TRUST BOARD MEETING IN PUBLIC AGENDA - West Herts College · HWE STP Hertfordshire & West Essex Sustainability and Transformation Parternship ... QIPP Quality, Improvement, Prevention

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TRUST BOARD MEETING IN PUBLIC

AGENDA

06 February 2020 at 9.30am – 12.30pm Lecture Hall, Postgraduate Centre, St Albans Hospital

Apologies should be conveyed to the Trust Secretary, Jean Hickman on [email protected] or call 01923 436 283

Time Item

ref Title Objective Accountable

officer Paper or verbal

Link to

BAF

9.30 01/79 Opening and welcome

Information Chair Verbal

02/79 Maternity safeguarding patient story

Information Chief Nurse Present-ation

INTRODUCTION

9.50 03/79 Apologies for absence


04/79 Declarations of interest

Information Chair Paper

05/79 Minutes of the meeting held on 09 January 2020

Approval Chair Paper

06/79 Board action log from 09 January 2020 and previous meetings and decision log


07/79 Chair’s report


08/79 Chief Executive’s report Information Chief Executive

Paper

09/79 Board assurance framework Approval Chief Executive

Paper

PERFORMANCE

10.00 10/79 Performance report on access standards

Information and

assurance

Chief Operating Officer

Paper 4a&b

11/79 Integrated performance report (month 8) Key messages from:


Chief Nurse

Chief Medical Officer

Chief People Officer

Chief Finance Officer

Information and

assurance


Paper 4a&b

STRATEGY

10.45 12/79 Five year strategy (2020 – 25)

Approval Chief Executive Paper

Agenda

1 of 236Trust Board Meeting in Public-06/02/20

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AIM 2: GREAT TEAM (OBJECTIVE 5 – 8)

11.10 13/79 2020- 25 People Strategy Approval Chief People Officer

Paper

AIM 4: GREAT PLACE (OBJECTIVE 10 – 12)

11.20 14/79 Strategy update Information and

assurance

Deputy Chief Executive

Paper

RISK AND GOVERNANCE

11.30 15/79 Corporate risk register report Information and

assurance


Paper

ASSURANCE FROM COMMITTEES

11.40 16/79 Assurance report from Trust Management Committee

Information

and

assurance

Chief Executive Paper

17/79 Assurance report from Finance and Performance Committee

Information

and

assurance

Chair of Committee/Chief Financial Officer

Paper

18/79 Assurance reports from Quality Committee

Information

and

assurance

Chair of Committee/ Chief Nurse

Paper

ADMINISTRATION

19/79 Any other business previously notified to the chair

N/A Chair Verbal

QUESTIONS FROM THE PUBLIC

11.50 20/79 Questions from Hertfordshire Healthwatch

N/A

Chair Verbal

21/79 Questions from our patients and members of the public

N/A Chair Verbal

CLOSING

12.00 22/79 Draft agenda for next meeting Approval Chair Paper

23/79 Date of the next board meeting: 05 March 2020, Executive Meeting Room, Watford


Agenda

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Acronyms and abbreviations



A AAA Abdominal Aortic Aneurysm ACS Accountable Care System AAU Acute Admissions Unit A&E Accident and Emergency ABPI Association of the British Pharmaceutical Industry AC Audit Commission ACS Adult Care Services ADM Assistant Divisional Manger AGM Annual General Meeting AGS Annual Governance Statement AHP Allied Health Professional ANP Advanced Nurse Practitioner

B BAF Board Assurance Framework BAMM British Association of Medical Managers BAU Business as usual BBE Bare Below Elbow BC Business Continuity BCP Business Continuity Plan B&H Bullying and Harassment BISE Business Integrated Standards Executive BMA British Medical Association BME Black and ethnic minorities BSI Bloodstream infection

C CAB/C&B Choose and Book Caldicott Guardian The named officer responsible for delivering and implementing the

Confidentiality and patient information systems CAMHS Child and adolescent mental health services CAS Central Alert System CCG Clinical Commissioning Groups

CCIO Chief Clinical Information Officer CCORT Clinical Care Outreach Team CCU Critical Care Unit CDI Clostridium Difficile Infection C.Diff Clostridium Difficile CEO Chief Executive Officer CfH/CFH Connecting for Health CFO Chief Financial Officer CHC Continuing Health Care CHD Coronary heart disease CIO Chief Information Officer CIP Cost improvement programme CIS Care Information Systems CMO Chief Medical Officer CNS Clinical Nurse Specialist CNST Clinical Negligence Scheme for Trusts COI Central Office of Information COO Chief Operating Officer



COPD Chronic Obstructive Pulmonary Disease COSHH Control of Substances Hazardous to Health CPA Clinical Pathology Accreditation CPD Continuing Professional Development CPOP Clinical Policy and Operations CFPG Capital Finance Planning Group CPR Cardiopulmonary resuscitation CQC Care Quality Commission CQUIN Commissioning for Quality & Innovation CRS Care Records Service CSE Child sexual exploitation CSSD Central Sterile Service Department CSU Commissioning Support Unit CT Computerised Tomography

D DBS Disclosure Barring Service DCC Direct Clinical Care DD Divisional Director DGH District General Hospital DGM Divisional General Manager DM Divisional Manager DIPC Director of Infection Prevention and Control DHSC Department of Health and Social Care DNA Did Not Attend DNR Do Not Resuscitate DO Developing our Organisation DoC Duty of Candor DoLS Deprivation of Liberty Safeguards DPH Director of Public Health DQ Data Quality DTA Decision to admit DTOC Delayed Transfers of Care DQ Data Quality

E EA Executive Assistant EADU Emergency Assessment and Discharge Unit ECG Echocardiogram ECIP Emergency Care Improvement Programme ED Emergency Department ED Executive Director EDD Expected Date of Discharge EDS Equality Delivery System EHR Electronic Health Record EHRC Equality and Human Rights Commission EIA Equality Impact Assessment ENHT East & North Herts NHS Trust ENT ear, nose and throat EoE East of England EoL End of Life EPAU Early Pregnancy Assessment Unit EPRR Emergency Preparedness, Resilience and Response ERAS Enhanced Recovery Programme after Surgery ESR Electronic Staff Record EWTD European Working-Time Directive



F FBC Full Blood Count FBC Full Business Case FCE Finished Consultant Episode FFT Friends and Family Test FD Finance Director FGM Female genital mutilation FOI Freedom of Information FRR Financial Risk Rating FSA Food Standards Agency FT Foundation Trust FTE Full Time Equivalent FYE Full Year End G GDC General Dental Council GGI Good Governance Institute GMC General Medical Council GP General Practitioner GUM Genito-urinary medicine

H H&S Health and Safety HAI Hospital Acquired Infection HAPU Hospital Acquired Pressure Ulcer HCA Health Care Assistant HCAI Healthcare-Associated Infections HCC Hertfordshire County Council HCT Hertfordshire Community NHS Trust HDA Health Development Agency HDD Historical Due Diligence HDU High Dependency Unit HEE Health Education England HHH Hemel Hempstead Hospital HES Hospital Episode Statistics HIA Health Impact Assessment HITP Hertfordshire Integrated Transport Partnership HON Head of Nursing HPA Health Protection Agency HPFT Hertfordshire Partnership NHS Foundation Trust HR Human Resources HRG Health Related Group HSC Health Service Circular; (House of Commons) Health Select Committee HSC Health Scrutiny Committee, sub-committee of Overview and Scrutiny

Committee, Hertfordshire County Council HSE Health and Safety Executive HSMR Hospital Standardised Mortality Ratio (Rates) HSO Health Service Ombudsman HTM 00 Health Technical Memorandum HUC Herts Urgent Care HVCCG Herts Valley Clinical Commissioning Group HWE STP Hertfordshire & West Essex Sustainability and Transformation Parternship



I IBP Integrated Business Plan IC Information Commissioner ICAS Independent Complaints Advocacy Service ICNs Infection Control Nurses ICO Information Commissioners Office ICS Integrated Care System ICT Information, Communications and Technology IDT Integrated Discharge Team IVF In Vitro Fertilisation ICU Intensive Care Unit IDVA Independent domestic violence advisors IG Information Governance IMAS Interim Management Service IM&T Information Management and Technology IP Inpatient IPR Integrated Performance Report ISE Integrated Standards Executive IST Intensive Support Team IT Information Technology ITFF Independent trust financial facility ITU Intensive Treatment Unit

J JSNA Joint Strategic Needs Assessment

K KLOE Key Line of Enquiry KPI Key Performance Indicator

L LAs Local authorities LABV Local Asset Backed Vehicle LAT Local Area Team (of NHS England) LCFS Local Counter Fraud Service LD Learning Disability L&D Learning and Development LDB Local delivery board LGBT Lesbian Gay Bisexual and Transgender LHCAI Local Health Care Associated Infections LHRP Local Health Resilience Partnerships LMC Local Medical Committee LSMS Local Security Management Specialist LSP Local Service Provider LTFM Long Term Financial Model



M MAU Medical Assessment Unit MCA Mental Capacity Act MD Medical Director MDA Medical Device Agency MDT Multi-Disciplinary Team MEWS Modified Early Warning Score MH Mental Health MHRA Medicines and Healthcare Products Regulatory Agency MIU Minor Injuries Unit MMR Measles, mumps, rubella MRET Marginal rate emergency tariff MRI Magnetic resonance imaging MRSA Methicillin-resistant Staphylococcus aureus MSSA Methicillin-sensitive Staphylococcus aureus

N NBOCAP National Bowel Cancer Audit Programme NE Never Event NED Non Executive Director NHS National Health Service NHS CFH NHS Connecting for Health NHSE NHS England NHSLA NHS Litigation Authority NHSTDA NHS Trust Development Agency NHSP NHS Professionals NHSP Newborn Hearing Screening Programme NICE National Institute for Health and Clinical Excellence NICU Neonatal Intensive Care Unit NIHR National Institute for Health Research NMC Nursing and Midwifery Council #NoF Fractured Neck of Femur NPSA National Patient Safety Agency NSF National Service Framework NTDA NHS Trust Development Agency

O OBC Outline Business Case OD Organisational Development OJEU Official Journal of the European Union OLM Oracle Learning Management OMG Operational Management Group ONS Office for National Statistics OOH Out of Hours Service OP Outpatient OSC (local authority) Overview and Scrutiny Committee OT Occupational Therapist/Therapy



P PA Programmed Activities PAC Public Accounts Committee PACS Picture Archiving and Communications System PALS Patient Advice and Liaison Service PAM Premises Assurance Model PAS Patient Administration System PAS 5748 Publicly Available Specification 5748 - provides a framework for the

planning, application and measurement of cleanliness in hospitals PbR Payment by Results PCC Primary Care Centre PCT Primary Care trust PEG Patient Experience Group PFI Private Finance Initiative PHO Public Health Observatory PID Project Initiation Document PLACE Patient Led Assessment of the Care Environment PMO Programme Management Office PMR Provider Management Regime PPI Proton Pump Inhibitors PPI Patient and Public Involvement PR Public Relations PSED Public Sector Equality Duty PSQR Patient Safety, Quality and Risk Committee PTL Patient Tracker List

Q QA Quality Assurance Q&A Questions and Answers QG Quality Governance QGAF Quality Governance Assurance Framework QIA Quality Impact Assessment QIP Quality Improvement Plan QIPP Quality, Improvement, Prevention and Promotion QRP Quality Risk Profile QSG Quality and Safety Group

R R&D Research and Development RA Registration Authority RAG Risk and Governance/Red Amber Green RCA Root Cause Analysis RCN Royal College of Nursing RCP Royal College of Physicians RCS Royal College of Surgeons RES Race Equality Scheme RFH Royal Free Hospitals NHS Foundation Trust RIDDOR Reporting of Injuries, Diseases and Dangerous Occurrences Regulations RSRC Risk Summit Response Committee RTT Referral to Treatment RTTC Releasing Time to Care



S SACH St Albans City Hospital SCBU Special Care Baby Unit SES Single Equality Scheme SFI Standing Financial Instructions SHMI Standardised Hospital Mortality Index SHO Senior House Officer SI Serious Incident SIC Statement of Internal Control SIRG Serious Incident Review Group SIRI Serious Incident Requiring Investigation SIRO Serious Incident Risk Officer SLA Service Level Agreement SLR Service Line Reporting SLM Service Line Management SMG Strategic Management Group SMS Security Management Service SOC Strategic Outline Case SOP Standard Operating Procedure SQ Safety and Quality SPA Supporting Professional Activity SRG System Resilience Group STEIS Strategic Executive Information System ST & M Statutory and Mandatory STF Sustainability and Transformation Funding STP Sustainability and Transformation Partnership SUI Serious Untoward Incident (same as Serious Incident, more commonly

used).

T T&D Training and Development TDA Trust Development Authority (also known as NTDA) TEC Trust Executive Committee TLEC Trust Leadership Executive Committee TNA Training Needs Analysis T&O Trauma and Orthopaedic TOP Termination of Pregnancy TOR Terms of Reference TPC Transformation Programme Committee TSSU Theatre Sterile Service Unit TUPE Transfer of Undertakings (Protection of Employment) Regulations TVT Tissue Viability Team

U UCC Urgent Care Centre UTI Urinary Tract Infection

V



VFM Value For Money VSM Very Senior Manager VTE Venous Thromboembolism

W WACS Women’s and Children’s Services WBC Watford Borough Council WFC Workforce Committee WGH Watford General Hospital WHHT West Hertfordshire Hospitals NHS Trust WHO World Health Organisation WRVS Women’s Royal Voluntary Service WTD Working-time directive WTE Whole Time Equivalent (staffing)

Y YTD Year to date YCYF Your care, your future



Last updated : August 2019

Declaration of board members and attendees interests

06 February 2020

Agenda item: 04/79

Name Role Description of interest Relevant dates

From To

Phil Townsend Chairman Son works for ATOS Sintel a separate legal entity wholly on work associated with the BBC

Jan 2019

Christine Allen Chief Executive None

Paul Bannister Chief Information Officer None January 2019 Present

Dr Andy Barlow Divisional Director, Medicine Barlow Medical Services Ltd

Director, London & Hertfordshire Respiratory Diagnostics Ltd

April 2011 Sept 2018

Present Present

John Brougham Non-Executive Director Non-Executive Director and Chair of the Audit Committee of Technetix Ltd

2010

Present

Helen Brown Deputy Chief Executive None

Tracey Carter Chief Nurse and Director of Infection

Prevention and Control None

Paul Cartwright Non-Executive Director Charitable Funds for West Hertfordshire Hospitals NHS Trust

Member of the Council for Kings College London.

Nov 2015 August 2019

Present Present

Paul da Gama

Chief People Officer None

Ginny Edwards Non-Executive Director (Vice-Chair) Trustee Peace Hospice Care

Director of Edwards Consulting Ltd

Charity Committee for West Hertfordshire

2011 2011 2014

Present Present Present

4

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eclarations of interest

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eeting in Public-06/02/20



From To

Hospitals NHS Trust

Volunteer organisation 'Help Force' advisor

In Touch networks - coaching consultant

Husband is CEO of The Nuffield Trust

Husband is Director of Edwards Consulting Ltd

Husband is a non-remunerated member of the Strategy Committee of Guy's and St Thomas's Charitable Trust

2019 2019 2011 2011 2011

Present Present Present Present Present

Natalie Edwards Associate Non-Executive Director None

Mr Jeremy Livingstone Divisional Director of Surgery , Anaesthetics

and Cancer

Jeremy Livingstone Ltd – Private practice Present

Jonathan Rennison Non-Executive Director Trustee of Rising Tides Ltd

Change Management and strategy support with Kings College London

Director of Yellow Chair Ltd

Edgecumbe Consulting - Associate

Association of NHS Charities

The Teapot Trust - Coaching

London Plus - Business Planning

In Touch networks - coaching consultant

Charity Committee for West Hertfordshire Hospitals NHS Trust

Governance, strategy and business planning support to London North West University Healthcare NHS Trust - work is focused on their NHS Charity.

Organisational development, change management, leadership development with Quo Vadis Trust - mental health residential care and supported housing service.

May 2015 March 2017 Aug 2012 April 2015 Sept 2016 June 2016 Oct 2016 Feb 2019 Jan 2019 August 2019 August 2019

Present Present Present Present Present Present Apr 2019 Present Present Present Present

Don Richards Chief Financial Officer None

4

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From To

Sally Tucker Chief Operating Officer None

Dr Mike van der Watt Chief Medical Officer Owner and Director Heart Consultants Ltd 2010 Present

Dr Anna Wood Deputy Medical Director/Director of Clinical

Standards and Audit None

4

Tab 4 D


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09 January 2020

Executive Meeting Room, Watford Hospital

Chair Title Attendance

Phil Townsend Chairman Yes

Voting members

Christine Allen Chief Executive Yes

John Brougham Non-Executive Director Yes

Helen Brown Deputy Chief Executive Yes

Tracey Carter Chief Nurse and Director of Infection Prevention and Control

Yes

Paul Cartwright Non-Executive Director Yes

Ginny Edwards Non-Executive Director (Vice-Chair) Yes

Jonathan Rennison Non-Executive Director (Senior Independent Director)

Yes

Don Richards Chief Financial Officer Yes

Dr Mike van der Watt Chief Medical Officer and Director of Patient Safety Yes

Non voting members

Dr Andy Barlow Divisional Director, Medicine Yes

Paul da Gama Chief People Officer Yes

Natalie Edwards Associate Non-Executive Director Yes

Mr Jeremy Livingstone Divisional Director, Surgery, Anaesthetics and Cancer

No

Dr Anna Wood Deputy Medical Director/Associate Medical Director for Clinical Standards and Audit

Yes

Sally Tucker Chief Operating Officer Yes

In attendance

Meg Carter Representative of Hertfordshire Healthwatch Yes

Louise Halfpenny Director of Communications Yes

Jean Hickman Trust Secretary (notes) Yes

Dr Renton L’Heureux Consultant Paediatrician Yes (item 2)

7 members of the public

5

Tab 5 Minutes of the meeting held on 09 January 2020


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MEETING NOTES

Agenda item

Discussion Lead Dead-line

01/78 Opening and welcome

01.01 The chairman opened the meeting and welcomed the Board and members of the public. He noted that it was a light agenda due to the long bank holiday period and reported that discussions were ongoing as to whether the Board meeting in December should be moved to later in the month in 2020 and the January 2021 meeting cancelled. The chairman assured the Board that no changes would be made until the next Care Quality Commission (CQC) inspection report had been received. The chairman noted that it was evident from conversations at visits undertaken by the Board prior to the meeting that the Trust was preparing well for the next CQC inspection. He reminded the Board that feedback on the visits would be received in the private session of the Board meeting. Finally, the chairman reported that the inaugural meeting of the chairs of provider organisations in the integrated care partnership (ICP) had recently been held.

02/78 Paediatric community service

02.01 Dr L’Heureux joined the meeting to update the Board on paediatric integrated care clinics. He advised that the Trust had worked in partnership with Herts Valleys Clinical Commissioning Group (HVCCG) to establish the clinics which had resulted in a significant reduction in the number of referrals to the hospital with over 60% of patients being assured and discharged.

02.02 The divisional director for medicine recognised that it was the first local integrated paediatric care clinic and noted that the approach followed the model used to set up tele-dermatology, respiratory and gynaecology community clinics. It was acknowledged that HVCCG was supportive of establishing community clinics, which had been a long process but was gradually getting easier. The deputy chief executive reported that the director of integrated care was working closely with a number of specialties that were keen to establish integrated care clinics and acknowledged that more support was required to allow this to be taken forward.

02.03 Ginny Edwards enquired whether changes to health visiting had impacted on the paediatric community clinic. The Board was informed that a paediatric taskforce had been established; this would consider all aspects of the community clinics and consider establishing multi-disciplinary team clinics.

02.04 The chairman thanked Dr L’Heureux for the presentation and noted that the Board would like to see evidence at future meetings of work around integrated care.

OPENING

03/78 Apologies for absence

03.01 Apologies were received from the divisional director of surgery, anaesthetics and cancer.

04/78 Declarations of interests

04.01 No further declarations of interest were received from those circulated prior to the meeting.

05/78 Minutes of the meeting held on 05 December 2019

05.01 Minute 10.03. It was reported that the urology services was developing an electronic system and it was not already in operation.

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Agenda item


05.02 Subject to the amendments recorded above, the minutes were agreed to be a true record of the meeting.

06/78 Board action log from 05 December 2019 and previous meetings and decision log

06.01 All actions had been completed. The decision log was noted.


07.01 The chairman presented his report and highlighted the excellent work done by the volunteer coordinator and volunteers to collect and deliver around 800 Christmas presents to inpatients as part of an initiative led by the Trust’s charity, Raise. The Board was reminded that an excellent television programme had been broadcast over Christmas which involved 60 members of staff in a choir created by Gareth Malone. A visit by a selection of staff to 10 Downing Street to meet the prime minster was also highlighted by the chairman.

08/78 Chief Executive’s report

08.01 The Board received a report from the chief executive. She advised that the Trust was under significant pressure and a business continuity exercise was into operation. She provided assurance that the situation was being carefully managed and advised that the Trust was able to handle the level of pressure due to the planning and processes which had been put in place, including increasing the ambulatory care capacity. The chief executive informed the Board that new medical assessment unit and orthopaedic outpatient facilities were expected to be open in the spring. She thanked staff for their continued hard work in very difficult circumstances which ensured that patients received the care they deserved. The chief executive also thanked the cytology team who were being transferred as part of national changes to the NHS cervical screening programme. Ginny Edwards asked how the Board could be assured on the quality and performance of the new cervical screening service and was informed that the national driver for the change had been to improve the service.

08.02 The Board was informed on additional investment for a new CT scanner and MRI unit and was pleased to be advised that the Trust had met its target to vaccinate 80% of frontline staff against flu. The chief executive reported that a redecoration programme to improve the current buildings was well underway and noted that a new electronic patient record programme was being rolled out which would provide a real time bed state. The chief executive concluded her report by welcoming the new charity director to the Trust.

PERFORMANCE

09/78 Board assurance framework.

09.01 The chief executive presented a report on the latest board assurance framework and reminded the Board on the importance of the framework in supporting the monitoring of risks to achieving the strategic objectives. An extreme risk on the BAF relating to the replacement of the existing local area network (LAN) was highlighted and the Board was reminded that it had approved a business case in December 2019 to mitigate against this. The chief executive advised that the trust management committee would closely monitor the delivery of the LAN and the Board would receive an update in February 2020. It was noted that two risks rated at amber were being monitored by the finance and performance committee and the Board would be updated on these risks

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Agenda item


through the access standards report and the integrated performance report. The Board noted that the risk appetite statement had been updated following discussion at the last Board meeting and would be considered when there was conflict or concern around the management of a risk.

10.02 Resolution: The Board approved the latest board assurance framework

10/78 Performance report on access standards

10.01 The chief operating officer presented a paper which provided assurance on the monitoring of compliance against national access standards, outlining areas that were performing well and those that needed improvement. In particular, the chief operating officer reported that the Christmas and New Year period had been challenging, however she assured the Board that the Trust’s refreshed surge plan had worked effectively. She noted that there had not been a downward trend in demand for emergency care over the bank holiday and patients had reported that this was due to being unable to book a GP appointment over that period of time. The Board was informed that winter systemwide meetings had been reconvened at which performance would be discussed and actions would be captured which could be used to improve future performance. The actions being taken to improve referral to treatment (RTT) performance were also reviewed.

10.02 The chairman reported that he had seen the new hospital ambulance liaison officer (HALO) service in action on a recent walkabout and the chief operating office confirmed that this was working well. She reminded the Board that the 2020 Christmas and New Year would present greater challenges due to the way the bank holidays fell and she provided assurance that executive level discussions were underway to agree the required resources which would ensure business as usual, including reviewing the staff leave policy. In response to a question from Natalie Edward, the chief operating officer advised that the HALO service was funded to 31 March 2020.

10.03 Paul Cartwright asked for an update on a pilot relating to the medical ‘take’ in the emergency department. The divisional director of medicine advised that as the pilot continued to demonstrate significant improvements the trust management committee had agreed to move to a business as usual position. Following discussions with the local negotiating committee, planning had commenced which was being supported by the workforce team. The chief medical officer brought the Board’s attention to benchmarking which indicated that A&E performance had moved from being placed 76th in the country to 29th, which was described as a phenomenal achievement. The deputy chief executive advised that the trust management committee had approved a business case which covered additional A&E staffing until June 2020 whilst a complex medical staffing analysis was undertaken to establish the permanent establishment.

10.04 Ginny Edwards acknowledged the significant work undertaken to manage the increased demand and reminded the Board on previous concerns raised by staff which related to the use of the cardiac cath lab as a surge area. The chief operating officer confirmed that following direct engagement with staff the escalation process had been improved to allow the cath lab to continue to function alongside being used as a surge area.

10.04 Jonathan Rennison asked for clarity on the impact that the increase in

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Agenda item


emergency demand over Christmas and New Year had on the RTT position. The chief operating officer advised that as there had only been low levels of elective work planned over the bank holiday period and assured the Board that the Trust was in close control regarding the implications and recovery.

11/78 Integrated performance report

11.01 The Board received a summary from the chief operating officer on operational performance in November 2019. In particular, she reported that IT network failures in November 2019 had significantly impacted on performance and further IT issues had been experienced in December following a black start generator testing exercise which had resulted in manual and paper based systems being used across a number services for up to a week. The Board was informed that the clinical prep service had moved into a new area and further work to improve the emergency footprint was continuing.

11.02 The chief nurse gave a summary of her report in the IPR, which advised the Board on a review of category three and four pressure ulcers and an assessment of clostrioides cases. The chief nurse reported on the results of a table top exercise with HVCCG which focused on antimicrobials and advised that a report on an above position for third and fourth degree tears and maternity haemorrhage had been received by the quality committee. The quality committee had also reviewed an update on the end of life care strategy. The Board was informed on the development of a system to record compliments across the Trust and the completion of works to improve the children’s waiting area in the minor injuries unit (MIU) at St Albans and the urgent treatment centre (UTC) in Hemel Hempstead. The chief nurse advised the Board on a successful bid to fund a volunteer project coordinator to support a better experience for patients and staff in the emergency department and the patients’ lounge, with the aim of expanding the service to the MIU and UTC in the future.

11.03 The chief medical officer presented an update on a pilot (operation SMART) which provided early consultant assessment in the ED department, as well as the latest position with regard to patients presenting with flu and on plans to roll out job planning.

11.04 The Board received a report from the chief people officer on performance against the workforce metrics, including vacancy, sickness absence, turnover, mandatory and essential training, appraisal rates. The Board was assured that all metrics remained green. The chief people officer also advised that the flu vaccination target of 80% had been met, the initial national staff survey results had been received and would be shared with the Board in February 2020 and initiatives to help mitigate against the impact of changes to pension tax arrangements had been launched. He reminded the Board that the people, education and research committee would continue to monitor the workforce metrics.

11.05 The chief financial officer presented a report on the latest financial position which had been discussed in detail by the finance and performance committee. He advised that despite a constant rise in emergency pressures, the Trust continued to manage income and expenditure in line with the financial plan. The chief financial officer reminded the Board that it would discuss the financial position in detail in the private session of the meeting and provided a summary update on the positive progress being made to the efficiency programme, as

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Page 6 of 10

Agenda item


well as the challenges being experienced to pay costs and the latest position with regard to capital expenditure. The chief financial officer concluded his report by advising that the Trust expected to meet the control total budget set by NHS Improvement at the end the financial year.

11.06 The chairman asked the chief information officer to update the Board on the latest position with regard to the IT system. He reported that the system was beginning to demonstrate signs of improvement despite challenges in December from significant issues following a black start generator test. He advised that the IT team had reacted well and considerable work had taken place over the Christmas and New Year period to stabilise the system.

11.07 The chief operating officer advised that it had been possible to anticipate the level of flu cases due to the previous outbreak in Australia and explained that the peak of flu cases in the Trust had been seen in December 2019 when a co-hosted escalation plan had been enacted. The chief nurse added that point of care testing had been launched earlier than the previous year, supported by the isolation suite, which had helped to manage the situation.

11.08 Ginny Edwards assured the Board that the quality committee would discuss the rise in pressure ulcers and in the caesarean section rate and would consider whether appropriate action was being taken. The chief nurse confirmed that work was ongoing with the chief medical officer with regard to the caesarean section rate and reminded the Board that pressure ulcer management was monitored as part of the quality priorities within the quality account.

11.09 Paul Cartwright queried an increase in divisional income due to overseas visitors. The chief financial officer advised that despite a robust system of control being put in place, there was always a high risk of non-payment from overseas visitor. He noted that this was managed by only recording the cash received rather than the value of the invoices.

12/78 2018/19 annual report on end of life care

12.01 The chief nurse presented a 2018/19 annual report on end of life care, which included a full review of the Gosport independent panel report. She assured the Board that the report had been fully discussed by the quality committee and highlighted a reduction in the number of complaints and identified the key themes and learning which had been shared with divisions to improve practices. In particular, the chief nurse brought the Board’s attention to improvements made as a result of complaints from patients with learning difficulties and to the end of life care key achievements and future priorities.

12.02 The deputy chief executive noted that it was often due to complex issues if a patient’s preferred place of death was not achieve. She reported that staff had advised on Board visits that end of life care discussions often happened too late due to deep rooted cultural issues. The deputy chief executive advised that work was planned through the five year strategy to achieve cultural changes. The deputy medical director commented that this was a national challenge and reminded the Board on the importance of working with general practitioners to begin conversations regarding end of life care.

12.03 The chairman noted the excellent report and thanked the end of life care team for their hard work.

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Agenda item


13/78 2020-23 research and development strategy

13.01 The Board received a research and development strategy from the chief people officer for the period of 2020 to 2023. It was noted that the strategy had been fully discussed by the people, education and research committee. The chief people officer provided a summary of the five key objectives of the strategy and pointed out that a good IT system and adequate time for clinicians and support staff to facilitate research activities would be required in order to achieve the objectives. The chief information officer advised that he believed an upgrade onto a Windows 10 operating system was required and although this was not available to the entire Trust at the current time, it may be possible to upgrade the research department.

13.02 John Brougham agreed in principle with the strategy and asked for clarity on the position with regard to achieving the recruitment target. The chief medical officer reported that the Trust was exceeding targets and the main focus was now on commercial projects from pharmaceutical companies.

13.03 The chief financial officer suggested that the strategy may not be ambitious enough to encourage innovation. The chief medical officer responded that it would only be possible to pursue innovation when clinician’s job plans included dedicated time for research and there was a dedicated research lead in each department.

13.04 Jonathan Rennison welcomed the strategy and pointed out that it did not cover how the Trust planned to focus on smaller scale research. It was acknowledged that this was an ambition; however at the current time as the Trust was not a tertiary centre it was limited on which research projects it could offer.

13.05 Ginny Edwards recognised the purpose and outcomes in the strategy, and suggested that the recruitment and education aspects needed to be mapped across into the people strategy and the strategic outline case (SOC) for the redevelopment of services. The deputy chief executive confirmed that the core assumption in the SOC was that non-clinical support space would need to be developed, however it was not included in the funding allocation and therefore it was anticipated that this would be achieved through a leasing arrangement. She further advised that the Trust was actively working on a project to relocate back office staff which would free up space on the hospital sites.

13.03 The chief executive also welcomed the strategy and asked for it to be reformatted into the corporate house style.

13.04 Resolution: The Board approved the 2020-23 research and development strategy.

14/78 2020-23 people strategy

14.01 The chief people officer presented a 2020-23 people strategy, which was a refresh of the previous successful 2016-19 workforce and development strategy. He noted that the people strategy focused on the emerging concept of ‘TeamwestHerts’ and on partnership working at ICP/integrated care system level, as well as other sharing opportunities. The Board was informed that the strategy had a proactive thread on diversity and inclusion throughout.

14.02 Ginny Edwards suggested that the strategy should be expanded to acknowledge and recognise the invaluable part that volunteers played in the people force.

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Agenda item


14.03 John Brougham recognised that the strategy would not have been possible a few years ago when the Trust was in a much different place. He stated that the strategy needed to emphasise on the importance of networking and on working on a sustainability and transformation partnership basis.

14.04 The Board reviewed the metric which underpinned the strategy and it was agreed that the strategy would be updated to align with the overall strategy and be re-presented for final approval in February 2020.

PDG

02/20

15/78 Draft five year strategy

15.01 The Board received the draft five year strategy from the deputy chief executive which set out a framework, vision and a communication tool for patients and staff. She reminded the Board that the Trust was now able to be less internally focused and advised that the strategy was very much a long term plan which would reflect and adapt over time to changes in commissioning and the partnership environment. It was noted that not all elements of the strategy were new and that the Trust had been working on a number over the last five years. The deputy chief executive advised that the strategy was aligned to the corporate objectives and confirmed that it outlined the core priorities to deliver as a provider and by which route this would be achieved. The Board was informed that the next stage would be to asses whether the strategic measures had been set correctly and for the strategy to be fully aligned with supporting strategies. Following engagement with clinicians, the deputy chief executive reported that the clinical strategy would be updated to explain how it would deliver the overarching strategy and how it related to the redevelopment plan, the digitalisation transformation plan and to the ICP. The Board was informed on delivery and engagement plans and, in particular, on a broadly positive engagement event which had taken place on 08 January 2020. Comments from this event would be reflected in the final draft of the strategy which would be presented to the Board for approval in February 2020.

15.02 Paul Cartwright commented on the excellent approach and requested for the Board to be updated on individual projects as they were progressed. In particular, he requested for the Board to receive the IT strategy. The chief information officer verbalised a high level summary of the IT projects currently underway and those which were planned for the future. He advised that the Board would receive the strategy outline case for the electronic patient record in February 2020 and the outline business case in April 2020.

15.03 John Brougham recognised that the five year strategy would underpin all the Trust’s plans and was at the core of the future. He commented on the importance of being paperless by 2025 and noted that this would be a significant investment which would need specific delivery commitments on an annual basis.

15.04 The Board discussed the metrics set out in the draft strategy and the deputy chief executive responded that the Trust was keen to set a reasonable level of ambition on which to benchmark itself. She advised that the Board would have an opportunity to discuss the metric before it came back to the Board for final approval in March 2020.

15.05 The deputy chief executive pointed out that following staff engagement the ‘sunny tree’ pictorial image of the Trust’s aims and objectives had been updated. Ginny Edwards commented that she would prefer the word ‘valued’ to replace ‘happy’ as this could be subjective. Jonathan

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Agenda item


Rennison suggested that words should be added to the birds in the tree to portrait the Trust’s values, such as kindness and speak-up,.

15.06 The chief executive praised the work done by the deputy chief executive and team to bring the strategy to its current position and suggested that some narrative could be included to explain the metric and to signal the Trust’s plans to become paperless. The deputy chief executive noted that the suggested changes would be made and the final document would be presented to the Board in February 2020.

16/78 Corporate objective review

16.01 The deputy chief executive presented a report which provided an update on the progress of the twelve 2018-20 strategic objectives. She pointed out that a large number of the areas had either made good progress or had been delivered, however some had not achieved as much as hoped which in some cases had been due to unfeasible targets. The deputy chief executive reported that a new set of high level objectives with clearly defined metrics to allow them to be appropriately tracked would be presented to the Board as part of the five year strategy in February 2020 and more detailed objectives would be received by the Board in March/April 2020.

17/78 Corporate risk register report

17.01 The chief medical officer provided a summary of a report on the corporate risk register. He advised that the register currently had 26 open risks with an additional risk relating to a no deal EU exit to be added following discussion by the risk review group in January 2020.

18/78 Assurance report from Trust Management Committee

18.01 The chief executive presented an assurance report from the trust management committee and pointed out areas of focus over the past month.

19/78 Assurance report from People, Education and Research Committee

19.01 The Board received an assurance report from Natalie Edwards on the work of the people, education and research committee. She noted that a number of the items discussed by the committee had already been covered under other parts of the agenda. The Board was informed that the committee had reviewed a consolidation of its work plan, had received assurance on progress towards achieving hospital teaching status and had introduced a divisional assurance programme on a rolling basis.


20.01 John Brougham presented an assurance report from the finance and performance committee and noted that many of the items would be discussed on the Board meeting agenda, either in the public or private section of the meeting. On behalf of the committee, John Brougham recommended that the Board ratify an NHS revenue support loan of £1.4m to cover funding requirements for December 2019.

20.05 Resolution: The report was received for information and assurance and a loan of £1.4m was ratified.

21/78 Assurance report from Quality Committee

21.01 Jonathan Rennison presented an assurance report on the work of the quality committee. He informed the Board that the committee had received strong evidence from the surgical anaesthetic and cancer division on key performance, governance processes and learning. The

5



Page 10 of 10

Agenda item


committee had also received assurance from an annual report relating to litigation and claims and on medical devices, which had a clear action plan in place which had yet to be delivered. An action plan to address concerns around food hygiene had been reviewed, some actions had been completed and some were in progress. The committee had also reviewed the corporate and BAF risks associated to quality.

CORPORATE TRUSTEE

22/78 Report from the Charity Committee

22.01 The Corporate Trustee received a report on the work of the charity committee from Jonathan Rennison. It was noted that the committee had reviewed a report on investments and had been assured that these were performing well and were aligned with the charity’s agreed profile and risk appetite. Jonathan Rennison informed the Corporate Trustee that a new charity website had been developed and a successful Christmas appeal had been held which had provided presents for every inpatient in the hospital on Christmas day. He reported that the launch of a new Trust lottery had been delayed whilst a preferred provider was confirmed and advised that a new charity director had joined the Trust with a further recruitment campaign underway to appoint a fundraising officer. Jonathan Rennison concluded his report by advising the Corporate Trustee that discussions were underway around the possible relaunch of the hospital radio as ‘Raise’ and he confirmed that this would be discussed at the next committee meeting.

23/78 Any other business

23.01 No other business was raised.

24/78 Questions from Hertfordshire Healthwatch

24.01 Meg Carter, representative for Hertfordshire Healthwatch provided feedback that an engagement event on 08 January 2020 to discuss the Trust’s five year strategy had been constructive and represented stakeholders from across a wide area.

24.02 The Board was asked whether a pay on exit system could be installed when the new multi-storey car park was built as the current pay on entry system was difficult for patients to know exactly how long they would need to park. The chief financial officer advised that an entry system had previously been considered and would be discussed again at the appropriate time.

25/78 Questions from patients and members of the public

25.01 No questions were raised by the public.

26/78 Draft agenda for next meeting

26.01 The agenda was approved subject to changes to reflect the meeting conversation.

27/78 Date of the next meeting

27.01 The next meeting will be held on 06 February 2020 in the Lecture Hall, St Albans City Hospital

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Page 1 of 1

Agenda item: 06/79Action log Part 1 – 06 February 2020

Ref No.

Action from agenda item

Action Lead for completing the action

Date to be completed

Update

1 14.04/78 To update the People Strategy to align with the overall five year strategy and represent to the Board.


02/20 Strategy updated and on Board meeting agenda in February 2020.

6

Tab 6 A

ction log and decision log

1 of 236T

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Agenda item: 06

Board meeting/decision date

Decision reference (from minutes)

Item presented to Board for action Comments/outcome

1/9/2020 20.05/78 Assurance report from Finance and Performance Committee The Board ratified an NHS revenue support loan of £1.4m for December 2019.

1/9/2020 09.02/78 Board assurance frameworkThe Board approved the latest version of the BAF.

1/9/2020 13.04/78 2020-23 Research and Development Strategy The Board approved the 2020-23 research and development strategy

12/5/2019 22.02/77 Charity update The Corporate Trustee approved Grant Thornton as the preferred bidder for external auditor services.

12/5/2019 20.02/77 Assurance report from Finance and Performance Committee The Board ratified an NHS revenue support loan of £3.4m for November 2019.

12/5/2019 09.01/77 Board assurance frameworkThe Board approved the laterst version of the BAD and risk appetite statement and the threshold matrix, subject to an amendment to the finance/value for money category.

11/7/2019 26.02/76 Assurance report from Charity CommitteeThe Corporate Trustee approved the use of PayPal.

11/7/2019 19.02/76 Corporate risk register reportThe Board endorsed the changes to the corporate risk register.

11/7/2019 18.02/76 Full business case for urgent and emergency care The Board approved the award of the contract to Greenbrook Healthcare, acknowledging that this would be subject to finalisation and signing of the contract.

11/7/2019 16.02/76 Assurance report from Finance and Performance CommitteeThe Board ratified the financial trajectory for 2020/21 (deficit no greater than £3.242m); 2021/22 (deficit no greater than £1.934m) and a break even state thereafter.

11/7/2019 13.02/76 Annual freedom to speak-up report and update The Board approved a recommendation for Ginny Edwards to be the nominated non-executive freedom to speak up lead.

11/7/2019 12.02/76 Seven day board assurance framework report The Board approved the seven day board assurance framework self-assessment for submission to NHS Improvement.

11/7/2019 09.04/76 Board assurance frameworkThe Board approved the recommended changes to the BAF

10/3/2019 22.03/75 Assurance report from Charity CommitteeThe Corporate Trusteee approved the 2019/20 terms of reference and work plan.

10/3/2019 19.01/75 Assurance report from Finance and Performance CommitteeThe Board ratified an NHS revenue support loan of £3.7m for September 2019.

10/3/2019 17.02/75 2019/20 committee terms of reference and work plansThe terms of reference and work plans for the finance and performance committee and the terms of reference for the auditor panel and remuneration committee were approved.

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10/3/2019 16.02/75 Corporate risk register report The Board endorsed the changes to the corporate risk register.

10/3/2019 15.02/75 Development of integrated care partnershipThe Board confirmed its support for the proposed development of an integrated care partnership for west Hertfordshire and agreed the key future steps.

9/5/2019 22.02/74 Assurance report from Finance and Performance CommitteeThe Board ratified an NHS revenue support loans of £2.7m for July 2019 and £3.9m for August 2019.

9/5/2019 19.02/74 2019/20 terms of reference and work plansThe terms of reference and work plans for the Board, audit committee, quality committee and people, research and education committee were approved.

9/5/2019 16.03/74 Workforce race equality standard report 2018/19 The report was approved for publication.

9/5/2019 15.03/74 Workforce disability equality standard report 2018/19 The report was approved for publication.

9/5/2019 14.03/74 Proposal to change the Trust’s name to West Hertfordshire Teaching Hospital NHS Trust The application was approved for submission.

9/5/2019 13.03/74 Annual medical appraisal report and statement of complianceThe Board approved the submission to NHS England/Improvement

9/5/2019 12.03/74 Emergency planning and business continuity reportThe Board approved the self-asessment against the emergency planning and resilience standards

7/4/2019 11.02/72 Clinical negligence scheme for Trusts – Maternity incentive scheme submissionThe Board delegated authority to Jonathan Rennison to sign-off the submission.

7/4/2019 14.03/72 Proposal to move oesophagogastric cancer surgery to Hammersmith HospitalThe Board approved the proposal

7/4/2019 15.02/72 Outline business case for urgent care servicesThe Board approved the outline business case and commencement of procurement

7/4/2019 16.02/72 Joint corporate risk register and board assurance framework reportThe Board reviewed and endorsed changes to the corporate risk register

7/4/2019 18.02/72 Assurance report from Finance and Investment CommitteeThe Board ratified an NHS revenue support loan of £4.5m for June 2019 to cover funding requirements

7/4/2019 22.02/72 Assurance report from Charity Committee

The Corporate Trustee received the report for information and assurance. It approved the recruitment of a new charity director and delegated authority to the committee to approve the charity’s annual report and accounts

5/2/2019 20.02/70 Assurance report from Finance and Investment Committee Approved the NHS revenue support loan for £6.3m

5/2/2019 17.02/70 Annual statement of modern slavery and human trafficking Approved for publication on website

5/2/2019 15.05/70 Future services in west HertfordshireThe Board confirmed the decision made on 07 March 2019 to move forward with options one to four and exclude new build emergency care hospital options.

5/2/2019 13.01/70 Gender pay gap report 2017/18 Approved for publication on website

5/2/2019 12.05/70 Public sector equality duty report 2017/18 Approved for publication on website

4/4/2019 12.03/69 Busines case for overseas nursing recruitement Approved the business case for overseas nursing recruitment and investment of £1.55m

4/4/2019 13.03/69 Corporate risk register and board assurance framework Approved the board assurance framework

4/4/2019 15.02/69 Assurance report from Finance and Investment Committee Approved the NHS revenue support loan for £0.5m

04/04.2019 18.02/69 Assurance report from the Charity Committee The Corporate Trustee approved in principle the use of designated haematology special purpose funds towards the redevelopment of the Helen Donald unit.

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Trust Board Meeting 06 February 2020

Title of the paper Chairman’s report

Agenda Item 07/79

Presenter Phil Townsend, Chairman

Author(s) Jean Hickman, Trust Secretary

Purpose

For approval For discussion For information

Executive Summary

The aim of this paper is to provide an update to the Board on items of national and local interest/relevance.

Trust strategic aims (please indicate which of the 4 aims is relevant to the subject of the report)

Aim 1 Best quality care

Objectives 1-5

Aim 2 Great place to

work Objectives 6-8

Aim 3 Improve our

finances

Objective 9

Aim 4 Strategy for the

future

Objective 10-12

Links to well-led key lines of enquiry

Is there the leadership capacity and capability to deliver high quality, sustainable care? Is there a clear vision and credible strategy to deliver high quality, sustainable care to people, and robust plans to deliver? Is there a culture of high quality, sustainable care? Are there clear responsibilities, roles and systems of accountability to support good governance and management? Are there clear and effective processes for managing risks, issues and performance? Is appropriate and accurate information being effectively processed, challenged and acted on? Are the people who use services, the public, staff and external partners engaged and involved to support high quality sustainable services? Are there robust systems and processes for learning, continuous improvement and innovation? How well is the trust using its resources?

