities 1,357 25,410 24,053

BorrowingLoans 102,805 102,846 41Finance Leases 651 705 54LIFT Contract 253 247 -6

Net Current Assets/ (Liabilities) 143,925 165,870 21,945

Total Assets Less Current Liabilities 108,687 108,543 -144

Non-Current Liabilities (amounts falling due after more than one year)Provisions 1,693 1,692 -1

BorrowingLoans 8,345 8,345Finance Leases 1,519 1,390 -129LIFT Contract 11,214 11,200 -14

Total Assets Employed 85,916 85,916

Taxpayers EquityPublic Dividend Capital 78,937 78,937Retained Earnings -46,379 -46,379Revaluation Reserve 53,357 53,357

Total Taxpayers' Equity 85,916 85,916Trust Board meeting: 26 May 2020 Page 117 of 130

15

Debtors and Creditors


16

Cash Flow March 2020


Capital Spend Outturn Mth 1


Appendices:

1. Activity and Income Report

2. I&E Restated: 1. Planned Care 2. Unplanned Care 3. Corporate


Month 1 Activity and Income Report

19

Appendix 1:


20

Total Trust Activity and Income – Year-to-date Month 1

Point of Delivery

YTD Plan Activity

YTD Actual

Activity

YTD Act Variance

% YTD Plan Income

YTD Actual Income

YTD Inc Variance

%

A&E Hillingdon A&E 5,852 2,858 (2,994) -51.2% 1,062 502 (560) -52.7%

MIU 2,558 0 (2,558) -

100.0% 220 0 (220) -

100.0% A&E Total 8,410 2,858 (5,552) -66.0% 1,283 502 (780) -60.8% Critical Care

Adult CC 414 413 (2) -0.5% 490 236 (254) -51.8% Neonatal 514 439 (75) -14.5% 287 253 (34) -11.8%

Critical Care Total 928 852 (76) -8.2% 777 489 (288) -37.1% Inpatients

Births 335 315 (20) -6.0% 1,194 1,093 (100) -8.4% Chemotherapy 126 70 (56) -44.3% 30 17 (13) -43.5% Daycase 1,747 195 (1,552) -88.8% 1,364 107 (1,258) -92.2% Elective 242 21 (221) -91.3% 1,033 29 (1,003) -97.2% Emergency 2,412 1,564 (848) -35.2% 4,421 3,034 (1,387) -31.4% Excess Beddays 682 401 (281) -41.2% 217 127 (89) -41.2%

Inpatients Total 5,544 2,566 (2,978) -53.7% 8,258 4,407 (3,851) -46.6% Outpatients, AEC & Community

Outpatients 37,819 22,678 (15,141) -40.0% 4,015 2,127 (1,888) -47.0% Ambulatory Care 1,266 553 (713) -56.3% 553 236 (317) -57.3% Community 1,420 309 (1,111) -78.2% 171 34 (137) -80.1%

Outpatients, AEC & Community Total 40,506 23,540 (16,966) -41.9% 4,739 2,397 (2,342) -49.4% Other (incl CQUIN)

Other including Rehab & CQUIN 9,932 647 (9,285) -93.5% 2,767 2,512 (255) -9.2% NHSI COVID Block funding 8,579 8,579

NHSI COVID Top-Up 1,883 1,883

Other (incl CQUIN) 9,932 647 (9,285) -93.5% 2,767 12,974 10,207 368.9% Grand Total 65,320 30,463 (34,857) -53.4% 17,823 20,769 2,947 16.5%


21

Divisional actual performance before the block income allocation

Actual Income Under Performance

Division YTD Plan ActivityYTD Actual Activity

YTD Activity Variance YTD Plan Cost

YTD Actual Cost YTD Cost Variance

CSS 13,550 4,093 -9,457 905,872 289,876 -615,997 Medicine 22,783 10,469 -12,314 6,936,351 3,877,150 -3,059,201 Surgery 16,915 6,172 -10,743 4,847,254 1,267,074 -3,580,180 Womens and Childrens 12,071 11,725 -346 3,305,838 2,695,697 -610,141 Corporate 0 0 0 264,449 264,449 0Grand Total 65,320 32,459 -32,861 16,259,765 8,394,246 -7,865,519

There are data quality issues currently which need to be ironed out, mainly relating to excess bed days and critical care, making the analysis by POD tricky. Once the organisation catches up with coding, these data quality issues will be resolved, and a more detailed analysis can be undertaken. A report is being developed with the information team in relation to COVID-19 patients, and this will be reported on in next months report.