Previously considered by

Committee/Group Date

N/A

Action required The Board is asked to receive the report for information.

7

Tab 7 Chair's report


Agenda Item: 07/79 Trust Board Meeting – 06 February 2020 Chairman’s report Presented by: Phil Townsend, Chairman 1. PURPOSE 1.1. The aim of this paper is to provide an update on items of national and local

interest/relevance to the Board.

2. NATIONAL NEWS AND DEVELOPMENTS

National People Plan 2.1. The National People Plan, which sets a vision for how people working in the NHS will be

supported to deliver care and identifies the actions needed to be taken to help them, is expected to be published shortly.

2.2. The Board will be discussing the Trust’s People Strategy at this meeting (agenda item 13) which is a refresh of the previous Workforce and Development Strategy 2016-2019. The strategy, which is aligned with the National Interim People Plan and the NHS Long Term Plan, places great emphasis on partnership working, quality improvement, diversity and inclusion and living the Trust’s values.

2.3. There is a national focus on workforce and promoting the NHS as a career choice as part

of the government strategy to address the 100,000 shortfall in NHS personnel, which will help to support some of the Trust’s own initiatives.

International Year of the Nurse and Midwife

2.4. 2020 is the International Year of the Nurse and Midwife and the Trust will use the

opportunity to promote awareness and career choices related to the profession. Planning has already started for the Trust’s celebrations, including different activities each month throughout the year and the opportunity for some nurses and midwives to attend a regional conference in May will 2020.

National Financial Update

2.5. Following the formation of a new government in December 2019, overall NHS spending

plans for the next five years are set to remain in line with existing plans – an average real terms increase of about 3.4% per year until 2024. In addition, the Conservatives pledged extra money in their manifesto for plans to increase the number of nurses in the NHS by 50,000 by 2024/25. This will be achieved through further training, international recruitment and better retention of existing staff.

7



3. LOCAL NEWS AND DEVELOPMENTS

Five year strategy

3.1. Following an extensive engagement schedule, reaching both internal and external stakeholders, the Board will discuss the Trust’s five year strategy for approval at this meeting (agenda item 12). The strategy sets out the Trust’s vision to provide ‘the very best care for every patient, every day’ and includes further work in collaboration with partner organisations to create a local health and care system that is fit for the future. Integrated Care Partnership

3.2. During the autumn, all boards within the west Hertfordshire system received and discussed case for change documents relating to the development of the local integrated care partnership (ICP). The case for change highlighted a number of questions that need to be addressed as the ICP is developed, these fall into four categories: vision, aims, objectives and principles; scope and pace; service design; and form and enablers. A programme of work was presented to chief executives and chairs on 31 January 2020 for discussion with a view to beginning the next steps of the design work. Integrated Care System

3.3. As the local integrated care partnership is developed, it is also important to ensure a strong and effective integrated care system (ICS). As a system, all partners have signed up to becoming an integrated care system by April 2021 and are currently part of the NHS England accelerator programme. There are four areas of focus: leading partnerships, system architecture, system payment mechanisms and population health management.

Mount Vernon Cancer Centre

3.4. Following the evaluation of bids to run the Mount Vernon Cancer Centre, NHS England’s

regional leadership team has agreed with a recommendation that University College London Hospitals NHS Foundation Trust (UCLH), subject to a period of due diligence, should be awarded the contract to run the centre from April 2021. It has also been agreed that UCLH should be appointed to provide leadership support to Mount Vernon Cancer Centre from April 2020.

3.5. There will be no immediate changes to where patients receive treatment whilst clinicians and patients consider the best way to meet the needs of the Mount Vernon Cancer Centre population in the long-term. The Trust was be engaging in the review process and will update the Board as it progresses.

Local leadership changes

3.6. David Evans, previously director of commissioning at Herts Valley Clinical Commissioning Group (HVCCG). He has been appointed as the interim chief executive and will remain in post as the joint accountable officer across all three CCGs in this area (Herts Valleys, East and North Herts and West Essex) until a substantive appointment is secured. Celebrating staff

3.7. Congratulations and well done to Dr Radhika for receiving a UCL MBBS Top Teacher award. UCL students nominated Dr Radhika following their year five obstetrics and gynaecology placement.

7



Supporting national healthcare campaigns 3.8. Thank you to staff who organised the following events in January 2020 in support of

national healthcare campaigns:

Staff across the organisation marked Holocaust Memorial Day by telling the story of the hundreds of Jewish women who won their freedom from the Nazis by working as NHS nurses.

The maternity team who celebrated an alternative to ‘Blue Monday’ with ‘Brew Monday’ by touring the women’s and children’s unit with a trolley to offer tea and cake to staff

The Trust’s charity raised £205 through an online auction of a keyboard which had been signed by Gareth Malone, the famous choirmaster. Gareth worked with the Trust on a TV documentary which was broadcast over Christmas 2019.

4. BOARD NEWS

Director of Governance appointed 4.1. Dr Anna Wood has been appointed to the newly created role of director of governance. Dr

Wood, previously deputy medical director/associate medical director of clinical standards and audit, will have responsibility for a number of key areas of integrated clinical governance and compliance and will work very closely with the chief medical officer and the chief nurse to ensure complete join up in terms clinical governance and compliance. The chief nurse will remain the overall executive lead for trust governance and the chief medical officer will continue to be the executive lead for patient safety and risk.

Board visit programme

4.2. As part of the monthly Board visit programme, the Board visited four areas at Watford

hospital in January 2020, namely the patient lounge, katherine ward, occupational health, starfish/safari ward and the palliative care team. Verbal feedback from the visits was received by the Board in the private session of the Board meeting in January 2020 and will be included in a bi-annual engagement Board report. Board development programme

4.3. The Board met for a development session on 22 January 2020 at which the Board discussed a forthcoming CQC inspection and the actions needed to be taken to achieve a ‘good’ rating.

5. KEY MEETINGS

5.1. Since the last Board meeting, I have undertaken the following business:

Attended a stakeholder event for a new joint accountable officer appointment

Had a meeting with Dean Russell, MP for Watford

Presented a number of staff awards

Introduced the new chair of Herts Community Trust to the Trust

Attended several meetings with leaders from HVCCG

Toured St Albans hospital with the head of nursing for surgery, anaesthetics and cancer

Chaired the inaugural West Herts ICP chairs’ event

Attended a number of assurance committee meetings

Met with Daisy Cooper, MP for St Albans

Attended a West Herts strategy and integrated day

Chaired a number of consultant interview panels

Attended an East of England chairs’ event

7



6. RECOMMENDATION

6.1. The Board is asked to receive the report for information. Phil Townsend Chairman February 2020

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Page 1 of 4


Title of the paper Chief Executive’s report

Agenda Item 08/79

Presenter Christine Allen, Chief Executive


Purpose

For approval

For discussion For information

Executive Summary

The aim of this paper is to provide an update to the Board on items of national and local interest/relevance.

Trust strategic aims


Objectives 1-5


work Objectives 6-8

Aim 3 Improve our

finances

Objective 9


future

Objective 10-12


Is there the leadership capacity and capability to deliver high quality, sustainable care? Is there a clear vision and credible strategy to deliver high quality, sustainable care to people, and robust plans to deliver? Is there a culture of high quality, sustainable care? Are there clear responsibilities, roles and systems of accountability to support good governance and management? Are there clear and effective processes for managing risks, issues and performance? Is appropriate and accurate information being effectively processed, challenged and acted on? Are the people who use services, the public, staff and external partners engaged and involved to support high quality sustainable services? Are there robust systems and processes for learning, continuous improvement and innovation? How well is the trust using its resources?



N/A

Action required The Board is asked to receive the report for information.

8

Tab 8 Chief Executive's Report


Page 2 of 4

Agenda Item: 08/79

Trust Board meeting – 06 February 2020 Chief Executive’s report Presented by: Christine Allen, Chief Executive Officer 1. PURPOSE

1.1. The aim of this paper is to provide an overview of the work of the executive team since the

previous Board meeting. 2. AIM ONE: BEST CARE

Winter pressures

2.1. Like many trusts across the country, the New Year has seen little let-up in demand for

emergency care and the Trust has continued to see increased levels of demand. Patient safety has remained the Trust’s key priority and staff have been doing all they can to enable more flow within the hospitals.

2.2. The level of teamwork demonstrated over this very challenging time has been

commendable and when everyone is so busy, it is easy to forget the impact that behaviour has on others, but it is clear that our patients and their families do notice. They not only comment on the kindness, compassion and standard of care they have received, they also note that this has taken place in a pressurised environment and, despite all that is going on, staff have remained calm and caring, providing much-valued and needed support and reassurance to patents and their families.

2.3. As a small gesture of thanks for their hard work and dedication over the Christmas and New

Year period, all staff have been given a voucher to exchange for a coffee and cake in the Trust’s restaurant over the next few weeks.

Care Quality Commission inspection

2.4. The Trust is due to be inspected by the Care Quality Commission (CQC) over the next two

months. On 26 February 2020, NHS Improvement’s use of resources assessment will take place. This is aimed at understanding how effectively the Trust is using its resources to provide high quality, efficient and sustainable care in line with the recommendations of Lord Carter’s review of operational productivity and performance.

2.5. In addition, on 10 March 2020, a three day well-led inspection will be undertaken by the CQC. This will assess whether the Trust has strong integrated governance and leadership in place across quality, finance and operations, whether it is in line with the changing operating environment and has an appropriate emphasis on organisational culture,

8



Page 3 of 4

improvement and system working.

2.6. The third and final element of the regime will be an unplanned inspection of a number of clinical areas. The Trust will have 30 minutes advance notice of this assessment.

Wuhan novel coronavirus

2.7. The Trust is following guidance published by Public Health England to an international alert

recently raised by the World Health Organisation regarding Wuhan novel coronavirus. The guidance outlines the patient pathway in the event of a suspected or confirmed case and outlines clinical management guidance for these patients, including the correct personal protective equipment for staff and visitors to wear.

2.8. Staff from across infection prevention and control, emergency planning and operations are working closely together to ensure the management of suspected cases is clear within the areas identified as points of admissions. A Trust policy has been developed, based on the available guidance which was discussed by the quality committee in January 2020.

Urgent Treatment Centre

2.9. An urgent treatment centre at the front door of the emergency department at Watford

hospital will open on 01 April 2020. Greenbrook HealthCare has been appointed as the provider of this service and the opening hours will be 8am to 2pm. Palliative care services

2.10. Patients, families and health and care professionals are now able to access advice on palliative and end of life care from a West Herts Advice Line, hosted by Peace Hospice Care and The Hospice of St Francis. The service operates from 5pm to 9am everyday including weekends and bank holidays and calls are handled by an experienced nursing team who liaise with on-call doctors and consultants.

Respiratory referral management system

2.11. The respiratory department has developed a referral management system hub in collaboration with Herts Valleys Clinical Commissioning Group and the Central London Community Healthcare Trust. The hub aims to provide a single point of access for all outpatient respiratory referrals enabling earlier accurate diagnosis and screening of patients with respiratory conditions.

3. AIM TWO: GREAT TEAM Supporting staff

3.1. Ensuring that staff are supported to allow them to continue to provide the best possible care

is vitally important. It is particularly important to be mindful of the impact that is created by the challenges faced by the rising demand, patient expectation and being able to discharge patients safely and effectively in order to create capacity.

3.2. With this in mind, staff are encouraged and supported to maintain and improve their

physical and mental health through the Trust’s health and wellbeing programme. In particular, February is national heart month when staff will be encouraged to take care of their heart and understand what they can do to help themselves.

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Page 4 of 4

Flu vaccination campaign

3.3. The Trust has met its target of vaccinating 80% of frontline patient facing staff, however

with an increase in the number of patients with flu in our hospitals, staff are being reminded of how important it is for them to get their flu jab. NHS Electronic Staff Record

3.4. Staff are now able to view their payslips and P60s through an NHS electronic staff record system. The system also allows staff to update their personal information and provides links to useful sites such as training and current job vacancies.

4. AIM FOUR: GREAT PLACE

Improving the environment 4.1. It’s been a few months since the Trust heard the great news that it is one of the six NHS

trusts sharing the £2.7bn pledged by the government. The Trust’s redevelopment plan is part of the national HIP 1 (health infrastructure programme) and final allocations are dependent on the submission of more detailed business cases.

4.2. In the meantime, a refresh and redevelopment programme is continuing across all three

hospital sites, including painting, new flooring, improved lighting and widening doors. In addition, in January there has been a real focus on de-cluttering and tidying clinical and non-clinical areas.

Updating NHSmail email addresses

4.3. When the Trust moved onto NHS mail in 2019, it was assigned the prefix ‘wherts-tr’. This has now been personalised to ‘westherts’ to make it more meaningful and easily identifiable for external organisations or members of the public.

5. RECOMMENDATION

5.1. The Board is asked to receive this report for information. Christine Allen Chief Executive February 2020

8



1

Trust Board Meeting06 February 2020

Title of the paper Board assurance framework report

Agenda Item 09/79

Presenter Christine Allen, Chief Executive


Purpose For approval For discussion For information

¸

Executive Summary This report is to provide the Board with assurance that risks to achieving the

Trust’s strategic objectives are being appropriately mitigated, to consider those elements that report direct to Board and any recommendations of changesfrom assurance committees.

Elements of the BAF were reviewed on 30 January 2019 by the Quality Committee and the Finance and Performance Committee and no changes were recommended to the Board.


Aim 1Best quality care

Objectives 1-5

Aim 2Great place to

workObjectives 6-8

Aim 3Improve our

finances

Objective 9

Aim 4Strategy for the

future

Objective 10-12¸ ¸ ¸ ¸


☒Is there the leadership capacity and capability to deliver high quality, sustainable care?☒Is there a clear vision and credible strategy to deliver high quality, sustainable care to people, and robust plans to deliver?☒Is there a culture of high quality, sustainable care?☒Are there clear responsibilities, roles and systems of accountability to support good governance and management?☒Are there clear and effective processes for managing risks, issues and performance?☒Is appropriate and accurate information being effectively processed, challenged and acted on?☒Are the people who use services, the public, staff and external partners engaged and involved to support high quality sustainable services?☒Are there robust systems and processes for learning, continuous improvement and innovation?☒How well is the trust using its resources?

9

Tab 9 Board assurance framework



∑ Finance and Performance Committee – 30 January 2020∑ Quality Committee – 30 January 2020

Action requiredThe Board is asked to consider and approve the latest version of the BAF.

9



Agenda Item: 09/79

Trust Board meeting – 06 February 2020

Board Assurance Framework report

Presented by: Christine Allen, Chief Executive

1. Purpose

1.1 This report aims to provide the Board with assurance that risks to achieving the Trust’sobjectives are being appropriately mitigated, to consider those elements that report direct to Board and any recommended changes from the committees.

2. Background

2.1 All NHS Trusts are required to use a Board Assurance Framework (BAF), not least because it’s been proven good practice for many years in both healthcare and a whole range of complicated high-risk organisations. The BAF is a “live” document that changes over time, and in particular it picks up all the controls that the Trust has in place to manage, minimise and/or remove the identified risks and points towards concise and comprehensive evidence that the controls are working.

2.2 The BAF forms part of the Trust’s overall board assurance and integrated risk management arrangements. It brings together three things:

∑ The Trust’s four aims and twelve underpinning strategic objectives∑ A headline summary of all the issues (risks) that might get in the way of achieving those

objectives∑ A headline summary of what the Trust is doing about those issues, along with a concise

description of how the Board can be assured that what is being doing is working.

2.3 Where appropriate the BAF is cross-referenced against operational risks on the corporate risk register. It should be noted that the BAF and corporate risk register are complementary but not the same thing.

2.4 The difference between “assurance” and “reassurance” is vital to make the BAF work. Reassurance is when someone tells you all’s well; Assurance is when they tell you what’s happening, show you the evidence and you can judge for yourself if all’s well. The diagram below demonstrates this in more detail.

Reassurance Assurance

∑ It is OK because management say it is

∑ Strong management personalities may dominate

∑ Track record of success∑ Professional background or

expertise∑ No contradictory evidence

∑ It is OK because how management have responded to questions from the Board has given me confidence by:

- Clear and logical explanations from Board members

- What has happened; why it has happened and what is the response

- Management explanations are consistent

It is OK because I have reviewed various reliable sources of information, such as:- Independent information

source- Evidence of historical

progress, outcomes- Triangulation with other

information

9



2.5 The approved risk appetite statement and threshold matrix is attached for Board reference (appendix 1). These are both dynamic documents and are used by the Board and assurance committees to influence decision making at an individual risk level.

3. Monthly review

3.1 The current BAF can be found in appendix 2. The description, controls, assurances and actions to address gaps in controls and assurances were reviewed and updated by executive leads in January 2020.

3.2 Elements of the BAF were reviewed on 30 January 2020 by the Quality Committee and the Finance and Performance Committee. No changes are recommended to the Board at the current time.

3.3 There is one area of extreme risk (assessed as red) where only limited assurance can be gained by the Board as detailed below. The rating of this risk will be reviewed once the work described below comes to fruition.

Risk no. Risk description Board assurance10e Failure to deliver upgrade to local

area network (LAN), telephonyservices

The Board will receive an update on the plan and implementation of the LAN in the private session of the Board meeting on 06 February 2020.

The first element of works to move to a digital telephony platform is scheduled for early March 2020.

3.4 The following risks are assessed as high (amber) and only limited assurance can be gained by the Board:

Risk no. Risk description Board assurance4a Non-delivery of the Trust’s

improvement plan for emergency care

The performance report on access targets and the integrated performance report under item 10 and 11.

10b Failure to secure improved service from new IT provider due to ineffective relationship and management of ITO provider and failure to address capacity/capability gaps within the Trust in-house IT team

A number of mitigating actions are underway within the IT department to manage this risk. A report outlining the improved quality of service from the new provider will be received by the Board at the end of quarter one 2020/21.

4. Next steps

4.1 The BAF will be refreshed to align with updated strategic objectives, which will be discussed for approved by the Board in February 2020 as part of the Trust’s five year strategy.

4.2 The committee chairs and executive leads are currently undertaking an exercise to cross reference the BAF risks against the work plans to ensure that all risks are being appropriately monitored.

9



5. Risks

5.1 There is a risk that failure to keep effective oversight of the Trust’s key risks may lead to the Trust not achieving its organisational strategic aims and objectives.

6. Recommendation

6.1 The Board is asked to consider the latest version of the BAF.

Christine AllenChief Executive

January 2019

Appendix 1. Risk appetite statement and threshold matrixAppendix 2. Board Assurance Framework

9



Exec leadLead

Committee

Link to

Corporate

Risk Register

Link to

Stand-

ards

Rating of risk

to delivering

objective

Control Gaps Identified assuranceAssurance

Gaps

1a Failure to sustain expected or better than expected

performance on key mortality indicators (SHMI and

HSMR)

Chief Medical

Officer

Quality Committee CQC Low 1. Morbidity and mortality meetings

1. Structured judgement review process fully embedded

1. Divisional Governance meetings

1. Consultant coders and medical examiners fully established

2. Quality, Mortality review group

2. Quality Committee reports

3. Dr Foster

None known

1b Failure to deliver quality priorities set out in the

Quality Account with a focus on harm free care and

Patient Safety.

Chief Nurse Quality Committee CQC,

NHSLA,

HSE

Medium Practice development gap to

support skill mix and ward

leaders to develop practice.

1. Quality Account.

1. Monitoring of patient safety and effectiveness through quality safety group and patient experience

metrics at patient experience group.

1. Ward leaders supervisory and supporting delivery of harm free care with specialist nursing teams.

1. Matrons part of QI forum reviewing overall ward dashboard metrics and harm free care.

1. Senior NMAHP staff going 'Back to the Floor' .

1. Divisional quality summits held by heads of nursing

2. Quarterly monitoring of progress with quality priorities by Quality Committee

2. Each priority is assigned an executive lead.

3. Quality assurance visits by HVCCG.

None known Development of practice development nursing team.

Using 'Back to the floor' to test what we are hearing and seeing, and

using themes to support development.

QI Forum to develop and review actions.

Discharge phone back system and utilising to ascertain themes and

actions for patient experience.

To undertake patient engagement and experience events.

Development of co-production

GIRFT governance strengthened

Chief Nurse

2a Failure to implement standardised ‘in hospital’

pathways, with improvement in consistency of care

and improved outcomes (working with the Royal

Free Partnership group)

Chief Medical

Officer

Quality Committee Medium Funding and recruitment for

additional clinical leadership

sessions.

1. CPG progress dashboard

1. Quality team meetings.

1. Leadership and supervision from Royal Free Associate Director

2. Trust management committee updates

2. Quality committee reports

3. Royal Free Partnership Board Strategy update papers to Trust Board

Proposal for additional resource for manual data collection.

Standardisation of clinical time to provide leadership for the pathway.

Director of

Integrated

Care/CPG

Lead

Action completed. Proposal was

reviewed by the Trust Management

Committee in November 2019.

Divisions are reviewing clinical job

plans to support time commitment

required. The proposal will be a

considered for approval at the

corporte finance review meeting.

2b Failure to deliver integrated pathway

developments agreed with HVCCG as set out within

the service delivery implementation plan (SDIP)

Deputy Chief

Executive

Quality Committee Medium 2. Trust management committee

3. QIPP Board (HVCCG)

2c Failure to develop patient centred planned and

ambulatory care pathways including maximising

planned surgery on the St Albans City Hospital site,

medical specialties at Hemel Hempstead General

Hospital and women's and children's services

Deputy Chief

Executive/

Chief

Operating

Officer

Quality Committee Medium 1. Divisional performance reviews

1. Acute redevelopment programme executive

3. QIPP Board (HVCCG)

Review St Albans pilot Deputy

Chief

Executive/

Chief

Operating

Officer

AIM 1:

Risk

no.

What could prevent

us from meeting this objective?

CQC,

NHSLA,

HSE, etc

1. First line of assurance (divisional)

2. Second line of assurance (committee)

3. Third line of assurance (external)

OBJECTIVE 1.

TO DELIVER EXCELLENT CLINICAL

OUTCOMES FOR OUR PATIENTS

-MORTALITY

- HARM FREE CARE

OBJECTIVE 2.

TO IMPLEMENT BEST PRACTICE,

INTEGRATED CARE PATHWAYS AND

REDUCE UNWARRANTED CLINICAL

VARIATION IN CARE AND OUTCOMES

Low/Medium/

High/

Extreme

The sub-committee

responsible for

monitoring the risk

BOARD ASSURANCE FRAMEWORK 2019/20

Mar-20

Strategic Objective 2019/20 Risks Identified

Exec lead

(to deliver

specific

action)

What the organisation aims to deliver (outcome

required)

Are the identified actions being

achieved?

Where we are

not gaining

effective

evidence?

Actions to address control and assurance gaps. Time

scale /review

date

Board level

lead

responsible for

achieving the

objective

Risks scored

15 and

above

Mar-20

BEST CARE

Update

Actions to Address gaps (controls and assurance)

Nov-19

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Exec leadLead

Committee

Link to

Corporate

Risk Register

Link to

Stand-

ards

Rating of risk

to delivering

objective

Control Gaps Identified assuranceAssurance

Gaps

Risk

no.

What could prevent

us from meeting this objective?

CQC,

NHSLA,

HSE, etc

1. First line of assurance (divisional)

2. Second line of assurance (committee)

3. Third line of assurance (external)

Low/Medium/

High/

Extreme

The sub-committee

responsible for

monitoring the risk

Strategic Objective 2019/20 Risks Identified

Exec lead

(to deliver

specific

action)


required)


achieved?

Where we are

not gaining

effective

evidence?

Actions to address control and assurance gaps. Time

scale /review

date

Board level

lead

responsible for

achieving the

objective

Risks scored

15 and

above

Update

Actions to Address gaps (controls and assurance)

3a Failure to roll out recognised quality improvement

(QI) methodology - developing internal capacity to

support QI and suite of training for clinical staff.

Chief Nurse/

Deputy Chief

Executive

Quality Committee CQC Low 1. Quality account agreed

1. Proactive quality improvement culture within the Trust

2. Monitoring of progress with quality priorities by quality committee

2. The following actions agreed as next steps: Source and connect current staff who have a Quality

Improvement (QI) title/aspect within their existing role.

3. CQC report

Awareness of

QI

methodology

being

embedded.

Widespread

training of staff

in QI.

Awareness campaign to commence.

Dosing programme being developed.

QI projects linked to quality priorities and application process.

Chief Nurse Action completed. Campaign

started. Paper received by Quality

Committee

Action completed. Programme

developed. Part Funding identified

in 19/20 from CPD monies.

4a Non-delivery of the Trust's improvement plan for

emergency care

Chief

Operating

Officer

Finance & Performance

Committee

3995 NHS High

Performance measures are

adverse to plan although a

number of metrics have seen

improvement in relation to

patient flow overall.

Lack of senior decision makers

on presentation to ED.

1. ED escalation, improvement and transition plans

1. Discharge Working Group

1. Patient Flow Transformation Board

1. ED team check ins with CEO

2. Trust Management Committee

2. Finance and Performance Committee

3. Joint Urgent Care Programme Board (with HVCCG)

3. System resilience group

3. Local Delivery Board

3. NHSI Progress Review Meeting

3. HVCCG Contract & Quality Review meeting

None known SMART Medical take redesign pilot has been embedded with steps to

transition as 'Business as usual' which enables

cardiology/respiratory/frailty and Gen med in ED.

Increase utilisation of Ambulatory Care and focus upon ambulance

handover.

Chief

Medical

Officer

Action completed. The pilot

continues to deliver improved

patient flow and efficiency. Each

department’s team job plans for

2020/21 are developed to make

SMART “business as usual”, where

appropriate

4b Non-delivery of the Trust's improvement plan for

planned care

- referral to treatment waiting time standard

- cancer waiting time

Chief

Operating

Officer

Finance & Performance

Committee

3828 NHS Medium Some performance measures

are better than planned, with a

number of other measures

showing steady improvement

against plan

1. RTT Improvement Plan

1. Cancer Improvement Plan

1. Weekly Access meetings

1. Divisional Performance reviews

1. Elective Care Programme Board

2. Trust Management Committee

2. Finance & Performance Committee

3. NHSI Progress Review Meeting

3. HVCCG Contract & Quality Review meeting

None known

4c Failure to deliver patient experience improvement

actions as set out in the quality account.

Chief Nurse Quality Committee CQC Medium None known1. Developing opportunities for increased patient involvement in service improvement/ redesign

1. Developed Trust Carer Lead role

1. To develop bespoke local patient surveys

1. Follow up calls on discharge for communication

2. Patient experience metrics.

2. Evidence of assurance for actions from national surveys

2. Divisional reports including learning from complaints, incidents and claims

2. Patient Experience & Carers Strategy progress updates

3. CQC National patient survey reports

3. CCG quality assurance visits

3. PHSO reports

4. GIRFT reviews

None known Develop and implement communication bundle.

Discharge phone back system and utilising to ascertain themes and

actions for patient experience.

Map patient engagement and develop PPI events twice a year a

steering group.

Commission Healthwatch review of patient engagement and use to

develop strategy and action.

Develop the governance and dashboard for MH patients in partnership.

Implement LD patient end of life care pathway.

Chief Nurse LD EOLC pathway developed and

reviewed at panel.

Evaluation of discharge phone call

service undertaken.

Healthwatch review completed and

co-production being developed.

Mar-20

OBJECTIVE 4.

TO IMPROVE THE PATIENT EXPERIENCE

AND THE RESPONSIVENESS OF OUR

SERVICES

OBJECTIVE 3.

TO IMPLEMENT AND EMBED OUR

'QUALITY COMMITMENT' AND 'WEST

HERTS WAY' QUALITY IMPROVEMENT

METHODOLOGY

Oct-19

Sept-19 Jan-

20

Nov-19

Jan 20

Mar-20

Jan-20

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Executive Lead

Lead Committee

Link to Corporate

Risk Register

Link to Stand-

ards

Rating of risk to delivering the

objectiveControl gaps Identified assurance Assurance Gaps

5a Failure to meet Clinical Research Network recruitment targets


People, Education and Research

Medium For the current year. This has to be reviewed on a yearly basis

1. Continual presence at each clinical divisional level to reinforce good practice and encourage research recruitment. 2. Research and Development steering group2. Quarterly report to People, Education and Research Committee3. North Thames Clinical Research Network

Director Research and Development, or deputy to continue presence at divisional clinical governance meetings to highlight research needs in the trust. To have an open door policy to discuss any new research interests.


5b Failure to secure a higher level of support from the National Institute for Health Research (NIHR) for commercial studies



Medium For the current year. This has to be reviewed on a yearly basis

1. To apply lean strategies of working. 1. To look for opportunities to apply for additional funding2. Continual review by People, Education and Research Committee to look at additional funding streams2. Quarterly report to People, Education and Research

Committee

The research funding is not under Trust control and is centrally driven and changes on a yearly basis

5c Failure to identify clinical capacity within job plans to support enhanced research capability



Medium To be trialled as an initiative in one or two clinical areas

1. Consider adding funded PA's to new consultant contracts in a bid to secure accountable research time2. Quarterly report to People, Education and Research Committee

Time taken to get funded PA's into practice

To trial funded PA time for research in one or two clinical departments


6a Failure to achieve improved results in the national staff survey through implementation of corporate and divisional staff engagement improvement plans



Low Staff survey is annual. Mixed results in quarterly F&FT in whether staff would recommend the Trust as a place to work

1. Developed Big 5 programme1. Used various communication channels to promote Big 51.Regular updates to TMC1. Implemented onboarding questionnaires for new starters2. Report performance to PERC3. Benchmark against other organisations

Some signifcant culture issues within organisation that are being addressed, but may impact on results

OD interventions to address hot spots in organisation where concerns exist in terms of staff engagement


6b Failure to improve performance against the workforce race equality standard indicators to improve the experience of staff from BME and other under represented groups



Medium Annual staff survey still shows that BAME staff report less positive experience and engagement

1. Developed and published workforce race equality scheme (WRES) with a set of actions to deliver race equality indicators1. Established BAME staff network1. Communicated Trust commitment through the focus on race equality as part of the BIG 5 programme1. Executive directors have a equality objective2. Provide regular updates to trust management committee and provide assurance to PERC3. Publish results which enables benchmarking

Creation of organisational weide pisitive action programme to demonstrate commitment

To further promote development opportunities for BAME staffTo establish programme of reverse mentoring


Mar-20


Mar-20

Exec lead (to deliver

specific action)

Strategic Objective 2019/20 Risks Identified Actions to Address gaps (controls and assurance)

Update1. First line of assurance (divisional)2. Second line of assurance (committee)3. Third line of assurance (external)

AIM 2:

OBJECTIVE 6.

TO HAVE HAPPY,

HEALTHY, WELL

SUPPORTED STAFF WHO

FEEL ABLE TO DELIVER

GREAT CARE AND 'MAKE

A DIFFERENCE' IN AN

INCLUSIVE

ENVIRONMENT AND TO

BE A CLINICALLY LED

ORGANISATION

Where we are not gaining effective

evidence?

Actions to address control and assurance gaps.


achieved?

OBJECTIVE 5.

TO FURTHER DEVELOP

THE TRUST'S

PARTICIPATION IN

RESEARCH AND

DEVELOPMENT

Board level lead

responsible for achieving

the risk to the objective

The sub-

committee

responsible for

monitoring the

risk

Risks scored 15 and above

Low/Medium/High/Extreme

What the organisation aims to deliver (outcome required)

Risk no.

What could preventus from meeting this objective?

CQC, NHSLA,

HSE, etc

Time-scale/review

date

Mar-20

Feb-20

GREAT TEAM

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7a Failure to achieve and maintain a positive vacancy rate



3995 Medium National vacancies in particular professional groups including nursing and doctors.

Impact of Brexit difficult to predict.

1. Approved business case for o/s nursing and established recruitment campaigns with good supply currently. 1. Workforce information shared with TMC and PERC in

monthly workforce report. 1. Divisional action plans focused on recruitment strategies monitored through Divisional Performance Reviews

Need more work on strategy for recruitment to medical vacancies

and difficult to recruitment positions such within Paeds/ theatreas

Currently recruiting to Head of Medical Resourcing and seeking to strengthen team with better skill mix.

Production of overall plan to recuit internationally for doctors.Recruitment for nurses from Australia


7b Failure to achieve and maintain a positive turnover rate



Medium 1. Good staff engagement programme with Big 5. 1. Established onboarding questionnaires as well as exit questionnaires to pick up staff at risk of leaving. 1. Divisional action plans monitored through Divisional Performance Reviews.1. Established career development support under 'Developing You' to improve retention. 2. Report to TMC and PERC via workforce performance reports.

Need abetter staff benefits package to help retain our staff

Production of business case to offer staff discounted food.Proudction of new package of staff benenfits


8a Failure to demonstrate Trust meets criteria for Teaching Hospital Status



Low A formal senior workforce group has been established where progress can be tracked and will report to TMC and PERC on progress.

1. Project plan developed to track progress. 1. Existing team resourced to undertake work required. 2. Report on progress to People, Education and Research Committee

Further work to establish governance around this and monitoring progress.

Written support from Medical SchoolNHS Comms. to check our proposed name is OKKet stakeholder engagementCollate our ‘Significant Teaching [and learning] Commitment’*Submit to DoH to amend our Establishment Order


8b Failure to maintain high levels of compliance in core and essential training



Low Core mandatory training above target of 90%. Essential training on improving trajectory towards target.

1. Acorn 2 established with elearning and reminders to staff when training due. 2. Reported to TMC2. People, Education and Research Committee workforce performance report. 3. Benchmark against organisations in STP quarterly.

ABLS and Fire Training which are face to face have lower levels of comliance

Plans in place to bring in additional support for both these elements to ensure 90% compliance


8c Failure to provide clear development options in place for every banding of role within the Trust



Medium Work on portal at STP level still at early stage and being fully scoped. Leads for all areas to be identified.

1. Developed apprenticeships approach locally for clinical staff and non clinical staff in junior roles. 1. Developed First Line Leadership Programme, Senior Leader Programme and Clinical Leadership Programmes. 1. Mapping career development options for all staff. 2. People Education and Research Committee3. Linking with STP to develop portal for development activity across region.

Need to agree upon prefered approach to management of apprenticeships, likely to be lead provider model for whole of ICP

Work being undertaken to devised our strategic apprenticeship approach. Launch of lead provider model


OBJECTIVE 8.

TO BECOME AN

EXCELLENT

ORGANISATION FOR

EMPLOYEE

DEVELOPMENT

OBJECTIVE 7.

TO REDUCE VACANCY

RATES AND REDUCE

OUR RELIANCE ON

AGENCY WORKERS

Jul-20

Jun-20

Apr-20

Mar-20

Apr-20

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Executive LeadLead

Committee

Link to Corporate

Risk Register

Link to Stand-

ards

Rating of risk to delivering the

objectiveControl Gaps Identified assurance Assurance Gaps

9a Failure to deliver the in-year financial plan.


Finance and Performance

42044205

Low Clarity is not yet secured regarding actions required to secure Financial Recovery Fund beyond simple achievement of annual control total

Ability to manage reduction in costs to match reduced funding

Prevention or identification of spending outside required control processes

1. Documented budget meetings, analysing variances and taking corrective actions1. Accurate forecasting and development of recovery plans. 2. Trust Management Committee2. Finance & Performance Committee3. Financial Assurance Meeting - NHSI/E3. Oversight and Support Meeting - NHSI/E

Formal written communications from NHSI/E explicitly stating the terms and conditions required to secure FRF payments

Guarantee that all service changes have not adversely affected the financial position

Assurance that changes in medical staff capacity are fully controlled

Complete medical workforce control project and implementation of medirota software.

Chief Financial Officer

The control project and rollout of medirota software is ongoing. Divisions have been asked to deliver on their respective actions

9b Failure to achieve year on year improvement in the underlying financial position



Medium Capital availability for schemes which require it, irrespective of governance compliance.

Limited CIP plan beyond the current year.

Division / directorate capacity for identification, compliance & delivery.

Limited SLR and benchmarking take-up reduces opportunity to identify potential new CIPs.

1. Detailed reporting of delivery against plan and variance in context of overall financial performance.

1. CIP forecast reviewed on at least a monthly / twice monthly basis within divisions

1. Monthly Trust Management Committee2. Monthly Finance & Performance Committee3. Detailed deep-dives by NHSI, other external bodies, and internal audits as validation of scheme management and underlying controls.

Project management software capacity not fully utilised, including integration with programme management processes

Complete drivers of deficit analysis.

Further develop 5 year rolling cost improvement programme. (See regular Board Part 2 FRP paper)

Complete roll out of project management software.


Completed.

9C Failure to achieve performance targets against key value for money metrics. ( e.g. model hospital, Carter metrics)



Medium More frequent reporting and action planning to improve performance against Model Hospital metrics.

1. Outcome of a comprehensive assessment against Model Hospital metrics undertaken in 2018/19.

1. Outcome of financial benchmarking exercise undertaken at department/ cost centre level in 2017/18

Report demonstrating improvements against last set of assessment.

Introduce reporting framework to assess improvements against model hospital metrics.


Jan-20

Mar-20

Mar-20

Mar-20

Jan 20

Mar-20


OBJECTIVE 9.

TO DELIVER BEST VALUE CARE

Where we are not gaining effective evidence?


Exec lead (to deliver

specific action)

What the organisation aims to deliver (outcome required)

Risk no.


CQC, NHSLA, HSE, etc

Are the identified actions being achieved?

Strategic Objective 2019/20 Risks Identified Actions to Address gaps (controls and assurance)

UpdateTime-scale /review date

AIM 3: BEST VALUE


Low/Medium/High/Extreme 1. First line of assurance (divisional)

2. Second line of assurance (committee)3. Third line of assurance (external)

Board level lead

responsible for achieving the

risk to the objective

The sub-committee

responsible for

monitoring the risk

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Exec leadLead

Committee

Link to Corporate

Risk Register

Link to Stand-

ards

Rating of risk to

delivering

Control Gaps Identified assurance Assurance Gaps

10a Failure to achieve a successful and safe transition to a new IT provider

Chief Information Officer

Board 4114 High A lack of documentation around infrastructure and routing and technical processes from CGI

1. ICT and Business continuity incident control rooms during transition 1. ICT resource engaged to manage a controlled and documented programme course

The Board approved for this risk to be removed as the Trust had transitioned onto a new IT provider.

10b Failure to secure improved service from new IT provider due to ineffective relationship and management of ITO provider & failure to address capacity / capability gaps within the Trust in-house IT team.


Board High Insufficient non technical skills to deploy the new governance and contractual processes

1. A divisional restructuring that will help us obtain the right seniority and balance of skills across technical and non technical resources appropriate to working in a hybrid ITO model.

Any restructure will not be complete during 2019

Personal involvement and leadership of key commercial relationship and meetings by the CIO


10c Failure to meet the compliance requirements of the general data protection regulations and data security toolkits and associated audits


Board 38974197

Medium A cultural and educational programme needs to be wrapped around the re-formed information group that is monitoring the DSPT action plan

2. Trust management committee Promotion of the importance of information governance and security and a structured training programme


10d Failure to implement remote access to radiology and other specialty images


Board Low None - specialist technical advice being sought to complete the pilot - no other reason the actions will not be achieved

1. Directorate team meetings

10e Failure to deliver upgrade to local area network (LAN), telephone and services. (Subject to approval of business cases for capital funding).


Board 3896 Extreme At present actions are on target - there are no obvious control gaps

1. Directorate team meeting.2. Trust management committee3. Trust Board

N/A In December the Board approved the Full Business Case for the redesign and replacement of the existing LAN. This business case represents a £1.7m investment by the Trust. The contract variation is in the process of being signed. It is expected that the design work will be complete by the end of January 2020 with the implementation commencing in February 2020, with the aim of seeing improvement by the summer.

A telephony business case for £400k has been approved, which is the first part of a two year plan to move to a digital (rather than analogue) platform. The first element of this is to replace the zip trunks which is scheduled for early March 2020.

10f Failure to improve 'paper' medical records and groundwork to support future implementation of electronic health records. (progress may be limited subject to approval of business case for capital funding).


Board 3120 Medium We are behind schedule due to the lack of a clear plan, ownership of delivery and dedicated resource

1. Production of a clear plan -signed off by TMC 1. Resource to deliver the plan

Resource not yet funded

Request to get capital resource to enable us to award the tender to develop the plan and manage delivery


Action completed. Funding identified. Consultants, Prederi have been commissioned and are currently writing the business case with the expectation that it will be completed by the end of January 2020.

10g Failure to develop outline business case for electronic health record implementation


Board Medium Lack of experienced resource

1. Directorate team meeting.2. Trust management committee3. Trust Board

Resource to support the development of the Strategic and Outline business case has been commissioned


Action completed. Funding secured from HVCCG. Procurement process completed and Deloitte have been commissioned to write the business case. It is expected that the strategic outline case wil be completed by mid-January 2020 and the outline business case by mid-March 2020.

The sub-committee

responsible for monitoring the

risk


Mar-20

Where we are not gaining

effective evidence?


Exec lead (to deliver specific action)

Time-scale/revie

w date


Board level lead responsible for

achieving the risk to the objective

Nov-19

Nov-19


required)

Risk no.

Strategic Objective 2019/20

Risks Identified Actions to Address gaps (controls and assurance)

Update

Mar-20

AIM 4: GREAT PLACE


CQC, NHSLA, HSE, etc

Low/Medium/High/Extreme

1. First line of assurance (divisional)2. Second line of assurance (committee)3. Third line of assurance (external)

Are the identified actions being achieved?

OBJECTIVE 10.

TO IMPROVE OUR IT AND MOVE

TOWARDS FULL

DIGITALISATION

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11a Failure to proactively communicate and engage with local communities and stakeholders in the development and delivery of our services


Board Medium Stakeholder strategy/plan to be reviewed and updated

1. Executive team meeting.2. Trust management committee3. Healthwatch review of trust engagement strategy

Stakeholder strategy / plan to be developed


11b Failure to actively engage in the development of an integrated care partnership for West Hertfordshire


Board Low 2. Trust management committee3. Sustainability and transformation partnership and HVCCG local delivery board

Joint work & OD programme with HVCCG and system partners to develop an ICP in development. Agree and implement internal governance to oversee transition to ICP

Deputy Chief Executive/HVCCG Programme Director (TBC)

All boards within the west Hertfordshire system have received and discussed case for change documents relating to the development of the integrated care partnership (ICP). A programme of work was presented to chief executives and chairs on 31 January 2020 for discussion with a view to beginning the next steps of the design work.

11c Failure to work with Herts Valleys Clinical Commissioning Group to test new contractual forms that share risk and support innovation.


Board Low 2. Trust management committee2. Finance and Performance Committee

Agree minimum income guarantee

Agree full business case for UEC



Completed.Board report - Nov-19

Completed.Full business case Nov-19

11d Failure to demonstrate active engagement in the West Herts and Essex Sustainability and Transformation Partnership


Board Low 3. Sustainability and transformation partnership governance3. Sustainability and transformation partnership chair's meetings

12a Failure to deliver agreed capital programme within agreed capital allocation.

Deputy Chief Executive/ Chief Financial Officer

Finance and Performance Committee

Low 1. Capital Finance Planning Group2. Trust Management Committee

Bring forward annual prioritisation process & develop multi-year view.

Continue regular calls with (new) Regional team to ensure joint understanding of opportunities and expectations and problem solve.

Deputy Chief Executive/ Chief Financial Officer

Projects that are currently approved are not forecast to cause an overspend against the approved capital resource limit. This forecast is assured by the Capital Finance Planning Group and TMC. There has been some movement against the plan set at the beginning of the year as previously reported to the board – some schemes have not progressed or timescales have slipped meaning that expenditure will cross over into next year (e.g. cardiac cath lab replacement, medical records revolumisation). Conversely some new / ‘emergency’ schemes have been included (e.g. uninterrupted power supply (UPS) replacement programme) and ambulatory care expansion. The Board received a detailed update in part 2 of the January 2020 Board and supported continuation of the current programme of spend which would lead to full utilisation of the capital allocation.

12b Failure to develop and achieve approval of development control plans and business cases to deliver the strategic priorities set out within the interim estate strategy


Board Medium 2. Acute redevelopment executive2. Trust Management Committee2. Capital Programme Finance Group2. Finance and Performance Committee

New terms of reference for delivery executive agreed - to be enacted

Terms of reference for delivery executive to be enacted


Delivery Executive in place and well attended, providing additional oversight of strategic capital projects. Good progress made with business cases - capital prioritisation for 20/21 to be confirmed by February 2020. Availability of capital expected to be a constraint in 2020. DCPs under development via acute redevelopment programme.

12c Failure to develop and achieve approval of outline business case/s for the long term redevelopment of our hospitals


Board Medium 1. Redevelopment team weekly catch-ups2. Programme executive2. Trust Management Committee2. Finance and Performance Committee

Internal governance arrangements only partially effective and require review

Complete development Control plans for SACH and Hemel.Business case for priority schemes

Secure approval for strategic outline case for the redevelopment of services and agree next steps


Mobilising additional capacity and expert advisory support for the redevelopment programme. Liaison with DH & NHSE/I re next steps for HIP 1 programme & funding release to support OBC development.

12d Failure to maximise capital funding via the full range of funding options (emergency capital applications, STP capital bids, other sources e.g. Salix)

Deputy Chief Executive/Chief Financial Officer


Low 2. Capital Programme Finance Group2. Finance and Performance Committee

Confirm emergency capital (external)Opportunistic bids (e.g. winter, diagnostics)

Prepare for wave 5 bids


Emergency Capital allocation for 19/20 confirmed. Successful bid for winter funding for ambulatory assessment expansion (0.5m). Approval for Salix funds granted, however scheme not ready for progression until 2020/21. The Trust has received additional funding to replace 1 x MRI and 1 x CT scanners via the national programme to replace medical equipment > 10 years old. This funding will be available in 2020/2021. The Trust will need to fund any associated building works.

Jan-20

Mar-20

OBJECTIVE 11.

TO WORK WITH LOCAL

STAKEHOLDERS AND PARTNER

ORGANISATIONS TO IDENTIFY WHERE, BY WORKING

TOGETHER, WE CAN IMPROVE CARE FOR OUR

PATIENTS

Dec 19

Mar-20

Mar-20

OBJECTIVE 12.

TO IMPROVE THE QUALITY OF OUR

ESTATE AND IMPLEMENT OUR SERVICE DRIVEN

ESTATES STRATEGY

Mar-20

Oct-19

Nov-19

Apr-20

Mar-20

9

Tab 9 B


ork

12 of 236T

rust Board M


Trust Board 06 February 2020

Title of the paper Performance report on access standards

Agenda Item 10/79

Presenter

Sally Tucker, Chief Operating Officer

Author(s)

Jane Shentall, Director of Performance

Purpose

Please tick the appropriate box

For approval


Executive Summary

This paper provides assurance on the monitoring of compliance with national Access standards in December 2019, identifying factors affecting performance and the actions to ensure a return to compliance.

Consistent compliance with the diagnostic waiting times standard has been maintained for many months, and this continues with 99.7% achieved this month. ED performance is lower at 79.4% (November 82.2%) and the position remains adverse to plan (88.2%). However December’s attendances at WGH ED were the highest recorded for 2019/20 at 9812, with a ytd increase of 8.7%. Ambulance arrivals were 9.4% higher than the previous month. Performance against the RTT 92% standard remained the same as the previous month, at 87.4% and is just below the trajectory plan (88.4%) for the month. There were no 52 week breaches at month end. Performance remains compliant with the 2 week wait and 2 week wait breast symptomatic and all 31 day standards. There has been an improvement in 62

10

Tab 10 Performance Report on Access Standards


2

day screening, with the target achieved this month (100%, target 90%). Performance against the 62 day referral to treatment standard at 83.2%, has not reached target (85%) but is better than the previous month (77.1%) and is in line with plan (83.1%). NB: Performance data accurate at time of reporting (31/1/20), but subject to change prior to external submission deadlines



Objectives 1-5

Aim 2 Great place to work

Objectives 6-8

Aim 3 Improve our finances

Objective 9

Aim 4 Strategy for the future

Objective 10-12


☒Is there the leadership capacity and capability to deliver high quality, sustainable

care? ☒Is there a clear vision and credible strategy to deliver high quality, sustainable care

to people, and robust plans to deliver? ☒Is there a culture of high quality, sustainable care?

☒Are there clear responsibilities, roles and systems of accountability to support good

governance and management?

☒Are there clear and effective processes for managing risks, issues and

performance?

☒Is appropriate and accurate information being effectively processed, challenged and

acted on?

☒Are the people who use services, the public, staff and external partners engaged

and involved to support high quality sustainable services?

☐Are there robust systems and processes for learning, continuous improvement and

innovation?

☒How well is the trust using its resources?



Trust Management Committee 29 January 2020

Finance & Performance Committee 30 January 2020

Action required

The Board is asked to receive this report for information and for assurance of ongoing monitoring of performance against nationally mandated waiting times.

10



Agenda Item: 10/79 Trust Board meeting – 06 February 2020 Performance report on access standards

Presented by: Sally Tucker, Chief Operating Officer

1. Purpose The purpose of this report is to provide clarity and context for performance against access targets, to identify the relevant factors where standards have not been achieved, and to describe the actions in place to improve waiting times and achieve compliance.

1.2 The relevant standards and guidance are included in appendix 1. 2. Indicators not achieved in the reporting period 2.1 At the time of reporting the following standards and indicators were not achieved in

December 2019.

3 A&E 95% target 3.1 Performance in December fell to 79.4% (from 82.2%). Compliance with the standard was

maintained at MIU (100%) and UTC (99.8%). Minors performance has fallen (from 94.3%) to 92.4%, with a decrease in Majors (from 58.9%) at 53.9%. CED has continued to experience significant pressure, achieving only 85.9% (previous month 87.7%).

10



4

3.2 In keeping with the overall position, performance against the 4 hour standard for non-admitted pathways was lower at 78.1% (vs 80.6% in November) as was admitted pathway performance (from 63.2%) at 56.8%, but still better than the start of the year (April 50.2%).

3.3 Benchmarking using Model Hospital shows WHHT in a better position than most peers for

November. WHHT is placed 29th of 94 providers (last month 76th) in terms of A&E performance. The trust position compares favourably with a regional peer median of 79% and a national median of 79.19%.

The chart below benchmarks WHHT with the Nightingale Group1 – other acute providers

with more than one site (shown in grey) where the median is 75.8%.

Despite the downturn in performance in December, when comparing trends across a 12

month period from November 2018, WHHT is improving while the regional and national position is deteriorating.

3.4 Increasing demand (activity above plan) continues as shown in the table and chart below.

Year to date the 11% overall growth rate has been consistent since August, and at WGH, the year to date growth has been above 8% since September.

December saw the highest recorded attendances at WGH (9812) year to date.

1 East Kent University NHS Foundation Trust Gloucestershire Hospitals NHS Foundation Trust

Mid-Yorkshire Hospitals NHS Trust North Cumbria University Hospitals NHS Trust Royal Cornwall Hospitals NHS Trust United Lincolnshire Hospitals NHS Trust University Hospitals of Morecambe Bay NHS Foundation Trust Worcestershire Acute Hospitals NHS Trust

10



5

3.5 Despite the ongoing growth in demand for urgent emergency care, the SMART (senior

clinicians from a range of medical specialties, working in ED) pilot has continued to impact ongoing flow as demonstrated in the chart below which shows type 1 (WGH) ED attendances and AAU admissions for 2019/20 in comparison with the previous year.

Looking at April to September 2018 7907 patients were admitted to AAU. In the same

period in 2019 this had risen by 6% to 8377. Between October and December 2018 there were 4147 admissions to AAU. SMART was implemented in October 2019 and

%

Increase

on

2018/19

YTD

Total atts

2019/20

Total atts

2018/19

%

Increase

on 18/19

YTD

WGH atts

2019/20

WGH atts

2018/19

April 15.3% 13127 11383 10.3% 8586 7787

May 12.3% 26833 23896 6.8% 17404 16303

June 10.3% 40355 36578 5.8% 26054 24619

July 10.3% 54895 49760 6.6% 35370 33197

August 11.3% 68058 61173 7.7% 43907 40776

September 11.6% 81895 73353 8.3% 52902 48851

October 11.6% 95779 85784 8.2% 62087 57374

November 11.1% 109734 98748 8.2% 71447 66057

December 11.3% 124105 111504 8.7% 81259 74747

2019/20

Month

Cummulative attendances Cummulative attendances

10



6

admissions (3529) from then through to December 2019 were 15% lower than the same period the previous year.

In October 2018 there were 14.3% more admissions in comparison to the previous month

but in October 2019 there were 17.6% fewer admissions than in September 2019. 4 Ambulance Handover Delays 4.1 There was a 9.4% increase in the number of ED arrivals by ambulance in December 2019

compared to the previous month (3085 vs 2821). The average daily ambulance arrivals rate increased from 94 in November to just over 99 in December and year to date the increase is 7.3%. The chart below shows the distribution of delays in the context of all ambulance arrivals.

4.2 There has been an increase in delays, over 60 minutes (192 vs 84) and 30-60 minutes (455 vs 383) and when comparing with previous years, this is a very similar picture to that of December 2017 (60+ - 192, 30-60 – 435).

4.3 The handover improvement trajectory plan factored in an increase in ambulance arrivals in

December, but the actual number was higher than anticipated.

10



7

4.4 In response to the worsening picture, the January joint ambulance handover improvement meeting with EEAST has been brought forward and the outcome of discussions is awaited.

5 Progress against the ED improvement plan 5.1 Actual performance remains adverse to the trajectory plan. Demand above the

planned/expected level of activity is remains the most significant factor in the adverse variance to plan. Although demand management initiatives are in place in the system, the impact is limited. The implementation of an Urgent Treatment Centre at Watford, acting as the single point of entry and streaming patients to the appropriate area for onward care, is expected to have a significant impact on performance improvement.

6 RTT Incomplete pathways 6.1 December’s performance against the 92% RTT standard was the same as the previous

month, ie 87.4%. In previous years, there was a drop in performance between November and December, by 2% in 2017 and 1.3% in 2018, so maintaining the same level performance is a positive indicator, given the potential risks to elective activity at that time of year.

6.2 Benchmarking using Model Hospital indicates that WHHT is placed 41st (previously 72nd) of 114 providers in terms of RTT incomplete pathway performance (86.8%) in October 2019, the national sector median being 84.2% and the regional median 81.4%.

The following chart benchmarks WHHT with the Nightingale Group (see p4) where the median is 81.9%.

Trajectory plan - ED

Trust

Ap

ril

May

Jun

e

July

Au

gust

Sep

tem

be

r

Oct

ob

er

No

vem

be

r

De

cem

be

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Jan

uar

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Feb

ruar

y

Mar

ch

National standard 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0%

Plan 81.1% 88.0% 88.5% 89.3% 90.2% 88.4% 87.8% 89.8% 88.2% 88.8% 90.6% 93.0%

Actual performance 81.2% 79.9% 82.1% 81.3% 80.5% 83.0% 83.4% 82.2% 79.4%

70%

75%

80%

85%

90%

95%

100%

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

% p

ati

ents

wit

hin

targ

et

WHHT ED Improvement Trajectory

Actual performance Plan National standard

10



8

Although December’s position was unchanged from the previous month, when comparing trends across a 12 month period from November 2018, WHHT is improving while the regional and national position is deteriorating.

6.3 The total PTL size is slightly lower than the previous month (December 23011 vs November 23017) and remains lower than that of March 2019 (24178) and the reduction in the backlog over 18 weeks continues, when compared with the previous month (2896 vs 2948) and April 2019 (4653).

6.4 Six breaches of the 28 day rebooking rule occurred in December, 2 Ophthalmology, 1

Urology, 1 ENT, 1 Orthopaedic and 1 Gynaecology. Most of the breaches were the result of not offering a new date within 28 days, with reasonable (3 weeks) notice. Patients are not always able or willing to accept a date within 28 days but there is more to do to ensure this is recorded appropriately.

7 52 week waits 7.1 At the end of December there were no patients whose waiting time exceeded 52 weeks.

7.2 Harm reviews for patients whose wait exceeds 48 weeks continue. As long waits reduce,

so does the number of harm reviews. The table below shows the latest position.

ENT 1 38 0

Ophthalmology 1 34 0

Oral Surgery 1 1 0

General

surgery

All with consultants being completed in administrative time.

3 low harm are from prolonged urinary catheterisation and

psychological distress.

3 new moderate harms identified in October under SI. Chasing

clinicians to complete outstanding reviews

Orthopaedics 1 280 12 No further Harm been identified

6Urology 4 225

Comments / update

1 305 0All re-escalated with teams, to date we are not aware of any harm.

Speciality

Review in

progress -

awaiting

treatment

Reviews

completed

Harm

identified

10



9

8 Progress against the RTT improvement programme 8.1 The improvement plan target for December was 88.4%, with an actual performance of

87.4%. While modelling indicated fewer clock stops would be made this month as a result of the Christmas/New Year break and less working days, the actual number was lower still and this is the main factor for variance to plan.

Outsourcing is ongoing and recent discussions with commissioners have resulted in agreement to work more collaboratively in terms of identifying additional capacity in the private sector and other NHS organisations with a view to increasing activity further. Some weekend and in week additional theatre lists are being undertaken but the impact of the NHS Pensions tax issue continues to affect take up of ad hoc sessions.

9 Cancer Waiting Times Performance

9.1 Two week wait and two week wait breast symptomatic performance improvements have been maintained, with compliance in both standards.

9.2 All 31 day pathway standards have been achieved this month. 9.4 Performance against the 62 day referral to first treatment standard is currently at 83.2%, an

improvement on November’s position of 79.2%. There are 15.5 breaches across the tumour sites, from a total of 91.5 pathways, in Urology, Lung and Breast. This is a provisional position which is expected to change up to national submission (3 February 2020).

A rolling 12 month summary of performance is included in appendix 3.

10



10

9.5 Model Hospital benchmarking of October’s performance shows WHHT ranked 72nd of 116

providers in terms of the 62 day urgent referral to first definitive treatment, the national sector median being 78.5% and the regional median 77.5%.

The chart below benchmarks WHHT with the Nightingale Group (see p4) where the median is 72.9%.

While WHHT’s performance is better than both the regional and national median, the deteriorating trend can be seen in all 3 below. However, this is less significant for WHHT than for the regional position.

10



11

9.6 Harm reviews have traditionally always been undertaken for patients whose waiting time exceeded 104 days and the RTT harm review process was built on the cancer model. The trigger for a cancer RCA and harm review has been lowered to include patients treated beyond 62 days as described in the regional inter-trust referral policy, with the responsibility for completion of the RCA with the treating hospital.

9.7 Given that a number of WHHT cancer pathways are closed with treatment at tertiary

centres, RCAs should be led by the treating hospital. However, following discussion with HVCCG, it was agreed that WHHT would implement a local RCA and review process, obtaining details from treating hospitals where possible.

9.8 The chart below shows the total number of breaches for 2019/20 and progress to date. No

harms have been identified to date.

10 Progress against the cancer improvement plan

10.1 At 83.2%, performance is in line with plan (83.1%).

10.2 The focused work with Lung and Urology is ongoing. The action groups for both tumour

sites are in place, both working on pathway redesign. Several changes in Urology have been agreed – a straight to test pathway (MP MRI), referral triage assessment (to direct

Trajectory plan - 62 day

Current month is provisional

Trust

Ap

ril

May

Jun

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July

Au

gust

Sep

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r

Oct

ob

er

No

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be

r

De

cem

be

r

Jan

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y

Feb

ruar

y

Mar

chNational standard 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0%

Plan 77.2% 77.4% 79.5% 81.3% 81.3% 80.8% 82.2% 84.3% 83.1% 85.6% 85.3% 86.4%

Actual performance 78.8% 85.2% 82.4% 74.5% 83.1% 85.7% 80.2% 77.1% 83.2%

68%

70%

72%

74%

76%

78%

80%

82%

84%

86%

88%

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

% p

ati

ents

wit

hin

targ

et

WHHT 62 Day GP Improvement Trajectory

Actual performance Plan National standard

10



12

and stream referrals through the correct pathway) and “micro” tracking of patients on the PTL to support a reduction in delays. These are to be implemented in January/February.

11 Risks

11.1 There is one risk on the corporate risk register (3828) which describes the principal focus of patient safety and the risk of harm associated with long waits. Although there has been a sustained reduction in the number of long waits and clinical harm reviews are well established, it is still relevant. The current score is 15 but this will reduce as waiting times decrease.

Risks to achievement of the Access standards include:

Failure of system wide demand management schemes resulting in

Increases in demand, above plan

Insufficient capacity to meet demand

A reduction in the uptake of vacated theatre sessions (surgeon and/or anaesthetist) both in week and at weekends, as a result of the pensions issue.

Reduced flow of inpatients from the hospital in to community capacity

Failure to deliver the core ED improvements required to improve flow in the department.

Estate (theatre) infrastructure.

Urgent care admissions to the elective care bed base at WGH.

Prioritisation of cancer and urgent treatment resulting in cancellation of routine surgery.

Patient choice / patient initiated treatment delays.

12 Recommendation

12.1 The Board is asked to receive this report for information and for assurance of ongoing monitoring of performance against nationally mandated waiting times.

Sally Tucker Chief Operating Officer 30 January 2020

10



13

Appendix 1 The Access standards

95% of patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department

Less than 1% of patients should wait 6 weeks or more for a diagnostic test, measured against 15 key diagnostic tests (see below).

More than 92% of patients on incomplete (open) pathways should have been waiting no more than 18 weeks from referral.

A maximum of 2 weeks - from urgent GP referral for suspected cancer to first outpatient appointment – 93%

operational standard - from referral or any patient with breast symptoms (where cancer is not suspected) to first

hospital assessment – 93% operational standard

Maximum one month (31 days) - from decision to treat to first definitive treatment – operational standard of 96% - decision to treat/earliest clinically appropriate date to start second/subsequent treatment

where the treatment is surgery (operational standard 94%), drug treatment (operational standard 98%), radiotherapy (operational standard 94%)

Maximum two months (62 days) from - urgent GP referral for suspected cancer to first treatment – 85% operational standard - urgent referral from NHS Cancer Screening Programme (breast, cervical, bowel) for

suspected cancer to first treatment – 90% operational standard The 15 key diagnostic tests 1. Imaging - Magnetic Resonance Imaging 2. Imaging - Computed Tomography 3. Imaging - Non-obstetric ultrasound 4. Imaging - Barium Enema 5. Imaging - DEXA Scan 6. Physiological Measurement - Audiology – Audiology Assessments 7. Physiological Measurement - Cardiology - echocardiography 8. Physiological Measurement - Cardiology - electrophysiology 9. Physiological Measurement - Neurophysiology - peripheral neurophysiology 10. Physiological Measurement - Respiratory physiology - sleep studies 11. Physiological Measurement - Urodynamics - pressures & flows 12. Endoscopy - Colonoscopy 13. Endoscopy - Flexi sigmoidoscopy 14. Endoscopy - Cystoscopy 15. Endoscopy – Gastroscopy https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2013/08/DM01-guidance-v-5.32.pdf

10



https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2013/08/DM01-guidance-v-5.32.pdf

https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2013/08/DM01-guidance-v-5.32.pdf

14

Appendix 2 Specialty level RTT performance against 92% open pathway standard – December 2019

Service Total PTL

< 18 weeks

18 Weeks Plus

% Under 18 Weeks

VASCULAR SURGERY 137 93 44 67.88%

PAIN MANAGEMENT 600 411 189 68.50%

ORAL SURGERY 1369 970 399 70.85%

ORTHODONTICS 96 69 27 71.88%

UROLOGY 1758 1361 397 77.42%

ENT 1924 1519 405 78.95%

TRAUMA & ORTHOPAEDICS 2255 1832 423 81.24%

GENERAL SURGERY 1434 1199 235 83.61%

OPHTHALMOLOGY 1715 1444 271 84.20%

PAED UROLOGY 141 121 20 85.82%

NEUROLOGY 1202 1093 109 90.93%

PAED EPILEPSY 12 11 1 91.67%

RHEUMATOLOGY 428 394 34 92.06%

COLORECTAL SURGERY 480 445 35 92.71%

ENDOCRINOLOGY 375 350 25 93.33%

DIABETIC MEDICINE 91 85 6 93.41%

GASTROENTEROLOGY 1704 1603 101 94.07%

PAED OPHTHALMOLOGY 172 164 8 95.35%

UPPER GI SURGERY 69 66 3 95.65%

PAED GASTROENTEROLOGY 100 96 4 96.00%

DERMATOLOGY 1767 1701 66 96.26%

HEPATOLOGY 86 83 3 96.51%

RESPIRATORY MEDICINE 543 528 15 97.24%

NEPHROLOGY 41 40 1 97.56%

CARDIOLOGY 1920 1878 42 97.81%

GERIATRIC MEDICINE 98 96 2 97.96%

CLINICAL HAEMATOLOGY 244 240 4 98.36%

GYNAECOLOGY 928 913 15 98.38%

BREAST SURGERY 247 243 4 98.38%

PAEDS 693 685 8 98.85%

GENERAL MEDICINE 11 11 0 100.00%

PAED ENDOCRINOLOGY 27 27 0 100.00%

PAED CLINICAL HAEMATOLOGY 23 23 0 100.00%

PAED DERMATOLOGY 69 69 0 100.00%

PAED CYSTIC FIBROSIS 1 1 0 100.00%

PAED CARDIOLOGY 101 101 0 100.00%

STROKE MEDICINE 5 5 0 100.00%

MEDICAL ONCOLOGY 12 12 0 100.00%

GYNAECOLOGICAL ONCOLOGY 23 23 0 100.00%

ORTHOTICS 77 77 0 100.00%

CLINICAL ONCOLOGY 33 33 0 100.00%

Total 23011 20115 2896 87.41%

10



Appendix 3

Cancer waiting times performance – update (at 30/1/20)

NB:

Performance is provisional at the time of writing

There has been a national change in the reporting of 31 day subsequent pathways. Although WHHT still submits data for all subsequent treatments (drug, surgery, palliative, radiotherapy and other) only subsequent treatments for drugs, surgery and radiotherapy are now available in the cancer waiting times preview for national reporting. On that basis subsequent treatments for palliative and other will be removed from reporting going forward, but radiotherapy (94% target) will be added.

Standard Target Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 YTD

2ww 93.0% 94.1% 94.8% 93.2% 93.0% 91.3% 93.0% 92.3% 91.1% 92.5% 93.2% 94.1% 96.3% 96.9% 93.5%

2ww breast 93.0% 90.8% 91.1% 90.7% 88.0% 87.4% 94.1% 90.8% 97.0% 98.4% 100.0% 100.0% 96.3% 98.4% 95.2%

31 day 1st 96.0% 97.9% 97.5% 97.7% 97.7% 99.4% 96.8% 98.2% 98.9% 96.5% 95.0% 94.3% 98.0% 99.4% 97.2%

31 day surgery 94.0% 100.0% 92.6% 96.3% 100.0% 100.0% 95.0% 93.8% 100.0% 100.0% 100.0% 78.9% 100.0% 100.0% 95.6%

31 day drug 98.0% 100.0% 97.1% 95.7% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 94.4% 90.0% 100.0% 100.0% 98.7%

31 day palliative 94.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

31 day other 94.0% 100.0% 93.3% 100.0% 100.0% 100.0% N/A 100.0% N/A N/A N/A N/A N/A N/A 100.0%

62 day 85.0% 78.7% 77.5% 74.3% 84.2% 78.6% 86.8% 83.0% 75.0% 83.9% 88.0% 80.2% 77.1% 83.2% 81.9%

62 day screening 90% 86.7% 90.0% 80.0% 75.0% 100.0% 100.0% 73.3% 93.1% 83.3% 64.0% 72.7% 100.0% 100.0% 84.8%

10

Tab 10 P

erformance R

eport on Access S

tandards

15 of 236T

rust Board M


Trust Board 06 February 2020

Title of the paper Integrated Performance Report

(January 2020 reporting period – December 2019 data)

Agenda Item 11/79

Presenter


Author(s)

Jane Shentall , Director of Performance

Purpose

For approval


Executive Summary

Safe Care & Improving Outcomes

Mortality indicators remain stable, and within the as expected range – HSMR 96.9, SHMI 100.3 (slides 4, 22)

There was 1 hospital and healthcare apportioned clostridium difficile case (previous month 3) with a year to date total of 37 (slides 4, 23-24)

The overall C-section rate has reduced, but remains above target (28%); choice is reflected in the elective rate at 16.4% which is above the local target (11%), but the emergency rate is better than target (15%) at 13.8% and benchmarking (October) is comparable with peers. The year to date rate for all c-sections is 32% (slides 4, 26).

The indicator for safe care, nursing shift fill, at 102.4%, is consistently better than target (95%), as is the year to date position at 102% (slides 4, 27)

There has been a rise in the percentage of patient safety incidents that are harmful, at 10.4% (previous month at 9.1%, year to date 8.9%) (slides 4, 31)

Safety thermometer new harms, at 98.9% (year to date 98.6%), remain better than the national picture, with no category 3 (ytd 12) or category 4 (ytd 0) pressure ulcers (slide 4, 32-35)

VTE risk assessment is below target (95%) at 92.7% but year to date the rate is 95% (slides 4, 36)

Stroke indicator performance has fallen - 66.7% (ytd 66.4%) of patients were admitted to the Stroke unit within 4 hours (target 90%, national average 56.3%), but more patients, 96.8% (was 95.6%) spent 90% of their admission on the unit (target 80%, ytd 94.3%, national average 83.6%) (slides 4, 37)

Caring & Responsive Services

Ambulance turnaround delays increased, with 455 (was 383) between 30 and 60 minutes and 192 over 60 minutes (previously 84) (slides 5, 36)

ED 4 hour performance is lower than last month at 79.4% (was 82.2%) with a year to date position of 81.4% (slides 5, 38)

Reporting requirements for delayed transfers of care (DToCs) have changed, now only bed days and beds used are reported - 804 bed days (previously 725) and 26 beds (was 24) were used (slides 5, 40)

Inpatient and Day Case Friends & Family positive scores are stable and above the 95% target. A&E scores at 94.8% and Maternity at 93.3% are below target (slides 5, 41-42)

Complaints response times are compliant with the target (80%) at 80% (ytd 81.4%), with 3 reactivated complaints received in the month (slides 5, 43)

RTT (incomplete) performance is unchanged, at 87.4% (ytd 85%). There were no 52 week breaches for the third consecutive month (slides 5, 45)

2 week wait (96.9%, ytd 93.3%) and 2 week wait breast symptomatic (98.4%, ytd 95.5%) are consistently compliant with waiting time standards (93%) (slides 5, 46)

All cancer 31 day targets have been achieved (slides 5, 47)

62 day urgent referral to first treatment is below target (85%) but has improved at 83.2% (was 79.2%), and is at 81.9% year to date (slide 5, 48)

62 day screening standard was achieved at 100% (90%, ytd 85.6%) (slides 5, 48)

11

Tab 11 Integrated Performance Report


Short notice appointment cancellations have risen slightly to 4.3% (from 3.7%) and are better than the local target, year to date 4.4% (target 5%) (slides 5, 49)

Outpatient DNA rates have improved to 9.2% (from 9.1%, ytd 8.7%) and the latest available benchmarking (Q2 2019/20) shows the trust position is slightly above the national and regional medians (slides 5, 49)

Workforce & Finance

12 month turnover rates are lower than November (15.1%) at 14.3% but remain above target (13%), year to date the rate is 14.9%; the vacancy rate is stable at 10.2% (ytd 10.4%) and close to target (10%) (slides 5, 50)

Sickness absence rates are similar to the previous month at 3.8% but above target (3.5%) - year to date the rate is 3.5% (slides 6, 50)

All staff appraisal rates are better than the target (90%) at 91.9% (including medical staff) (slides 5, 51)

Mandatory training rates remain consistently better than target (90%) at 93.9%; Essential training compliance is 91.1% and better than target (90%) (slides 5, 51)

Bank pay is better (lower) than the target (12%) at 11.2% (ytd 11.6%), but agency pay at 4.9% is above (worse than) target (4.4%) and is 5.1% ytd (slides 6, 17)

Actual I&E expenditure was better than plan and the forecast remains unchanged (slides 6, 11)

Capital expenditure is worse than plan at month end and year to date (slides 6, 20)

CIP delivery is behind plan in month (£1.903m delivered against a plan of £1.922m) but the year to date actual is better than the year to date target. (slides 6, 19).

A range of activity counts are now included for information (slide 6): - GP referrals are lower than the previous month - A&E attendances are significantly higher than expected - Elective overnight spells are in line with plan - Total elective spells are higher than expected - Outpatient attendances are lower than planned - Outpatient attendances are higher than the target total - Births are lower than planned Activity RAG ratings are shown in the context of the minimum income contract where the primary objective is to match capacity to demand. Therefore, non-elective activity above plan/expectations would be rated red. Births are classified as non-elective activity and so activity below plan is rated green. Elective spell underperformance against expectations is rated red in the context of waiting list management.

NB: Data correct at the time of reporting – 31/01/2020


(please indicate which of the 4 aims is relevant to the subject of the report)


Objectives 1-5

Aim 2 Great place to work

Objectives 6-8

Aim 3 Improve our finances

Objective 9

Aim 4 Strategy for the future

Objective 10-12


☒Is there the leadership capacity and capability to deliver high quality, sustainable

care? ☒Is there a clear vision and credible strategy to deliver high quality, sustainable care

to people, and robust plans to deliver? ☐Is there a culture of high quality, sustainable care?

☒Are there clear responsibilities, roles and systems of accountability to support good

governance and management?


performance?

☒Is appropriate and accurate information being effectively processed, challenged and

acted on?

☐Are the people who use services, the public, staff and external partners engaged

and involved to support high quality sustainable services?

☒Are there robust systems and processes for learning, continuous improvement and

innovation?


11





Trust Management Committee 29 January 2020

Finance & Performance Committee 30 January 2020

Action required

The Board is asked to receive this report for information and assurance.

11



Integrated Performance Report

January 2020

Reporting Period: December 2019

1

Trust Board: 6 February 2020 11

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Patient Experience

The very best care for every patient, every day

How Are we Doing?

2

Safety Thermometer

New Harm Free Care

Target 95%

Inpatient Friends & Family

positive scores

Target 95%

CWT: 62 day referral

to first treatment

Target 85%

Complaints

response times

Target 80%

I&E I&E

forecast actual

(Full year) (YTD actual & YTD plan)

Target

Mandatory

Training

Appraisal

Rates

Target 90%

VTE

assessment

Target 95%

Clostrioides

Difficile

cases

ED 4 hour

standard

Target 95%

RTT open

pathways

Target 92%

Agency

pay

Target 4.4%

Vacancy

rate

Target 10%

Safe Care &

Improving Outcomes

Caring &

Responsive Services

Workforce

& Finance

98.9%

92.7%

95.8%

80.0%

79.4% 87.4%

Target 2

93.9% 91.9%

4.9% 10.2%

83.2%-£22,741 -£20,729

1

20,810-£

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Essential Measures – Executive Summary

Quality & Safety Patient Experience

Workforce & Finance

Patient Experience


Reporting Sub-Committees

3

All staff appraisal Improved, and better than target

Reporting Sub-Committee

Quality Committee People, Education & Research Committee

Finance & Performance Committee

Reporting Sub-Committees Reporting Sub-Committees

People, Education & Research Committee

Finance & Performance Committee

Mortality SHMI has increased this month but

Remains within as expected range

Infection Control – clostrioides

Difficile Hospital & healthcare associated

cases – some improvement

Serious incidents & Never

Events (NE) Variable

Patient safety incidents

which are harmful Worse than previous month

Combined Caesarean Section Standard not achieved – variable but

lower than previous month

VTE assessments Deteriorated and target not

achieved

Stroke Indicators Admission to the Stroke Unit

within 4 hrs – target not achieved

90% admission spent in the Stroke

Unit – variable, consistently achieved

Complaints response times Target not achieved

Inpatient Friends & Family Test Positive scores mainly compliant

although variable, ED just below target

Mixed sex accommodation Variable but none reported this month

Outpatient DNA rates Increase on previous month and

worse than target

ED waiting times Performance deteriorated. Below

target and adverse to plan

RTT waiting times Improving although below target and

just below plan

Cancer waiting times 2ww achieved and improving

62 day not achieved but improving,

better than previous month and in line

with plan

Mandatory training Consistently achieved and stable

Turnover at 12 months Worse than target but better than

recent months

Income & Expenditure

Capital Spend

Other Finance Indicators Financial risk rating

Activity vs plan

Elective activity

Non-elective activity

CIP Efficiency Full year savings of

£15.15m identified (target £15m)

Safe Care &

Improving Outcomes

Caring &

Responsive Services

Workforce

& Finance

SHMI 100.3

HSMR 96.9

1 (Cat1: 1 +

Cat 2:0) YTD 37

SI 3 YTD 23

NE 1 YTD 2

10.4%

YTD 8.9%

30.2%

YTD 32.0%

92.7%

YTD 95.0%

4 hr 66.7%

YTD 66.4%

Adm 96.8%

YTD 94.3%

80.0%

YTD 81.4%

0

YTD 24

79.4%

YTD 81.4%

87.4%

YTD 85.0%

Resp 17.6%

+ ve 95.8%

9.2%

YTD 8.7%

2ww 96.9%

YTD 93.3%

62 day 83.2%

YTD 81.7%

91.9%

YTD 88.1%

93.9%

YTD 92.4%

14.3%

YTD 14.9%

(£1.99)m

YTD (£20.73)m

(£0.96)m

YTD (£6.19)m

£1.90m

YTD £11.05m

FRR 3Elec 3523 vs 3156

Non-Elec 4617 vs 3974

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Indicator Summary


4

Key Description

Performance better than

target/threshold

Performance better

than target/threshold

Performance worse than

target/threshold

Performance worse

than target/threshold

Performance improved - statistically significant change

compared to previous 12 months (2

standard deviations SPC)

Performance

deteriorated - statistically

significant change compared to

previous 12 months (2 standard

deviations SPC)

Performance stable - no

statistically significant change

compared to previous 12 months (2

standard deviations SPC)

Theme Page Target Trend Oct-19 Nov-19 Dec-19 YTD actualYTD

target

Data

period

National /

Local /

Trust

Bench-

marking

Bench-

marking

period

SHMI (Rolling 12 months) 22 100Performance deteriorated and

worse than target95.4 99.0 100.3 Jul-19 National 100 Jul-19

HSMR - Total (Rolling three months) 22 100Performance improved and

better than target99.5 99.5 96.9 Sep-19 National 100 Sep-19

Clostridioides Difficile - Hospital associated (Cat 1) 23 n/aPerformance stable and better

than target2 1 1 24 Dec-19 National

Clostridioides Difficile - Healthcare associated (Cat 2) 23 n/a Performance stable and better

than target1 2 0 13 Dec-19 National

Clostridioides Difficile - Hospital and Healthcare associated Total 23 2Performance stable and better

than target3 3 1 37 28 Dec-19 National

Hand Hygiene Compliance 24 95%Performance stable and better

than target96.5% 95.2% 96.2% 97.1% 95% Dec-19 Local n/a

30 Day Emergency Readmissions - Elective * 25 4.3% Performance stable and better

than target4.0% 3.2% 3.4% 3.5% 4.3% Jun-19 National 4.3% Jun-19

30 Day Emergency Readmissions - Emerg * 25 13.6% Performance deteriorated but

better than target12.3% 13.0% 13.5% 12.9% 13.6% Jun-19 National 13.6% Jun-19

Caesarean Section rate - Combined* 26 28.0% Performance stable but worse

than target31.5% 34.3% 30.2% 32.0% 28.0% Dec-19 Local 28.0% 2017/18

Caesarean Section rate - Emergency* 26 15.0% Performance stable and better


Caesarean Section rate - Elective* 26 11.0% Performance stable but worse


% nursing hours (shift fill rate) 27 95.0% Performance stable and better

than target101.9% 102.5% 102.4% 102.0% 95.0% Dec-19 National n/a

Serious incidents - number* 31 0Performance stable but worse

than target4 1 3 23 0 Dec-19 National n/a

Serious incidents - % that are harmful* 31 0.0% Performance stable but worse

than target100.0% 100.0% 100.0% 100.0% 0% Dec-19 National n/a

% of patients safety incidents which are harmful* 31 0.0% Performance stable but worse


Never events 31 0 Performance deteriorated and

worse than target0 0 1 2 0 Dec-19 National n/a

Safety Thermometer Harm Free Care (acquired within and outside of Trust) 33 95.0%Performance stable but worse

than target92.2% 88.7% 91.9% 91.1% 95.0% Dec-19 National 94.0% Dec-19

Safety Thermometer % New Harm Free Care (acquired within Trust) 33 95.0% Performance stable and better


Category 4 pressure ulcers - New (Hospital acquired) 35 0 Performance stable and better

than target0 0 0 0 0 Dec-19 Local

Category 3 pressure ulcers - New (Hospital acquired) 35 0Performance stable and better

than target1 0 0 12 0 Dec-19 Local

VTE risk assessment* 36 95.0%Performance deteriorated and

worse than target94.8% 95.1% 92.7% 95.0% 95.0% Dec-19 National 95.5% Q2 19/20

Patients admitted to stroke unit within 4 hours of hospital arrival 37 90.0%Performance stable but worse

than target71.0% 81.1% 66.7% 66.4% 90.0% Dec-19 National 56.8% Sep-19

Stroke patients spending 90% of their time on stroke unit 37 80.0%Performance stable and better

than target92.6% 95.6% 96.8% 94.3% 80.0% Dec-19 National 83.8% Sep-19

Quality of Care: Mortality Indicators

Patient Safety

Domain

Safe care &

Improving

Outcomes

Quality of Care: Infection Control

Quality of Care: Emergency Readmissions

Quality of Care: Caesarean Section rates

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Indicator Summary The very best care for every patient, every day

5


target

Data

period

National /

Local /

Trust

Bench-

marking

Bench-

marking

period

Ambulance turnaround time between 30 and 60 mins 0Performance deteriorated and

worse than target402 383 455 3174 0 Dec-19 National n/a

Ambulance turnaround time > 60 mins 0Performance stable but worse


% Patients admitted through A&E - 0 day LOSPerformance improved but

worse than target38.3% 38.7% 37.2% 34.3% Dec-19 National

Discharges between 8am and 12pm (main adult wards excl AAU) 33.0%Performance deteriorated and

worse than target18.5% 21.2% 16.4% 19.4% 33.0% Dec-19 National

Mixed sex accommodation breaches 39 0Performance stable and better

than target0 1 0 24 0 Dec-19 National

58 Trusts

breachingNov-19

LOS > 21 days 40 71Performance stable but worse


Delayed Tranfers of Care (DToC) beddays used in month 40 n/aPerformance stable and better

than target1088 725 804 7239 n/a Dec-19 National n/a

Delayed Tranfers of Care (DToC) beds used in month 40 n/a Performance stable and better

than target35 24 26 30 n/a Dec-19 National n/a

A&E FFT % positive 41 95% Performance stable but worse

than target90.6% 94.2% 94.8% 91.8% 95% Dec-19 National 84.0% Nov-19

Inpatient Scores FFT % positive 41 95% Performance stable and better


Daycase FFT % positive 42 95% Performance stable and better


Maternity FFT % positive 42 95%Performance stable but worse


Complaints responded to within target/agreed timescale 43 80% Performance stable and better


Reactivated complaints 43 0 Performance stable but worse


New indicators to be included in Q4

New indicators to be included in Q4

ED 4hr waits (Type 1, 2 & 3) 38 95.0% Performance stable but worse


Referral to Treatment - Incomplete* 45 92.0% Performance improved but

worse than target86.9% 87.4% 87.4% 85.0% 92.0% Dec-19 National 84.4% Nov-19

Referral to Treatment - 52 week waits - Incompletes 45 0 Performance stable and better

than target0 0 0 17 0 Dec-19 National 1398 (all Trusts) Nov-19

Diagnostic (DM01) <6 weeks 99.0% Performance stable and better

than target99.9% 99.5% 99.7% 99.8% 99.0% Dec-19 National 97.1% Nov-19

Cancer - Two week wait * 46 93.0% Performance improved and

better than target94.1% 96.2% 96.9% 93.3% 93.0% Dec-19 National 90.2% Q2 19/20

Cancer - Breast Symptomatic two week wait * 46 93.0%Performance stable and better

than target100.0% 96.3% 98.4% 95.5% 93.0% Dec-19 National 85.3% Q2 19/20

Cancer - 31 day * 47 96.0% Performance stable and better


Cancer - 31 day subsequent drug * 47 98.0% Performance stable and better


Cancer - 31 day subsequent surgery * 47 94.0% Performance stable and better


Cancer - 31 day subsequent radiology * 47 94.0% Performance improved and

better than target- - - - 94.0% Dec-19 National 91.3% Q2 19/20

Cancer - 62 day * 48 85.0% Performance stable but worse


Cancer - 62 day screening * 48 90.0% Performance stable and better


Outpatient cancellation rate within 6 weeks^ 49 5.0% Performance stable and better

than target5.4% 3.6% 4.3% 4.4% 5.0% Dec-19 Local n/a

DNA rate 49 8.0%Performance stable but worse

than target9.0% 8.8% 9.2% 8.7% 8.0% Dec-19 National n/a

Patient Experience: Complaints

Patient Experience: End of life care

Access to Services

Access to Services: Outpatients

Cancer

Patient Flow: Emergency Department

Patient Flow: In hospital flow

Patient Experience: Friends & Family Test

Domain

Caring &

Responsive

Services

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Indicator Summary


6

* No official cash target ** Straight line target


target

Data

period

National /

Local /

Trust

Bench-

marking

Bench-

marking

period

Staff turnover rate (rolling 12 months) 50 13.0%Performance improved but

worse than target14.7% 15.1% 14.3% 14.9% 13.0% Dec-19 National

15.0% (Beds and

Herts orgs)Q1 19/20

% staff leaving within first year (excluding medics and fixed term contracts) 50 n/a Performance stable and better

than target16.7% 17.1% 17.0% 18.6% n/a Dec-19 National n/a

Vacancy rate 50 10.0%Performance stable but worse

than target10.7% 10.1% 10.2% 10.4% 10.0% Dec-19 National

11.1% (local

survey)Q1 19/20

Sickness rate 50 3.5%Performance improved but

worse than target3.9% 3.9% 3.8% 3.5% 3.5% Dec-19 National 3.7% (EoE orgs) Q1 19/20

Appraisal rate (Total) 51 90.0% Performance improved and

better than target90.8% 89.9% 91.9% 88.1% 90.0% Dec-19 National

Mandatory Training 51 90.0% Performance deteriorated but

better than target92.7% 93.9% 93.9% 92.4% 90.0% Dec-19 Local 91.0% (local

survey)Q1 19/20

Essential Training 51 90.0%Performance improved and

better than target90.3% 91.1% 91.1% 87.6% 90.0% Dec-19 Local

Financial Risk Rating 10-20 3 Performance improved and

better than target3.00 3.00 3.00 Dec-19 Local

Income & Expenditure Actual 10-20 -£2,003Performance stable and better

than target£119 -£1,054 -£1,987 -£20,729 -£20,810 Dec-19 Local

Income & Expenditure forecast 10-20 -£22,741Performance improved and

better than target-£22,741 -£22,741 -£22,741 -£22,741 -£22,741 Dec-19 Local

Cash balance at the end of the month 10-20 £1,765Performance improved and

better than target£3,693 £7,077 £7,827 £7,827 £1,765 Dec-19 Local

Capital expenditure 10-20 -£2,482Performance stable but worse

than target-£900 -£723 -£960 -£6,185 -£18,045 Dec-19 Local

CIP delivery against plan 10-20 £1,922Performance stable but worse

than target£1,388 £1,539 £1,903 £11,045 £9,164 Dec-19 Local

% Bank Pay** 10-20 12.0%Performance stable and better

than target11.4% 12.6% 11.2% 11.6% 12.0% Dec-19 Local n/a

% Agency Pay** 10-20 4.4%Performance stable but worse

than target5.1% 4.6% 4.9% 5.1% 4.4% Dec-19 Local

7.3% (local

survey)Q1 19/20

GP referrals 6,839 Performance stable and better

than target9,204 7,916 7,173 71,456 71,042 Dec-19 National

A&E attendances 12,777 Performance deteriorated and

worse than target13,869 13,937 14,269 110,611 103,097 Dec-19 National

Elective spells (overnight) 465 Performance stable and better

than target549 494 468 4,544 5,092 Dec-19 National

Elective daycase 2,691 Performance stable and better


Total elective spells 3,156 Performance stable and better


Non-elective spells 3,974 Performance stable but worse


Births 406 Performance stable and better

than target390 357 350 3,235 3,635 Dec-19 National

Outpatient attendances 16,946 Performance stable and better


Recruitment & Retention

Activity (chargeable)

Workforce and

finance

Domain

Developing Staff

Finance overview

Activity RAG ratings are shown in the context of the minimum income contract where the primary objective is to match capacity to demand. Therefore, non-elective activity above plan/expectations would be rated red. Births are classified as non-elective activity and so activity below plan is rated green. Elective spell underperformance against expectations is rated red in the context of waiting list management.

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Key messages for the Board


Chief Nurse


7

Safe Care &

Improving Outcomes

The Wuhan novel coronavirus (WN-CoV) was raised as an international alert from the World Health Organisation (WHO) in January. Public Health England

(PHE) guidance has been issued which the Trust has followed. The infection prevention control team (IPC), emergency planning and operations have worked

in partnership to ensure the management of suspected cases is clear within the areas identified as points of admissions such as the emergency department

(ED). A policy has been developed based on the guidance issued and has been approved by the Director of Infection & Prevention Control (DIPC), trust

preparedness has been discussed at the Quality Committee and will be reported in the committee assurance report to Trust Board.

The Trust has tested the policy and it has been amended after a review at the end of January including any further emerging guidance from PHE.

The ward accreditation programme has been reviewed and the programme is underway, all wards will have been accredited by August 2020.

I’m very pleased to confirm that Dr Howard Borkett-Jones has been appointed as the Associate Medical Director for Appraisal and Revalidation, and Dr

Ashleigh Reece has been appointed as the Director (and AMD) for medical education. They will commence in their posts in April 2020.

The SMART medical take pilot has continued to deliver improved patient flow and efficiency, and the trust’s ED performance is nearly at upper quartile, having

previously been in the lowest quartile of all reporting acute trusts in England. We remain above the region’s reported ED performance, and this has now been

maintained for the duration of the pilot. We have therefore requested that each department’s team job plans for 2020/21 are developed to make SMART

“business as usual”, where appropriate.

All staff are obviously focused on the imminent CQC inspection, and multiple teams have been proudly submitting their achievements since the last inspection,

and ensuring they are fully prepared to demonstrate their commitment to the trust’s values of the very best care for every patient, every day!

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Key messages for the Board

Patient Experience Workforce & Finance Chief Nurse



8

Caring &

Responsive Services

Maternity have had an initial assessment for UNICEF ‘baby friendly’ stage 2 with very good preliminary results, we now await the final report by April 2020.

The Safeguarding team have developed Makaton (a programme using speech with signs and symbols to help communication) lanyards and card packs

which they have piloted and are now rolling out to all paediatric areas – to be completed by February 2020.