Income For the duration of the COVID -19 crisis, a simplified basis of contracting has been put into place. The Trust will receive block payments from 1 April 2020 to 31July 2020.Top up payments will be made in addition to the block contract value. The block payment is based on the previous years reported position. Normal contracting activity has ceased during this period, returns for SLAM will still be submitted, but with no commissioner challenges at this stage A revised operating plan has been put in place by NHSI for the interim period as a result of the above to support the amended financial arrangements. The clinical income position for April (M1) is £2.9m above the Trusts original operating plan, the block payment received for April has been recognized in the position. The total block payment for the Trust was £20.76m, (this included both clinical and non-clinical income). Furthermore the Trust has recognised a further £1.9m as covid-top up. Point of Delivery & Divisional Performance Divisional income performance against plan has been severely impacted; as a result the block payment has been allocated to divisions to support their financial income positions. The funding of this £7.86m has been made to a central reserve line within the divisions. This allocation brings the divisions back to neutral against their original operating plans, and offsets the adverse income variances shown in the table below.


I&E Restated (New structure)

22

Appendix 2:


23

Annual Plan Actual Variance

Plan M1 M1 M1

£m £m £m £m

Planned Care NHS Clinical Income 116.38 9.23 4.56 (4.67)Top Up Income - - 4.59 4.59Other Income 4.77 0.40 0.48 0.08Pay (79.11) (6.64) (6.76) (0.12)Non-Pay (21.38) (1.79) (1.01) 0.78Total 20.67 1.19 1.86 0.67

Unplanned Care NHS Clinical Income 102.19 8.41 4.92 (3.49)Top Up Income - - 3.27 3.27Other Income 3.84 0.32 0.26 (0.06)Pay (62.13) (5.18) (5.63) (0.44)Non-Pay (24.23) (2.03) (1.65) 0.38Total 19.67 1.52 1.17 (0.34)

Corporate NHS Clinical Income 0.01 0.00 0.00 0.00Top Up Income - - - -Other Income 12.43 1.04 0.76 (0.28)Pay (33.63) (2.80) (2.79) 0.01Non-Pay (30.09) (2.49) (2.52) (0.03)Total (51.28) (4.26) (4.55) (0.29)

Central Budgets NHS Clinical Income 24.61 2.01 5.24 3.23Top Up Income - - 0.00 0.00Other Income 6.37 0.52 0.53 0.00Pay (3.41) (0.46) (0.28) 0.18Non-Pay, Depn & Interest (16.62) (1.65) (3.98) (2.34)Total 10.94 0.43 1.51 1.08

Trust Summary NHS Clinical Activity Income 243.19 19.64 14.72 (4.92)Top Up Income - - 7.87 7.87Other Income 27.41 2.28 2.03 (0.25)Pay (178.28) (15.08) (15.46) (0.37)Non-Pay, Depn & Interest (92.32) (7.96) (9.16) (1.21)Total (0.00) (1.11) - 1.11

I&E Restated (New structure)

This table shows the month 1 position, but in the new clinical divisional structure. This report will fully reflect the new structure from next month.