We will also be launching a campaign across the Trust using useful signs and shared across the intranet each month in 2020

We have continued to see a sustained position in our response to complaints and will be continuing work to build on this, developing the complaints team to

support investigating and learning. The learning from complaints has been built into our ward accreditation programme. This will also form part of our shared

governance model supporting leadership and encouraging personal and professional development whilst focusing on improving pat ient safety, patient

experience and staff experience. A paper will be presented at Trust Management Committee in March 2020.

The Trust continued to experience high levels of demand during December. Record attendances were reported on Monday 23rd December with 366

attendances at Watford alone. Whilst we saw reduced demand on Christmas Day, Boxing day saw in excess of 300 attendances at Watford. Christmas &

New Year proved to be a busy period with the Trust’s surge plan being fully executed and culminating in a Business Continuity Incident being declared on 30th

December 2019 and not stood down until 9th January 2020.

Point of Care Flu Testing was operationalised prior to Christmas, speeding up the process of diagnosis and any subsequent isolation actions necessary. The

Trusts cohorting plan was enabled with Red Suite being used as a Flu ward, the use of PPE and Deep Clean programmes was enacted.

Good progress was made with a number of the Winter enabling schemes including the relocation of Medical Records Clinic prep staff, the expansion of rooms

within ambulatory care and the relocation and provision of new accommodation for IDT, Emergency Planning and Operational Management.

In terms of patterns of demand during December, Respiratory and Stroke saw increases, placing pressure into the specialist bed areas.

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Key Messages for the Board

Patient Experience Workforce & Finance






9

Workforce

& Finance

Despite vacancy rates being marginally above target, we have seen an increase of 112wte in post over the last 12 months, with 516wte current vacancies. For Band

5 nurses the vacancy rate is currently 4.6%, a small increase from 2.5% last month, the main cause being a reduction of staff joining during the festive period. We

also have our first cohort of internal OET students due to take their exams in March / April. We predict circa eight to ten candidates will be in a good position to pass

their exam. Turnover is 14.3%, a small decrease from last month and from 12 months ago when it was 15.4%. The percentage of staff who leave their post before

serving one year is currently 17%. The 3 monthly turnover rates which help identify more immediate changes is currently 14%. Sickness absence is 3.8%, which is

high by normal trust standards, but still compares well against peer groups with the Trust being ranked 6 / 16 in terms of the lowest sickness scores for local NHS

benchmarking. Appraisal rates stand at 91.9%, mandatory training rate remains above target at 94%. Essential training compliance is now 91%, the same as

the last three months. The overall BAF workforce assessment rating remains green.

The Trust confirmed allocation of its Continued Professional Development (CPD) funding for 2020-21 with £596k being allocated for CPD against a funding

requirement of £820k. A robust process is in place to decide upon priority requirements and to mitigate against risks with non-funding. The Trust has also

commenced on a major new organisational development programme aimed at its obstetrics and midwifery staff. The Trust has also launched its reverse mentoring

scheme of its Executive team by BAME staff. Finally two key appointment into the HR function have also been made this month with the appointment of a new

Deputy Director of HR and Freedom to Speak Up Guardian.

After the important third quarter results, we continue to report success in managing revenue income and expenditure in line with the plan. For the month of

December (Month 9) we planned to spend £2.0m more than income received, and this was achieved. The results take the year to date deficit to £20.73m which is

also in line with our plan.

As reported last month innovative changes in clinical practice are mitigating the demand for hospital beds, and consequently the demand for extra temporary staff.

Admitted care income, for the year to date, continues to be behind plan mainly due to more efficient emergency patient treatment pathways. However, due to

prudent estimates for elective care activity, based on previous year’s experience, we earned more elective income than planned. Good elective activity performance

helps to minimise waiting for routine operations. The efficiency programme continues to generate savings. After nine months we’ve developed efficiencies worth

£11m, having planned to achieve £8.7m at this stage. We expect savings to rise to £15.3m by the end of the year. Throughout the year keeping pay costs within

budget has been a challenge. The overspending was £0.3m again this month. 1:1 nursing care pressures continue although agency spend is lower than previous

years for the fourth consecutive year.

Overall we expect to end the year meeting the Control Total budget set by NHSI. Our forecast to spend c£21m on new and replacement assets remains, although

after 9 months only £6m of this forecast has been spent. Additional reviews of projects confirm that the forecast remains intact, as much of the work was planned for

the winter period. The expectations for building refurbishment and replacement IT and equipment (ahead of the Trust‘s major redevelopment) are especially high for

the 2020/21 year. 11

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Key Messages for the Board

Patient Experience Workforce & Finance





10

Corporate - ICT

The Chief Information Officer’s portfolio covers ICT, Business Intelligence and Outpatient administration. These key messages will likely focus on ICT to avoid

potential duplication elsewhere in the IPR.

During December we formally closed the ICT transition programme, with WHHT and Atos signing off a programme closure report that included lessons learnt, and

the 24 December 2019 marked the end of a 3 month (post cut over) stabilisation period with Atos. We are therefore, now, operating in business as usual, with

contractual terms and conditions applying, formal performance being reported and monitored and governance meetings held as appropriate.

From a service perspective, December painted a mixed picture. On the whole, service began to stabilise, with calls to the service desk reducing from 5,404 in

November to 3,839 in December and high priority incidents reducing from 64 in November to 20 in December. Additionally, the total incident backlog (i.e. those that

have breached the SLA standard) reduced from 782 in November to 567 in December and call answering statistics (87% answered within 20 seconds) were

positive, but we need to improve the end user experience during an incident and ensure we have enough physical presence on the floor and we are working hard

with Atos to improve this.

Unfortunately, 10 December 2019 saw a serious incident. At 8am, the Trust performed a Black start generator test. This caused the UPS in the main computer room

to fail which in turn caused a number of distribution switches to fail. The power interruption also caused network traffic to re-route through two core switches which

caused disruption across a range of applications, including PAS, printing, PACS, Infoflex. It took 16 hours for impacted IT services to return to normal service. A full

incident investigation has been undertaken and UPS provision across the Trust has been reviewed.

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August 2019– Income and Expenditure

Summary

11

A – The trust reported a favourable position in month by delivering an over performance of £16k in December. The YTD position is also on plan with an actual £20.73m deficit, which is £81k better than plan (J). B- The in month income position showed an over performance of £763k against plan. Bii – Divisional income showed an over performance of £572k against plan in month. This was largely driven by an increase in receipt of Education Funding received from the deanery. The YTD divisional income position is now better than plan by £708k (Fii). Bi- NHS Revenue over performed in month by £275k. An improvement against plan within surgical elective activity was the main driver behind the over performance. The YTD position on NHS revenue shows under performance of £1,186k of which £2,345k relates to other SLA which includes pass through items (Fi). C – The overall pay bill for the month was £21,782k which was £263k overspent. Medical and Nursing pay positions represent the key areas of concern. Premium cover for high levels of vacancies and sickness across divisions represent the main problems within medical staff. The cost of 1:1 nursing care sits within other clinical pay. This is explained further on the pay slides. The YTD pay position is £2,557k overspent (G). D – The non pay position reported an underspend of £491k in month. A £184k was overspend within Clinical supplies was driven by the increase in high cost devices within Cardiology. Although the majority of the drugs overspend (£289k) was pass-through, a general increase in spend was seen across drugs , including home care. E – Financing charges underspent by £7k . The YTD £143k underspend (I) is linked to the timing of interest payable on revenue loans.

Workforce & Finance: Income and Expenditure December 2019


Trust Definition Expense Type Annual Budget Budget Actual Variance Budget Actual Variance

Income Divisional Income 56,423 5,429 6,001 572 Bii 40,231 40,940 708 Fii

NHS Revenue 324,083 25,296 25,571 275 Bi 244,045 242,859 (1,186) Fi

Income Unallocated CIPs 620 85 (85) 315 (315)

Income Total 381,126 30,809 31,571 763 B 284,591 283,799 (792) FPay Medical Pay (78,717) (6,508) (6,633) (125) (58,904) (60,227) (1,323)

Non-Clinical Pay (50,340) (4,082) (4,097) (15) (37,640) (36,734) 906

Nursing Pay (77,172) (6,834) (6,429) 404 (57,356) (58,388) (1,032)

Other Clinical Pay (28,626) (2,413) (2,394) 19 (21,391) (21,370) 21

Scientific, Technical & Profes (25,779) (2,131) (2,229) (98) (19,341) (20,086) (745)

Pay Unallocated CIPs 2,711 448 (448) 425 42 (383)

Pay Total (257,922) (21,519) (21,782) (263) C (194,207) (196,764) (2,557) GNon Pay Clin Supp Serv (31,012) (2,265) (2,449) (184) (23,144) (22,949) 195

Drugs (22,557) (1,694) (1,983) (289) (16,975) (16,262) 713

OTHER (NON CLIN) (80,187) (5,727) (5,830) (103) (61,123) (58,792) 2,330

Non Pay Unallocated CIPS 819 (86) 86 (49) 49

Non Pay Total (132,937) (9,772) (10,263) (491) D (101,290) (98,003) 3,287 HRecharges Recharges () ()

Recharges Total () ()

Financing Charges Depreciation (8,999) (759) (759) () (6,722) (6,671) 51

Trust Debt Redemption (3,952) (757) (753) 3 (3,140) (3,082) 58

Unwinding Discount (57) (5) (1) 4 (43) (9) 34

Financing Charges Total (13,008) (1,520) (1,514) 7 E (9,904) (9,761) 143 I

Total (22,741) (2,003) (1,987) 16 A (20,810) (20,729) 81 J

In Month (£000's) YTD

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12

Overview Dashboard

Commentary See earlier pages for I&E detail. A financial risk rating of 3. Five divisions: Medicine, Surgery , Corporate, CSS and Environment are adverse to budget year to date. The Better Practice Payment statistics show 80% on number and 57% on value. This represents an improvement compared to November. The cash balance at the end of December was £7.8m. Savings were £1.9m in December.

Workforce & Finance: Finance overview dashboard


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August 2019– Trust Income Performance

In Month Performance (£s)

In Month Performance (spells)

Divisional income showed an over performance of £572k against plan in month. The majority of this is driven by a YTD adjustment in relation to the Trust’s education budget.

Divisional Income

NHS Revenue: Performance by Month (£s)

13

NHS Revenue in December over performed by £275k by delivering £25.6m against a plan of £25.3m. This can be explained at a point of delivery level: • A&E over performed by £131k which was linked to both an increase in

volume and complexity of attendances. • Critical care showed a small over performance of £27k. Occupancy levels

continue to remain consistent. • Elective performance was £545k above plan. At a high level activity

numbers dropped but this was mitigated against by a substantial increase in orthopedic case mix.

• For Non Elective the in month position broadly in line with plan. A £71k under performance was delivered in month.

• Outpatient performance was £666k better than plan. All clinical divisions saw an over performance in month against plan. The most notable over performances were within Women's’ & Children's’, £232k, and Medicine, £238k. .

Finally other SLA income underperformed by performed by £1,081k. This was driven by an underperformance against pass-through drugs and an adjustment associated with the minimum income contract.

Workforce & Finance: Trust Income - December 2019


Expense Type POD Annual Budget Budget Actual Variance

NHS Revenue A&E 20,052 1,729 1,860 131

Critical Care 13,147 1,134 1,161 27

Elective 55,082 3,774 4,318 545

Non elective 117,497 10,134 10,057 (77)

Other SLA 43,180 3,329 2,311 (1,018)

Outpatient 75,125 5,197 5,863 666

NHS Rev Unallocated CIPs

NHS Revenue TotalTotal 324,083 25,296 25,571 275

In Month (£000's)

Expense Type POD Annual Budget Budget Actual Variance

NHS Revenue A&E 124,013 10,533 11,827 1,294

Critical Care 21,831 1,855 1,211 -644

Elective 46,421 3,132 3,686 554

Non elective 51,550 4,379 5,070 691

Other SLA 3,731,065 252,217 263,013 10,796

Outpatient 453,623 30,630 36,470 5,840

NHS Revenue Total Total 4,428,503 302,745 321,277 18,532

In Month (Activity)

1,650

1,700

1,750

1,800

1,850

1,900

Budget Actual

£000

s

Plan vs Actual

A&E

A&E

1,115

1,120

1,125

1,130

1,135

1,140

1,145

1,150

1,155

1,160

1,165

Budget Actual

£000

s

Plan vs Actual

Critical Care

Critical Care

3,500

3,600

3,700

3,800

3,900

4,000

4,100

4,200

4,300

4,400

Budget Actual

£000

s

Plan vs Actual

Elective

Elective

10,000

10,020

10,040

10,060

10,080

10,100

10,120

10,140

Budget Actual

£000

sPlan vs Actual

Non elective

Non elective

500

1,000

1,500

2,000

2,500

3,000

3,500

Budget Actual

£000

s

Plan vs Actual

Other SLA

Other SLA

4,800

5,000

5,200

5,400

5,600

5,800

6,000

Budget Actual

£000

s

Plan vs Actual

Outpatient

Outpatient

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Year To Date (YTD)– Trust Income Performance

YTD Performance (£s)

YTD Performance (spells)

YTD divisional income is £708k above plan. This is driven by an increase in overseas patients ,car parking income and education funding

Divisional Income

NHS Revenue: Performance by Month (£s)

• Month 9 YTD Shows Income under recovery of £1.19m. £242.86m has been generated against plan.

• A&E has a YTD over performance of £915k which is linked to a price and volume variance.

• Critical care is £175k better than plan and has seen an average occupancy rate of 73%.

• Elective performance is £1,485k away from the YTD plan. This is mostly driven by underperformances across the Surgery division linked to reduced uptake of consultant additional sessions.

• Non Elective activity continues to be the feature of the YTD over performance with a surplus against plan of £659k. However, a consistent lower birth rate within maternity is masked within the performance. In addition to this, a declining case mix over the last 3 months has seen the level of over performance begin to decline.

• YTD Outpatient performance shows £894k over performance. Under performances within Surgery (£889k) and WACS (113k) is offset by over performances within Medicine (£1,120k), Emergency medicine (£129k) and Clinical support (£647k).

• Other SLA income was £2,344k away from plan. This is mostly driven by lower pass-through drugs and devices which are mostly offset within the non pay position.


Workforce & Finance: Trust Income - Year to date

14

POD

A&E

Critical Care

Elective

Non elective

Other SLA

Outpatient

NHS Rev Unallocated CIPs

Total

POD

A&E

Critical Care

Elective

Non elective

Other SLA

Outpatient

Total

14,600

14,800

15,000

15,200

15,400

15,600

15,800

16,000

16,200

Budget Actual

£0

00

s

Plan vs Actual

A&E

A&E

9,800

9,850

9,900

9,950

10,000

10,050

10,100

10,150

Budget Actual

£0

00

s

Plan vs Actual

Critical Care

Critical Care

38,500

39,000

39,500

40,000

40,500

41,000

41,500

Budget Actual

£0

00

s

Plan vs Actual

Elective

Elective

89,400

89,600

89,800

90,000

90,200

90,400

90,600

90,800

Budget Actual

£0

00

s

Plan vs Actual

Non elective

Non elective

28,500

29,000

29,500

30,000

30,500

31,000

31,500

32,000

32,500

Budget Actual

£0

00

s

Plan vs Actual

Other SLA

Other SLA

55,400

55,600

55,800

56,000

56,200

56,400

56,600

56,800

57,000

Budget Actual

£0

00

s

Plan vs Actual

Outpatient

Outpatient

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August 2019– Trust Pay Performance

The Trust reported an in month overspend of £263k. The key areas of spend are; • Medical pay overspent by £125k. Within this it should be noted: - There was a £145k overspend within Emergency Medicine. This is linked to temporary staffing premiums for medical cover within A&E. - A £46k overspend within Women's & Children's associated with Locum Consultant spend within Gynaecology and temporary staffing premiums to cover rota gaps within Paediatrics. - This was partially offset by underspends within Surgery and Medicine of £6k and £45k respectively. • Nursing pay showed an underspend against plan of £404k. This was driven by the receipt of winter pressure money allocated

to the winter surge budget which offset monies spent earlier in the financial year. After taking this into consideration, it should be noted that nursing pay remained consistent with the average monthly trend. Further to this, the following points should be noted:

• The division of Medicine was over spent by £73k. This is attributed to both temporary staffing cover and additional costs

relating to outpatient attendances. - The cost for enhanced care nursing was £143k in month which generated a £60k overspend. • Agency premium to cover scientific and professional vacancies across clinical support, theatres and cardiology generates a

combined overspend of £98k in month. • The phasing of the CIP target created a negative variance within the pay lines of £448k.

Trust Pay Performance

15

Workforce & Finance: Trust Pay December 2019


Expense Type Annual Budget Budget Actual Variance Budget Actual Variance

Medical Pay (78,717) (6,508) (6,633) (125) 681.78 698.18 -16.40

Non-Clinical Pay (50,340) (4,082) (4,097) (15) 1,252.67 1,247.93 4.74

Nursing Pay (77,172) (6,834) (6,429) 404 1,620.97 1,671.63 -50.66

Other Clinical Pay (28,626) (2,413) (2,394) 19 1,017.83 1,078.80 -60.97

Scientific, Technical & Profes (25,779) (2,131) (2,229) (98) 507.41 519.97 -12.56

Pay Unidentified CIPs 2,711 448 (448) 0.00 0.00 0.00

Total (257,922) (21,519) (21,782) (263) 5,080.66 5,216.51 -135.85

In Month (£000's) WTE

(6,660)

(6,640)

(6,620)

(6,600)

(6,580)

(6,560)

(6,540)

(6,520)

(6,500)

(6,480)

(6,460)

(6,440)

Budget Actual

Medical Pay

Medical Pay

(4,100)

(4,095)

(4,090)

(4,085)

(4,080)

(4,075)

(4,070)

Budget Actual

Non-Clinical Pay

Non-Clinical Pay

(9,300)

(9,200)

(9,100)

(9,000)

(8,900)

(8,800)

(8,700)

(8,600)

Budget Actual

Nursing & Other Clinical Pay


(2,240)

(2,220)

(2,200)

(2,180)

(2,160)

(2,140)

(2,120)

(2,100)

(2,080)

Budget Actual

Scientific, Technical & Profes

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Year to Date – Trust Pay Performance

The year to date reported position shows an

overspend of £2,294k.

Key year to date themes to note are:

1. Medical pay is showing an overspend of

£1,323k. This represents agency

premium to cover vacancies and

pockets of sickness across all divisions.

2. Nursing and Other clinical pay

combined overspent by £1,011k. The

majority of this overspend relates to

double running costs associated with

qualified nursing. In addition to this, 1:1

nursing care continues to be a key

driver for spend. The YTD overspend

on 1:1 nursing care is £371k.

3. Scientific & therapeutic vacancies

across clinical support, theatres and

cardiology are causing a £745k YTD

overspend.

4. The above overspends are buffered by

unutilised growth monies sitting on the

non clinical pay line.

YTD Pay Performance

16

Workforce & Finance: Trust Pay year to date


Expense Type Annual Budget Budget Actual Variance

Medical Pay (78,717) (58,904) (60,227) (1,323)

Non-Clinical Pay (50,340) (37,640) (36,734) 906

Nursing Pay (77,172) (57,356) (58,388) (1,032)

Other Clinical Pay (28,626) (21,391) (21,370) 21

Scientific, Technical & Profes (25,779) (19,341) (20,086) (745)

Pay Unallocated CIPs 2,711 425 42 (383)

(257,922) (194,207) (196,764) (2,557)

YTD

(23,000)

(22,500)

(22,000)

(21,500)

(21,000)

(20,500)

(20,000)

(19,500)

(19,000)

(18,500)

1 2 3 4 5 6 7 8 9 10 11 12

Pay Spend

Plan Actual 18-19 Actual

(60,500)

(60,000)

(59,500)

(59,000)

(58,500)

(58,000)

Budget Actual

Medical Pay

Medical Pay

(37,800)

(37,600)

(37,400)

(37,200)

(37,000)

(36,800)

(36,600)

(36,400)

(36,200)

Budget Actual

Non-Clinical Pay

Non-Clinical Pay

(80,000)

(79,800)

(79,600)

(79,400)

(79,200)

(79,000)

(78,800)

(78,600)

(78,400)

(78,200)

Budget Actual



(20,200)

(20,000)

(19,800)

(19,600)

(19,400)

(19,200)

(19,000)

(18,800)

Budget Actual



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August 2019- Trust Bank & Agency Spend

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Workforce & Finance: Bank & Agency Spend December 2019


Agency The Trust has set an internal target of

£13m for 2019-20.

This is £1m lower than the internal target

set last year and total spend for 18-19

amounted to £14.9m.

Agency expenditure in the month totaled

£1.06m. This was slightly higher than the

in month target of £1.03m

YTD the Trust is £0.07m adrift of its

internal agency target but well within the

ceiling set by NHSI.

Bank Bank spend for December was £2.43m.

There continues to be a shift from agency

to bank as shown by the graphs.

However the Trust has spent £0.24m

more on bank & agency when compared

to December last year. Cumulatively,

2019-20 spend for temporary staffing is

£2m higher than the same period last

year.

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August 2019– Trust Non Pay Performance

Non Pay Performance YTD Performance

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Workforce & Finance: Non Pay December 2019


Expense Type Annual Budget Budget Actual Variance Budget Actual Variance

Clin Supp Serv (31,012) (2,265) (2,449) (184) (23,144) (22,949) 195

Drugs (22,557) (1,694) (1,983) (289) (16,975) (16,262) 713

OTHER (NON CLIN) (80,187) (5,727) (5,830) (103) (61,123) (58,792) 2,330

Non Pay Unallocated CIPS 819 (86) 86 (49) 49

Total (132,937) (9,772) (10,263) (491) (101,290) (98,003) 3,287

In Month (£000's) YTD

(23,200)

(23,150)

(23,100)

(23,050)

(23,000)

(22,950)

(22,900)

(22,850)

Budget Actual

Clin Supp Serv

Clin Supp Serv

(17,200)

(17,000)

(16,800)

(16,600)

(16,400)

(16,200)

(16,000)

(15,800)

Budget Actual

Drugs

Drugs

(61,500)

(61,000)

(60,500)

(60,000)

(59,500)

(59,000)

(58,500)

(58,000)

(57,500)

Budget Actual

OTHER (NON CLIN)

OTHER (NON CLIN)

The in month non pay position reported an overspend of £491k. Actual Spend was £10.26m against a budget of £9.77m. The main drivers of the position include: 1. An overspend against Clinical Supplies of £184k. At a high level, this was driven by an increase in purchases of high

cost devices within cardiology.

2. A £289k overspend against Drugs. £200k of this relates to pass-through items and is offset by income. A £103k underspend spend on Other Non Clinical. A retrospective bill for water and sewerage and an increase in the level of bad debt provision have driven the adverse position against budget.

3. The YTD non pay position shows an underspend of £3.28m. This is driven by lower pass through expenditure on drugs and unutilised growth monies. In addition to this, the prior month release of a central provision, VAT rebates and revenue to capital corrections mask specific non pay challenges that divisions are facing. These are covered by the divisional slides later on in this pack.

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Efficiency Programme - Planning Workforce & Finance: Efficiency Programme


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Workforce & Finance: Capital Expenditure December 2019

YTD Capital spend by Scheme

The Annual Plan for 2019/20 has reverted to £25.9m a with revised capital forecast

of £21.1m.


Month Scheme Spend (£m)

1 Bought Forward schemes 0.15

Month 1 Total Spend 0.15

2 Your Care Your Future 0.2

2 Winter Pressure 0.2

2 Tactical Servers & NHSMail2 0.1

2 Fire Safety 0.1

2 OCT Scanner and Server 0.1


3 Acute Redevelopment 0.2

3 IT infrastructure 0.8

3 Fire Safety 0.2


4 Your Care Your Future 0.1

4 NHS mail2 0.1

4 Isolation Rooms 0.2

4 Fire Safety 0.2

4 Estates projects 0.1


5Your Care Your Future & Strategic Estate

development0.05

5 NHS mail2 & Tactical Servers 0.1

5 Isolation Rooms 0.05

5 Fire Safety 0.05

5 UPS Cardiac Cath Lab batteries 0.07



6Your Care Your Future & Strategic Estate

development 0.12

6 IT Cyber Resilience 0.07

6 Fire Safety 0.2

6 Hotwell project 0.05



7 Power Tools for Theatres 0.2

7 Lift 5&6 0.1

7 Fire Safety 0.2



8 Holywell Orthopaedics Outpatients 0.1

8 Theatres 0.04

8 Shrodells Garden Prep for Portakabin 0.07

8 Fire Safety 0.26

8 Hotwell Boiler 0.05

8 Refurbishment of Clinical Areas – CQC related 0.12

8 IT projects 0.07

8 Other sundry 0.01


9 Holywell Orthopaedics Outpatients 0.2

9 Shrodells Garden Prep for Portakabin 0.2

9 Lift 5&6 0.1

9 Fire Safety 0.1

9 IT Related projects 0.1

9 Medical Equipment 0.2

9 Other sundry 0.1


YTD Spend 6.22

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Detailed reports

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Safe Care & Improving Outcomes: Mortality Indicators

In this reporting period:

The latest available (August 2018 to July 2019) Summary Hospital Mortality Indicator (SHMI) was 100.56 and within the ‘as

expected’ range (band 2). SHMI data had a new baseline calculated in May and the Trust has been informed by Dr Foster

that this increased all trusts’ SHMI by approximately 3%. For the 12 month period (October 2018 to September 2019), the

Trust’s overall HSMR of 99.2 was within the ‘as expected’ range.

Factors / Themes:

A case note deep dive review is undertaken for each ‘outlying’ primary diagnostic SMR group with a speciality or senior trust

consultant and the coding manager.

Next steps:

Monthly specialty/departmental Mortality Review meetings continue, cases from which are then referred for Structured

Judgement Review in accordance with criteria described in the Trust’s ‘Learning From Deaths’ policy.

A large percentage of cases are now being referred by the Medical Examiners in a timely way and the backlog of SJRs is

being worked through.

22

Benchmarking: MODEL HOSPITAL

Summary Hospital Mortality

Indicator (SHMI)

Period: 31/04/19

WHHT 0.99 Sector: 1.00

Performance stable Better than target/threshold

HSMR – rolling 3 months SHMI – rolling 12 months

0

30

60

90

120

150

Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb

2016/17 2017/18 2018/19 2019/20

HSMR (overall) HSMR (weekend) Threshold (HSMR overall)

60

90

120

SHMI (Rolling 12 months) Actual SHMI (Rolling 12 months) 100

DOMAIN EXECUTIVE LEAD SUB-COMMITTEE BAF Objective Ref

Safe Care & Improving Outcomes: Safe Chief Medical Officer Quality Committee 1a / 1b / 2a / 3a / 4a

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Safe care & Improving Outcomes: Infection Control (1 of 2)


Clostrioides difficile Infection (CDI) objectives for 2019/20 are based on a new criteria for apportioning of cases; this system commenced on

1 April 2019:

• Hospital onset healthcare associated – cases detected 2 days or more after admission (cat 1).

• Community onset healthcare associated – cases that occur in the community that have had a hospital admission/inpatient in the

previous 4 weeks (cat 2).

• Community onset indeterminate association – cases detected in the community when a patient has had an admission or been an

inpatient in the previous 12 weeks but not the most recent 4 weeks (cat 3).

• Community onset community associated – cases that occur in the community when the patient has not had an admission or been an

inpatient in the previous 12 weeks (cat 4).

Objectives for acute providers are based on the first 2 categories and the Trust has a trajectory of no more than 34 cases with identified

lapses in care for the full year. The IPC Team is continuing to embed the implementation of the CDI action plan, which includes data review

and visits to clinical areas to support to raise awareness regarding learning for CID reviews.

In December 1 x cat 1 case and 0 x cat 2 case. Monthly RCA meetings with community/CCG colleagues continues, where appeals for

lapses in care are determined. The next appeal meeting will be in February where the additional CDI cases will be reviewed. Our total

successful appeals remains at 25 cases, where no lapses in care identified.

MRSA bacteraemia (MRSAb): There is no formal target set for MRSAb, a zero tolerance approach is in place. No cases of MRSAb were

identified in December.

Factors / Themes:

All CDI cases have an individual review meeting, in addition to the monthly appeals meeting with the CCG. Learning from all CDI cases is

included in action plans and fed back to the IPC panel. CDI management and awareness continues, including weekly CDI power training to

embed compliance with the learning from the RCA reviews. Divisional governance meetings are attended to give feedback and support the

divisions to deliver local actions to improve CDI management. Matron’s meeting is attended to provide support with RCA and action plans

from IPC. The recent CCG CDI deep dive is being implemented progressively, in order to reduce our CDI numbers and improve patient care

and experience.

23


Rolling 12 month trust apportioned

Cdiff infections / 12 month avg

occupied bed days

Period: to March 2019

WHHT 6.42 Peer 13.68

National 11.11

(Peers = Nightingale Group – acute

multi-site trusts)

Clostrioides Difficile Infection (CDI) MRSA MSSA

0

5

10

15

20

25

30

35

40

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

2019/20

Clostridioides Difficile Actual Clostridioides Difficile Target

Clostridioides Difficile Actual YTD Clostridioides Difficile Target YTD

Actual YTD (Excl. cases with no lapses in care)

Apr

May

Jun

JulAug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

JulAug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

JulAug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

2017/18 2018/19 2019/20

MRSA bacteraemias Actual 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0

MRSA bacteraemias Target 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

E. Coli Bacteraemia 1 1 3 8 3 2 4 4 2 2 8 3 2 2 2 3 5 2 3 3 1 6 6 5 6 4 4 5 3 6 3 3 3

0

1

2

3

4

5

6

7

8

9

0

1

2

3

4

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

2017/18 2018/19 2019/20

MSSA Actual MSSA Trajectory MSSA Target


Safe Care & Improving Outcomes: Safe Chief Nurse & DIPC Quality Committee 1b / 2a / 2b / 2c / 3a


11

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E. Coli bacteraemia (E colib)

There were 3 post-48hr (trust apportioned) cases and 26 pre-48 hour cases (non-trust) reported in December. There is no externally set target for the trust but the national

target is to deliver a 25% reduction by 2021 and 50% by 2024; this is reflected in the quality indicator which is monitored by the CCG. Thematic data is gathered for post-

48 hour cases and reviewed alongside microbiology review of the pre-48 hour cases. Broader work with partner organisations regarding AMR, ‘To Dip and Not To Dip’

and trust-wide implementation of the hydration QI project for the prevention of UTIs, to improve hydration in patients. Our new antimicrobial pharmacist is supporting this

programme to contribute to improving antimicrobial stewardship, which aims to reduce gram-negative resistance.

Methicillin-sensitive Staphylococcus aureus (MSSAb)

There were 3 post-48 hour (trust apportioned) case and five pre-48 hour (non-trust) cases of MSSAb reported in December. Each case is reviewed by a microbiologist

using an RCA tool to identify and share learning. Our new antimicrobial pharmacist will contribute to this work.

Infection Prevention Control (IPC) Progress Update

The IPC Code of Practice (CoP) audits continues. The IPCT provide ward-based support for areas that have not met the required audit standards. Scores below 80% are

escalated to departmental leads, divisional senior teams and the DIPC. During December work on the use of PPE, hand hygiene practices, ANTT, Sharps, Chlorclean and

environmental reviews took place.

Next steps:

Extensive work is underway through conducting weekly environmental walkabouts with IPC, Facilities, Estates, Mitie and the divisional team. The aim is to ensure we

work together ensuring IPC and cleanliness is seen as everyone's business, ensuring we have a clean and safe environment. All walkabouts are documented and

distributed to the relevant leads to ensure that the findings are followed up and actioned.

Compliance with hand hygiene and CPE screening continues to remain good. Flu and norovirus are closely monitored to reduce the risks of outbreaks and maintain good

patient safety, quality and experience.

24

Safe care & Improving Outcomes: Infection Control (2 of 2)

Carbapenemase-producing Enterobacteriaceae (CPE) Hand hygiene compliance

Apr

May

Jun

JulAug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

JulAug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

JulAug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

2017/18 2018/19 2019/20

CPE Actual 2 1 4 0 2 2 0 3 2 5 1 4 3 2 8 4 8 4 8 0 1 1 3 5 5 2 3 3 2 1 0 6 2

CPE Target 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0

1

2

3

4

5

6

7

8

9

70%

75%

80%

85%

90%

95%

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

Ap

r

Ma

y

Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Ma

r

2017/18 2018/19 2019/20

Hand hygiene Actual Hand hygiene Target


Safe Care & Improving Outcomes: Safe Chief Nurse & DIPC Quality Committee 1b / 2a / 2b / 2c / 3a

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Safe care & Improving Outcomes: Emergency Readmissions


The readmission rate, benchmarked against the most up to date national position (June 2019) was in line with the national

average overall, and for readmissions following an elective and emergency (original) admission.

Factors / Themes:

Combined readmission rates (emergency and elective admissions), includes all patients with more than one admission to

the hospital within a period of 30 days, regardless of whether the second admission was related.

25


Emergency Readmission 30 days

Period: Q2 2019/20

WHHT 7.90% Peer 7.27%

National 7.85%


multi-site trusts)


Emergency Readmissions

0%

2%

4%

6%

8%

10%

12%

14%

16%

Apr

May

Jun Jul Aug

Sep

Oct

Nov

Dec

Jan Feb

Mar

Apr

May

Jun Jul Aug

Sep

Oct

Nov

Dec

Jan Feb

Mar

Apr

May

Jun Jul Aug

Sep

Oct

Nov

Dec

Jan Feb

Mar

2017/18 2018/19 2019/20

Overall - National Elective - NationalEmergency - National Emergency - WHHTOverall - WHHT Elective - WHHT


Safe Care & Improving Outcomes: Safe Chief Medical Officer Quality Committee 2a / 2b / 2c / 3a / 4c

11

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Safe care & Improving Outcomes: Caesarean Section rates

C-section rate

The elective LSCS rate of 14.2% was just above the national target of 14% keeping the total LSCS rate in the amber alert

range at 30%. This is an improvement on November’s figure of 34.3%.

The c section audit was presented at the Women's and Children’s Divisional governance meetings and a number of actions

agreed

1. It appeared that there was variation in the use of Syntocinon, a drug which augments labour. There will now be focused

work on the use of this drug particularly training and education in order to provide confidence and consistency of its

use.

2. A focus will be given to instrumental deliveries. From February there will be a yearly compulsory training day for all

levels of medical staff. This will ensure the doctors have up to date skills ,knowledge and competencies in the use of

forceps and ventouse for those working on the labour ward.

3. This will be re audited again in 3 months.

4. A second stage of labour audit has also been completed during he last few months. This will be presented at the next

governance meeting. There will be a comparison of the two audits presented at the Divisional Performance Meeting in

January, this will include the findings, outcomes and an action plan.

26


Emergency Caesarean section rate

Period: October 2019

WHHT 15.8% Peer: 15.9%

National: 16.3%


multi-site trusts)

Caesarean section rates

13%

12%

11%

10% 11%

11% 14

%12

%10

%11

%11

% 13%

12% 15

%14

%13

%12

%12

% 14%

14%

13%

13%

14%

10% 16

%16

%13

% 16%

14% 18

%15

%15

%16

%

17%

18%

13%

17%

13% 17% 19

%17

%18

%15

% 16% 16

%17

% 17% 24

%19

%16

% 19% 24

%12

%15

% 19%

18%

20%

17%

16%

15%

19%

15%

16%

16% 19%

14%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Apr

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Ap

r

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Ap

r

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

2017/18 2018/19 2019/20

Caesarean Section rate - Elective Actual Caesarean Section rate - Emergency Actual

Caesarean Section rate - Combined Target

DOMAIN EXECUTIVE LEAD SUB-COMMITTEE BAF Ref

Safe Care & Improving Outcomes: Safe Chief Medical Officer Quality Committee 2a / 2c / 3a / 4c


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Care hours per patient day – total

nursing & midwifery staff


WHHT: 7.8 Peer: 7.9

National: 8.0


multi-site trusts)


Safe care & Improving Outcomes: Workforce and CHPPD


Overall fill rate was 102.4% (national threshold of 95%). Within the total fill rates, 98.7% were registered nurses and 98.8% were

unregistered. 71.2% shifts were RAG rated green, 28.6% shifts were rated amber and 0.1% rated red.

Current nursing band 5 vacancy rate on adult inpatient areas has risen to 4.6%, with significant vacancies within paediatrics and theatre

services; on going recruitment initiatives continue. The current turn over for band 5s this month is 17%, the trust target is16%.

There were no NICE red flags relating to shifts with less than 2 RNs identified, but three were reported with a short fall in RN time. When a

NICE red flag relating to staffing is recorded on safecare the ward manager and matron are alerted and mitigations recorded on both safecare

and Datix. In addition Red flags and mitigations taken are also discussed at the monthly workforce meetings.

Ward leaders supervisory time was 74.6%, indicating the majority of their time was focused on promoting patient safety, developing and

supporting junior staff and managing the ward. The other 25.4%, is when they are deployed to clinical time supporting safe staffing or due to

leave (11.37 and 14.05 respectively). Safe Care % utilisation – of the 32 inpatient areas, 3 in maternity and 1 in children services had fill rates

below 95% (range 90.8%-93.9%), and one maternity area had fill rates below 90%. Although fill rates are low in maternity no red flags were

reported. Senior staff attend the daily operational meeting and provide assurance around safe staffing and mitigations taken, including staff

redeployment. Staff also report on any quality or patient safety issues incurred from staffing decisions made the previous day for inpatient and

surge areas.

Bank and agency requested hours was 64,636 hours with a fill rate of 85.4%; (76.3% bank and 9.1% agency). A number of escalation beds

were open - the highest utilisation being 30 December when there were an additional 57 beds open across ten areas. Simpson ward opened

an additional 3 beds on the 31st December increasing its capacity to 24 patients. In the week commencing 29 December, due to flu, Red

suite was not able to utilise 5 beds. All additional shifts requested within hours are authorised by Heads of Nursing and out of hours by the

senior nurse in discussion with on call manager. Enhanced care team usage in December was 7795.21 hours. CHPPD is currently 7.95.

27

Factors/ Themes:

For N&M staffing continues to positively benchmark for CHPPD against our peers in Model Hospital.

October data on Model Hospitals shows WHHT at 7.8, peers 7.8 and National 8.0.

There was a positive visit by NHSI on the Trust on 4th December to discuss our Level of Attainment

for nursing and midwifery.

ESRGo Project –Interface ESR and E-roster went live on10th December - no major issues reported.

Paediatric establishment review final sign off December 2019.

UTC and MIU establishment review sign off December 2019.

ED establishment scheduled sign off January

Paediatric and Theatre recruitment drive to Australia scheduled in January 2020

Paper to TMC by Chief of People to review current OSCE pipeline

DHSC has committed to £7million of capital funding. Bidding is now open to accelerate NHS

Providers’ utilisation of workforce deployment systems , WHHT submitted a bid in September for

Nursing, Midwifery and AHP – outcome of bids due December 2019, still waiting to hear.


104.4%103.8%

102.6%102.6%103.3%

102.5%102.4%

102.8%103.2%

100.6%101.4%

103.0%

100.2%

101.9% 102.5%102.4%

5.0

5.5

6.0

6.5

7.0

7.5

8.0

8.5

9.0

90%

92%

94%

96%

98%

100%

102%

104%

106%

Care

Hour

s Per

Patie

nt D

ay

Perce

ntag

e ove

rall p

lanne

d vs.

actua

l nur

sing h

ours

Workforce and CHPPD: Percentage overall planned vs. actual nursing

Care Hours Per Patient Day (CHPPD) % Fill Rate Threshold - fill rate


Safe Care & Improving Outcomes: Safe Chief Nurse Quality Committee 1b / 4c / 7a / 7b / 8c

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Ward scorecard: themes from adult IP scorecard & Safety Thermometer

28


Analysis

Safety Alerts

In December there were 46 safety alerts- this is similar to November (46). Falls with harm and pressure ulcers continue to be the main cause of the safety alerts.

Process Alerts

In December there were 60 process alerts compared with 53 in November

The alerts have similar figures to November. Supervisory time scored (22/30 process errors), FFT responses (18/33 process errors) The FFT process errors are higher than in

November (11/33)r. The improvement in the commode audit has been sustained 2/28 process errors compared with 13/27 in October.

Divisional Nurse Summit meetings continue within medicine, surgery and emergency medicine. Quality Improvement Forum continues to identify, support and guide quality

initiatives; all matrons now attend.

Next Steps

1. Increased ward based teaching on assessments with clinical staff

2. National Pressure ulcer collaborative on-going on Croxley and Tudor ward

3. Swarming on phased implementation to the Trust using a QI approach. Two ‘swarm meetings have taken place on Heronsgate ward. Swarming is due to be rolled out to

Tudor Ward in February 2020

4. VTE section added to the discharge checklist.

5. Through the new E Coli steering group – work streams have been instigated to analyse the high use of urinary catheters, use of catheter passports, education and training.

6. MUST training e-learning module developed. Dieticians leading on MUST training and have sessions planned for the next 6 months.

7. Harm Free Study Day to be delivered in December 2019. Ward based awareness campaigns on harm free care planned monthly

8. 9 Divisional Nurse Summit to explore the supervisory time scores.

All data is taken to the Quality Improvement Forum (QIF) to drive learning, innovation and improvement. At this forum the wards needing support are identified. Currently

supporting AAU Level 3 Blue/ Yellow and plans to develop a support programme for Letchmore in January 2020.

Evaluation

• The safety thermometer data for Falls is the same as the National average for December (it was below National average in November. For HAPU the Trust is below the

National average- an improvement on November 2019

• Tissue viability and falls remain a focus within Divisions

11

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29

Ward Scorecard


11

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30

Ward Scorecard (Other/ Non Adult Inpatient)


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Safe Care & Improving Outcomes: Patient Safety

31


Serious Incidents closed within 60

days

Period: 2018/19

WHHT 95% Peer: 72%

National: 61%


Never events

There was 1 (one) Never Events reported in December 2019 which met the criteria for “wrong site block.” Immediate actions

have been taken by the division and the investigation is underway.

Serious Incidents

There were 3 serious incidents declared in December 2019; 2 in WACS and 1 Medicine

At the end of December 2019 the Trust had 17 open SIs. Of these, 5 investigations were complete and with commissioners

pending formal closure on StEIS. There were 12 ongoing open SI investigations, 2 of which were overdue.

Learning from SIs

There were 2 completed reports submitted to the commissioners during December 2019 -

Learning:

DW122277 - Registered nurse to complete first set of baseline observations on patients returning from theatre to enable

recognition of any deterioration.

DW121123 - Anaethetists must review patients with head injuries who are being transferred to a specialist unit.

% of patient safety incidents which are harmful

10.4% of incidents reported in December 2019 were recorded as having caused harm to the patient, compared to 9.1% in

November 2019. This increase in incidents causing harm to patients will be closely monitored by the patient safety team, but

may be due to natural variation.

There were 20 incidents reported in December 2019 with a moderate or above level of harm. There were zero (0) incidents

reported in December 2019 with a harm level of Death/Catastrophic.


% medication incidents reported

as causing harm or death/all

medication errors

Period: 31/03/2019

WHHT 10.0% Peer: 17.1%

National: 10.7%


multi-site trusts)

Safety incidents (% harmful) Medication incidents causing serious harm Serious Incidents

-2

-1

0

1

2

3

4

5

6

7

8

9

Ap

r

Ma

y

Ju

n

Ju

l

Au

g

Sep

Oct

No

v

De

c

Ja

n

Feb

Ma

r

Ap

r

Ma

y

Ju

n

Ju

l

Au

g

Sep

Oct

No

v

De

c

Ja

n

Feb

Ma

r

Ap

r

Ma

y

Ju

n

Ju

l

Au

g

Sep

Oct

No

v

De

c

Ja

n

Feb

Ma

r

2017/18 2018/19 2019/20

Actual Target to follow UPL will be used Upper control limit (3 sd)

Lower control limit (3 sd) Mean

0%

5%

10%

15%

20%

25%

30%

35%

40%

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

2017/18 2018/19 2019/20

Actual Target

0

1

2

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

2017/18 2018/19 2019/20

Actual Target


Safe Care & Improving Outcomes: Safe Chief Nurse Quality Committee 1a / 1b / 2a / 3a / 4a / 4b / 4c

Performance deteriorated Worse than target/threshold

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Safe Care & Improving Outcomes: Falls & Falls with harm

32


In December there were 106 falls in total. 29 Falls with harm. 4 patients sustained moderate harm. Analysis shows that 23

(79.3%) falls were not witnessed, 6 (20.7%) falls were witnessed , 17 incidents occurred during the day shift and 12 during the

night shift, 17 (58.6%) incidents involved patients with cognitive impairment. Of these 10 patients were reported as having

dementia. The majority of falls (22/75.9%) occurred around the bed area.

Falls with harm remain low in comparison to the number of falls reported locally and nationally. Of the 106 falls reported in

December, 12 recurrent fallers accounted for (33%) 35 incidents. In December three clinical areas reported significant number

of falls; Heronsgate/Gade – 10, Tudor/Castle – 9 and Bluebells – 9.

Next steps:

• To further improve learning for SI’s and Divisional Learning Reviews they are presented at the bi-monthly Patient Falls

Review group where there is a focus around disseminating learning and what can be done differently – this has been

reinforced through the QIF meeting

• Swarming will now be piloted on two clinical areas Heronsgate/Gade and Tudor/Castle – SOP to be revised.

• Matrons have conducted a full survey and are evaluating the results regarding night lights within the wards following findings

from a night walk by senior staff . Ongoing trial of nightlights- To be reviewed in January 2020 at quality improvement

forum.

• NHSI falls collaborative – pilot on Ridge and Croxley ward to commence

• Focusing on the CQUIN three high impact interventions to reduce falls and improve patient safety and outcomes. Q3 data

shows 57% compliance which is an increase when compared to Q2 results of 26%


Proportion of patients with harm

from a fall in care

Period: April 2019

WHHT 0.2% Peer: 0.8%

National: 0.3%


multi-site trusts)


Number of falls (total and with harm)

0

20

40

60

80

100

120

140

Apr

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Ap

r

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Ap

r

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

2017/18 2018/19 2019/20

Num

ber o

f fal

ls

Number of falls Number of falls with harm


Safe Care & Improving Outcomes: Safe Chief Nurse Quality Committee 1b / 2a / 3a / 4c

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33

Safe Care & Improving Outcomes: Harm free care


The Adult Safety Thermometer focuses on four commonly occurring harms in healthcare: pressure ulcers, falls, UTI in

patients with a catheter and VTEs. This is a point prevalence survey with a national target of 95%. New Harm Free Care

acquired in the Trust during December 98.9% compared to national average of 97.8%

December comparison with national data:

• New Pressure Ulcers 0.5% (decrease from 1.2% in

November) compared with a national average of 0.9%

• Falls with harm 0.5% ( an increase from 0.2% in November)

vs national figure 0.5%

• New VTE 0.2% (a decrease on November 0.3%) vs national

figure 0.5%

• Patients with a urinary catheter 16.6% (a decrease on

November 19.6% ) vs national figure 13.9% Patient with

catheter and UTI 0.3% (an increase from 0.2%) in November

vs national figure 0.7% .


Proportion of patients with harm

free care (including harm acquired

outside the trust

Period: April 2019

WHHT 90.1% Peer 93.2%

National 94%


multi-site trusts)

Adult safety thermometer: Harm free care

Adult safety thermometer : Pressure ulcers (new harms)

Performance stable Worse than target/threshold

80%

82%

84%

86%

88%

90%

92%

94%

96%

98%

100%

Ap

r

Ma

y

Jun

Jul

Aug Sep Oct

Nov

Dec Ja

n

Feb

Mar

Apr

Ma

y

Jun

Jul

Au

g

Sep

Oct

Nov

Dec Ja

n

Feb

Mar

Ap

r

May Jun

Jul

Aug Sep Oct

Nov

Dec Ja

n

Feb

Mar

2017/18 2018/19 2019/20

Harm Free Care (acquired within and outside of Trust)

Harm Free Care (acquired within and outside of Trust) Target

New Harm Free Care (acquired within Trust)

New Harm Free Care (acquired within Trust) national average



0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

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

2019/20

Pressure Ulcers New Harms Pressure Ulcers New Harms - national average

Adult safety thermometer : New VTE Adult safety thermometer : Falls with harm Adult safety thermometer : Catheter & UTI

0

0.2

0.4

0.6

0.8

1

1.2


2019/20

New VTEs New VTEs - national average

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7


2019/20

Falls with harm Falls with harm - national average

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35


2019/20

Catheter and New UTIs Catheter and New UTIs - national average

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34

Safe Care & Improving Outcomes: Harm free care

In this reporting period

Children and Young People's Services Safety Thermometer:

The Children and Young People’s Service Safety Thermometer focuses on patient observations (PEWS completed) that are

triggered but not escalated, extravasation (leakage of a fluid out of its container), patients in pain at the time of survey and

any pressure ulcer or any moisture lesion. Harm free care was 73.7% in December 2019, lower than the national average of

86.2%. We believe this was a reporting error, the audit was completed by a new auditor and the questions were interpreted

incorrectly. The questions have now been reviewed and necessary training for undertaking the audit has been completed.

This should be reflected in the next month’s results.

Maternity Safety Thermometer:

The Maternity Safety Thermometer captures data representative of a particular day and does not capture a proportionate

number representative across the month. On the day of review, 0.0% of women experienced a 3rd/4th degree tear in this

audit, which is below the national average of 2.1%. The proportion of term babies born with an APGAR of 7 or less at 5

minutes was 0.0%, well below the national average of 3.1%. The proportion of woman with a maternal infection from onset of

labour to 10 days postnatal was 0.0% lower than the national average being 6.2%. These figures are not representative of the

month’s total figures, but represent a ‘snapshot’ of the cases on the day. PPH rates were, however, 13.8%, above the national

average of 9.9%, which although is not consistent with the monthly data, is representative of the trend of maternal

haemorrhages within the maternity department. A programme is in place to monitor cases of maternal haemorrhages. These

indicators are monitored through the maternity dashboard at quality committee.

The combined harm free care point prevalence audit score is above the national average of 70.0.% (86.2%).

Children safety thermometer: Harm free care Maternity Safety thermometer: Harm free care

0%

20%

40%

60%

80%

100%

120%

Ap

r

Ma

y

Jun

Jul

Aug Sep Oct

Nov

Dec Ja

n

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep Oct

Nov

Dec Ja

n

Feb

Mar

Apr

May Jun

Jul

Au

g

Sep Oct

Nov

Dec Ja

n

Feb

Mar

2017/18 2018/19 2019/20

Children's Harm Free Care Actual Children's Harm Free Care national average



0%

20%

40%

60%

80%

100%

120%

Apr

May Jun

Jul

Aug Sep Oct

No

v

De

c

Jan

Feb

Mar

Apr

May Jun

Jul

Au

g

Sep

Oct

No

v

Dec Ja

n

Feb

Mar

Apr

May Jun

Jul

Aug Sep Oct

Nov

De

c

Jan

Feb

Ma

r

2017/18 2018/19 2019/20

Maternity Harm Free care Maternity Harm Free care National Average

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Proportion of patients with new

pressure ulcers (grade 2-4)

Period: April 2019

WHHT 1.0% Peer 0.7%

National 0.7%


multi-site trusts)


Safe Care & Improving Outcomes: Pressure ulcers (HAPUs)

35

Stable In this reporting period

In December there were 27 reportable HAPU’s affecting 24 patients. In addition there were 12 category 1 pressure ulcers

affecting 8 patients and 13 cases of SDTI affecting 10 patients.

0 x Category 4 / 2 x Unstageable / 0 x Category 3 / 25 x Category 2 / 12 x Category 1 / 13 x SDTI

The pressure ulcer incidence data for December is almost identical to November although there was a slight increase in the

overall number of patients affected. The majority of pressure damage remains in the medical division (9 wards), compared to 5

surgical areas. Both of the unstageable pressure ulcers occurred on surgical wards. The unstageable HAPU on ITU had no

lapses of care identified.

The 9 medical device related pressure ulcers (MDRPUs) occurred across clinical wards in both Medicine & Surgery. A third of

the MDRPU were related to the use of NIV therapy, although preventative measures had been put in place. The remaining

MDRPU occrred as a result of AES stocking, catheter and nasogastric tubing. Of the 13 SDTI’s, 7 were on patients were

discharged with the SDTI remaining uncategorisable, the remaining injuries were identified on patients who subsequently died.

Next steps:

• Continued focus within the safety huddles patients with medical devices and heel offloading.

• Effective repositioning being highlighted to clinical areas in ward wards. TVN team undertaking check and challenge

exercise across clinical areas, and supporting wards experiencing repositioning challenges.

• Target work from the TVN team member working alongside HCA and clinical support workers to enable role modelling good

patient care in relation to skin management. Focus was on Ridge ward and AAU 3 Blue/Yellow in December, and

commenced in Elizabeth in January.

• Implementation programme for NHSI recommendations for defining and measuring pressure ulcers, published in June 2018

• Continued support to the matrons who validate Category 2 pressure ulcers for the clinical areas.

• The Trust is progressing through the National collaborative ‘Stop the Pressure’ on Croxley and Tudor ward.

Pressure Ulcers (HAPUs)

AprMay Jun Jul Aug Sep Oct NovDec Jan FebMar AprMay Jun Jul Aug Sep Oct NovDec Jan FebMar AprMay Jun Jul Aug Sep Oct NovDec Jan FebMar

2017/18 2018/19 2019/20

Unstageable Pressure Ulcers 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 2 2 3 8 1 5 1 2 0 5 0 1 2

Category 4 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0

Category 3 1 0 1 4 2 3 2 2 4 9 3 3 8 4 4 1 3 10 0 0 0 2 1 1 3 4 0 1 1 2 1 0 0

Category 2 19 13 15 13 13 16 19 8 14 22 17 16 21 11 11 21 12 24 21 20 22 31 23 31 16 17 15 12 14 28 20 25 25

Deep TissueInjuries 13 8 4 7 18 11 16 18 11 14 14 9 9 13

0

5

10

15

20

25

30

35

40

45


Safe Care & Improving Outcomes: Safe Chief Nurse Quality Committee 1b / 2a / 2c / 3a

Pressure Ulcers SPC Grade 2 Pressure Ulcers SPC Grades 3 & 4

0

5

10

15

20

25

30

35

40

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

2018/19 2019/20

Category 2 Mean Upper control limit (3 sd) Lower control limit (3 sd)

-4

-2

0

2

4

6

8

10

12

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

2018/19 2019/20

Category 2 Mean Upper control limit (3 sd) Lower control limit (3 sd)

11

Tab 11 Integrated P

erformance R

eport

38 of 236T

rust Board M



VTE assessment

Period: Q2 2019/20

WHHT 94.73% Peer: 94.78%

National 96.06%


multi-site trusts)


Safe care & Improving Outcomes: VTE risk assessment

36


The current reported position is worse than target, however compliance is expected to improve as inpatient episodes are

completed and then coded.

Factors / Themes:

Gaps in risk assessments in admitting areas.

Next steps:

• Regular reporting is being provided to all wards where VTE risk assessments are below threshold

• Focused awareness and training sessions in AAU Level 1.

• VTE prevention specialist nurse to target these areas and to visit Safety Huddles as well as liaise with senior sisters.

• VTE learning is part of Doctors’ and nurses’ mandatory training


VTE risk assessment

80%

85%

90%

95%

100%

Ap

r

Ma

y

Jun

Jul

Aug Sep

Oct

Nov

Dec Ja

n

Feb

Mar

Apr

May Jun

Jul

Au

g

Sep Oct

Nov

Dec Ja

n

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep Oct

Nov

Dec Ja

n

Feb

Mar

2017/18 2018/19 2019/20

VTE risk assessment Actual VTE risk assessment Target Mean

Upper control limit (3 sd) Lower control limit (3 sd)


Safe Care & Improving Outcomes: Safe Chief Medical Officer Quality Committee 1a / 1b / 2a / 2c / 4c

11

Tab 11 Integrated P

erformance R

eport

39 of 236T

rust Board M



Safe Care & Improving Outcomes: Stroke


Stroke

Performance against the 4 hour target for admission to the stroke unit was 68.1%.

Maintaining ring fenced beds on the stroke unit is challenging when the Trust experiences capacity constraints affecting “right

bed” availability. However patients continue to receive stroke specialist care and input while they await transfer to the stroke

unit.

90% stay on the Stroke Unit

96.9% of stroke patients in this reporting month spent 90% of their stay on the stroke unit, better than the 96.9% target.

Thrombolysis within one hour

45.5% of patients were thrombolysed within 1 hour (target is 50%)

37

Benchmarking: SSNAP

Period: July to September 2019

Admission within 4 hours: 56.8%

90% admission on Stroke

Unit: 83.8%

Stroke: Admission within 4 hours Stroke: 90% of admission on Stroke Unit

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

Ap

r

Ma

y

Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Ma

r

2017/18 2018/19 2019/20

Performance Target Mean Upper control limit (3 sd) Lower control limit (3 sd)

0%

20%

40%

60%

80%

100%

120%

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

2017/18 2018/19 2019/20



Safe Care & Improving Outcomes: Safe Chief Medical Officer Quality Committee 1a / 1b / 2a / 2b / 2c / 3a / 4a / 4c


11

Tab 11 Integrated P

erformance R

eport

40 of 236T

rust Board M



% of patients admitted or

discharged within 4 hours of

arrival

Period: November 2019

WHHT: 82.2% Peer: 75.8%

National: 79.2%


multi-site trusts)


Caring & Responsive Services: Emergency Department


Overall performance against the 95% 4 hour standard is lower than the previous month at 79.4%. Increasing acuity has been

a major factor impacting the position and Minors performance has reduced from 93.8% to 92.3% and CED performance was

85.9% (from 87.8%). Compliance above the standard was maintained at HHGH UTC and MIU, both over 99%.

Next Steps:

• The regular check in meetings between the service team and Executive colleagues continue, together with the weekly

access meetings. There is a robust framework for monitoring the improvement plan.

• The ambulatory care service returned to full capacity mid December. This will support an increase in patients being

streamed away from the ED.

• Work with system partners is ongoing to develop the urgent care strategy which includes the development of Urgent

Treatment Centres (UTCs) across all 3 trust sites.

• Ambulance handover delays spiked in December but work with EEAST continues. The monthly programme board meetings

oversee this work stream with a joint action plan between EEAST and the Trust is in place. The focus will be on improving

the 15 minute off load times and initially a reduction in 60 minute delays, by ensuring a robust STARRing SOP and

escalation policy. Validation of activity is underway between EEAST and WHHT.

• A recruitment plan for medical staffing is in place, 4 Middle Grades have been recruited but await their visas, Consultant

recruitment has not been as successful. The department is reviewing the possibility of joint posts and being supported by

recruitment agencies.

• The new medical take model pilot is underway with regular review meetings being held. This has shown a reduction in LOS

and conversion to admission.

38

AE&: Attendances within 4 hours

70%

75%

80%

85%

90%

95%

100%

Apr

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Ap

r

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Ap

r

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

2017/18 2018/19 2019/20



Caring & Responsive Services: Responsive Chief Operating Officer Finance & Performance Committee 1a / 1b / / 2b / 2c / 4a / 4c / 12b / 12c / 12d


11

Tab 11 Integrated P

erformance R

eport

41 of 236T

rust Board M



Caring & Responsive Services: Mixed sex accommodation breaches


There were no breaches in December 2019.

Factors / Themes:

All historical breaches occurred in ITU and were due to pressures on the emergency care pathway.

Next steps:

The monitoring and management of patients requiring step down from ITU is reviewed daily as part of the regular

operational management meetings. Privacy and dignity is maintained at all times. Full length curtains are used and patients

are offered the use of the toilet/shower if they are able.

39

Benchmarking:

Not currently available

Mixed sex accommodation breaches

0

20

40

60

80

100

120

140

160

180

Apr

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Ap

r

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Ap

r

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

2017/18 2018/19 2019/20

MSA breaches Actual MSA breaches Target



Caring & Responsive Services: Effective Chief Nurse Quality Committee 4a / 4c / 12b / 12c

11

Tab 11 Integrated P

erformance R

eport

42 of 236T

rust Board M



Caring & Responsive Services: Delayed Transfers of Care

In this reporting period: 804 bed days, the equivalent of 26 beds were used, compared to 725 bed days/24 beds used by

DToC patients in November. The national reporting of the snapshot position on one day only of the number of patients

waiting each month, expressed as a percentage of beds, has ceased. As a result, only the bed days and total beds consumed

will be included. This is a more robust measure to illustrate the impact because it includes all patients waiting in the month

rather than the number of patients waiting on one day. The position is better (33%) than the challenging position seen in

October 2019. The split of delays were fairly even: Health 34.8%, Social Care 35.3%, Joint 29.9%, although there is weekly

variance in the % split, the greatest in delays attributable to social care, which may be accounted for by the volume of

referrals and the new winter care capacity being brought online.

Health: 25% of patients were delayed awaiting rehab beds or other health funded beds, it maybe suggested that these were

delays awaiting either CHC bed resource and / or Holywell beds, given the excellent flow and bed availability observed in

CLCH beds over the festive period. Referrals for rehab were at less than 20% of the total IDT workload. 61.9% of the health

delays were attributed to people funding their own care either sourcing the support independently, through CHS or the Local

Authority. There was a relatively even split between people requiring residential and home care. 8% of people were recorded

as delayed due to choice which suggests an improved awareness and use of the policy.

Social: The most challenging area of performance is delay awaiting care homes at 46% of social care’s reportable delays.

This may mask some of the demand for home care and people being recorded as delayed awaiting care homes whilst

awaiting for home care. The alternate decision making is often a response to hospital pressures and lack of care capacity.

34.2% of people delayed are accountable to home care, which like last month, is well documented and probably accounting

for at least 30% of all IDT delays, possibly more. The other area of note is that approximately 6% of people were delayed due

to assessment which is an area for development although it may represent the high level of referrals over the festive period

and unlike last year, there was no break in activity levels , placing increased pressure on holiday period staffing levels.

40


Total number of bed days lost due

to patients not being transferred to

a more appropriate care setting

Period: March 2019

WHHT: 579 Peer: 928

National: 579


multi-site trusts) Delayed Transfers of Care

0

10

20

30

40

50

60

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

2017/18 2018/19 2019/20

Beds used by DToC patients in month



Caring & Responsive Services: Effective Chief Operating Officer Finance & Performance Committee 1b / 2b / 2c / 4a / 4c / 11a

11

Tab 11 Integrated P

erformance R

eport

43 of 236T

rust Board M



Inpatient FFT scores % positive

WHHT: 95.5% Peer: 95.3%

National: 96.2%

A&E scores - % positive


WHHT 94.2% Region 86.7%

National 85.6%


multi-site trusts)


Caring & Responsive Services: Friends & Family Test (1 of 2)


Inpatients 17 adult inpatient wards achieved the trust’s response rate target of 30%;12 achieved the CCG’s 35% target

Overall there were 3 lower scoring inpatient wards at 10% , 9.4% and 8.4% (Bluebell, Sarratt & Starfish). The areas with low

scores were Ambulatory Care, Cath Lab, Helen Donald, Endoscopy, Fraility, ESAU, DSU, and Safari .

A total of 1039 comments were received from inpatients of which only 5 were negative. 95.8% positive response with 843

indicating extremely likely to recommend the organisation , 196 likely and 33 neither likely or unlikely

A positive comment from Aldenham ward ‘All the staff and doctors work non stop making sure everyone is comfortable,

Nurses are so warming and friendly. Thank you so much ’

There has been a decrease in the response rate due to the delayed Christmas postal service

NB: Changes to FFT commence in April when the question will change to ‘how was your experience of our service?

A&E

The positive recommendation rate improved to 94.8% with an increased overall response of 2.0%

5 responses were not recommending due to the length of time spent waiting to be seen. One of the 202 positive comments

was ‘They treat you with dignity and respect. They see you as soon as they can even when busy and very professional ’

NHSEI have reiterated that the FFT is not designed to make comparisons between organisations. It should be used for

continuous improvement, opportunity for feedback, anonymous, quick and easy for users, can be shared with staff in near real

time, collectively can identify themes.

Next steps:

Following a presentation from NHSI/E on the FFT changes being implemented in April 2020, a paper will be presented to PAC

& TMC

41


Inpatient FFT: responses and % positive A&E FFT: responses and % positive

0%

20%

40%

60%

80%

100%

120%

Ap

r

May Jun

Jul

Au

g

Sep Oct

No

v

De

c

Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep Oct

No

v

Dec Ja

n

Feb

Ma

r

Ap

r

May Jun

Jul

Au

g

Sep Oct

No

v

De

c

Jan

Feb

Mar

2017/18 2018/19 2019/20

Inpatient Scores FFT % positive performance Inpatient FFT response rate

Inpatient FFT response rate Target Inpatient FFT response rate trajectory

0%

20%

40%

60%

80%

100%

120%

Ap

r

May Jun

Jul

Au

g

Sep

Oct

Nov

Dec Ja

n

Feb

Mar

Ap

r

Ma

y

Jun

Jul

Au

g

Sep

Oct

Nov

Dec Ja

n

Feb

Mar

Ap

r

Ma

y

Jun

Jul

Aug Sep

Oct

Nov

Dec Ja

n

Feb

Mar

2017/18 2018/19 2019/20

A&E FFT response rate performance A&E FFT % positive Performance

A&E FFT response rate Target A&E FFT response rate Trajectory

New targets for response rate agreed with HVCCG in July 18


Caring & Responsive Services: Caring Chief Nurse Quality Committee 2a / 2c / 3a / 4c / 11a / 12c

11

Tab 11 Integrated P

erformance R

eport

44 of 236T

rust Board M



Maternity scores from FFT – Q2

Birth % positive


WHHT: 96.9% Peer: 98.2%

National: 97.9% (Peers = Nightingale Group – acute

multi-site trusts)


Caring & Responsive Services: Friends & Family Test (2 of 2)

Day Case

The average response rate within day surgery has remained the same at 23.6%; St Albans is 26.8% and Watford is 1.3%.;

the recommendation rate remains at 99%. A positive comment from Day surgery from St Albans is ‘you are all very kind

and professional also very understanding, specially with people with language difficulties. a big thank you for talking care of

my mum,

Outpatients

The recommendation rate remains above 94% at 94.1% with a negative response of 1.3% of patients not recommending

the service. There were a total 2269 responses which has decreased significantly due to the Christmas period.

Of the 1570 positive comments for outpatients one at Gastro outpatients at St Albans said ‘friendly receptionist and clinic

receptionist great atmosphere fantastic service for elderly patients’

Themes continue to be regarding length of time waiting to be seen and some communication issues with cancelled

appointments.

Maternity

The response rate has decreased to 29.7%. There were 98 positive comments with only 2 negative.

One of the positive comments was ‘such a scary and vulnerable time and every member of staff even the housekeeper

were so respectful and kind.’

Next steps:

Following a presentation from NHSEI on the changes due in April 2020, a paper will be presented to PAC & TMC with

recommendations for alternative feedback mechanisms for capturing patient experience.

42


Daycase FFT: responses and % positive Outpatient FFT: responses and % positive Maternity FFT: responses and % positive

0%

20%

40%

60%

80%

100%

120%

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

2017/18 2018/19 2019/20

Daycase FFT % positive Performance Daycases FFT response rate Performance

Daycases FFT response rate Trajectory Daycases FFT response rate Target


88%

89%

90%

91%

92%

93%

94%

95%

96%

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

2017/18 2018/19 2019/20

Outpatient FFT % positive Performance Outpatient FFT response rate Performance


Caring & Responsive Services: Caring Chief Nurse Quality Committee 2a / 2c / 3a / 4c / 11a / 12c

0%

20%

40%

60%

80%

100%

120%

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

2017/18 2018/19 2019/20

Maternity FFT % positive PerformanceMaternity FFT response rate PerformanceMaternity FFT response rate Target


11

Tab 11 Integrated P

erformance R

eport

45 of 236T

rust Board M



Number of written complaints

received per 1000 staff (wte)

Period: Q2 2019/20

WHHT 19.18 Peer 29.99

National 23.66


multi-site trusts)


Caring & Responsive Services: Complaints


The Trust’s monthly target of 80% was achieved. 16 new complaints were received in December 2019.

• 12.5% (2) relate to Surgery, Anaesthetics and Cancer (SAC)

• 50% (8) Medicine

• 12.5% (2) Emergency Medicine/USC

• 25% (4) Women’s & Children’s (WACs)

At month end there were a total of 55 live complaints. 26 complaints were closed in the month. 3 complaints were

reopened during December.

Improvement plan: During December SAC performance improved with 28 open complaints (down from 38 previous

month) which was aided by a lower level of complaints being received. The complaints team continue to work with SAC to

address the backlog and improve performance (January having seen a further decrease in open complaints). Weekly

meetings are held with the SAC Divisional Manager and senior staff to review all complaints and progress going forward to

improve the response rate.

Factors/Themes: Trust wide, most common themes remain all aspects of clinical care (including clinical care and

treatment) 69% (11); attitude of staff and communication at 13% (2), 18% (3) around admission and delays in appointments.

No specific themes or trends have been identified although communication remains a consistent factor in complaints

received.

43

% Complaints responded to within one month/ agreed time Reactivated complaints

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Apr

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Ap

r

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Ap

r

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

2017/18 2018/19 2019/20

Complaints timely response Target Mean

Upper control limit (3 sd) Lower control limit (3 sd) Trajectory

-4

-2

0

2

4

6

8

10

12

14

Apr

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Ap

r

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Ap

r

May Jun Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

2017/18 2018/19 2019/20

Reactivated complaints Threshold Mean


Performance improved Better than target/threshold


Caring & Responsive Services: Caring Chief Nurse Quality Committee 1b / 2a / 2c / 3a / 4a / 4b / 4c / 10e / 10f / 11a / 12c

11

Tab 11 Integrated P

erformance R

eport

46 of 236T

rust Board M



Caring & Responsive Services: End of life care


The NHS End of Life Care Strategy (2008) emphasised that improved end of life care provision in acute hospitals was

crucial; this is where more than half of all deaths take place.

Referrals to Specialist Palliative Care

The strategy identified that people weren’t supported to die in their place of choice; and although progress has been made,

this has been evidenced in many other reports. There continues to be a national focus on reducing the numbers of patients

dying in hospital and offering everyone who is approaching the end of their life the opportunity to express and share their

preference for where they want to die as well as any goals that are important to them (National Palliative and End of Life

Care Partnership, 2015).

In December, 85 referrals were made to the Trust Specialist Palliative Care Team. Of the patients with capacity to make

decisions about PPD, 100% had an identified PPD.

Patients who died at WGH where their identified preferred place of death (PPD) was not achieved

Two patients died in a setting that was not their preferred place of death. In both cases the reason was due to the patients’

physical symptoms not permitting their transfer.

Patients on an Individualised Plan of Care for the Dying Person (IPCD)

Of the 10 patients whose death was reviewed in December, six patients did not have an IPCD and it was deemed that for

two it would not have been appropriate. Learning from the audit will be fed back to ward areas to support the identification of

patients appropriate for an IPCD.

Treatment Escalation Plans (TEP)

TEPs ensure that every patient’s care is reviewed, individualised and their levels of care are considered in line with Trust

guidelines. In December 2019, of the 10 deceased patients reviewed, 7 had a TEP in place. In 5 the TEP had been

reviewed as needed and was appropriate. There were 3 patients without a TEP.

44

Benchmarking:

Not currently available

Stable

Referrals to Trust Specialist Palliative Care Team Patients on Individualised Plan of Care for the Dying Person Patients with a Treatment Escalation Plan

0

20

40

60

80

100

120

140

Jan-17 Mar-17May-17 Jul-17 Sep-17 Nov-17 Jan-18 Mar-18May-18 Jul-18 Sep-18 Nov-18 Jan-19 Mar-19May-19 Jul-19 Sep-19 Nov-19

Nu

mb

er

of r

efe

rral

s p

er

qu

arte

r

Jan-17

Feb-17

Mar-17

Apr-17

May-

17

Jun-17

Jul-17

Aug-17

Sep-17

Oct-17

Nov-17

Dec-17

Jan-18

Feb-18

Mar-18

Apr-18

May-

18

Jun-18

Jul-18

Aug-18

Sep-18

Oct-18

Nov-18

Dec-18

Jan-19

Feb-19

Mar-19

Apr-19

May-

19

Jun-19

Jul-19

Aug-19

Sep-19

Oct-19

Nov-19

Dec-19

Total referrals 98 111 120 103 96 108 84 72 90 120 112 93 94 94 68 78 79 74 69 82 70 89 89 83 102 83 76 81 89 68 95 86 85 98 101 85

Upper control limit 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110 110

Lower control limit 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68 68

Referrals to Trust Specialist Palliative Care Team

0

2

4

6

8

10

12

Patients on Individualised Plan of Care for the Dying Person

Number of patients on IPCD

Number where IPCD would have been appropriate

Number of patient deaths

Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 0ct-19 Nov-19 Dec-19

Notes reviewed 11 10 6 5 9 7 4 11 9 10

Patients with a TEP 11 9 5 5 8 6 4 9 7 7

Patients without a TEP 0 1 1 0 1 1 0 2 2 3

TEP reviewed appropriately 7 8 3 2 5 4 1 9 3 5

0

2

4

6

8

10

12Patients with a Treatment Escalation Plan


Caring & Responsive Services: Caring Chief Nurse Quality Committee 2a / 2b / 2c / 3a / 4c / 11a

11

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erformance R

eport

47 of 236T

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RTT – 18 weeks incomplete wait


WHHT: 86.86% Peer: 81.88%

National: 84.2%


multi-site trusts)


Caring & Responsive Services: RTT Open pathways


At 87.4% performance against the 92% open pathway standard is unchanged from the previous month. The position is

favourable when compared with the most recent national data available (November 2019) which shows that WHHT

performance that month was better than the national average (84.4%).

The median waiting time at WHHT (ie the weeks half the patients on an RTT pathway were waiting) was better than the

national position (6.8 vs 7.7 weeks) and the 92nd percentile wait time (22.5 vs 23.9 weeks). The overall PTL size remains

lower than the March 2019 position and is on track to meet national expectations. The 18 week plus backlog continues to

decrease.

At the end of the month there were no patients whose waiting time exceeded 52 weeks.

Next steps:

Good progress is being made against, although actual performance is lower than the improvement plan target. However,

waiting list initiatives, outsourcing and focused validation continue as the primary actions driving change.

45

RTT - % within 18 weeks Number of 52 week waits

Performance improved Worse than target/threshold

74%

76%

78%

80%

82%

84%

86%

88%

90%

92%

94%

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

2017/18 2018/19 2019/20

Performance Mean Upper control limit (3 sd)

Lower control limit (3 sd) Target Series3

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

2017/18 2018/19 2019/20

52+ actual 0 0 0 0 0 0 0 1 0 20 41 52 63 70 114 124 123 111 87 83 51 35 23 4 2 3 4 4 1 3 0 0 0

52+ week trajectory 101 76 59 35 11 0 0 0 0 0 0 0 0 0 0

0

20

40

60

80

100

120

140

Nu

mb

er

of

pat

ien

ts


Caring & Responsive Services: Responsive Chief Operating Officer Finance & Performance Committee 2c / 4b / 4c / 12c

11

Tab 11 Integrated P

erformance R

eport

48 of 236T

rust Board M



Caring & Responsive Services – Cancer: Two week wait

In this reporting period: The provisional position for December is compliant at 96.9% with 1405 referrals of which 43 were seen beyond 14 days. The referral numbers are slightly below average. (Average since April 2019 is 1594 referrals/month) The areas with the highest number of breaches were: • LGI with 18 - this is a month on month improvement • Breast with 8 • Gynae with 6 • Skin with 5 - this is a month on month improvement The LGI improvement is expected to continue as colonoscopy scheduling changes are happening in January 2020 to increase flexibility. Breast symptomatic The provisional position for December is compliant at 98.4%. There were 128 referrals and 2 patients were seen beyond 14 days. Next steps: Monitor the affect of the change in scheduling for the colonoscopies

46

Benchmarking: NHSI ANALYTICS HUB

Cancer Waiting time dashboard


WHHT: 96.2% Peer: 88.8%

National: 91.3%

(Peers = East of England region

Two week waits: % within target time Breast symptomatic patients: % within target time

86%

88%

90%

92%

94%

96%

98%

100%

Ap

r

Ma

y

Jun

Jul

Au

g

Sep

Oct

Nov

Dec Ja

n

Feb

Mar

Ap

r

Ma

y

Jun

Jul

Au

g

Sep

Oct

Nov

Dec Ja

n

Feb

Mar

Apr

Ma

y

Jun

Jul

Aug Sep

Oct

Nov

Dec Ja

n

Feb

Mar

2017/18 2018/19 2019/20

Two week wait performance Two week wait target

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Apr

May Jun

Jul

Aug Sep

Oct

No

v

De

c

Jan

Feb

Mar

Apr

Ma

y

Jun

Jul

Aug Sep Oct

Nov

De

c

Jan

Feb

Mar

Apr

Ma

y

Jun

Jul

Aug Sep Oct

Nov

De

c

Jan

Feb

Mar

2017/18 2018/19 2019/20

Breast Symptomatic performance Breast Symptomatic target



Caring & Responsive Services: Responsive Chief Operating Officer Quality Committee 2c / 4b / 4c / 12c

11

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eport

49 of 236T

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Caring & Responsive Services: Cancer 31 day

In this reporting period: 31 day first The position for December is provisionally compliant at 98.8% with 167 pathways with 2 breaches. There were 1 x breast and 1 x urology breach. 31 day subsequent Surgery The provisional position for December is provisionally compliant at 100%, with 9 pathways 31 day subsequent Drug, The position for December is provisionally compliant with 100% . There were 16 pathways all in target 31 day subsequent palliative The provisional position for December is compliant at 100 % Next steps: Escalation processes continue to be an area of focus, particularly within urology. Actions within POA to ensure that the process is timely, including anaesthetic review.

47

Benchmarking: NHSI Analytics Hub


31 day first:

WHHT: 98.0% Region: 96.6%

National: 95.9%

31 day surgery:

WHHT: 100% Region: 88.9%

National: 91.7%

31 day first: % within target time 31 day subsequent drug: % within target time 31 day subsequent surgery: % within target time

91%

92%

93%

94%

95%

96%

97%

98%

99%

100%

Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb

2017/18 2018/19 2019/20

Cancer - 31 day Performance Cancer - 31 day Target

70%

75%

80%

85%

90%

95%

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

Ap

r

Ma

y

Jun

Jul

Au

g

Sep Oct

No

v

De

c

Jan

Feb

Ma

r

2017/18 2018/19 2019/20

Cancer - 31 day subsequent drug Performance Cancer - 31 day subsequent drug Target

0%

20%

40%

60%

80%

100%

120%

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

2017/18 2018/19 2019/20

Cancer - 31 day subsequent surgery Performance Cancer - 31 day subsequent surgery Target


Caring & Responsive Services : Responsive Chief Operating Officer Quality Committee 2c / 4b / 4c / 12c


11

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eport

50 of 236T

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62 day wait from urgent GP referral


WHHT: 77.55% Peer: 74.69%

National: 78.54%

Peers = Nightingale Group – acute multi-

site trusts

Benchmarking: NHS Analytics Hub


WHHT: 78.3% Peer: 75%

National: 77.4%

Peers = East of England Region


Caring & Responsive Services: Cancer 62 day urgent GP referral


62 day GP – urgent

The provisional position for December is non- compliant at 83.2% although this is an improvement on the previous month.

Provisionally there are 92 treatments with 15.5 breaches (21 patients).

12 x urology 2 x H&N 2 x gynae 1 x derm 1 x breast 3 x lung

Breaches

A review of the breaches indicate an increase in administrative errors, these include clinicians not ordering tests,

escalations which are ineffective, booking tests as routine patients rather than 2ww, booking outside target despite

escalations. The usual issues of not having sufficient capacity quickly is still a problem when patients cancel at short notice

and re-booking quickly is very difficult.

104 day breaches

Open pathways: In December’s submission there were 11 patients on an open pathway longer than 104 days. A

review of the breaches indicated some complex pathways requiring discussion at >1 MDT, waiting for clinical review after

investigations, particularly those appearing benign, some late referrals (x2), some patient choice with holiday and wanting

specific hospital sites and time of day.

Closed – Provisionally the Trust has closed 4 pathways over 104 days (including consultant upgrades and screening) :

3 x urology, 1 x lung.

Next Steps:

Continue working with services to implement the Cancer Improvement Plan and monitor progress in each area.

48

62 day GP: % within target time 62 day GP: Tumour Site 62 day screening: % within target time

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

No

v

De

c

Jan

Fe

b

Ma

r

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

No

v

De

c

Jan

Fe

b

Ma

r

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

No

v

De

c

Jan

Fe

b

Ma

r

2017/18 2018/19 2019/20

Cancer - 62 day Performance Cancer - 62 day Trajectory Cancer - 62 day Target

0%

20%

40%

60%

80%

100%

120%

Apr

May Jun

Jul

Aug Sep

Oct

Nov

Dec Ja

n

Feb

Mar

Apr

Ma

y

Jun

Jul

Aug Sep

Oct

Nov

Dec Ja

n

Feb

Mar

Apr

Ma

y

Jun

Jul

Aug Sep

Oct

Nov

Dec Ja

n

Feb

Mar

2017/18 2018/19 2019/20

Cancer - 62 day screening Performance Cancer - 62 day screening Target



Caring & Responsive Services: Caring Chief Operating Officer Finance & Performance Committee 2c / 4b / 4c / 12c

Tumour type October November December Q3 (provisional)

Breast 95.7 93.8 91.3 94.1

Gynaecological 100 100 100 100

Haematological 33.3 50 100 64.3

Head and Neck 100 50 100 85.7

Lower Gastrointestinal 60.9 100 100 81.6

Lung 25 0 25 21.4

Skin 100 100 100 100

Upper Gastrointestinal 60 100 100 78.9

Urological 61 54.1 60 58.6

Testicular 100 0 100 75

Acute leukaemia 100 0 0 100

Other 0 100 0 66.7

Total 80.4 79.2 83.2 81.0

11

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Caring & Responsive Services: Outpatients


Short notice, hospital initiated cancellation rates remain within tolerance levels (target 5%) this month (excluding valid

cancellations and patient initiated cancellations).

It should be noted that the total cancellation rate does not equate to unfilled capacity as vacated appointment slots are often

re-filled.

The DNA rate has also increased slightly at 9.2% and specialties with high DNA rates continue to include ENT, Oral

Surgery, Gastroenterology, Thoracic (Respiratory) Medicine, Cardiology and Neurology.

Next steps:

The Elective Care Programme Board will task the Outpatient Users Group, overseen by the Outpatient Transformation

Board works with services to give assurance that there are appropriate actions in place to address these and other issues

relating to outpatients.

49


Did not attend rate

Period: Q2 2019/20

WHHT 7.63% Peer: 6.72%

National: 7.14%


multi-site trusts

All cancellations Under 6 weeks All cancellations Under 6 weeks

12.3% 4.3% 10.2% 9.6%

Total cancellations: 25.2%

Hospital initiated Patient initiated


Outpatient cancellation rate DNA rate

0%

2%

4%

6%

8%

10%

12%

14%

16%


2017/18 2018/19 2019/20

Outpatient cancellation rate Actual

Outpatient cancellation rateTarget

Mean

Upper control limit (3 sd)

Lower control limit (3 sd)

Outpatient cancellation rate within 6 weeks

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

11.0%

12.0%


2017/18 2018/19 2019/20

DNA rate Actual Mean



Caring & Responsive Services: Responsive Chief Operating Officer Finance & Performance Committee 3a / 4b / 4c / 10e / 10g / 11a

11

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Model Hospital benchmarking:

Proportion of staff leaving each

month


WHHT: 1.54% Peer: 0.83%

National: 0.98%

Peers = Nightingale Group – acute multi-

site trusts)


Workforce & Finance: Recruitment & Retention

50


Staff in Post and Vacancies

The number of staff in post increased to 4,550wte, an increase of 112wte over the last 12 months. This includes the TUPE transfer of staff

for Simpson Ward. The funded establishment has increased by 67wte over the same period. The Trust’s workforce establishment is now

5066wte (excl external staff working on rotation).

The number of vacancies is currently 516wte (10.2%) (568wte in Dec 2018). For Band 5 nurses the vacancy rate is currently 4.6%, a small

increase from 2.5% last month, but a significant change when compared with 123wte or 17.2% in March 2018 and 32% in 2015. The

figure includes approx. 22 overseas transitional nurses who are currently working towards their NMC registration. There are plans to

recruit both in the UK and abroad to reduce these vacancies to maintain the vacancy rate at under 5%. Current projections show that

recruitment plans will meet this aim.

Sickness Rate :

Sickness absence is currently 3.8%, above the 3.5% target. The Trust is ranked 6 / 16 in terms of the lowest sickness scores as at Q2 for

local NHS benchmarking organisations.

Labour Turnover and Number of staff leaving within first year

Turnover based on a rolling 12 months is currently 14.3%, a decrease from last month and from 12 months ago when it was 15.4%. The 3

monthly turnover rate is 14% and this helps identify more immediate changes in trends. 17% of staff leave their post before serving 1

year. However, this is better than 22.6% a year ago. Nursing Band 5 turnover has increased slightly to 17.0% or just under for the last 3

months.

Next steps:

Adverts have been increased and interviews are held bi-weekly. Regular review of overseas nurse pipeline and with a plan to increase to

approx. 10 per month to March 2021. The first cohort of internal OET students are due to take their exam in March / April. Early mock

results show that around half are on their way to pass, on the lead up to their exam focus will be given to the areas where they need most

support. A CPD funding bid has been submitted to fund a further 10 HCA’s to undertake their OET this year (subject to approval).

Accommodation is being addressed, the Trust is looking at a contract to manage a new build of 30 apartments within 10 mins walk from

WGH (pending business case and approval).

Performance stable Worse than target/threshold

Staff turnover and vacancy performance Sickness absence performance Number of staff leaving within first year

To be updated 0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Apr

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Ma

r

Apr

May Jun

Jul

Au

g

Sep Oct

No

v

Dec Ja

n

Feb

Mar

Apr

May Jun

Jul

Au

g

Sep Oct

No

v

De

c

Jan

Feb

Ma

r

2017/18 2018/19 2019/20

Staff turnover Performance Staff turnover Trajectory Staff turnover target

Vacancy rate Performance Vacancy rate Trajectory Vacancy rate Target

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%

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

2017/18 2018/19 2019/20

Sickness rate performance Sickness rate target Sickness rate Trajectory

Mean Upper control limit (3 sd) Lower control limit (3 sd)

0%

5%

10%

15%

20%

25%

0

50

100

150

200

250

Apr

May Jun

Jul

Aug Sep

Oct

Nov

De

c

Jan

Feb

Mar

Apr

Ma

y

Jun

Jul

Aug Sep Oct

Nov

De

c

Jan

Feb

Mar

Apr

Ma

y

Jun

Jul

Aug Sep Oct

Nov

De

c

Jan

Feb

Mar

2017/18 2018/19 2019/20

Number of staff % of new staff


Workforce & Finance: Well Led Chief People Officer People, Education & Research Committee 3a / 6a / 6b / 7a / 7b / 12c

11

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Workforce & Finance – Developing Staff

51


Appraisals

• Current compliance is at 91.9% (target 90%) for December. This figure includes medical staff. It should be noted that

the Trust’s appraisal rate was compliant for most of November, but fell marginally below target when measured at the

end of the month. Performance improved to a compliant position again in the first week of December.

Mandatory training

• The all Trust mandatory training rate remains above target at 93.9%, an increase compared to last month. Compliance

in the low 90’s has now been consistently maintained since November of 2018.

• Essential training compliance is now also at 90% or above since October 2019. It is currently at 91.1%, the same as the

last three months.