Covid-19 Cost Summary

24

Appendix 2:


Covid 19 Cost Summary

Income

Description Source / Commentary Return Category Mar-20 Apr-20£ £

Car parking income Estates & Facil ities Car parking income 20,502 147,582 Catering & Retail Estates & Facil ities Catering 63,369 122,826 Non-NHS: private patients Non-NHS: private patients 7,818 - NCA Income lost Other - please provide details 220,396 - Annual Leave Accrual Separate Worksheet 895,125 -

1,207,210 270,408

Expenditure

Pay Source / Commentary Return Category Mar-20 Apr-20Description £ £Additional Medical Shifts Patchwork Sickness / isolation cover 98,150 131,856 Other Additional Shifts Health Roster Sickness / isolation cover 74,890 261,606 Surgery Returning Consultant Sickness / isolation cover - 11,096 Surgery Returning ITU Nurse Sickness / isolation cover - 5,473 Surgery - Anaesthetists Extra PAs Sickness / isolation cover 40,000 86,735 Medicine - Extra JD alloacted Haematology Sickness / isolation cover - 7,510 Medicine - Extra JD alloacted Gastroenterology Sickness / isolation cover - 8,416 Medicine Extra PAs / Hours Sickness / isolation cover - 56,075 Womens & Children Extra PAs / Hours Sickness / isolation cover - 7,188 CCSS Extra PAs / Hours Sickness / isolation cover 1,300 8% on Call Standby - Junior Doctors + Salary ∆ Medical Workforce Sickness / isolation cover - 52,757 Catering Staff Estates & Facil ities Support stay at home model - 3,426 Cleaning / Domestics / Security Estates & Facil ities Decontamination 39,050 46,374

252,090 679,813

Non Pay Source / Commentary Return Category Mar-20 Apr-20Description £ £PPE & Other Consumables Cost Centre 508 PPE 196,675 1,698,704 Clinical Supplies & Consumables Cost Centre 508 Increase hospital assisted respiratory support 65,357 - Pathology Diagnostic Testing Pathology Contracts Diagnostic Sampling (in Hospital) 297,000 - Premises Cost Centre 508 Segregation of patient pathways 34,470 - Hotel Bookings outside of CTM Silver Command Hotels 2,580 Free Food for Staff Estates & Facil ities Support stay at home model 42,700 1,757 Taxis Estates & Facil ities Support stay at home model 7,920 22,314 Consultancy - Pinchpoint Estates & Facil ities Support stay at home model 16,000 - Software Licences Visionable Order Remote management of patients 20,275 86,882 Linen Estates & Facil ities Decontamination 40,000 14,258 Clinical Waste Estates & Facil ities Decontamination 21,290 - Patient Transport Estates & Facil ities Transportation of patients - 73,055 Temporary build works Estates & Facil ities Decontamination 188,122 - Temporary build works Estates & Facil ities Segregation of patient pathways 32,197 -

962,006 1,899,550

Total 2,421,306 2,849,772

Memorandum Mar-20 Apr-20£ £

Hotel Costs - Paid for Centrally - April 2020 213,386 Annual Leave Accrual - March Year End only 895,125

The Covid-19 summary shows the total additional costs incurred by the Trust in relation to the current situation. The actual net financial impact on the Trust is less than the £2.85m as per this schedule due to the fact that the Trust has seen reduced costs attributable to the delivery of its normal activity. However it should be noted that the Trust is receiving income higher than plan due to the NHSI block funding arrangements. Each division is reporting its net Covid19 position.

25


1


Title Use of Trust Seal

Report Author Deborah Lawrenson, Trust Secretary

Report Sponsor Sarah Tedford, Chief Executive

Status of Report Public Private Internal x

Purpose of Report

For Decision For Assurance For Information x

Summary

The Board is asked to note the following use of the Trust Seal:

Ref No 220: Licence to Charge between Hillingdon NHS Foundation Trust as landlord and

• Bishopswood SPV limited as tenant• Generale De Sante International Limited as Guarantor and• BMI Healthcare Limited as sub-tenant

Date seal applied: 19 May 2020

Seal applied by: The Hillingdon Hospitals NHS Foundation Trust

Signatories: Sarah Tedford (Chief Executive) and Deborah Lawrenson (Trust Secretary)

Location of sealed document: Capsticks

Recommendations For information and noting


Impact

Quality and Safety

Legal x

Financial x


2

Human Resources

Equality & Diversity

Engagement and Communication


Documents

Meeting of the Board of Directors Tuesday 26 May 2020 ...€¦ · Tahir Ahmed, Director of Estates & Facilities . Tina Benson, Chief Operating Officer . Linda Burke (NED) Dr Cathy