Benchmarking: Model Hospital

Trust staff with appraisal completed

by the required date

Period: 2017/18

WHHT: 76% Peer: 83%

National: 93%


Benchmarking: Model Hospital

Statutory & Mandatory training

compliance rate

Period: 2017/18

WHHT 86% Region 87%

National 89% Peers = Nightingale Group – acute multi-

site trusts)

Appraisal performance Essential training and mandatory training performance

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

No

v

De

c

Jan

Fe

b

Ma

r

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

No

v

De

c

Jan

Fe

b

Ma

r

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

No

v

De

c

Jan

Fe

b

Ma

r

2017/18 2018/19 2019/20

Appraisal rate Performance Appraisal rate Target Appraisal rate Trajectory

Mean Upper control limit (3 sd) Lower control limit (3 sd)

60%

65%

70%

75%

80%

85%

90%

95%

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

Ap

r

Ma

y

Jun

Jul

Au

g

Sep Oct

No

v

De

c

Jan

Feb

Ma

r

2017/18 2018/19 2019/20

Essential training Mandatory Training Performance Mandatory Training Target


Workforce & Finance: Well Led Chief People Officer People, Education & Research Committee 3a / 5c / 6a / 6b / 8b / 8c


11

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Workforce & Finance: Workforce BAF scorecard


52

The Board Assurance Framework shows key workforce indicators in the context of current performance, performance 12 and 3 months ago, Trust workforce targets, the distance to these targets and a RAG rating based on 5 scales. It also has benchmarking data taken from NHS healthcare providers in the Hertfordshire and West Essex and Bedford, Luton and Milton Keynes STPs. The RAG rating is based on distance to targets – if current performance is within 0% to 20% (or exceeds) its target then the RAG rating is green. If performance is within 60% – 80% of target then the rating is yellow. This is repeated at 20% intervals for amber and brown until performance is over 80% from the target when the RAG rating is red. If 2 indicators are rated red, then the overall rating is red. If all indicators are rated green, or one is amber then the overall rating is green. Any other combination is amber. The BAF performance indicators reflect core areas of the workforce that we are monitoring. These include B5 nurse vacancies and turnover, reflecting the focus on recruitment and retention of these staff in conjunction with NHSI. These areas are identified as the Trust’s highest workforce risk factors.. The turnover of our band 5 nurses is currently at 16.9% vs 13.4% overall for all registered midwives/nurses. This represents a small increase from when we have hit our target of under 16% two months ago, and this is a reduction from nearly 30% turnover in May 17 to approx. 15%, an overall reduction of almost a half). For Band 5 nurse vacancy rates, these are currently 4.6%, a small increase from 2.5% last month, and 0% over the previous few months. This in turn though is a significant decrease from 123wte or 17.2% in March 2018 and 32% in 2015. NB – the Band 5 Nurse vacancy wte figure includes approx. 22 overseas transitional nurses who are currently working towards their NMC registration. There are plans to recruit both in the UK and abroad to reduce these vacancies over 19/20 to maintain the vacancy rate at under 5%. Current projections and action being taken show that recruitment plans will meet this aim. When measured at month end, combined appraisals rates are compliant against the 90% target (91.9% overall). The overall rate for medical staff (97%) includes all medics apart from training posts. Mandatory training compliance is 94%, and is now consistently above the 90% target. It should be noted that results are now taken from the Acorn system to ensure improved reporting accuracy. The November monthly Trust sickness rate is 3.8% against a 3.5% target, and so is above target. The 12 month sickness figure is 3.38%, below the target. It is anticipated that sickness will rise over Winter months. The current agency pay bill percentage is 4.9%. The overall target rate for 2019/20 is 5%, reflecting the reduced agency cost target envelope. The 12 month turnover rate is 14.3%, amongst the lowest rates we have recorded. The Trust is ranked 7 / 13 nearby NHS organisations. The Trust has received data in relation to the 2019 staff survey however the detail of this is embargoed until 18th February 2020. We can confirm that we continue to compare favourably with our NHS comparator organisations. In 58% of questions we have improved or remained the same as compared to last year. In 42% we have unfortunately performed worse than we did last year (but only typically by only 1%). In 68% of questions we have continued to do better than our comparators. 11

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Data sources

53

Theme Source Executive lead Lead Board IPR Quality IPRPatient

Experience IPRDivisional IPRs

SHMI (Rolling 12 months) Dr Foster MD 1 1 -1 1

HSMR - Total (Rolling three months) Dr Foster MD 1 1 -1 1

Clostridioides Difficile - Hospital associated (Cat 1) WHHT CN 1 1 -1 1

Clostridioides Difficile - Healthcare associated (Cat 2) WHHT CN 1 1 -1 1

Clostridioides Difficile - Hospital and Healthcare associated Total WHHT CN 1 1 -1 1

Hand Hygiene Compliance CN 1 1 -1 1

30 Day Emergency Readmissions - Elective * Dr Foster MD 1 -1 -1 1

30 Day Emergency Readmissions - Emerg * Dr Foster MD 1 -1 -1 1

Caesarean Section rate - Combined* WHHT MD 1 1 -1 1

Caesarean Section rate - Emergency* WHHT MD 1 1 -1 1

Caesarean Section rate - Elective* WHHT MD 1 1 -1 1

% nursing hours (shift fill rate) WHHT CN 1 1 -1 1

Serious incidents - number* WHHT MD 1 1 -1 1

Serious incidents - % that are harmful* WHHT MD 1 1 -1 1

% of patients safety incidents which are harmful* WHHT MD 1 1 -1 1

Never events WHHT MD 1 1 -1 1

Safety Thermometer Harm Free Care (acquired within and outside of Trust) WHHT CN 1 1 -1 1

Safety Thermometer % New Harm Free Care (acquired within Trust) WHHT CN 1 1 -1 1

Category 4 pressure ulcers - New (Hospital acquired) WHHT CN 1 1 -1 1

Category 3 pressure ulcers - New (Hospital acquired) WHHT CN 1 1 -1 1

VTE risk assessment* WHHT MD 1 1 -1 1

Patients admitted to stroke unit within 4 hours of hospital arrival SSNAP MD 1 1 -1 1

Stroke patients spending 90% of their time on stroke unit SSNAP MD 1 1 -1 1

Domain

Safe care

&

Improvin

g

Outcome

s

Safe

Quality of Care: Mortality Indicators

Quality of Care: Infection Control

Quality of Care: Emergency Readmissions

Quality of Care: Caesarean Section rates

Patient Safety

11

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Data sources

54



Ambulance turnaround time between 30 and 60 mins East of England Ambulance Service COO 1 -1 -1 1

Ambulance turnaround time > 60 mins East of England Ambulance Service COO 1 -1 -1 1

% Patients admitted through A&E - 0 day LOS WHHT COO 1 -1 -1 1

Discharges between 8am and 12pm (main adult wards excl AAU) WHHT COO 1 -1 -1 1

Mixed sex accommodation breaches WHHT COO 1 -1 -1 1

LOS > 21 days WHHT COO 1 -1 -1 1

Delayed Tranfers of Care (DToC) beddays used in month Integrated Discharge Team COO 1 -1 -1 1

Delayed Tranfers of Care (DToC) beds used in month Integrated Discharge Team COO 1 -1 -1 1

A&E FFT % positive Meridian CPO 1 1 1 1

Inpatient Scores FFT % positive Meridian CPO 1 1 1 1

Daycase FFT % positive Meridian CPO 1 1 1 1

Maternity FFT % positive Meridian CPO 1 1 1 1

Complaints responded to within target/agreed timescale WHHT CN 1 1 1 1

Reactivated complaints WHHT CN 1 1 1 1

New indicators to be included in Q3 WHHT CN 1 1 1 1

New indicators to be included in Q3 WHHT CN 1 1 1 1

ED 4hr waits (Type 1, 2 & 3) WHHT COO 1 -1 -1 1

Referral to Treatment - Incomplete* WHHT COO 1 -1 -1 1

Referral to Treatment - 52 week waits - Incompletes WHHT COO 1 -1 -1 1

Diagnostic (DM01) <6 weeks WHHT COO 1 -1 -1 1

Cancer - Two week wait * WHHT COO 1 -1 -1 1

Cancer - Breast Symptomatic two week wait * WHHT COO 1 -1 -1 1

Cancer - 31 day * WHHT COO 1 -1 -1 1

Cancer - 31 day subsequent drug * WHHT COO 1 -1 -1 1

Cancer - 31 day subsequent surgery * WHHT COO 1 -1 -1 1

Cancer - 31 day subsequent radiology * WHHT COO 1 -1 -1 1

Cancer - 62 day * WHHT COO 1 -1 -1 1

Cancer - 62 day screening * WHHT COO 1 -1 -1 1

Outpatient cancellation rate within 6 weeks^ WHHT COO 1 -1 -1 1

DNA rate WHHT COO 1 -1 -1 1

Patient Experience: End of life care

Access to Services

Cancer

Access to Services: Outpatients

Patient Flow: Emergency Department

Patient Flow: In hospital flow

Domain

Caring &

Responsi

ve

Services

Effective

Caring

Responsi

ve

Patient Experience: Friends & Family Test

Patient Experience: Complaints

11

Tab 11 Integrated P

erformance R

eport

57 of 236T

rust Board M


Data sources

55



Staff turnover rate (rolling 12 months) WHHT CPO 1 -1 -1 1

% staff leaving within first year (excluding medics and fixed term contracts) WHHT CPO 1 -1 -1 1

Vacancy rate WHHT CPO 1 -1 -1 1

Sickness rate WHHT CPO 1 -1 -1 1

Appraisal rate (Total) WHHT CPO 1 -1 -1 1

Mandatory Training WHHT CPO 1 -1 -1 1

Essential Training WHHT CPO 1 -1 -1 1

Financial Risk Rating WHHT CFO 1 -1 -1 1

Income & Expenditure Actual WHHT CFO 1 -1 -1 1

Income & Expenditure forecast WHHT CFO 1 -1 -1 1

Cash balance at the end of the month WHHT CFO 1 -1 -1 1

Capital expenditure WHHT CFO 1 -1 -1 1

CIP delivery against plan WHHT CFO 1 -1 -1 1

% Bank Pay** WHHT CFO 1 -1 -1 1

% Agency Pay** WHHT CFO 1 -1 -1 1

GP referrals WHHT CFO 1 -1 -1 1

A&E attendances WHHT CFO 1 -1 -1 1

Elective spells (overnight) WHHT CFO 1 -1 -1 1

Elective daycase WHHT CFO 1 -1 -1 1

Total elective spells WHHT CFO 1 -1 -1 1

Non-elective spells WHHT CFO 1 -1 -1 1

Births WHHT CFO 1 -1 -1 1

Outpatient attendances WHHT CFO 1 -1 -1 1

Workforc

e and

finance

Well led

Domain

Recruitment & Retention

Developing Staff

Finance overview

Activity (chargeable)

11

Tab 11 Integrated P

erformance R

eport

58 of 236T

rust Board M


1

Trust Board Meeting06 February 2020

Title of the paper Five Year Trust Strategy

Agenda Item 12/79

Presenter Helen Brown, Deputy Chief Executive

Author(s) Helen Brown, Deputy Chief Executive

Purpose Please tick the appropriate box For approval For discussion For information

¸

Executive Summary

This Trust Strategy sets out our priorities for the next five years and has been developed with input from a wide range of staff, stakeholders and patients, following an extensive engagement schedule, reaching both internal and external stakeholders.

The Trust has engaged extensively in the development of the strategy. A paper summarising who has been involved in the engagement programme, the key feedback received and how this has been reflected in the strategy is attached for information. Overall engagement was very positive. The 4 key aims were widely supported. The engagement process has influenced the development of the strategy in a wide range of ways – including ensuring the strategy uses accessible language that reflects the values of our staff, the emphasis given to key aspects of the strategy (e.g. the importance of involving patients in their care, improving communication, improving health and joining-up care, and the urgency and importance of improving our estate and digital infrastructure).

Some stakeholders would like to see more detail on how the ambitions set out in the strategy will be delivered.

Further detail on actions to deliver the strategy are / will be included within a range of supporting strategies as set out in the strategy document. Annual delivery programmes will be developed as set out in the final section of the strategy and progress will be monitored via Board committees. Progress updates will be reported via the relevant Board sub-committees with updates on progress across the whole programme provided to the Board via regular reporting cycle.

Final drafts of the 5 year strategy – full and summary versions are attached for Board approval.

Key changes since the draft presented to the February Board include:

∑ Finalised high level measures of success for each aim

12

Tab 12 Five year strategy


2

∑ Current baseline performance against each measure of success is included within annexe one to the strategy.

∑ Placeholders for ‘pop out’ case studies have been included within the draft – these are being finalised.

A fully designed version with photographs and completed case studies will be made available to the Board in advance on the meeting.

A supporting ‘case studies’ brochure has been developed to provide greater depth and an opportunity for the Trust to showcase how we have been developing services in line with our strategy over recent years.

The following documents are attached for Board review and approval:

∑ 5 year Trust Strategy – summary version∑ 5 year Trust Strategy – full version∑ Engagement summary report




Objectives 1-5

Aim 2Great place to

workObjectives 6-8

Aim 3Improve our

finances

Objective 9


future

Objective 10-12¸


☐Is there the leadership capacity and capability to deliver high quality, sustainable care?☒Is there a clear vision and credible strategy to deliver high quality, sustainable care to people, and robust plans to deliver?☐Is there a culture of high quality, sustainable care?☐Are there clear responsibilities, roles and systems of accountability to support good governance and management?☐Are there clear and effective processes for managing risks, issues and performance?☐Is appropriate and accurate information being effectively processed, challenged and acted on?☒Are the people who use services, the public, staff and external partners engaged and involved to support high quality sustainable services?☐Are there robust systems and processes for learning, continuous improvement and innovation?☐How well is the trust using its resources?


In addition to the engagement programme highlighted above, the strategy hasbeen reviewed by the trust management committee, CAG and at the January Trust Board.

Action required The Board is asked to receive the final draft of the five year Trust strategy for approval.

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5 year strategy – summary version 30/12/19 v. 0.1

Five Year Strategy2020-2025

Summary Version

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Introduction

Our vision is to provide ‘the very best care for every patient, every day’. Over recent years #teamwestHerts has made tremendous progress in improving services for our patients; we have moved out of ‘special measures’ and have won a range of national awards, reduced our vacancies and have seen our staff morale continue to rise.

This strategy sets out our priorities for the next five years and has been developed with input from a wide range of staff, stakeholders and patients. Its delivery will require similar collaboration; we are absolutely committed to working in partnership to create a local health and care system that is fit for the future and will deliver the very best care for every patient, every day.

Christine Phil

Phil TownsendChairman

Christine AllenChief executive

12




About us

We provide services to approximately 500,000 people living in Hertfordshire and north London.

We run services from our hospitals at Watford, St Albans and Hemel Hempstead. We also provide services from a range of community settings across west Hertfordshire.

• Watford General Hospital (WGH) provides emergency care, with accident and emergency, inpatient services, an acute admissions unit, women’s and children’s services and a range of outpatient and diagnostic services.

∑ St Albans City Hospital (SACH) is a dedicated centre for planned surgery. It has a minor injury unit, two surgical wards, an outpatients department and cancer and diagnostic services.

∑ Hemel Hempstead Hospital (HHH) provides urgent care, endoscopy, diagnostics, outpatient clinics and an inpatient ward.

National and Local Context

The NHS Long Term Plan published in 2019 and the NHS Five Year Forward View (2014) set the direction for health and care services over the next 10 years. The Hertfordshire and West Essex (HWE) Health and Care Strategy (2019) and ‘Your Care, Your Future’ (2014) set out our health system’s local strategies and plans for implementing the national vision.

West Hertfordshire Integrated Care Partnership

One of the key elements of both national and local plans is the development of ‘Integrated Care Partnerships’ which bring health and care organisations together to collectively meet the needs of local people. Work is underway to develop the vision, aims, principles and priorities for a West Hertfordshire Integrated Care Partnership. The Trust is playing a key leadership role in this work. 12




Our Four Key Aims

We have developed four key aims to support delivery of our vision ~ ‘the very best care for every patient, every day’:

BEST CAREensure our patients and their carer’s have a

great experience of care

BEST VALUEdeliver efficient care to make the best use of

every NHS £

GREAT TEAMgreat people & a great place to work and

learn

GREAT PLACEmodern, fit for purpose estate and digital

technology

This strategy summarises our key aims and priorities for the next five years. Working in partnership to deliver the new integrated care model is a key strand, reflected within each of the aims.

Best Care: our priorities

Promote a quality improvement culture which supports all staff to reduce harm, learn from mistakes and improve care. Use data to improve care.

Ensure consistent high quality across everything we do – reduce variation through implementing 7 day working and rolling out clinical practice group (CPG) programme (in partnership with the Royal Free London), implementing 40 best practice standardised care pathways for common conditions over the next 5 years.

Improve access and reduce waiting times.

Provide patients and carers with choice, valuing them as active partners in decisions about their health and wellbeing.

Work with partners to improve the health of our population (not just manage ill health) and to redesign care to make it more responsive, person centred and more joined up. Enhance quality of life for people with complex needs or long term conditions – plan ahead more and support people to manage their own health conditions.

Improve outpatient care – ‘make every contact count’. Reduce the need to travel to hospitals to receive care that could be delivered closer to home or via digital technology.

Identify opportunities to develop our more specialist services, reducing the need for local people to travel out of area for care. Work with neighbouring hospitals to ensure local people with more specialist needs can access the best care and treatment available.

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Involve local people and patients in our quality improvement and redesign work.

How will we measure success?

We want to be one of the best hospital trusts in England for:

• Mortality: HSMR and SHMI are the key national indicators for mortality.

• Harm free care: new pressure ulcers, falls with harm, new venous thromboembolism, urinary tract infections (in patients with a catheter) and e-coli bacteraemia

• Access to care (national waiting time standards): emergency department 4 hour waits, 18 week referral to treatment and diagnostic waiting times, cancer two week wait, cancer 62 day treatment and the new faster diagnosis standard (maximum 28 days to communication of definitive cancer / not cancer diagnosis).

We want to significantly improve our patients’ experience of care

• Patient Experience: Friends and Family Test scores and national patient survey results

(Our full strategy document sets out further detail on our baseline performance and future measures of success).

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Best Value: our priorities

We spend more than £1m every single day of the year delivering our services. We need make the best possible use of this money for the benefit of local people and ensure financial strength and stability for our hospitals.

To achieve best value, we will work with partners to:

∑ Identify opportunities to become more efficient – focusing on how to bring costs down together whilst continuing to deliver the best possible care

∑ Develop new contract arrangements that move away from ‘cost per case’ and instead focus on best value for the whole system.

Within the trust we will:

∑ Build on our successful track record in delivering savings, aiming for cost efficiency savings of£50m over the next five years. We will continue to use our clinically led quality impact assessment process to ensure that cost improvement plans do not adversely impact delivery of safe patient care.

∑ Improve how we use our capacity (maximising theatre and outpatient slots and making the best use of clinical time).

∑ Identify new opportunities for research & development and education & training funding. ∑ Grow our specialist services and reduce the need for patients to travel out of area for care

(and improve value by delivering growth at marginal cost). ∑ Make better use of our existing charitable funds and raise more to support improvements to

care for patients.∑ Deliver our annual control totals and reach breakeven by 2023.


We regularly make financial information available through our board papers and our savings programme and progress against the control total can be tracked.

We aim to achieve a ‘cost per weighted activity unit’ that places us in the top 50% of acute hospital trusts for efficiency (using the NHS Improvement Model Hospital metrics).

Measuring ‘value’ is more difficult than measuring ‘efficiency’. For example, we could deliver a surgical procedure, such as a foot amputation in a diabetic patient, in a very cost efficient way. However, it would be much better value if, through improved diabetic medical management, we can prevent the amputation altogether.

We will work with partners through the new integrated care partnership to identify metrics that help us measure value as well as efficiency.

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Great team: our priorities

We want to be known for having happy, engaged and well supported staff with a great team working culture and a real sense of pride to be part of teamwestHerts.

And we are aiming to be an organisation that attracts talented people who want to deliver outstanding care.

To achieve this we will:

∑ Continue to develop our clinical leadership– supporting, developing and empoweringour clinical leaders.

∑ Deliver excellence in training, education & development for our staff and learners, achieving Teaching trust status by 2021.

∑ Work hard to create a truly inclusive culture and actively value the diversity of all staff, all the time.

∑ Design new roles that support care delivery, fill workforce gaps and provide development and career and role opportunities for our staff, including apprentices and volunteers.

∑ Expand our research and development activity so that more staff have the opportunity to be involved in research and more patients can benefit.

∑ Support the health and wellbeing of our staff and give real recognition to our people for great work, including a review of the benefits we provide to our people.

∑ Support our volunteers to help our patients through offering valuable and fulfilling opportunities – doubling the number of volunteer hours over the next 5 years.


We want to in the top 20% of acute hospital trusts in England for staff engagement in the annual staff survey.

(Our full strategy document sets out further detail on our baseline performance and future measures of success).

Winner of the Nursing Times Workforce Award for

‘Best UK Employer of the year, 2019’

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Great Place: our priorities

Whilst we aim to provide the best care, the age of our buildings makes it hard to always deliver the best experience for our patients and staff. We are delighted that funding has been announced to improve our estate and we are committed to making modernising our information technology at the same time.

To deliver our ‘great place’ aim, we will:

∑ Finalise our plans for a major investment in our hospitals and aim to start building by 2022 at the latest.

∑ Continue to improve the safety and appropriateness of our estate in the short to medium term – including investment in fire safety, theatres improvement (WGH), diagnostics and urgent and emergency care.

∑ Complete our planned telephony upgrades to improve patient and staff experience. ∑ Upgrade our IT infrastructure to improve speed and reliability and significantly improve staff

experience, increasing efficiency and freeing up time to care. (Our programme includes: installing a new local area network, rolling out windows 10 across our hospitals, upgrading our patient administration system and implementing a patient portal.

∑ Develop plans and secure funding to implement an electronic patient record. ∑ Work with partners to make sure our IT systems talk to each other – so that, with the

consent of patients, we can share data and support more effective, better co-ordinated care across different health and care providers.

∑ Identify opportunities to use digital technology to improve patient experience, reduce unnecessary travel and make care easier to access and more efficient.

∑ Take immediate steps to improve how we store and manage our current paper medical records.


We hope that our progress against ‘great place’ will be hard to miss as so much of this work is about our buildings.

Our aim is that by 2025 we will have

∑ improved facilities delivered by 2025∑ Become paperless as part of our digital transformation

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A Well Led Organisation

Delivering our four strategic aims; best care, best value, great team and great place will require strong leadership, successful partnership working and good governance.

Over the past three years we have being working hard to build a culture of continuous improvement, to improve staff engagement, to develop clinical leadership and make sure we have strong governance to provide assurance from ‘ward to board’ that we are providing high quality, good value care and meeting our statutory duties.

Over the next five years we will continue to keep our leadership and governance arrangements under review to make sure they are working effectively and adapting appropriately to the new ‘integrated care partnership’ way of working.

Delivering our Strategy

Our improvement programme will be organised under our four aims with the following key programmes of work monitored via Board committees, with regular progress updates to the Trust Board:

Best Care Best Value Great Team Great Place

Quality Improvement programme (Quality Account).

Quality committee.

Long term financial recovery plan

Finance and Performance Committee.

People Programme

People, Education and Research Committee

Digital transformation programme


Integrated care Partnership / service development improvement Programme

Quality Committee.

Annual cost improvement plan


Research & Development Programme


Estate Transformation Programme


Access Improvement Programme


Raise – Charity strategy.

Charity Committee

Communications and Engagement Strategy

Trust Management Committee

This is a summary version of our 5 year Strategy – the Full version can be found here <<insert weblink>> or by contacting [email protected]

12



Final Draft – 16 Jan 2020 VERSION 5

Our Vision

the very best care, for every patient, every

day

Five Year Strategy2020-2025

12




Introduction

We have really brought our vision - ‘the very best care for every patient, every day’ - to life overrecent years through the efforts and commitment of #teamwestHerts. Huge progress has been made to improve services for our patients; we moved out of ‘special measures’, won a range of national awards, reduced our vacancies and have seen our staff morale continue to rise.

We want to build on this. Our five year strategy sets out how we will continue our successful improvement journey and deliver national and local priorities for the NHS.

The strategy has been developed to help us steer a course at a time when the NHS is facing many challenges. Our local population is living longer and the number of patients with multiple conditions and complex health needs in increasing; the incidence of mental ill health in our community is rising and demand for emergency care continues to grow.

Whilst we get lots of positive feedback about our care, we know there is much still to do. Patients and their families tell us that care and support sometimes comes too late and can feel disjointed. In common with many other hospital trusts across the country, we have a financial deficit despite a good track record in making savings and efficiencies.

Pressure on the NHS and care services will continue and so we need to make changes – in collaboration with our partners – to the way we work to develop a local healthcare system which meets the future needs of our population and makes the best use of available resources. For example, we must build closer links with GPs, community healthcare providers and our other partners to improve our patients’ experience, providing earlier care and support, not just when a crisis point has been reached.

This strategy sets out our priorities for the next five years and has been developed with input from a wide range of staff, stakeholders and patients. Its delivery will require similar collaboration; we are absolutely committed to working in partnership to create a local health and care system that is fit for the future and will deliver the very best care for every patient, every day.

Christine Phil

Phil TownsendChairman

Christine AllenChief executive

12




About us

We provide services to a population of approximately 500,000 people living in Hertfordshire and north London.

We run services from our hospitals at Watford, St Albans and Hemel Hempstead. We also provide services from a range of community settings across west Hertfordshire.

• Watford General Hospital (WGH) provides emergency care, with accident and emergency, inpatient services, an acute admissions unit, women’s and children’s services and a range of outpatient and diagnostic services.

∑ St Albans City Hospital (SACH) is a dedicated centre for planned surgery. It has a minor injury unit, two surgical wards, an outpatients department and cancer and diagnostic services.

∑ Hemel Hempstead Hospital (HHH) provides urgent care, endoscopy, diagnostics, outpatient clinics and an inpatient ward.

National and Local Context

The NHS Long Term Plan published in 2019 and the NHS Five Year Forward View (2014) set the direction for health and care services over the next 10 years. The Hertfordshire and West Essex (HWE) Health and Care Strategy (2019) and ‘Your Care, Your Future’ (2014) set out our health system’s local strategies and plans for implementing the national vision.

Hertfordshire and West Essex Integrated Care System

Across the country, NHS organisations, together with local authorities, are developing new ways of working to meet the challenges facing health and care services and deliver the ambitions in the NHSlong term plan.

The Hertfordshire and West Essex Sustainability and Transformation Partnership (HWE STP) will become a more formal ‘Integrated Care System’ to support organisations to work together to achieve improved health outcomes, provide more joined up care for local residents and ensure that services are managed in the most cost effective way possible to meet the needs of the population.

At a local level, four integrated care partnerships (ICPs) are being developed; three that are geographical; West Hertfordshire, East & North Hertfordshire and West Essex and one specialist Hertfordshire-wide integrated care partnership for people with complex mental health needs.

12




West Hertfordshire Integrated Care Partnership

Work is underway to develop the vision, aims, principles and priorities for the West Hertfordshire Integrated Care Partnership. The Trust is playing a key leadership role in this work.

Currently, acute hospitals are, in the main, responsible for meeting the health needs of people who are already ill and need specialist care and treatment. Hospitals have historically been paid for on a case-by-case basis. In the new ICP model we will share responsibility with partners for preventing ill health, enabling earlier diagnosis and treatment and ensuring that care is joined-up. The way we are funded is changing to reflect this, with a move towards ‘fixed’ or ‘population’ budgets.

We will continue to be driven by wanting to provide the very best care for every patient in our careevery day; but we will also need to think differently about how, where and when care is provided -continuously striving to improve health outcomes, reduce health inequalities and meet the health and care needs of local residents.

12




Our Four Key Aims

We have developed four key aims to support delivery of our vision ~ the very best care for every patient, every day:

BEST CAREthe very best care for every patient, every

day

BEST VALUEdeliver efficient care to make the best use of

every NHS £

GREAT TEAMgreat people & a great place to work and

learn

GREAT PLACEmodern, fit for purpose estate and digital

technology

This strategy summarises our key aims and priorities for the next five years. Working in partnership to deliver the new integrated care model is a key strand, reflected within each of the aims.

The strategy is underpinned by a series of more detailed Trust strategies and improvement plans. A number of these ‘underpinning’ strategies are currently being updated or are due to be updated within the next year and several are updated on an annual basis as part of our annual business planning cycle.

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Key National Strategies


Five Year Forward View (2014) and NHS Long Term Plan (2019)

NHS Outcomes Framework (2019)

National Patient Safety Strategy (2019)

Health and social care strategy – due 2020

Finance annexe to the long term plan (2019)

Interim NHS People Plan (2019)

Final People Plan - due 2020

Personalised health and care 2020 (2014)

Health Infrastructure Plan (2019)

Key local strategies


A Healthier Future – Improving health and care in Herts and west Essex

NHS Long Term Plan – Herts and west Essex delivery plan (2019)

Your Care Your Future – HVCCG (2015)

HWE STP Medium Term Financial Plan (2018)

HWE STP WorkforceStrategy (2019)

HWE STP Estates and Capital workbook (2018 & 2019 update)

Key WHHT supporting strategies and plans


Quality Commitment (2017)

Patient Experience & Carer’s Strategy (2016 -19)

Clinical Strategy (2016)

Access Improvement Plan (2019 / continuously updated)

Quality Account (annual)

Service Delivery Improvement Plan (SDIP) (annual)

Long Term Financial Recovery Plan (2019 / continuously updated)

Drivers of the deficit report (2019)

Cost Improvement Plan (annual)

People Strategy (2020)

Research Strategy (2020)

Nursing, Midwifery and Allied Health Professions strategy (2017 - 20)

Workforce Race Equality Standard (WRES) Report (annual)

Strategic Outline Case (SOC) – redevelopment of our hospitals. (2019)

Interim estates Strategy (2017)

Digital Vision (2018)

Communications and engagement strategy (2020)

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Best Care

Our vision is to provide ‘the very best care for every patient every day’. This means ensuring that our services are safe, effective, caring and responsive. Our quality ambition is to match the highest performing NHS hospitals. In some areas, our performance is comparable – for example, on mortality and harm free care indicators. But there are others where we can improve, such as performance against waiting time standards. We want to ensure consistent high quality across everything we do, ensuring that our patients and their carers have a great experience of care.

The best performing hospitals in the country have developed really strong safety and quality improvement cultures which support and enable all staff to reduce harm, learn from mistakes and improve care. We have started this work and have many areas of good practice and pockets of excellence. Continuing to strengthen our quality improvement culture across all our services and improving how we use data to improve care is an essential element in delivering our ‘best care’ aimover the next five years.

We will also continue to work with the Royal Free London and partners on the ‘clinical pathway group’ (CPG) programme. This brings clinicians together to design and systematically implement best practice ‘care pathways’ for common clinical conditions, continuously testing and improving design using in-depth monitoring and analysis. In 2019, we began work on eight standardised best practice pathways and over the next five years we expect to implement another 40.

Ensuring senior doctors, therapists and nurses are available every single day through implementing ‘7 day working’ also remains a priority, as does continuing to improve access in line with national waiting time standards for emergency care, planned care, cancer treatment and diagnostics.

Other priorities include providing patients and their carers with choice, valuing them as active partners in decisions about their health and wellbeing, supporting patients with additional needs (e.g. mental health, learning disabilities and vulnerable children) and continuing to improve end of life care.

Importantly, providing the very best care for every patient every day doesn’t just mean providing great care for local people when they are ill and receiving treatment in one of our hospitals. We need to work to improve the health of our population, not just manage ill health.

We also need to join up care and constantly ask ourselves whether we can redesign care with local health and care partners, including voluntary sector providers, to make it more responsive, person-centred and better co-ordinated.

For people with complex needs or long term conditions we need to plan ahead more and actively support people to manage their own health conditions at home or in primary and community care settings, and by doing this, prevent - as far as possible - the need for hospital care.

Pop out with integrated diabetes service / diabetic foot

Pop out with details of Dr Narayan’s award for clinical audit practitioner of the year and / or a QI case study e.g mat neo

12




There are also real opportunities to improve outpatient care by ‘making every contact count’. We want to make outpatient care more convenient for patients and make the best use of the skills and time of our specialist clinicians by working more closely with local GPs and community providers and harnessing the potential of new digital technologies to transform how care is provided.

Pop out with case study from one of our integrated care redesign programmes – joint paediatric clinics – Renton.

We also need to join up care between hospitals when more specialist interventions are needed or where neighbouring hospitals have clinical expertise or facilities that could benefit local residents. There are many examples of this already which work well but there are more opportunities to develop specialist care pathways that would benefit local people.

Pop out re UGI centre at Hammersmith?

Equally we will continue to identify opportunities to develop our more specialist services, reducing the need for local people to travel out of area (e.g. into London) for care.

Pop out re cardiac MRI

Finally, we will do more to engage local people and our patients in improving services. People who have experience of the care we provide can make a real contribution by helping us to design new service models that better meet the needs of local people. We want to move from ‘communication’ and ‘engagement’ towards ‘co-production’. A patient’s ‘pathway’ or programme of care is often provided by a number of organisations and so we are working with local partners to embed this approach into our new integrated care partnership, sharing skills and resources and developing a joint approach to help us do this really well.

What do we plan to do:

• Promote a quality improvement culture, providing training and support to our staff so that they have the skills to turn great ideas into real improvements in care for our patients.

• Work with the RFL CPG programme to design and implement a minimum of 40 standardised best practice clinical pathways, improving outcomes and reducing variation in care.

• Develop a new clinical strategy that sets out

• future service models across our hospital sites

• how we plan to develop our services to reduce the need for local residents to travel elsewhere for care that we could provide locally

• how we can work with neighbouring hospitals to improve care for local residentswhere they have specialist skills and expertise that can benefit our patients

Our updated clinical strategy will inform our hospital redevelopment plans (see Aim Four –‘Great Place’)

∑ Work with partners to jointly agree priorities for the west Hertfordshire Integrated Care Partnership and reflect these into our clinical strategy and improvement plans.

• Maternity, Children and Young People • Planned care and outpatient transformation

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• Urgent and Emergency care • Mental Health • Frailty and end of life care

• Work with partners to strengthen how we engage with patients and the public in our quality improvement and service transformation work, developing and embedding a culture of ‘co-production’.

• Work with partners to ensure that, together, we are using data in the most effective way to support new care models and meet the needs of the population.

• Annually update our ‘Quality Account’ publishing a report on progress and setting out in detail our quality and safety priorities and actions for the year ahead.


We want to be one of the best acute hospital Trusts in England for:

• Mortality (SHMI & HSMR): ‘as expected’ or ‘better than expected’ for HSMR and above national median for SHMI.

• Avoidable Harm (harm free care): continuous improvement and better than national average for new pressure ulcers, falls with harm, new venous thromboembolism, urinary tract infections (in patients with a catheter) and e-coli (detailed measure to be confirmed following NHS E updated guidance)

• Access to care (national waiting time standards): continuous improvement and top 25% of hospitals for emergency department 4 hour waits, 18 week referral to treatment and diagnostic waiting time and above national median for cancer two week wait, 62 day treatment and the new faster diagnosis standard (maximum 28 days to communication of definitive cancer / not cancer diagnosis).

We want to significantly improve our patient’s experience of care:

• Patient Experience: improve our scores on the Friends and Family Test and national patient survey result to above the national median.

A baseline of current performance is set out in annexe one.

OUR ANNUAL QUALITY ACCOUNT, SERVICE DELIVERY IMPROVEMENT PLAN / INTEGRATED CARE PARTNERSHIP PLAN AND UPDATED CLINICAL STRATEGY WILL SET OUT IN MORE DETAIL ACTIONS TO DELIVER OUR ‘BEST CARE AIM’.

Best Value

Every day, 365 days per year, we spend more than £1m delivering our services. We need to be confident that we are making the best possible use of this money for the benefit of local people and ensure financial strength and stability for our hospitals.

12




In common with many hospital trusts up and down the country, our costs significantly exceed our income, despite a good track record in meeting our annual cost improvement targets and delivering more than £50m savings over the past four years.

Pop out – best example we have of a cost efficiency improvement?

Benchmarking data indicates that our costs are comparable to similar sized hospital trusts. However, our poor estate and IT and three site configuration make it more difficult for us to be as efficient as hospitals with more modern infrastructure.

Our plans to modernise our hospitals through investment in improving our buildings and digital technology are part of the solution and are set out in more detail under our ‘Great Place’ strategic aim.

We know there is much more that can be done to make our services more efficient and in turn make the best use of every NHS £, even before investment in our estate and IT.

We carried out an in-depth assessment to understand what drives our deficit. A combination of operational, structural (poor estates and digital infrastructure) and strategic (system wide) issues were identified. We will use the findings to devise the longer term solutions required to get us to a financially balanced position. We will continuously update this plan over the coming years as weidentify further opportunities to improve efficiency and value.

Historically, acute hospitals have been paid under an arrangement called ‘payment by results’ –receiving a payment for every outpatient attendance, surgical procedure and emergency attendance or admission. In 2019 we agreed a new ‘guaranteed income contract’ contract with our main commissioner, Herts Valleys CCG, which fixes our income for the year. This is a big change and is intended to help both organisations plan with more certainty and focus on reducing the total cost of delivering care across all local organisations. We plan to build on this approach for future years; this is an important step towards the new ways of working that the proposed west Hertfordshire Integrated Care Partnership will bring.

Raise – the charity that supports the Trust – will play a bigger part in helping to deliver ‘best value’by encouraging fund holders to be more active in their stewardship of their funds to ensure that money already donated and any new income is used to good effect, maximising the positive impact of all charitable donations. Additionally, Raise will establish a capital appeal for a new interventional radiology suite, thereby making best value from local goodwill and support by turning this into tangible benefit for our patients.

What do we plan to do?

• Achieve ‘break-even’ by 2023

• Develop a multi-year strategy to eliminate our deficit and meet our agreed annual control totals (our agreed deficit figure set by regulators).

• Work with partners to identify opportunities to deliver the best overall value for every NHS £ for local people. This will be driven clinically but ensuring best value will be a key factor in decisions about changes to care models. New contract and payment arrangements will support this.

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• Work smarter across the organisation to deliver costs efficiency savings of more than £50mover the next five years. (We will continue to use our clinically led quality impact assessment process to ensure that cost improvement plans do not adversely impact delivery of safe patient care).

• Improve how we plan and use our capacity as effectively as possible (maximising use of theatre and outpatient slots and making the best use of clinical staff time).

• Grow our specialist services and reduce the need for patients to travel out of area for care and improving value by delivering growth at marginal cost.

• Identify new opportunities for research and development and education and training funding.

• Raise – make best use of our existing charitable funds and raise more to support improvements to patient experience.


∑ Deliver our annual control totals and reach breakeven by 2023 (and publish this in our publically available board papers).

∑ Achieve a ‘cost per weighted activity unit’ that places us in the top 50% of acute trusts for efficiency (using the NHS Improvement Model Hospital metrics)

Measuring ‘value’ is more difficult than measuring ‘efficiency’ – for example we could deliver a surgical procedure, such as a foot amputation in a diabetic patient, in a very cost efficient way. However, it would be much better value if, through improved diabetic medical management, we canprevent the amputation altogether. We will work with partners through the new integrated care partnership to identify metrics that help us measure value as well as efficiency.

OUR ‘DRIVERS OF THE DEFICIT’ REPORT, LONG TERM FINANCIAL RECOVERY PLAN, ANNUAL COST IMPROVEMENT PLANS AND JOINT ‘ SERVICE DEVELOPMENT AND IMPROVEMENT PLAN’ WILL SET OUT IN MORE DETAIL ACTIONS TO DELIVER OUR ‘BEST VALUE AIM’.

GREAT TEAM

Evidence shows that happy, engaged and well supported staff are more likely to deliver outstanding care. . We want all our staff to feel a real sense of pride in being part of teamwestHerts and to bean organisation that attracts and retains talented people who want to deliver outstanding care and have a growing reputation for being a great place to work

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Over the past five years we have worked hard to engage our staff and improve their satisfaction at work. We have significantly reduced vacancy rates, particularly in more junior nursing roles and have provided a range of support and development opportunities to encourage our staff to stay with us and ensure they have the skills and support to enable them to deliver great care.

Pop out – workforce redesign example – e.g. nursing associates & ANPs

We have also focused our efforts on promoting a positive, supportive, clinically led ‘team-working’ culture. Our new ‘People Strategy’ sets out in detail our plans for the next five years. Team working and clinical leadership continue to be at the heart of our strategy.

We want to be known as an organisation that provides excellent education, training and professional development and to offer opportunities for more of our staff to be involved in research and development.

Pop out simulation centre?

As models of care change, with a focus on more joined-up, preventative care we need to work in partnership, through the Hertfordshire and West Essex ‘One Workforce’ programme and with organisations in neighbouring areas, to ensure our collective health and care workforce is able to meet future needs and adapt to the new ways of working.

Pop out – example from STP of joint work – e.g. rotations


Put clinical leadership at the forefront – support, develop and empower our clinicians, freeing up time for them to lead, not just internally but in helping to shape and deliver new integrated care models in partnership with colleagues across the health and care system.

Use the expertise of our disability and diversity staff to help us create a truly inclusive culture and actively value the ‘diversability’ of all staff, all the time. Deliver excellence in training, education & development for our staff and learners, achieving Teaching trust status by 2021.

Design new roles that support care delivery, fill workforce gaps and provide development and career opportunities for our staff, including making best use of the apprenticeship levy.

Expand our research and development activity so that more staff have the opportunity to be involved in research and more patients can benefit.

Support the health and wellbeing of our staff, giving real recognition to our people for great work(including a review of the benefits we provide to our people).

Winner of the Nursing Times Workforce Award for

‘Best UK Employer of the year, 2019’

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Collaborate with health and care partners to get the best outcomes and experience of care for local residents through the Hertfordshire and West Essex ‘One Workforce’ programme and our partnership with the Royal Free London.

Support our volunteers to help our patients through offering valuable and fulfilling volunteering opportunities. Our ambition is to double the number of volunteer hours donated for the benefit of patients over the next five years.


We want to be one of the best hospitals in England for staff engagement

∑ To be in the top 20% acute hospital Trusts in the country for NHS national staff survey results.

A baseline of current performance is set out in annexe one.

OUR UPDATED PEOPLE STRATEGY, ANNUAL WORKFORCE RACE EQUALITY STANDARD REPORT AND RESEARCH AND DEVELOPMENT STRATEGY SET OUT IN MORE DETAIL ACTIONS TO DELIVER OUR ‘GREAT TEAM’ AIM.

Great Place

We want to be a great place to receive care and to work, and have already described our strategic priorities to improve the quality of our clinical care and to recruit, retain, engage and support our staff.

Our estate and digital infrastructure impedes us –our patients and our staff are impacted by the current poor state of our hospital buildings and digital technology. Our Great Place aim therefore focuses on addressing this ‘twin challenge’ – upgrading our hospital estate and IT so that both patients and staff can benefit from modern, fit for purpose care facilities.

We are very pleased that the need for investment has been recognised by the Government and that we are one of six hospital trusts in the first wave of the new national ‘health infrastructure programme’ (HIP). Our strategic outline case (SOC) published in July 2019 sets out our plans for a major rebuild and refurbishment of emergency care and specialist services at Watford General Hospital, and investment in planned surgical and cancer services at St Albans City Hospital and in planned medical services at Hemel Hempstead Hospital. Making rapid progress with our plans so that construction can start as soon as possible is a key priority; we aim to commence building workby 2023 at the latest.

Our IT is also a source of frustration for staff and patients and does not enable us to take advantage of modern digital technology that can support more effective and efficient ways of delivering care.

In 2019 we moved to a new outsourced IT support provider and are working with them to make improvements to our IT infrastructure and improve how the support service responds to organisational needs.

We are committed to implementing a full, modern electronic patient record (EPR) as soon aspossible – this will support improvements in our care, information sharing with partners to support joined up care and release time to care by reducing the administrative burden on our clinical staff.

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Over the life time of this strategy we will develop a detailed business case for an EPR, work to secure the required funding and complete the necessary streamlining of our processes, ready for implementation. The Royal Free London (RFL) - who have recently upgraded their EPR and opened the new Chase Farm Hospital as a fully paperless hospital - are supporting us in this project. We will learn from their experience and identify opportunities to fast track our improvement programme where possible.

We also plan to take immediate steps to improve how we store and manage our current paper medical records, a key step on the way to an EPR.

Investment in estate and digital technology needs to go hand in hand – we want our buildings and digital technology to support best practice, efficient care and not inhibit it. Our estate and digital transformation programme will be clinically-led and we are committed to involving local residents and patients in developing our plans. We will also work with other HIP hospitals to make sure we are learning from each other and from national and international best practice in estate and digitally enabled transformation.

In the meantime, we continue our work to ensure our buildings are maintained safely and to make improvements when urgently required to enable us to continue to deliver safe care. Our transitional estates plan sets out key priorities while we progress our long-term major redevelopment plans.

We will also continue to invest in improving our core IT infrastructure and will look for opportunities to use modern digital technology to improve care delivery. Priorities for the next five years include further improvements to our IT and telephony infrastructure and upgrades to key clinical systems.

Pop out – upgrading telephony to support outpatient booking processes?

The NHS Long Term Plan identifies significant opportunities to transform outpatient care models by using modern digital technologies.

We want to improve patient experience by making our appointment systems easier to access and more responsive – we know that our current appointment systems are frustrating for patients.

We also want to reduce the need for costly and time consuming (for patients and staff) face to face outpatient appointments where possible. We will do this through implementing IT-enabled patient tracking and information management systems that help us to deliver new care models and by making use of new clinical apps and other communication tools.

Pop out teledermatology

We will work with our partners to ensure that our IT system ‘talk to’ each other so that, with the consent of patients, we can share data and support more effective care for patients across the whole health and care system.

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• Finalise our plans for a major investment in our hospitals – aim to start building by 2023 at the latest.

• Continue to improve the safety and appropriateness of our estate in the short to medium term – including investment in fire safety, theatres improvement (WGH), diagnostics and urgent and emergency care.

• Complete our planned telephony upgrade to improve patient and staff experience.

• Upgrade our IT infrastructure to improve speed and reliability and significantly improve patient and staff experience, increasing efficiency and freeing up time to care. The programme includes: installing a new local area network, rolling out windows 10 across our hospitals, upgrading our patient administration system (PAS) and implementing a patient portal.

• Develop plans and secure funding to implement an electronic patient record.

• Take immediate steps to improve how we store and manage our current paper medical records.

• Improve patient experience by making our appointment systems easier to access and more responsive.

• Work with partners to make sure our IT systems talk to each other so that we can share data and support more effective care for patients.

• Identify opportunities to use digital technology to improve patient experience, reduce unnecessary travel and make care easier to access and more efficient.


We will track the progress of our redevelopment programme against the timeline we have set – for –building work to commence no later than 2023 - and will share information publically.

We will become paperless by 2025.

OUR ANNUAL CAPITAL PROGRAMME WILL SET OUT IN MORE DETAIL OUR PLANS TO IMPROVE ESTATE AND DIGITAL TECHNOLOGY IN THE SHORT TO MEDIUM TERM.

OUTLINE AND FULL BUSINESS CASES FOR ESTATE REDEVELOPMENT AND DIGITAL TRANSFORMATION / ELECTRONIC PATIENT RECORD IMPLEMENTATION WILL BE DEVELOPED TO ENABLE US TO SECURE SUBSTANTIAL LONG TERM INVESTMENT IN OUR INFRASTRUCTURE AND SET OUT DETAILED DELIVERY PLANS.

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A Well Led Organisation

Delivering our four strategic aims; best care, best value, great team and great place will require strong leadership, successful partnership working and good governance.

Over the past three years we have being working hard to build a culture of continuous improvement, to improve staff engagement, to develop clinical leadership and make sure we have strong governance to provide assurance from ‘ward to board’ that we are providing high quality, good value care and meeting our statutory duties.

Over the next five years we will continue to keep our leadership and governance arrangements under review to make sure they are working effectively and adapting appropriately to the new ‘integrated care partnership’ way of working.

Delivering our Strategy

Our improvement programme will be organised under our four aims with the following key programmes of work monitored via Board committees, with regular progress updates to the Trust Board:


Quality Improvement programme (Quality Account).

Quality committee.

Long term financial recovery plan


People Programme


Digital transformation programme


Integrated care Partnership / service development improvement Programme

Quality Committee.

Annual cost improvement plan


Research & Development Programme


Estate Transformation Programme


Access Improvement Programme


Raise – Charity strategy.

Charity Committee

Communications and Engagement Strategy

Trust Management Committee

For more information please contact: [email protected]

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Annexe One – Baseline data for key measures of success (note: final version with latest data to be included in publication draft of strategy).

Proposed top line objective Measure BaselineWHHT will be one of the best hospitals in the country for safe, harm free care.

Q1 Lowest Q2 Q3 Q4 TopNew harms Continuous improvement from our current baseline and better than national average for each of the 4 key Safety Thermometer metrics (New Pressure Ulcers, Falls with harm, New Venous Thromboembolism of any type, urinary tract infections (in patients with a catheter). Reduction in e-coli bacteraemia - detailed measure TBC following NHS E guidance for 2020.

NHSI Safety Thermometer• new harm free care• New Pressure Ulcers (category II, III, IV) • Falls with harm within previous 72 hours • New Venous Thromboembolism of any type• Patient with catheter and UTI • E-Coli

• 98.5% vs 95.0% YTD to Nov• 1% vs national figure 1% • 0.2% vs national figure 0.5%• 0.3 % vs national figure 0.5%• 0.2%vs national figure 0.7% (measure TBC)

Top 50% of hospitals in the country for mortality using SHMI

Consistently achieving ‘as expected’ or ‘better than expected’ HSMR.

NHSI New Model Hospital SHMI

HSMR

Trust value: 1.01 @ Aug 18 - July 19.

Current performance 'as expected'.

◊

WHHT will be one of the best hospitals in the country for access to care (waiting time standards)

Continuous improvement in performance and top25% of hospitals for Emergency care, Referral totreatment and diagnostic waiting times

Continuous improvement and above nationalmedian for three key cancer standards (urgent 2week wait, 62 day wait from urgent GP referral,faster diagnosis standard (28 days forcommunication of definitive cancer / not cancerdiagnosis).

NHSI New Model Hospital

•ED - Trust value: 82.21% Position: 28/ 94 = 70.2% Median 79.19% Benchmark 95.00% Nov 19•RTT - Trust value: 86.86% Position: 40/ 114 = 64.9% Median 84.2% Benchmark92.0% Oct 19Diagnostic waiting times - 99.5% Nov 19

•Cancer 2WW - 96.2%.(nov 19), YTD @ nov 19 = 92.6%. Banchmark 93%. Ju•Cancer 62 day wait from GP referral-Trust value: 77.55% Position: 63/ 116 = 45.7% Peer 78.54% National 85.00% Oct 19Data on 28 day standard not yet available (new standard)

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WHHT will significantly improve our patients’experience of careHigher than national average scores across usingnew model hospital Friends and Family Test (FFT)and Patient Experience national patient surveyresults.

NHSI Friends and Family Test

•FFT - Inpatient % patient rate. Trust value: 95.5% Peer 96.1% Quartile 2 lowest 50%. Nov 19•FFT Maternity - Trust value: 96.9% Peer value 97.9% Quartile 2 – lowest 50% Nov 19•A&E % positive. Trust value: 94.2% Peer Value 85.4% Quartile 4 –highest 25% Nov 19•Out Pt % positive - Distribution chart not available. Trust value: 93.2% Quartile 2- assume lowest 50% Nov 19

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WHHT will deliver efficient, best value care &ensure our hospitals are financially sustainable.

Achieve a ‘cost per weighted activity unit’ thatplaces WHHT in the top 50% of acute trusts forefficiency.

NHSI New Model Hospital 16-17 Trust £3442 National £3,48717-18 Trust £3546 National £3,48618-19 Trust £3,650 (not yet validated)

◊

WHHT will be one of the best hospitals in thecountry for staff engagementTop 20% of acute hospitals in England for staffengagement. (NHS Staff Survey)

NHS Staff Survey

Scores ranked 0-10. The national average score is 7. WHHT scored 7.02 in 2018. Highest national score was 7.6. 2017 6.9 (highest 7.4)

◊

National Distribution

Note - A national distribution for new harms or individual indicators is not currently readily available via Safety Thermometer.

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Strategy Engagement Programme – January 2020

Developing the Trust Strategy and setting out the priorities for the next five years has required the collective effort of a wide group of staff, stakeholders and patients.

Over the past six months the strategy has been on something of a road show, with opinions being canvassed from as wide an audience as has been possible to reach.

Over 250 people from over 44 organisations have taken part in the engagement programme and contributed their thoughts and views on what good care means to them, our shared values and priorities and how we might go about achieving them.

Our thanks are extended to the following for taking part.

Herts Valley CCG Patient Panel

Three Rivers District Council

Dacorum Council

Hertfordshire County Council

Watford and Three Rivers Trust

Carers in Hertfordshire

Central London Community Healthcare Trust

Rothschild House PPG

Hertfordshire Partnership Trust

East and North Herts CCG

Three Rivers District Council

Age UK

Peace Hospice

Macmillan

Herts Valley CCG.

Hertfordshire County Council

Healthwatch Hertfordshire

Central London Community Healthcare Trust

Herts and West Essex STP

Carers in Herts

Herts Community NHS Trust

Headway

MIND

Moorfield’s Eye Hospital

Marie Curie

Herts Hearing Advisory Service

Beds and Herts Local Medical Committee

Royal Free London NHS Trust

Community Action Dacorum

Rennie Grove Hospice Care

Thanks also to our staff and volunteers, including the WHHT Patient’s Panel, for their input into the development of the strategy.

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A final draft was presented at a Strategy Engagement Stakeholder Event held in January 2020. Close to one hundred people attended the event.

The agenda on the day included:

∑ Overview of WHHT and highlights from recent years - (Tracey Carter, Chief Nurse)∑ Introduction to the five year strategy - (Clare Parker, Director of Integrated Care Partnership

Development and Helen Brown, Deputy Chief Executive)∑ Developing our approach to engaging local people and partners - (Louise Halfpenny, Director

of Communications and David Thorpe, Deputy Chief Nurs

From the earliest draft of this strategy, through to the engagement event in January, the feedback has generally been positive.

Language was important to get right and testing this out helped shape the four strategic aims of Best Care, Best Value, Great Team and Great Place. Healthy debates around a hierarchy of each of those balanced in the end with a shared understanding that our primary aim is to provide the best care for every patient and that best value is also important, both of which are enabled by having a great team working in a great place. There is no great care without a great team after all – so all agreed that valuing, supporting and developing our staff is an absolutely key priority.

All stakeholders, both internal and external also recognised and welcomed the emphasis on ‘joined up’ care and the need for WHHT to play a very active role in new models of integrated care, with a greater focus on health and well-being and a shared responsibility for system sustainability and value.

The key themes of feedback included:

∑ Improved communication – both with individual patients and their carer’s, as well as between different health and care professionals and organisations

∑ greater involvement of patients, their carer’s and local people in the design and delivery of care– requiring a shift in culture for NHS staff and supporting cultural change with appropriate training and development or OD interventions.

∑ the importance of investing in our staff and ensuring that ‘teamwestHerts’ is a great team to be part of and our hospitals great places to work

∑ the urgent need for an improved estate and digital infrastructure& the significant opportunities this would present to transform care, particularly through adopting digital technology

Each of these is directly addressed in the strategy.

Best Care

Improved communications between teams, patients and their families and other services was a strong theme within the Best Care aim. Some examples of comments received include:

∑ Care planning for the patient must be shared with the whole family so that choice is fully understood, personalised care is delivered and so that the service understands the individual needs of the patient.

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∑ Tailor communication styles around the patient’s needs, i.e., autism, LD, sensory disorders and dementia.

∑ Support carers∑ Need more psychological support for cancer patients∑ Use volunteers more on wards for patient support e.g. end of life

This feedback is valuable to us and reflects itself in our priority to provide patients and their carers with choice, valuing them as active partners in decisions about their health and wellbeing. It is also a priority to continue to find better ways to support patients with additional needs (e.g. mental health, learning disabilities and vulnerable children) and continuing to improve end of life care. The Trust has a number of improvement projects in place designed to improve communication with our patients and their carers and will further develop our approach and focus on improvement in this area over the life of the strategy.

The Trust is also working with Healthwatch to develop co-production plans to strengthen how weengage local people and our patients to improve our services.

We want to significantly improve our patient’s experience of care and will measure our success in this area through improvement in our scores on the Friends and Family Test and national patient survey result to above the national median.

Best Value

All stakeholders involved in the development of the strategy agreed that delivering ‘Best Value’ care should be a priority, although it is important that financial savings and efficiencies should not compromise the delivery of ‘Best Care’. Discussion on this aspect of the strategy cross referenced to the other 3 aims – can’t have good value without good care and effective use of our workforce, estate and IT are all essential to delivering best value care. There was also a discussion about the relationship between an ‘efficient’ hospital and ‘good value’ healthcare more broadly.

Some examples of comments received include:

∑ Maximise opportunities to develop the skills of our staff, develop new roles / skill mix teams and invest in education, training and development.

∑ A lot of face to face outpatient’s appointments are unnecessary for the patient. To journey in, pay to park and have a long wait, to be told you are fine feels pointless. The ‘you are fine and can be discharged’ patients could be communicated with by phone and that could be best care and best value for all.

∑ More one stop clinical ‘shops’ are needed.∑ Invest in ‘pre-habilitation’ before surgery for conditions such as cancer.∑ Use IT to maximise efficiencies in stock control, warehousing, supply chain and

procurement. ∑ Equipment loans and returns, linked to and a shared service with the community. ∑ The Trust is limited by its facilities and an estate that requires significant investment.

A confirmed measurement of success will be to achieve a ‘cost per weighted activity unit’ that places us in the top 50% of acute trusts for efficiency (using the NHS Improvement Model Hospital metrics.)

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We will work with partners to develop a set of ‘value measures’ as part of the developing integrated care partnership.

Great Team

Staff was the highest focus of feedback across the engagement process overall, with a majority of comments around investing in our staff. Some examples of those comments are:

∑ Promote flexible working.∑ Better car parking at lowest cost for staff ∑ Promote key worker housing schemes or offer accommodation.∑ Health and wellbeing of staff is vital.∑ Promote healthy lifestyles with changing facilities and showers. ∑ Use senior staff to talk about their career journey in inductions. ∑ Inclusion and diversity allowing staff to bring their whole selves to their workplace.

(See also comments in previous sections re staff development, new roles and team working culture).

We want to be known as an organisation that provides excellent education, training and professional development and to offer opportunities for more of our staff to be involved in research and development.

Our People Strategy sets out in more detail our approach to ensuring we continue to build a ‘great team’ and meet our ambition to be a top 20% acute provider for staff engagement.

Great Place.

There was consensus amongst all participants that the estate improvements are a long over-due necessity. Equal weight was given to the vital need for a modern digital infrastructure. Additionally the following comments were made:

∑ Transport links need to improve∑ Transport for those with disabilities needs to improve.∑ Improve signage and way-finders around the estate. Follow a patient’s journey to see where

improvements are needed. ∑ Consider using technology for estate wayfinding and traffic/transport updates.

The engagement event proved to be a valuable opportunity to describe the planned improvement programme to upgrade of our IT infrastructure that will improve speed, reliability and improvepatient and staff experience, freeing up time to care.

Further work is required on outline and full business cases for estate redevelopment and digital transformation. Substantial investment is required.

We acknowledge the importance of the feedback around transport and access to our hospitals.

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Specific areas of feedback on the strategy

In addition to the feedback summarised above, specific points in relation to the draft strategy included the following:

The strategy is quite internally focused / more detail requested on local integrated care plans.

The strategy is explicitly focused on WHHT’s role as a provider of acute health care services, but recognises our responsibility to actively contribute to the broader integrated care agenda. As the local Integrated Care Partnership develops more detail will be shared with stakeholders about how organisations will work together differently and set out the key aims and priorities for the partnership.

The strategy is quite ‘aspirational’ and doesn’t provide very much detail on exactly what the Trust is planning to do to deliver the ambitions set out.

The strategy is a high level document that sets out the key areas of focus for the Trust over the next 5 years. Supporting strategies and plans will set out in more detail the specific actions that the Trust is planning to take. Some of these strategies are being updated currently or are due to be updated in 2020 – for example our Clinical Strategy. Our annual quality account provides more detail on our quality improvement work.

Baseline data should be provided for any measures of success included within the strategy.

Baseline data for proposed measures of success has been included as an annexe to the strategy.

Case studies should be used to ‘bring the strategy to life’.

The final designed version of the strategy will include short ‘pop outs’ that illustrate some of the key priorities within the strategy. These focus on improvements we have already made but bring to life the types of changes and improvements we will continue to make over the coming years.

A separate ‘case studies’ brochure is being developed as a supporting document to the strategy that provides lots of examples of how we are developing our services in line with our strategy.

Travel and access to our sites, including car parking can be very difficult, especially for people with disabilities, young children or frail older people.

We plan to set up a ‘travel and access working group’ to review opportunities to make improvements to access to our 3 hospitals, working in partnership with district councils and transport providers and with support and advice from expert advisors. We will also be producing a ‘green travel plan’.

Thank you to everyone in Team West Herts and to our partners, who have helped shape and develop this five year strategy.

Helen Brown – Deputy CEONatalie Miles-Kemp – Head of Strategy Delivery.

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Trust Board06 February 2020

Title of the paper 2020-2025 People Strategy

Agenda Item 13/79

Presenter Paul Da Gama Chief People Officer

Author(s) Jayne Taylor, Head of ODPaul Mendes, Head of Education, Learning and DevelopmentTania Marcus, Head of HR Business Partnering & ODLaura Bevan, Deputy Director of HRPaul Da Gama, Chief People Officer

Purpose Please tick the appropriate box For approval For discussion For information

√

Executive Summary

This strategy refreshes our previous Workforce and Development Strategy 2016-2019.

As a Trust we are in a much, much stronger place now and whilst we must continue to ensure that the foundations we have laid over the duration of the last strategy remain strong, in this new People Strategy we have placed much greater emphasis on partnership working, quality improvement, diversity and inclusion, and living our values.

We have cross referenced the strategy again the Herts and West Essex Workforce Strategy (HW STP, 2019), the NHS Long Term Plan and the Interim People Plan (NHSE, 2019) among other key policy drivers including the Topol Review(HEE, 2019). We have tried to ground the strategy in the reality of what we know will happen over the next few years whilst also striving to instill a sense of excitement going forwards.

The new People Strategy follows a similar structure to the previous version with four phases that mimic the career pathway of a typical team member, andthe four cross cutting themes mentioned above. The four phases are Building our team; supporting and engaging our team; developing our team; and moving forwards.

Each of the phases is comprised three parts. For example, Building our team covers attracting the best people; a great first few months and beyond; and a flexible and inclusive workforce. At the end of the discussion about each phase we have added a tangible set of commitments and included examples of how we would measure success.

The final structure outlines governance, monitoring and evaluation, and a summary of what we aim to achieve.

The senior HR team is currently attending a number of meetings to gain feedback on the draft. The questions the team are asking are:

• Does what’s being proposed sound right? • Is there anything missing? What else?• Does the strategy align sufficiently to other related strategies e.g. the

NHS Interim People Plan, our STP workforce plan, our nursing and

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Tab 13 2020-25 People Strategy


midwifery strategy?

It is important that we have a strategy that guides our work and provides a mechanism to coordinate an enormous amount of work, and to have a framework in place to review it and evaluate progress. Soon after approval a detailed implementation plan will be developed which will be the blueprint for this work.




Objectives 1-5

Aim 2Great place to

workObjectives 6-8

Aim 3Improve our

finances

Objective 9


future

Objective 10-12√ √


☒Is there the leadership capacity and capability to deliver high quality, sustainable care?☒Is there a clear vision and credible strategy to deliver high quality, sustainable care to people, and robust plans to deliver?☒Is there a culture of high quality, sustainable care?☒Are there clear responsibilities, roles and systems of accountability to support good governance and management?☒Are there clear and effective processes for managing risks, issues and performance?☒Is appropriate and accurate information being effectively processed, challenged and acted on?☐Are the people who use services, the public, staff and external partners engaged and involved to support high quality sustainable services?☒Are there robust systems and processes for learning, continuous improvement and innovation?☒How well is the trust using its resources?

Previously considered by Committee/Group Date

Professional advisory committee 18.11.19Joint consultative committee 05.11.19Trust management committee 11.12.19People, education and research committee 12.12.19Board - draft 09.01.20

Action requiredThe Board is asked to receive this strategy for approval.

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People Strategy

2020-2025

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Contents

Page

Section 1 Introduction 3

Section 2 Vision, Values and Aims 5

Section 3 Overview of our People Strategy 6

Section 4 Creating the Right Conditions for Success 6

Section 5 The Phases of the Strategy - Building our team - Supporting and engaging our team - Developing our team - Moving forward

9 9

14 18 23

Section 6 Governance, monitoring and evaluation 28

Section 7 Summary of What we will Achieve and introduction to the implementation plan

29

References 30

Appendix I 31

Appendix II 34

Version control (remove from approved version)

Version Date Distribution Outcome

7.7 30.10.19 Direct reports

7.8 05.11.19 Direct reports LB to edit + AB changes

7.9 25.11.19 Direct reports Case studies included. Changes suggested by TM made

7.10 28.11.19 Direct reports Changes made by team on 02.12.19

7.11 02.12.19 Direct reports, PERC, TMC

Changes made to graphic, from clinical leaders feedback and TMC

Final 18.12.19 Direct reports, JH, PDG

Changes suggested by Deputy CEO

Final v1.2

15.01.20 PDG, Board Changes made following Board review

Final 28.01.20

28.01.20 Board

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Section 1: Introduction

This strategy builds upon the work developed through our original Workforce and

Development Strategy 2016-2019. It has as its main aim to help us to move from

being a good place to work and learn, to a great one.

The position in which we find ourselves as we embark upon the next five-year phase

of our journey to becoming ‘Outstanding’ could not be more different to the one from

which we started in 2016. Some of the biggest changes include:

Our staff survey results have gone overall from bottom quartile to top 20% in

the country.

A massive improvement in filling our vacancies – we’ve gone from a 32%

vacancy rate for our nursing workforce to 0% for band 5 nurses within our

adult in patient wards.

A sea change in agency spend - at the start of the last strategy we were

spending £37m on agency workers, today that figure is less than £13m.

All of our key workforce metrics have vastly improved e.g. appraisal

compliance rates were less than 50%, today they stand at over 90%.

These changes haven’t gone unnoticed and I was delighted that this culminated in

our Trust winning the prestigious Nursing Times Employer of the Year Award for

2019. There is little doubt that these improvements have been fundamental in

helping us to deliver on our Trust’s vision of providing the very best care for every

patient, every day.

One of the concepts which emerged most powerfully during the life-time of our

previous strategy has been that of teamwestHerts. Originally intended as a branding

exercise for a range of Human Resources initiatives, it has become a powerful

descriptor for one of our greatest strengths, namely the way in which our people

come together each and every day to do the most remarkable of things. Whatever

the challenge, when teamwestHerts come together, brilliant things happen!

That is why we have moved our focus from ‘people’ to ‘team’ within this strategy.

Working together as a team is good for our people, our stakeholders and most

importantly our patients. Strong engagement is seen as fundamental to the

successful delivery of our strategy.

Our teamwestHerts approach is underpinned by a genuine commitment to promote

inclusion and diversity, on-going quality improvement and working in collaboration

with all our partners. Our values and ensuring that we live by them, are key to

ensuring that we achieve the goals set out in this strategy.

The refresh of our strategy coincides with an exciting time nationally and locally.

In January 2019 we saw the publication by NHS England of the 10-year NHS Long

Term Plan followed by the Interim People Plan in June 2019. Nationally we know

there is a drive to put the people who provide care as well as those who receive care

at the heart of the NHS.

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The Interim People Plan 2019 is clear that the future workforce will look very different

from how it looks today. There will be more staff, working in very different ways and

in different settings. There is a real push to make better use of modern technology,

and grasping the opportunities to be had by it offers to transform care for the better.

The plan also emphasizes the need for a strong, distributed leadership culture which

has a strong focus on quality improvement.

Locally, there has never been a more exciting time to work in west Hertfordshire. The

NHS Long Term Plan is clear that integrated care systems (ICSs) should be the

main organising unit for local health systems. In Hertfordshire and West Essex which

is our ICS footprint we have a strong commitment to working together. The system-

wide Health and Social Care Workforce Strategy 2019 and the Workforce Strategy

2019 have shaped and influenced our own People Strategy 2020-2025 and we are

working together to ensure that as a health and social care system we have the right

numbers of staff, with the right skills, delivering excellent patient-centered care. We

have strong and evolving working relationships with our STP partners, but also with

the Royal Free London NHS Foundation Trust which we will continue to develop and

we will work together on specific pieces of work where it is to our mutual benefit to

do so.

In west Hertfordshire we are also at the cusp of seeing the start of an exciting

journey to transform our hospital buildings and estate. During the lifetime of our

People Strategy we will start to see major improvements to existing estate and

technology and by the end of the period covered by the strategy we should be

seeing significant work starting on new buildings, creating sites that are inclusive,

accessible and which support the delivery of best care for best value for our patient

population and is a great place for our great team to work in. This, and our other key

aims and priorities are set out in the Trust’s Five-Year Strategy 2020-2025 .

As Chief People Officer it has been my pleasure and privilege to be part of the

transformation that has taken place over the lifetime of our previous strategy. Roll on

2020-25 and the next stage of our exciting journey!

Paul da Gama, Chief People Officer

February 2020

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Section 2: Vision, values and aims

The vision of the Trust is to provide:

“the very best care for every patient, every day”

We have three values underpinned by a set of behaviour standards. Our three values are:

Commitment, Care, Quality1

Our four key aims are:

BEST CARE

the very best care for every patient every day

BEST VALUE

deliver efficient care to make the best use of every NHS £

£

GREAT TEAM

great people & a great place to work and learn

GREAT PLACE

modern, fit for purpose estate and digital technology

Although our People Strategy aligns with all four aims, clearly it most closely informs

the Great Team aim. Evidence shows that happy, engaged and well supported staff

are more likely to deliver outstanding care. We want West Herts Hospitals to be a top

20% trust for staff engagement, a great place to work and to be an organisation that

attracts and retains talented people who want to deliver outstanding care. We want

our staff to feel a real sense of pride in being part of teamwestHerts.

1 To note that it is the intention to revisit the values as one of our first pieces of work attached to this strategy

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Section 3: Overview of our people strategy

The graphic wheel below shows our overall strategy and how the four different

phases all fit together with the four threads that run through and join up our strategy.

Section 4: Creating the right conditions for success

In this section we provide the context of the four phases of our People Strategy and

the four threads that run through it.

Building our team is about ensuring we

have the best people in the right roles, with the right skills, doing the right things, in the right way. This involves making sure that our recruitment practices are first class and that we give people the best experience we can when they join us and beyond. It means working with our partners to embrace the Herts and West Essex ‘One Workforce’ programme, ensuring we attract talented people who are comfortable with our values, making sure our systems and processes are inclusive and celebrate diversity, and that we consistently strive to improve and learn as individuals, across teams and as an organisation.

Supporting and engaging our team is

about making sure we look after our most valuable asset – our staff. Their health and wellbeing are of fundamental importance to us and we want staff to know this. We want to be an organisation that celebrates the great things our staff do, that add up to make our patient care the best it can be. We want to make sure that every single member of staff and all our volunteers are listened to and feel engaged. We are particularly keen to strengthen the voices of those less well heard through a range of safe space channels, such as staff networks and employee groups, and via Speak Up Champions.

Developing our team is about making sure

we develop our staff and volunteers so that our teams feel they have every opportunity to

Moving forwards is all about embracing

change. We are hugely excited about emerging plans for the development of our

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contribute their full potential, develop their careers and gain great job satisfaction. We want our hospitals to be great places to learn for our students as well as for our staff. We want to be known as an organisation that provides excellent education, training and professional development. We want to make sure that we embrace the concept of distributed leadership – recognizing that we are all leaders, and we want to make sure there are opportunities to develop leadership skills appropriate to each role. We particularly want to promote a supportive, clinically-led ‘team working’ culture and we want to develop people who can lead across our teams, our hospital and the wider system.

sites and need to make sure that we support change. We are hearing about and experiencing the power of new technologies and need to make sure we embrace the opportunities these bring. We also want to embrace new roles and new ways of work made possible by regulation and new flexibilities. We will be doing this with our system partners to ensure our collective health and care workforce is able to meet future demands and adapt to new ways of working. We need to ensure that we build a truly inclusive culture so everyone can benefit. We particularly want to offer more opportunities for staff to become involved in research and development.

There are four key threads running through and joining up all the elements of our strategy

Partnership Working Diversity and Inclusion Working closely with our staff and volunteers, promoting our teamwestHerts brand and further developing our communication processes Working closely with our patients, their carers and families, our local communities including HealthWatch, the voluntary sector and the education sector Internally we want to build our relationship with our staff side colleagues Continuing to strengthen links with the Herts and West Essex Sustainable Transformation Partnership and the ‘One Workforce’ programme, and the Royal Free London NHS Foundation Trust and understanding how the changing landscape impacts on us.

Creating a truly inclusive culture and actively valuing the diversity of all staff, all the time

Making sure we hear the voices and perspectives of our diverse teams, to help us to be a great place to work and learn

Including the voices of all our teams, and empowering our teams to ensure that no-one has a less positive experience of working within the Trust because of a protected characteristic

Making sure that across all our services and functions that we always consider the impact of change on all members of our teams.

More closely reflecting the demographic of our local community at all levels of the organisation.

Quality Improvement (QI) Living the Values Building a community of QI practitioners and embedding quality improvement across all areas of the organisation, making sure it is at the forefront of our thinking Ensuring that there is absolute cohesion between the People Strategy and the quality improvement agenda.

Co-creating a new set of values, refreshing our behaviours and making sure our values drive all we do Promoting strong leadership and great, high performing teams and promoting a positive, supportive and clinically led ‘team working’ culture

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Using research and innovation to drive future improvement and maximize evidence based clinical practice, and making sure our People Strategy aligns with the Research and Development Strategy 2020-2023.

Empowering members of teamwestHerts, our partners and others to challenge bad practice, to act where we do not live up to our values, to encourage good practice and the best care of our patients

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Section 5: The phases of the strategy

In this section we expand the four different phases of our strategy: - Building our team - Supporting and engaging our team - Developing our team - Moving forwards.

Each phase is made up of three inter-related areas. Each area is described and we have also included some examples of our commitments to bring about change, and provided examples of how we will measure success. We have also included a few short cases studies highlighting some of the great work that has taken place over the life-time of our previous strategy. A full implementation plan will accompany this strategy which will contain all commitments and related measures – although we have included a snapshot of some of these here. Clearly there are some parts of our strategy that will be easier to measure than others. In our implementation plan we have included much more detail about how we will utilize a range of qualitative and quantitative measurement so that we can effectively measure and monitor the progress of our actions. Whilst the strategy is designed to cover the next five-year period (2020-2025), its implementation requires this to be a dynamic and constantly changing document that will reflect in real time our progress towards meeting our commitments.

5.1 Building our team

This is the first phase of our strategy and encompasses three inter-related areas:

Attracting the best people

A great first few months and beyond

A flexible and inclusive workforce.

Attracting the best people The first phase of our strategy is all about finding the right people. This means recruiting and retaining a stable, competent, cost effective workforce. It means working with our local communities to reach out to a wide range of people with different skills as well as reaching out nationally and internationally to attract and retain talented people who want to deliver outstanding care to come and work with us including students who have trained with us. We will be building on the tremendous success of our overseas nurse recruitment campaign and looking at how this approach can be used among other hard-to-recruit-to posts. As models of care change, with a focus on more joined-up, preventative care we will work with our partners across the system where it makes sense to do so and seek to make employee movement between the organisations in our Integrated Care System as straight-forward as possible, through the ‘One Workforce’ programme. We need to make sure that wherever our new staff come from and whatever their role in the Trust we have recruitment processes that are fair and transparent, professional, inclusive, flexible and slick. We will for example be exploring robotic

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solutions to increase efficiency in how we bring new staff into the organisation. We will also look at the best way of organizing our recruitment services so that they are efficient and cost effective and that is likely to see us partnering up with other NHS providers across many recruitment activities. We will endeavor to attract people from our diverse local community and we are introducing reverse mentoring which will help to ensure our leaders recognize and value the talents of people from a diverse range of backgrounds. Whilst we seek wherever possible to employ staff on a permanent contractual basis,

we recognize that across the NHS and locally, temporary staff are a vital and valued

part of our workforce. During the period of this strategy we will continue to work with

our bank services partner, NHSP, and will make sure that our temporary staffing

processes are robust and that we look after our temporary team.

We will be building on our ‘One Workforce’ approach to managing temporary staffing

(see below) within our Integrated Care System and will be collaborating with other

local NHS trusts to procure the most effective quality temporary staffing solution that

also offers value for money. We will continue to work across the Integrated Care

System to maximize opportunities offered by the shared bank.

Across the NHS and locally we are also fortunate to be supported by an army of

volunteers who support us in countless different ways. We could not run our

hospitals without our volunteers and we will develop our volunteer function, attracting

new volunteers and doubling our volunteer hours over the course of this strategy,

making sure that they feel supported, engaged and valued. We are particularly keen

Focus on success: Case studies from our 2016-19 strategy

Case Study 1: Managing our Temporary Workforce

In 2015 with our agency spend out of control, we came together with a number of

other local trusts to form The Herts and Beds Agency Consortium. The key goals

being to collaborate to procure best value and consistent agency rates and to move

away from ‘agency’ to ‘bank’ as our main source of temporary workers. We began

by having a clear procurement strategy and use only those agencies offering better

rates, offering them longer lead in times in return. In addition, we did substantial

work to align internal processes with all partner organisations so we were not

inadvertently competing with each other.

Working collectively has delivered major benefits including consistent agency and

staff bank rates across trusts. There is no longer any benefit from workers ‘rate

chasing’ between trusts, which has led to a more stable workforce and better

consistency of care.

It has also led to the formation of one of the first truly shared banks within the UK

with five core members - some with different bank systems, coming together to

facilitate their workers to be able to work within each other’s organisations.

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to ensure our volunteering opportunities are available to members of local

communities who may be interested in developing a future career with us or as part

of the wider NHS family. We will actively encourage and support any of our

volunteers who want to join our team as employees.

When we have our teams in place, we must make sure we use them in the best

possible ways to provide high quality services for patients. This means making sure

we have excellent processes to allocate our staff to the work that needs to be

undertaken, and that staff are working appropriately and effectively.

That is why at WHHT we are committing to:

Exploring technological solutions (including robotics) across the recruitment and on-boarding functions including medical resourcing

Exploring the use of apps to make it easier and more cost effective for temporary and locum staff to work shifts in our hospitals where we need them

Rebranding our recruitment and on boarding materials and changing the focus from a reactive to a proactive approach to how we attract and recruit staff

Revisiting our search approaches for different staff groups (including overseas staff and hard to recruit to posts) and ensuring we appeal to a diverse market

Looking for ways of ensuring the student workforce chooses our hospitals as their employer of choice

Working with our local communities to offer valuable and fulfilling volunteering opportunities and supporting those volunteers looking for a career in the NHS

Ensuring an effective temporary staffing provision through collaborative procurement and management of the outsourced provider.

Some of the ways we will measure success include:

An increase in the ratio of appropriate candidates to posts particularly for hard to fill roles

Reduced time to hire by 10%

Candidates reporting increasingly improved satisfaction with recruitment and onboarding functions as measured by the onboarding survey. At least 90% of candidates will rate their recruitment experience positively.

Clearer published career pathways in place for every staff group

Increasing conversion of students to employees by 20%

Doubling the number of volunteer hours donated for the benefit of patients by 2025

Increased temporary staffing fill in areas where this is needed so that on average our unfilled shifts are no higher than 10% and agency staffing spend consistently under target.

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Case Study 2: Recruitment of Band 5 nurses

In 2016 the Trust had a worrying high level of Band 5 Nurse vacancies – approximately 30% of these posts were vacant and therefore we were running with staff shortages and lots of agency staff. We therefore embarked on a real recruitment drive both locally and overseas, mainly to India and the Philippines. We have welcomed so many new nurses to the Trust over the past three years and amazingly in August 2019 we hit a 0% vacancy rate for Band 5 nurses on our adult ward nurses. The nurses who have joined us have fed back that their recruitment experience has been really positive. They have been well supported to complete their English language test and their Objective Structured Clinical Examination (OSCE) which they require to obtain their NMC pin. Perhaps more importantly however they have been able to join in small groups and so have built lasting friendships with other nurses joining the Trust who share similar backgrounds. Our overseas nurses have quickly settled in to become highly valued colleagues that help make teamwestHerts the thriving diverse community we are so proud of! On average an amazing 96% of our Indian and Pilipino nurses are still with us after three years.

A great first few months and beyond Attracting great and talented staff to join our organisation and work in our Integrated Care System is a great start but we also need to make sure that we keep these staff and so retention is vital. We will make sure that people who join us are fully supported during the first few weeks and months by, for example, expanding the remit of on-boarding support, ensuring people have a positive, robust and meaningful induction with continuing development opportunities, enhancing the skills of our managers and expanding coaching opportunities. We will create a sense of belonging by engaging effectively with new staff and seeking to meet their expectations in respect of the Trust being a great place to work and learn. The Trust already offers staff a comprehensive corporate and local induction so new starters are brought up to speed from the outset with what they need to know to settle quickly into their new roles and teams but we want to make this even better. New starters will be supported through their initial few months with regular input from their line managers to ensure they understand and can meet their objectives and perform well in their roles. Having an effective appraisal helps to motivate and engage staff and we have made great strides in improving appraisal. We want to continue to improve this and make sure all staff receive an annual appraisal with a clear focus on their performance in respect of their objectives and behaviours, their wellbeing and on the support that they may benefit from to enhance performance further and help them in their career aspirations.

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New employees will benefit from excellent preceptorship and build long and effective relationships with their preceptor or mentor to ensure they can develop the skills and approaches required to perform well in their new roles. There are new career development pathways which take our clinical staff from registration to senior positions. That is why at WHHT we are committing to:

Measuring the employee’s onboarding experience through the on-boarding survey and taking steps to improve this based on feedback

Providing a positive, robust and meaningful induction with on-going continuing development opportunities

Providing excellent preceptorship to new clinical and non-clinical staff and on-going professional development and clinical supervision for clinical staff

All staff having a comprehensive annual appraisal with a focus on wellbeing, behaviours, objectives and their career aspirations so these can be planned for and met wherever possible.


Improved retention rates for new starters. On average our turnover rates for new starters leaving within a year has been circa 22%, our goal is to bring this down to 17%

Consistently excellent feedback from new starters about their onboarding experience as measured by the onboarding survey

Consistently achieving the 90% target for appraisals. The effectiveness of appraisals will be measured by the following staff survey question: Did your appraisal help you improve the way in which you did your job? We want to achieve a 90% positive response to this question

Positive evaluation of satisfaction with preceptor programmes. A flexible and inclusive workforce To recruit and retain the very best staff we need to create a flexible and inclusive workforce where all staff feel valued and able to contribute and give their best at work no matter what their role or their background. The Trust will be ensuring that it uses best practice approaches to create a truly inclusive culture and actively value the diversity of all staff, all the time. We will carefully monitor any differences in staff experience based on employees’ race, gender, sexual orientation and disability and seek to ensure all staff can benefit from working in a culture whereby diversity is celebrated and innovation through difference is maximized. The Trust will also create tailored and targeted interventions through clear action plans based on data, metrics and indicators from the Workforce Race Equality Standards as well as the Workforce Disability Equality Standards. This will include maximizing the employee support groups and networks particularly for staff and volunteers with a protected characteristic under the Equality Act (2010). It is recognized that our staff can bring their best selves to work when they are also being supported in their home lives and wherever possible the Trust will support

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employees in meeting their other responsibilities, for example as carers of young children or elderly parents. In becoming a more flexible employer the Trust is genuinely committed to exploring opportunities for agile working, aided by technological advancements. We have already been able to make some progress with this for some of our corporate teams but want to give all staff greater control and input about when and how they work through, for example, effective rostering. We are also working with our Bank provider to build work pattern opportunities that better match the preferences of our Bank staff with a view to increasing satisfaction with work/life balance for the temporary and permanent workforce. We also aspire to being more inclusive – bringing the equality, diversity and inclusion agenda to every part of the organisation and to everything we do. This includes ensuring that we support all people with a protected characteristic under the 2010 Equality Act, including people with a disability or long-term health condition by embedding the use of Equality Impact Assessments and each Director being accountable for a diversity and inclusion-related objective. We are committed to progressing to Disability Confident Leader status. That is why at WHHT we are committing to:

Ensuring employees contribute to rostering where possible to ensure their home life needs are also met

Building an inclusive culture that values the diversity of all staff at all times and facilitating opportunities for staff and volunteers with particular protected characteristics to meet together for mutual support and development

Supporting our staff who have caring responsibilities and personalising our approach to how we manage and care for our team.


Improved staff survey results relating to equality, diversity and inclusion so that we are at least above average for our benchmark group in all questions.

WRES and WDES indicator improvements year on year

We will have reduced our gender pay gap from 33% to 28%

Better representation of a diverse workforce at all levels of the organisation, including in the most senior roles

Staff reporting effective rostering including medical staff

Greater take up of agile working and use of technology to support staff to work remotely where possible.

5.2 Supporting and engaging our team

The second phase of this strategy encompasses three inter-related areas:

Looking after your health and wellbeing

Recognising your efforts

Listening to you

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Looking after your health and wellbeing We recognize the importance of having a happy and healthy workforce who feel a part of a team and who look forward to coming to work. We want to look after the physical, mental, spiritual and emotional health of our staff. Intrinsically we know this the right thing to do and there is a growing body of evidence that happy, healthy staff correlates to better clinical outcomes. As part of this area we are implementing the NHS Workforce Health and Wellbeing Framework, which looks at all aspects of staff health and wellbeing as well as continuing to promote our award-winning Schwartz rounds, Freedom to Speak Up and Safe Space initiatives and our pastoral and spiritual care services. We will continue to offer structured and formal debrief sessions when required as well as localized counselling services. A particular priority over the course of this strategy is to strengthen our support for the mental health and wellbeing of staff and to build upon the many initiatives and resources already introduced. The Trust will also be introducing the Thrive at Work initiative - a standard of good practice and a quality mark for health and wellbeing at work. We are working in partnership with colleagues from the Royal Free to develop an Occupational Health offer across both organisations that will bring benefits in terms of efficiencies and impact. Together we will introduce a range of practical resources and gain support from the wider community. Looking after thehealth and wellbeing of staff is something we will do throughout their time with us, from when they first start with us, if something happens whilst they work here that means they require additional support and workplace adjustment, if they take a break and return to work, and when they are thinking of perhaps retiring from work. We also understand that it can be difficult and stressful for staff to find local and affordable accommodation. This can be especially challenging for staff joining us from overseas. We will therefore look at our accommodation offering with a view to expanding this and thereby supporting our staff. That is why at WHHT we are committing to:

Ensuring our health and wellbeing services are known about and support is accessible for all staff

Maximising opportunities for peer support and clinical supervision

Developing a support package for staff who are off sick with stress and muscular skeletal ailments from the first day of absence

Provision of a range of new affordable and accessible staff accommodation options

Tackling violence and bullying so that all staff can come to work knowing that all actions have been taken to mitigate risks for a safe working environment

Having a toolkit of interventions to provide excellent support for the mental health and wellbeing of staff and ensuring managers are competent in its use.


An improvement in our health and wellbeing staff survey questions so that we are at least average for our sector in all questions.

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Achievement of the standards within the Health and Wellbeing Framework developed by NHS Employers, NHS England and NHS Improvement

Long, and short-term sickness rates that are consistently below 3.5%

Gaining Disability Confident Leader status.

Case study 3: Improvements in engagement - The Big 5

In 2017 West Hertfordshire Hospitals NHS Trust was in the bottom quarter for results

for the NHS Staff Survey with a response rate of 41 per cent. Staff did not believe

that the Trust was listening to their feedback. In light of this, the trust set about

addressing the lack of engagement by developing a campaign called the Big 5. The

Big 5 focussed on five key themes from staff survey results with each theme being

promoted for a whole month and a series of activities under each theme. The Big 5

was branded, widely promoted across the Trust and visibly linked to the staff survey

to ensure staff recognised they were being listened to.

The various initiatives have improved morale and culture at the Trust as well as

enabling us to recognise and value our staff and teams. The Big 5 is now in its

second year and has helped move the trust from the bottom third to the top 20 per

cent of organisations in NHS Staff Survey ratings.

Recognising your efforts One of the key factors affecting whether we feel engaged at work is the degree to which we feel valued and recognised by the organisation we work for and the people we work with. Recognising staff for their work can take many forms from a personal thank you from more senior staff, to an item in the staff newsletter, right through to a formal awards ceremony. We are always looking for new ways to make sure that we are making and taking time to recognise the enormous efforts that people make to do demanding jobs and ‘go the extra mile’. We look at what the best organisations do including those that are successful in winning some of the prestigious national awards to see what good practice we can bring to our organisation and teams. When we do something outstanding, we will also enter national awards as a way of sharing our good work with others, and more importantly, as a way of celebrating success with our teams - letting them know how proud we are of them. We also want to make sure that we remunerate our staff fairly for the work they do

and that we enhance the potential for staff to take advantage of opportunities to

maximise their own income and make their money go further. As a Trust we work to

Agenda for Change terms and conditions and already have a number of salary

sacrifice schemes but will be looking to extend our staff benefits by introducing a

WHHT staff discount scheme to complement the NHS staff discount scheme so that

we are amongst the best Trusts in the country in terms of staff benefit packages.

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That is why at WHHT we are committing to: • Supporting the health and wellbeing of our staff, giving real recognition to

our people for great work • Developing a fully branded, cohesive staff benefit/reward/discount

package that incorporates all the Trust’s reward initiatives • Exploring increased discounts on staff food over and above what we

already have • Looking at other useful facilities we can bring to our hospitals such as

hairdressing, opticians etc. • Celebrating and sharing staff awards and achievements via a dedicated

page on the internet and intranet and through e update • Continuing with the Big 5 and expanding staff recognition activities • Building our webpages / microsite and facilitating a one-stop

teamwestHerts portal


Year-on-year improvement in questions relating to staff feeling valued in our Staff Survey results. Our goal is to achieve the following positive response rates for these questions:

o 75% of our colleagues say that they look forward to going to work o 85% of our colleagues say that their manager values their work.

Increase in nominations for staff awards

Uptake of staff signing up to salary sacrifice and staff discount schemes. Listening to you We want our staff, without exception, to have strong voices and for them to tell us what we get right and what we need to do to improve when things go wrong. We already engage in the national staff survey and the staff Friends and Family Test which are formal ways of gathering in staff feedback. We will continue to develop forums for all groups of staff to have strong voices, to provide feedback and ensure that we respond to this feedback. Two ideas we are looking at, for example, include implementing an “only a coffee away” initiative and a big conversation tent because we want all teams to genuinely feel empowered to change things that need changing. We will build on the Big 5, our response to the staff survey. The Big 5 takes the five

‘big ticket’ areas of feedback each year and looks at ways of making things better or

introducing new and innovative initiatives to the Trust. We aim to develop this

successful initiative and incorporate clinical engagement plans to ensure we are

responsive to staff feedback.

We will continue to build upon the work to strengthen our partnership working with our staff side colleagues. We will ensure they are represented at key meetings / panels where staff experience is on the agenda. We will be maximizing the use of IT such as the staff engagement app to ensure

there are proactive ways of enabling staff to feedback to the organisation about how

we are doing.

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Our recognition initiatives are about rewarding individuals and teams who are doing

outstanding things but we also recognise that not everyone works in high functioning

teams or has brilliant experiences of the workplace. When things go wrong, we want

to make sure that we address concerns quickly and consistently. We will continue to

strengthen and promote our Freedom to Speak Up opportunities and address reports

of bullying and/or harassment. We will move to a resolution approach with an

absolute focus on mediation to achieve better communications and team work and

address concerns. We will also react quickly when teams are experiencing difficulties

with relationships and will provide structured support from our HR and Organisational

Development professionals.


Continuing with the Big 5 which focuses on areas that staff tell us are of most concern

Developing new forums for staff feedback and conversation and strengthen existing staff networks, recognising the contributions that staff make to these networks

Introducing an improved staff engagement app and maximising use of other technology to enhance engagement

Developing a resolution approach to achieve better communication, team work and address concerns.

Refreshing our comprehensive clinical engagement plan. Some of the ways we will measure success include:

Incremental increase in overall staff engagement score in the annual Staff Survey and questions relating to motivation, involvement and advocacy.

Incremental reduction in the numbers of staff reporting abuse, bullying and/or harassment via the Staff Survey

Incremental increase in numbers engaging in quarterly staff Friends and Family test.

Staff networks optimised and impacting the Trust; ensuring inclusion is wired into all decision making measured through numbers participating and evidence of impact.

5.3 Developing our team The third phase of our strategy encompasses three inter-related areas:

Developing your career

Everyone as a leader

A great place to learn Developing your career From the moment people join the Trust we want them to be supported and enthused to develop their full potential. This includes students who are on placements with us as we want them to choose us as their employer of choice when they qualify. Supporting and enthusing development is achieved through the Trust actively offering our staff learning opportunities, and through our managers and leaders having a great understanding of how they can best support their staff at all levels to

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develop and help staff achieve fulfilling careers. Staff will be supported both in their learning and in making evidence-based decisions in their role by a professionally staffed library and knowledge service and the Research Office We know that people will have diverse aspirations and at times staff will be striving to achieve promotional opportunities and at other times they may be looking to simply gain more expertise within their existing role or looking to diversify in terms of their skills and experience. Through regular discussion, we need to understand the development aspirations of our staff and seek to match these wherever possible. In this respect we will continue to provide the “Careers Matters” service, expanding it to be a one stop shop for expert careers advice and, where appropriate, coaching. It will be a hub where people can seek advice and guidance on developing their career in any direction and they will be offered:

Coaching to help them decide for themselves their direction.

Expert advice so that they will know the steps required.

Networking with those already in the desired roles so that they may get a deeper understanding of what the roles involve.

Mentoring to help them achieve their desired outcome. For those starting out in their careers, those looking for career change, and those looking to enhance their careers along specific clinical and professional pathways, the Trust is committed to continuing to use its Apprenticeship Levy to provide as many Traineeship and Apprenticeship opportunities as possible whether this involves training brand new staff as healthcare support workers or administrative staff, developing our people to become nursing associates (or therapies assistants, clinic coordinators, trainee healthcare scientists etc.) or then converting those assistants and associates into fully qualified nurses, allied health professionals, managers, accountants or scientists. Now that graduate professional apprenticeships are becoming available, we will actively look to start using these, in particular the direct nursing apprenticeship. The Trust will also continue to provide and expand its well-received nurse development programmes ranging from the preceptorship programme through to the implementation of the clinical nurse specialist and matrons’ frameworks. These opportunities are now open to our allied health professional staff and biomedical scientists as well as nurses. For those aspiring to be future leaders whether clinically or managerially we will link them into expert advice and where appropriate support people to engage in regional and national development programmes. We will be developing our Talent Management Strategy over the next few months, working to firm up our framework of support and take an active role in the regional Talent Management Community of Practice to ensure we have access to resources and intelligence to inform this area of work. Ensuring diversity and inclusion is embedded into this will be crucial. That is why at WHHT we are committing to:

Maximising use of the Reducing Pre-registration Attrition and Improving Retention (REPAIR) initiative to help students make the transition to becoming qualified staff and promoting on-going clinical supervision

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Expanding the scope of the Careers Matters service to create a one-stop resource for all those who wish to develop, change or explore new careers

Expanding the scope of our apprenticeship offerings, in particular introducing direct graduate apprenticeships in nursing and other professions and reaching out to our local community

Further enhancing and expanding the excellent development programmes for nurses and other clinical staff to incorporate action learning, coaching and clinical supervision

Recognising and managing our talent pool, and developing our Talent Management Strategy


The number of staff accessing careers matters and the number of those who report they found it helpful with their career development

In the staff survey the percentage of our staff believing their manager supports them to receive training, learning or development should be at least 95%

In the staff survey less than 15% of our staff should say they will be looking for a job in a new organisation within 12 months

An increase in our apprenticeship metrics and levy spend and the number of new professionals either directly or incrementally created through these programmes

The numbers attending and numbers benefitting from the development programmes for nurses and other clinical staff

Having a board-approved Talent Management Strategy which is fully implemented.

Everyone as a leader, supported by the very best managers The Trust recognises that every one of its people has the potential and ability to act as a leader within the organisation. Through effective leadership we can drive the Trust forward to become the best that it can be for its patients and service users. All staff should feel confident to express their ideas and suggest and implement innovations to help us to continually improve the services we provide. We also aim to ensure that research activity is integrated into clinical care. We will therefore offer a suite of leadership and management programmes to develop our staff at all levels, building on the success of the Trust’s own long-established Leadership Academy which has been running for the past 12 years. The Trust has already introduced an International Coach Federation accredited coaching skills course relevant for all staff. This is in addition to the new coaching courses for all levels of managers. The new “Evolve” First Line Leadership and Management programme started in 2019 and in 2020 it will be joined by “Rise,” a refreshed programme to develop first line managers into senior managers.

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Case study 4: MSc in Healthcare Leadership & Management

The WHHT Trust Leadership Academy started to deliver credit bearing short courses from 2008. There are six short courses delivered by the Trust and accredited by the University of Hertfordshire. The beauty of the courses is that they are delivered locally by our own teaching staff and the content is totally grounded in the work of the Trust. The assessment for each short course focuses on the student’s own area of work and enables the students to engage in quality and service improvement. Students who wish to do so can bolt these courses together to form an MSc in Healthcare Leadership & Management. Many students take up to five years to complete the whole programme which is a big challenge for people who are working in demanding jobs. To date we have had 32 members of teamwestHerts who have been awarded the MSc and we have a further 36 people who (all being well) will get their awards in 2020.

The Trust is a clinically led organisation so our Clinical and Divisional Directors need to be accomplished leaders and require highly targeted leadership and management support. The “Transform” programme for clinical leaders, established in October 2019, will provide them with all the skills, knowledge and support they need to be great clinical leaders. The Trust puts clinical leadership at the forefront and is part of an excellent community of practice in the East of England and a core member of the Hertfordshire and West Essex STP team focused on the leadership agenda through its Health and Care Academy. The Trust therefore will both drive and benefit from excellent leadership, in both its practice and specific programmes, across the STP. We will

support, develop and empower our clinicians, freeing up time for them to lead, not just internally to the Trust but in helping to shape and deliver new integrated care models in partnership with colleagues across the health and care system.

As a system the aspiration is for member organisations to take lead responsibility on appropriate interventions which will foster a greater level of collaborative working and maximise the use of resources, whilst preventing duplication of effort. As part of the Health and Care Academy website a ‘virtual hub’ will be created for leadership and development opportunities across health and social care, enabling easier sharing of best practice and access to the development programmes available in member organisations as well those organised at STP level.

Our reverse mentoring programme will also help create distributed leadership – the concept of everyone as a leader - by turning traditional mentorship on its head as senior leaders/board members become the mentees and colleagues from our staff become the mentors. There will be a focus upon colleagues with protected characteristics to become mentees. That is why at WHHT we are committing to:

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Putting clinical leadership at the forefront and supporting clinicians to maximise leadership opportunities

Developing the “Rise” Leadership and Management Programme for senior managers

Delivering a complete cycle of the first “Evolve” (First Line), “Rise” (Senior) and “Transform” (Clinical) Leadership and Management Programmes, evaluating them, and then delivering a new cycle every year thereafter

Providing coaching support to all leaders and managers in the Trust who would benefit from it

Providing coaching skills to all leaders and managers in the Trust so as to improve both their emotional intelligence and leadership and management skills

Continuing to support the STP level iteration of the Mary Seacole Programme

Actively contributing to the development of the leadership agenda and the development of leadership programmes at STP level, sharing our knowledge accordingly

Rolling out reverse mentoring Some of the ways we will measure success include:

Numbers attending leadership and management programmes and the quality of the evaluations

Incremental increase in staff survey questions relating to leadership and management development

STP level programmes accessed by our staff and staff from across the STP accessing our programmes

Numbers accessing coaching and subsequent improvements in morale in those areas

Positive evaluation of the reverse mentoring scheme by mentors and mentees A great place to learn To make the Trust a great place to learn we need a conducive learning environment, whether staff are learning with state of art equipment in the new simulation centre or simply using a seminar room for a follow up coaching session. We also need to support all learning, whether that is through our programmes, clinical research or simply the individual search for knowledge. We need to support the implementation of our Research Strategy 2020. Through our educational support services of the libraries, simulation, learning management systems and the investment the Trust provides for individual and departmental Continuing Professional Development (CPD), we will support all learning, truly making this Trust a great place to learn. With Acorn we have a learning management system that ensures that all mandatory training is properly counted and reported, reminding staff when their compliance is due. Our Simulation Centre has state of the art equipment and a dedicated team that generates valuable income. Going forward we are looking to achieve Teaching Hospital status by 2021 to give the Trust the recognition it deserves for great learning. We will be using Acorn to

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support developmental training in addition to mandatory training, starting with the leadership programmes to provide high class e-learning, both to back up our classroom offerings, and act as a standalone resource. That is why at WHHT we are committing to:

Deliver excellence in training, education and development for our staff and learners achieving Teaching Hospital Status for the Trust by 2021

Broadening out the e-learning offering to cover all non-mandatory training, starting with support for the leadership programmes and standalone resources in these areas increasing the activity and revenue of the Simulation Centre.

Auditing the décor and equipment of our classrooms and learning centers, making improvements where necessary and affordable

Upgrading the MEC Lecture theatres

Increasing research activity and supporting the implementation of our Research Strategy 2020.


Teaching hospital status being obtained by 2021

Classrooms and lecture theatres judged by user satisfaction surveys as being positive learning environments

Numbers of new e-learning programmes becoming available, and the metrics of those accessing them

Simulation Centre revenue and activity increasing incrementally.

5.4 Moving Forwards

The fourth phase of our strategy encompasses three inter-related areas:

Innovation & Technology

Working differently

Supporting change

Innovation & Technology Whilst we recognise that our IT infrastructure is currently in a poor condition it is an exciting time for us, with the promise of better hospitals and major investment in our buildings and IT. This is so important because we want to be able to introduce innovation which is not only about creating new things but is also about structured adoption of best practice. Best practice learning might come from government or other publications such as the Topol Review, from networking with colleagues from the Royal Free or across the STP or from systems and processes that people have observed from outside the sector. There is a clear need to ensure that staff are enabled to use new technology so they can make full use of what is available including decision support, artificial intelligence, robotics and genomics and adopt digital solutions. We recognize therefore that whilst many of the issues around access to IT infrastructure sit within the accountability of other parts of the

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organisation, it is fundamentally our role to make certain our people have the competences to maximize its power. That there is a link between innovation and technology is without question. Over the course of our People Strategy we expect to see massive strides made in digitalisation, technology to allow us to go ‘paperless’ and become more mobile, a plethora of ‘Apps’, robotic solutions, patient safety devices and probably things we have not even imagined. As a Trust we are embarking on a massive ‘catch up’ programme to address the poor state of our Information Technology and as this happens we need to be ready to adopt digital solutions such as the use of robotics in recruitment, agile and mobile working within a secure framework, better electronic learning to include the regular use of skype, webinars and other technologies across all our hospital sites. We also plan to continue our journey to make sure that our staff have crucial information at their fingertips. The full roll out of the electronic staff record (ESR) so that our staff can have better information on a self-serve basis to information about pay and pensions is a priority and will also give staff access to information about total rewards and benefits. As a workforce it is vital that staff, wherever they are based, are up-to-date in their practices and can access the best and newest evidence. This means having good access to information and our library and information services play a significant part in this process as mentioned above. We must ensure that we are using technology to deliver training and education where possible. We want, over the duration of this strategy, to support the objectives set out in the Research and Development Strategy as research and development are so fundamentally important to enabling our teams to provide the best care, for every patient, every day. Finally, we need to make sure that as a function responsible for looking after teamwestHerts we are exemplars of good practice in terms of our own parts of the website. We want people to be able to relate to our clear workforce brand and be able to promote our services with the minimum effort of the part of users. We need informatics leadership across the organisation. That is why at WHHT we are committing to:

Supporting all staff to be competent to fully embrace the power of technology appropriate to their roles and to adopt new technologies in their practice

Expanding our research and development activity so that more staff have the opportunity to be involved in research and more patients can benefit

Rolling out ESR self-service and supporting all staff to use it

Streamlining and modernising our library and information services and maximising elearning

Revising our parts of the website

Supporting a move towards agile and digitally enabled working as soon as the IT systems allow


Staff trained and competent to use and adopt digital solutions/technology

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Complete coverage of ESR, including increased data on the demographic and diversity of our people

Staff use and satisfaction with library and information services

Hits and positive feedback on our webpages

Agile working fully implemented. Working differently Over the past few years in the NHS we have seen the introduction of many new roles and advancement of existing roles. The Five Year Forward View introduced new ways of working and the NHS Long Term Plan and Interim People Plan have built upon these and added to them. New roles and new ways of working do bring challenges as well as multiple benefits. Making sure we have the right staff, with the right skills, working safely and effectively in the right services is no simple task and as an employer we must ensure that the governance structures we have in place enable staff to work differently. Developing the support workforce (clinical and non-clinical) including assistant practitioner roles, social prescribing roles, and the use of volunteers is highlighted in the NHS Long Term Plan. We expect to see an expansion of the Nursing Associate which we have been involved with from the outset and Physicians Associate roles. We need to make sure we are making best use of the Apprenticeship Levy in developing our staff at all levels but particularly for these staff. Advanced roles such as expanding advanced practitioners in A&E and theatres will be crucial to enable us to maintain services and we need to ensure robust medical and non-medical credentialing is in place to support the governance framework around these extended roles. We need to make sure we apply these principles to our valued clinical nurse specialist roles as well and enable them to work in an increasingly autonomous way, with access to excellent evidence and support. We also recognise the aspiration of the STP to move to a more integrated workforce and as we move to more Integrated Care Provider contracts and to an Integrated Care System we will be working together to look at how this can become a reality. The vision is to have ‘One workforce across Hertfordshire and West Essex; delivering high quality, seamless, and person centred care’. The STP workforce strategy is built upon five key themes:

1. Attraction, recruitment and retention

2. Education and development

3. Innovation and technology

4. Leadership and organisational development

5. Enabling a one workforce approach

Finally, we need to make sure we use benchmarking data being produced as part of the national Model Hospital work to reduce unwarranted variation in our workforce and to learn from and adopt, where relevant, best practice from those that are achieving the best results.

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Fundamental to delivering change is the role of the Organisational Development teams who can support our people to think differently and work in different ways. This may challenge some in a variety of ways and we need to ensure that people can be equipped to manage and cope with change. That is why at WHHT we are committing to:

Designing new roles that support care delivery, fill workforce gaps and provide development and career opportunities for our staff, including making best use of the apprenticeship levy

Adopting new roles and new ways of working in a proactive way with appropriate development and appropriate governance structures in place

Embracing the concept of credentialing as set out in the NHS Long Term Plan

Working with STP partners to deliver the STPs workforce strategy

Strengthening our Organisational Development (OD) offer to support key organizational and system priorities.


Number of staff working in new (defined) roles including the number of nursing associates, physician’s associates, advanced practitioners and the impact on overall performance

Spending of the Apprenticeship Levy

Numbers of staff actively engaged in OD work

Level of joint working with the STP measured through numbers of shared initiatives, numbers participating.

Supporting change There has never been a more exciting time to work at WHHT with a massive

redevelopment programme on the horizon, digital transformation opportunities,

integrated care which will change the shape of services and shared decision-making.

We are closer than ever before to being able to significantly invest in our three

hospital sites. The development of the sites will bring great opportunities to work

differently and we recognize that the shape of our teams might need to change.

When this becomes evident, we will be working with staff and service users who

have the requisite knowledge and experience to harness their ideas about how best

to do things differently. Co-production and co-design are genuine aspirations and we

must make sure our leaders, our staff and our patients are enabled to understand

what this means and how to do it well.

We will also be looking to adopt Agile Working and there may be opportunities to

streamline or outsource some services across the STP or wider system. Advances in

medicine may also mean that some services can safely be managed out of hospital

and we expect to see more and more use of remote telemedicine.

As we plan for our site development and new ways of working, we will require

support with good people management practices and we expect that our HR

Business Partner (HRBP) roles will be significant in ensuring any required changes

are handled sensitively and effectively and with the full consultation of our teams. As

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new teams emerge, they may also need support from our HR and Organisational

Development (OD) practitioners, and others to work in new environments, with new

technology and in new teams.

The Herts & West Essex Health and Workforce Strategy sets out the clear aspiration

for one workforce and we need to be prepared and ready for this. We will also work

collaboratively with our colleagues at the Royal Free who have recent experience of

moving from old buildings to new premises on a large scale.


Further developing our existing HRBPs

Refining our OD capability and capacity to support organizational and system priorities

Ensuring that the needs of our staff (as well as our patients) are considered in the new hospital development


Smooth transitions when services change measured through levels of challenge

A stable and skilled HRBP and OD resource able to meet the demands of the organization

Evaluation of success for key OD programmes e.g. Electronic Health Record (EHR) implementation

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Section 6: Governance, monitoring and evaluation

Having an approved People Strategy is clearly an important first step in our

continued improvement journey but if the strategy is not implemented, and the

actions we propose are not put into practice then our progress towards excellence

will falter.

Governance The team responsible for developing the strategy wants to be held to account for its delivery. The group that will oversee the implementation of the strategy is the newly established ‘Great Place to Work Implementation Group’. This groups reports to the Trust Management Committee and feeds into the ‘People, Research and Education Committee’ which is a committee of the Trust Board. Monitoring Each of the four phases of the People Strategy has a lead with responsibility for ensuring that the activities within the phase are monitored and reported on. The lead role is one of co-ordination – leads are not necessarily responsible for the actions within the phase although in some cases roles will be coterminous. All four leads have a shared responsibility for ensuring the threads of the strategy are given due cognizance. Evaluation Dedicated agenda time at the monthly Senior People Leadership Management Group will be used to continuously update the detailed implementation plan. Each lead will be expected to provide a short, written highlight report for their phase and report any exceptions to progress, with an associated rectification plan. There will be four scheduled formal reviews – one at the end of the each of the first four years of the strategy. The strategy will then be renewed mid-way through the fifth year.

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Section 7: Introduction to the implementation plan

A full implementation plan will accompany this strategy which will contain all

commitments and related measures. We have included the basis of the plan in

Appendix I, which is derived from the measures of success set out in the previous

sections of our strategy.

In Appendix II we have included further detail of our staff survey metrics – this will be

one of the significant ways that we will measure the progress of our People Strategy.

We have included the 2018-2019 staff survey results for the Trust in questions

relevant to our People Strategy and our stretch targets where appropriate.

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References

Carter, Lord Carter of Coles 2016 Productivity in NHS Hospitals. DHSC. London.

Department of Health and Social Care 2019 Kark review of the fit and proper

persons requirement. DHSC. London.

Health Education England 2019 Preparing the healthcare workforce to deliver the

digital future – The Topol Review. Available from https://topol.hee.nhs.uk

Herts and West Essex STP 2019 Health and Social Care Workforce Strategy.

Unpublished.

NHS Employers 2018 NHS Health and Wellbeing Framework. Available from

www.nhs.employers.org

NHS England 2019 NHS Long Term Plan. Available from www.longtermplan.nhs.uk

NHS England 2019 Interim People Plan. Available from www.England..nhs.uk

NHS England 2015 Five-year forward view. Available from www.England.nhs.uk/wp-

content/uploads/2014/10/5yfv-web.pdf

West M. and Dawson J. F. 2012 Employee engagement and NHS performance The

Kings Fund. London.

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https://topol.hee.nhs.uk/

http://www.nhs.employers.org/

http://www.longtermplan.nhs.uk/

http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

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Appendix 1: Summary of what we will achieve

1. An increase in the ratio of appropriate candidates to posts particularly for hard to fill roles

2. Reduced time to hire by 10% 3. Candidates reporting increasingly improved satisfaction with recruitment and

onboarding functions as measured by the onboarding survey. At least 90% of candidates will rate their recruitment experience positively.

4. Clearer published career pathways in place for every staff group 5. Increasing conversion of students to employees by 20% 6. Doubling the number of volunteer hours donated for the benefit of patients by

2025 7. Increased temporary staffing fill in areas where this is needed so that on

average our unfilled shifts are no higher than 10% and agency staffing spend consistently under target

8. Improved retention rates for new starters. On average our turnover rates for new starters leaving within a year has been circa 22%, our goal is to bring this down to 17%

9. Consistently excellent feedback from new starters about their onboarding experience as measured by the onboarding survey

10. Consistently achieving the 90% target for appraisals. The effectiveness of appraisals will be measured by the following staff survey question: Did your appraisal help you improve the way in which you did your job? We want to achieve a 90% positive response to this question

11. Positive evaluation of satisfaction with preceptor programmes. 12. Improved staff survey results relating to equality, diversity and inclusion so

that we are at least above average for our benchmark group in all questions. 13. WRES and WDES indicator improvements year on year 14. We will have reduced our gender pay gap from 33% to 28% 15. Better representation of a diverse workforce at all levels of the organisation,

including in the most senior roles 16. Staff reporting effective rostering including medical staff 17. Greater take up of agile working and use of technology to support staff to

work remotely where possible. 18. An improvement in our health and wellbeing staff survey questions so that we

are at least average for our sector in all questions. 19. Achievement of the standards within the Health and Wellbeing Framework

developed by NHS Employers, NHS England and NHS Improvement 20. Long, and short-term sickness rates that are consistently below 3.5% 21. Gaining Disability Confident Leader status 22. Year-on-year improvement in questions relating to staff feeling valued in our

Staff Survey results. Our goal is to achieve the following positive response rates for these questions:

a. 75% of our colleagues say that they look forward to going to work b. 85% of our colleagues say that their manager values their work.

23. Increase in nominations for staff awards 24. Uptake of staff signing up to salary sacrifice and staff discount schemes.

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25. Incremental increase in overall staff engagement score in the annual Staff Survey and questions relating to motivation, involvement and advocacy.

26. Incremental reduction in the numbers of staff reporting abuse, bullying and/or harassment via the Staff Survey

27. Incremental increase in numbers engaging in quarterly staff Friends and Family test.

28. Staff networks optimised and impacting the Trust; ensuring inclusion is wired into all decision making measured through numbers participating and evidence of impact.

29. The number of staff accessing careers matters and the number of those who report they found it helpful with their career development

30. In the staff survey the percentage of our staff believing their manager supports them to receive training, learning or development should be at least 95%

31. In the staff survey less than 15% of our staff should say they will be looking for a job in a new organisation within 12 months

32. An increase in our apprenticeship metrics and levy spend and the number of new professionals either directly or incrementally created through these programmes

33. The numbers attending and numbers benefitting from the development programmes for nurses and other clinical staff

34. Having a board-approved Talent Management Strategy which is fully implemented.

35. Numbers attending leadership and management programmes and the quality of the evaluations

36. Incremental increase in staff survey questions relating to leadership and management development

37. STP level programmes accessed by our staff and staff from across the STP accessing our programmes

38. Numbers accessing coaching and subsequent improvements in morale in those areas

39. Positive evaluation of the reverse mentoring scheme by mentors and mentees 40. Teaching hospital status being obtained by 2021 41. Classrooms and lecture theatres judged by user satisfaction surveys as being

positive learning environments 42. Numbers of new e-learning programmes becoming available, and the metrics

of those accessing them 43. Simulation Centre revenue and activity increasing incrementally. 44. Staff trained and competent to use and adopt digital solutions/technology 45. Complete coverage of ESR, including increased data on the demographic and

diversity of our people 46. Staff use and satisfaction with library and information services 47. Hits and positive feedback on our webpages 48. Agile working fully implemented. 49. Number of staff working in new (defined) roles including the number of

nursing associates, physician’s associates, advanced practitioners and the impact on overall performance

50. Spending of the Apprenticeship Levy 51. Numbers of staff actively engaged in OD work

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52. Level of joint working with the STP measured through numbers of shared initiatives, numbers participating.

53. Smooth transitions when services change measured through levels of challenge

54. A stable and skilled HRBP and OD resource able to meet the demands of the organization

55. Evaluation of success for key OD programmes e.g. Electronic Health Record (EHR) implementation.

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Appendix II: Key staff survey metrics and how they will change

over the course of the strategy

The table below details the key staff survey related metrics set out in this document

and their current position in terms of how many of our staff either agree or strongly

agree with the statement, how this benchmarks against other NHS providers and our

target goal for this metric. There are ten grouped themes within the staff survey. A

significant number are relevant but we have tried to pick out those that relate most

specifically to our People Strategy.

Question Current Performance

Benchmark Performance

Target goal

I look forward to going to work

65% 58% 75%

I am enthusiastic about my job.

78% 74% 80%

I would recommend my organisation as a place to work.

59% 60% 65%

If a friend or relative needed treatment I would be happy with the standard of care provided by this organisation.

59% 68% 70%

The organisation acts fairly with regard to career progression/promotion regardless of ethnic background, gender, religion, sexual orientation, disability of age

82% 84% 85%

I have experienced musculoskeletal problems as a result of work activities

31% 29% 27%

I have felt unwell as a result of work-related stress

36% 39% 34%

I have come to work despite not feeling well enough to perform duties

52% 57% 50%

I have experienced discrimination at work from patient/service users, their relatives or other members of the public

9% 6% 5%

I have experienced discrimination at work from a manager/team leader or other colleagues

9% 8% 5%

I have experienced bullying and harassment from patients/public

28% 29% 20%

Experienced harassment, bullying or abuse at work from managers in the last 12 months.

12% 14% 10%

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I have experienced bullying and harassment from colleagues

20% 20% 13%

Has your employer made adequate adjustment(s) to enable you to carry out your work?

74% 73% 85%

How satisfied are you with the opportunities for flexible working

54% 51% 60%

Does the organisation take positive action on health and well being

91% 89% 92%

My immediate manager values my work

76% 71% 85%

I am satisfied with the support I get from my immediate manager

73% 68% 75%

My immediate manager gives me clear feedback on my work

67% 59% 70%

My manager asks for my opinion before making changes which affect my work

60% 53% 70%

My immediate manager takes a positive interest in my health and well-being

71% 67% 75%

I am able to make suggestions to improve my working environment

75% 73% 85%

My manager supports me to receive training, learning or development

93% 92% 95%

I am involved in deciding on changes introduced that affect my work area/team/department

54% 51% 55%

I receive the respect I deserve from my colleagues at work

75% 71% 80%

I have unrealistic time pressures.

31% 33% 25%

Relationships at work are strained

16% 17% 10%

My immediate manager encourages me at work.

73% 67% 75%

I often think about leaving this organisation

27% 30% 20%

I will probably look for a job in a new organisation within the next 12 months

21% 21% 15%

As soon as I can find another job, I will 16% 15% 12%

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leave this organisation.

Did it (the appraisal, annual review, development review or KSF review) help you to improve how you do your job?

78% 70% 80%

Did it (the appraisal, annual review, development review or KSF review) help you agree clear objectives for your work?

89% 84% 90%

Did it (the appraisal, annual review, development review or KSF review) leave you feeling that your work is valued by your organisation?

81% 76% 90%

Were the values of your organisation discussed as part of the appraisal process?

85% 79% 90%

Experienced physical violence at work from patients / service users, their relatives or other members of the public in the last 12 months.

15% 15% 10%

Experienced physical violence at work from managers in the last 12 months.

1% 1% 0%

Experienced physical violence at work from other colleagues in the last 12 months.

2% 2% 0%

My organisation treats staff who are involved in an error, near miss or incident fairly.

61% 57% 65%

I would feel secure raising concerns about unsafe clinical practice.

69% 68% 80%

I am confident that my organisation would address my concern.

59% 54% 80%

There are enough staff at this organisation for me to do my job properly.

37% 29% 50%

[How satisfied are you with] The recognition I get for good work.

60% 55% 70%

[How satisfied are you with] The 81% 81% 85%

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support I get from my work colleagues.

[How satisfied are you with] The extent to which my organisation values my work.

52% 44% 60%

[How satisfied are you with] My level of pay.

31% 34% 35%

Senior managers here try to involve staff in important decisions.

39% 32% 45%

Senior managers act on staff feedback.

40% 30% 45%

Have you felt pressure from your manager to come to work?

26% 26% 20%

Have you felt pressure from colleagues to come to work?

21% 22% 20%

The last time you experienced harassment, bullying or abuse at work, did you or a colleague report it?

46% 46% 75%

In the last 12 months, have you had an appraisal, annual review, development review, or Knowledge and Skills Framework (KSF) development review?

87% 87% 90%

Were any training, learning or development needs identified?

72% 67% 90%

Have you had any training, learning or development in the last 12 months?

71% 70% 80%

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1

Trust Board Meeting

06 February 2020

Title of the paper Strategy Update

Agenda Item 14/79

Presenter

Helen Brown, Deputy Chief Executive

Author(s)

Helen Brown, Deputy Chief Executive

Purpose

Please tick the appropriate box

For approval


Executive Summary

This paper provides an update to the Committee on the progress of the key strategic work programmes for 2019-2020.



Objectives 1-5


work Objectives 6-8

Aim 3 Improve our

finances

Objective 9


future

Objective 10-12


☐Is there the leadership capacity and capability to deliver high quality,

sustainable care?

☒Is there a clear vision and credible strategy to deliver high quality,

sustainable care to people, and robust plans to deliver?

☐Is there a culture of high quality, sustainable care?

☒Are there clear responsibilities, roles and systems of accountability to

support good governance and management?


performance?

☒Is appropriate and accurate information being effectively processed,

challenged and acted on?

☐Are the people who use services, the public, staff and external partners

engaged and involved to support high quality sustainable services?

☐Are there robust systems and processes for learning, continuous

improvement and innovation?



Trust Management Committee – 29 January 2020

Action required

The Board is asked to receive the report as assurance on the progress of the key strategic work programme in delivery for year 2019-2020.

14

Tab 14 Strategy update


2

Agenda Item: 14/79 Trust Board meeting – 06 February 2020 Strategy Update. Presented by: Helen Brown, Deputy Chief Executive

1. Purpose 1.1 This paper provides an update to the Committee on the progress of the key strategic work

programmes for 2019-2020.

1.2 In line with the new bi-monthly reporting schedule, the following work programmes are included this month and are reporting on the January (M10) position (with the exception of the Access programme which is reporting a December, M9 position): 1. Workforce 2. Getting to Good 3. Clinical 4. Integrated Care 5. Access 6. Research

1.3 The Committee is asked to note the attached paper and the position on the 13 projects

reported.

1.4 Table 1 (Year 1 – 2019-2020 Strategic Priorities) lists projects which are within a variety of project life cycle stages, ranging from ‘development of business case’ to ‘in delivery’ and for which project leads provide RAG rated updates.

1.5 RAG ratings are based on delivery against the Trust’s improvement plans and are reported and tracked through their associated committees.

1.6 Emergency Care Transformation remains Red rated, as performance continues to be adverse to plan. This month’s performance report highlights an unprecedented demand and activity in December 2019.

1.7 There were two movements on RAG rating in month; the first relates to the Urgent Treatment Centre on the Watford site, which has moved from an Amber rating to a Green rating to reflect the programme of work being back on track and the second relates to the RTT & Cancer Access Programme, which has moved from a Green rating to an Amber rating, due to both standards not currently being met, details of which are set out in the January TMC Access Performance update paper.

1.8 The project to transfer oesophago-gastric (OG) services to the new Specialist OG Cancer Unit at Hammersmith has now completed.

14



3

1.9 Of the remaining schemes, five projects remain Amber rated and four projects remains Green rated.

2. The priorities are listed below and known RAGs are as follows.

Table 1: Year 1 – 2019-2020 Strategic Priorities.

3. Discussion.

Great People

3.1 Following further work to ensure strategic alignment to the new Five Year Strategy, the ‘PeopleStrategy’ is being presented to Trust Board in February 2020 for approval.

G A R C TBC

Green / on trackAmber / some

risks or delays.

Red / significant

risks or delays.

Complete /

closed.

New to list or

update yet to be

received

14



4

Best Care - Getting to Good

3.2 CPG Programme. All pathways have been process mapped against existing pathways. Seven out of eight pathways have cohorts identified, annual activity reviewed and a measurement plan agreed. A Data Collection Officer came into post in January 2020 (3 days a week) to support the manual data collection process. The next step is to present the data analysis for all pathways at divisional level to understand any unwarranted variation and to begin redesigning pathways.

3.3 Quality Hub Development and QI Roll Out. A QI coaching course with representation from the Divisions commenced in November 2019 and is due to complete in April 2020. Funding has been secured to run a further two cohorts of QI coaching course in 2020/2021. A Quality Improvement Awareness Campaign (bitesize sessions) is underway with an emphasis on the QI PDSA methodology, to support the dosing strategy until the end of March 2020. A second QI Lead is now in post.

3.4 The ‘Getting it Right First Time’ (GIRFT) programme has recently been extended to now cover a series of forty surgical and medical workstreams.

3.5 Recent workstreams launched include the Lung Cancer workstream; the Trust is awaiting dates for the deep dive visit which is expected in be in Q1 2020/21. The Paediatric T&O workstream has also recently launched and a Trust data collection exercise is underway, with a visit expected to be scheduled from May onwards. An Adult Spinal Services review is also underway at the Trust. This review has been developed to support assurance on delivery of adult spine services in England and helps supplement the ongoing work being led by GIRFT on adult spine delivery and transformation. GIRFT visits continue to be well attended by the clinical leads and wider clinical team, with divisional support, alongside key members of the Executive team. Recent deep dive visits held at the Trust include Radiology (12th December) and Emergency Medicine (15th January). Follow up meetings will be scheduled to review the GIRFT recommendations from these visits and to agree implementation plans. Progress will be monitored both at divisional level and through the Trust's Quality Committee.

Best Care - Clinical Strategy/Service Redesign

3.6 The number of patients being identified for Enhanced Care at SACH is now increasing and uptake from General Surgery and Urology has been good. It is worth noting that the service was originally anticipated to be running 5 days per week; however this is not the case due to a lack of outreach nursing cover on Friday nights & weekends meaning that the service is only available 4 days per week. The division is considering whether it would be appropriate to amend activity targets to reflect this. 109 procedures took place during 2019 (February 2019 to December 2019) and work is ongoing to continue to improve performance with an action plan being developed to support this. Data for January 2020 is positive with 24 cases completed.

14



5

3.7 Plans to launch a Vascular Network across Hertfordshire and West Essex continue to be progressed. East and North Herts NHS Trust (E&NH) have been chosen as the hub, with Princess Alexandra Hospital (PAH) and WHHT being specified as the spoke services.

The next steps for this project are to assess the impact of proposed changes on local

services. The draft pathways, appropriate for wider clinical sharing, have been drafted and

shared at CAG and at divisional management groups, with the key concerns being out of

hours cover, under the proposed staffing model, ways of mitigating these issues are being

developed with the hub.

Further impact on the financial and staffing impact of the network is dependent on

information being generated by the hub team, this has been delayed, though is now

expected by mid February 2020, with an impact assessment over the following months, to

integrate into the business case before it goes through Board approval processes in all

relevant NHS organisations.

The outline business case is being developed and is currently expected to come to WHHT

Trust Board in May, with a full business case proposed to be presented later in the year.

3.8 Medical Take Pilot. TMC have now approved an extension to the pilot until June 2020, which also extends the pilots to weekends. The project team are engaging with HR representatives to ensure oversight on job plans for the transition to BAU and progress any related management of change processes.

3.9 The process of completing the transfer of both WHHT surgeons & registrars and WHHT patients to the new Hammersmith Oesophago-gastric cancer unit has now been completed. The focus is now on backfilling WGH Theatres with benign activity and measuring the performance and associated financial benefit of the move of OG activity to Hammersmith. A benefits realisation paper will be presented to TMC in April 2020, six months post the new service go-live in September 2019.

Best Care - Integrated Care

3.10 There are no areas for escalation on the 2019-20 SDIP. Progress on pathways include:

Development of an Integrated Dermatology Pathway: The community pilot launched in February 2019. The first six months audit of the pilot has been developed and discussed with Herts Valleys CCG (HVCCG). HVCCG has asked WHHT to provide a pilot community service for St Albans and Hertsmere localities up until the end of July 2020. The proposed model was presented at TMC on 29th January and approval to proceed was given. Development of the Cardiology Pathway: The service specification for the Cardiology Referral Support Service (CRSS) along with associated activity and financial modelling has been agreed between WHHT & HVCCG. The proposal for the new service model was presented to TMC 29th January 2020 and approved. Next steps are the CRSS will be rolled out from April 2020.

3.11 The Urgent Treatment Centre at WGH has a confirmed go live date of 1st April 2020 (subject to a final ‘go / no-go readiness assurance process in March 2020) with Greenbrook Healthcare as the service provider. Good progess is being made with all aspects of the

14



6

implementation plan and a positive relationship has been established between Greenbrook, the WHHT Emergency Care leadership team and the Programme team. Stakeholder engagement is underway and a successful open evening was held for all stakeholders on the Watford site.

4. Recommendation

4.1 The Board is asked to receive the report as assurance on the progress towards delivery status of strategic priorities.

Helen Brown Deputy Chief Executive January 2020

14



7

Appendix A WHHT Strategy Delivery Master Programme 2019-2020

Vis

ion

AIM

S

Best Care Best Value Great People Great Place

Getting to Good CIP Workforce Digital Programme

Mike Van der Watt / Tracey Carter Rodney Pindai Paul Da Gama Paul Bannister / Sean Gilchrist

Clinical Pathway redesign / Royal Free

CPG programme ( 7 x clinical pathways)Private Patients programme

Develop the Trust’s refreshed People Strategy

(and supporting Implementation Plan)Electronic Patient Record (Outline Business Case)

Quality Hub development and QI roll out Health Records Standardisation (Business Case)

Practice Development to support R&R of

new workforce and skill mix Telephony Replacement (Business Case)

GIRFT (Getting it Right First Time) Transition to ATOs

New Local Area Network

Financial recovery plan Research StrategyStabilising the IT infrastructure (Migration & Service

Improvement)

Don Richards Mike Van der WattCancer Information System (CIS) - full implementation

and benefits realisation

Interim Estate

Esther Moors

Consolidation of Orthopaedic Outpatients at SACH

(Holywell)

Urology Centre (Business Case) - in scope

Develop Interventional Radiology service (OBC)

Medical Take Redesign (4 week pilot)Neonatal FBC - to improve the environment on

Woodlands Neonatal Unit

ED Development (Wave 4 capital - FBC) Capital from

NHSI

Watford Theatre Reconfiguration (FBC)

WGH Multi-Storey Car Park FBC & approvals

To improve Pathology service to the Trust and HVCCG

(STP Pathology outsourcing)

Back office relocation (to release space at WGH for

key estate and IT priorities)

Hemel Planned Care -in scope

2019-20 Winter Plans (to provide additional

assessment space for Winter)

Acute Redevelopment

Esther Moors

Refresh Strategic Outline Case (SOC) Yr 1

Strategic Programme 2019-20 v8.0 20191107

2019-2020 Integrated Care (incl SDIP & Urgent and Emergency Care Redesign)

Access

Sally Tucker / Jane Shentall

Emergency Care Transformation (ED Access)

Patient Flow Transformation (Inpatients)

RTT & Cancer Programme Yr 1 (Elective)

WHHT Strategy Delivery Master Programme 2019-2020

OUR VISION IS TO PROVIDE THE BEST CARE TO EVERY PATIENT EVERY DAY.

Str

ate

gic

Pri

ori

tie

s 1

9-2

0 Clinical Strategy/Service Redesign

Helen Brown

SACH Expansion of Enhanced Surgical Activity for Enhanced Care Patients

Vascular Hub

To merge WHHT Oesophago-gastric cancer unit with Imperial

Integrated Care

Fran Gertler / Helen Brown

14



8

14




Title of the paper

Corporate risk register report

Agenda Item

15/79

Presenter

Mike van der Watt, Chief Medical Officer

Author(s)

Dorothy Otite, Interim Risk Manager

Purpose Please tick the appropriate box

For approval For discussion For information

Executive

Summary

The purpose of this report is to provide an update on the status of the Corporate Risk Register (CRR) including current risk scores, new, escalated, de-escalated and closed risks.

Trust strategic

aims



Objectives 1-5


work Objectives 6-8

Aim 3 Improve our

finances

Objective 9


future

Objective 10-12


☒Is there the leadership capacity and capability to deliver high quality,

sustainable care?

☒Is there a clear vision and credible strategy to deliver high quality,

sustainable care to people, and robust plans to deliver?

☒Is there a culture of high quality, sustainable care?

☒Are there clear responsibilities, roles and systems of accountability to

support good governance and management?


performance?

☒Is appropriate and accurate information being effectively processed,

challenged and acted on?

☒Are the people who use services, the public, staff and external partners

engaged and involved to support high quality sustainable services?

15

Tab 15 Corporate Risk Register


☒Are there robust systems and processes for learning, continuous

improvement and innovation?


Previously

considered by

Since the last Board meeting, the CRR has been reviewed by the Risk Review Group once (on 20 January 2020). Specific elements of the CRR have been reviewed through the committee structure during this period.

Action required

The Board is asked to review the corporate risk register and endorse the

changes to the CRR.

15



Agenda Item: 15/79 Trust Board meeting – 06 February 2020 Corporate Risk Register Report Presented by: Mike van der Watt, Chief Medical Officer

1. Purpose

1.1 The purpose of this report is to provide the Board with an update on the status of the CRR including current risk scores, new, escalated, de-escalated and closed risks.

1.2 To provide the Board with assurance that the risks to achieving the strategic aims and objectives are being appropriately mitigated against and that progress is being made against fulfilling the actions as commissioned by each respective committee.

2. Background

2.1 The CRR forms part of the Trust’s overall board assurance and integrated risk management arrangements.

2.2 The CRR contains all risks rated 15 and above from each of the operational & divisional

risk registers. The risk register is a ‘live’ document recorded on Datix; each lead for risk regularly reviews and updates the entries.

2.3 The Chief Medical Officer is the Trust’s delegated lead executive for risk management. 2.4 The Quality Committee is a subcommittee of the Board which oversees assurance for risk

management arrangements within the Trust.

3. Corporate Risk Register (CRR)

3.1 This report captures the decisions made by the Risk Review Group (RRG) on 20 January 2020. Data for this report was extracted from the CRR on 13 January 2020, a total of 25 open risks were registered.

3.2 Appendix 1 provides a full summary of all corporate risks as presented to the RRG on 20 January 2020.

3.3 Table 1 below presents the movement of risks by division, against each month since

August 2018 to date as registered on the CRR.

15



3.4 Risk activity

The following provides an overview of risk activity as discussed at the Risk Review Group on 20 January 2020.

New risk (1) Risk 4241 was discussed at the RRG meeting on 20 January 2020; there was discussion related to the risk and it was highlighted that an order had been placed in December which would resolve this risk and that delivery was imminent. The risk was not accepted onto the Corporate Risk Register and the group agreed that this risk would be reviewed at the next RRG meeting in February.

ID Division Current Risk Rating

Risk title Rationale Exec Lead

4241 Medicine 16 L4 X C4

McKesson storage/ archiving capacity deficit

There are concerns that McKesson (a Picture Archiving Communication System (PACS)) may reach full capacity due to an increase in demand for inpatient echocardiography investigations and the introduction of a 7 day echocardiography service. Once capacity has been reached the system’s ability to store and archive images will immediately cease leading to Cardiology’s inability to provide an in/outpatient echocardiography service or undertake some CCL procedures in the interest of patient safety. This has a potential negative impact on patient safety, putting the Trust at risk of prosecution or a major incident. Including potential impact on the Trust’s reputation and regulatory concerns.


Mitigated risk approved for closure/Closed risk (1) Risk 4114 was reviewed by the RRG and agreed for closure and removal from the risk register.

ID Division Current Risk Rating

Risk title Rationale Exec Lead

4114 Clinical Informatics

15 L5 X C3

Delivery of the ICT Service Transition Programme

The final Programme Board took place on 10th December 2019 to close down the programme of work. As such this risk has been fully mitigated and should be closed.


15



De-escalated risks (2) Two risks were presented to the RRG for de-escalation. Risk 3710 – Further work has been undertaken to mitigate this risk and there is a QI project which is addressing the documentation compliance element. The group agreed the de-escalation of this risk. Risk 4065 – The RRG discussed this risk and requested further information is obtained from the Director of Environment to clarify the rationale behind the scoring of the risk and the actions which are being taken to mitigate it. The risk will be reviewed by the group in February 2020.

ID Division Risk Rating

Risk title Exec Lead Rationale

3710 Corporate 15 ↓12 Incomplete / Non- compliance with Do Not Attempt Cardiopulmonary Resuscitation process


Safeguarding panel continues to monitor compliance with MCA and DNACPR using a Dip audit tool. This risk has been de-escalated to the Corporate Services Divisional Risk Register due to completion of the actions and strengthening of the controls in place to mitigate the risk.

4065 Environment 15 ↓12 Non-compliant Georgian Wired (GW) Glazing in Non-compliant Georgian Wired (GW) Glazing in areas of the Trust

Director of Environment

This risk was not approved for addition to the CRR at the last RRG meeting as the group requested that the score is reviewed.

Revised current risk scores (0) During the reporting period, there has been no movement in risk scores other than the de-escalated risk reported above. The remaining risks on the CRR have remained static. Emerging risk (0) During the reporting period, no emerging risk has been identified or reported.

4. Risks 4.1 A failure to keep effective oversight of the Trust’s key risks may lead to the Trust not

achieving its organisational strategic aims and objectives.

15



5. Recommendation

5.1 The Board is asked to review the CRR and agree the changes made to the CRR during this reporting period.

Dr Mike van der Watt Chief Medical Officer January 2020

15



Appendix 1 – Corporate risk register summary (by Division)

ID

OP

EN

ED

DA

TE

DIVISION

RISK TITLE

INIT

IAL

R

ISK

RA

TIN

G S

CO

RE

PROGRESS NOTE

RA

TIN

G (

CU

RR

EN

T)

EX

EC

UT

IVE

LE

AD

New Risk (1)

4241

10/1

2/2

019

Medicine McKesson storage/archiving capacity deficit 2

0 This risk was not accepted onto the Corporate Risk

Register by the RRG on 20 January 2020; to be reviewed by the group in February 2020.

16

Mike van der Watt

Closed risk (1)

4114

20/1

1/2

018

Clinical Informatics Delivery of the ICT Service Transition Programme 1

2 The final Programme Board met on 10th December

to close down this programme of work. As such this risk is fully mitigated.

15

Paul Bannister

Risks by Division

Clinical Informatics (6)

15

Tab 15 C

orporate Risk R

egister

7 of 236T

rust Board M


3894

12/0

6/2

017

Clinical Informatics ICT Applications reduced availability, poor reliability & performance

20

Both e-handover and iReporter have been moved onto the new SQL environment. This leaves Infoflex remaining; this is being scheduled with the supplier.

20

Paul Bannister

3899

12/0

6/2

017

Clinical Informatics ICT Trust Bleep System

20

Now that the Business Case has been approved, the team are working with procurement to produce the requirements specification. This will then go to procurement to go out to tender.

20

Paul Bannister

3897

12/0

6/2

017

Clinical Informatics Cyber Risk

16

Maintenance windows being negotiated and agreed with Emergency Planning and Operational teams. This is key to allow the patching work to take place. A new patching policy has been created and the patching schedule features in this. Once schedule agreed, plans will be updated to align.

16

Paul Bannister

4116

23/1

1/2

018

Clinical Informatics Delivery of the Trust's Digital transformation programme

16

Tender process to develop user requirements, strategic outline case and outline business case has completed and a business case discussed at Trust Management Committee on 9th Oct for consultancy resources. Detail requirements gathering exercise will be further clinical engagement. Benefits review has completed and a report will be used to reflect back findings of initial engagement.

16

Paul Bannister

3896

12/0

6/2

07

Clinical Informatics ICT Data Networks reduced availability, poor reliability & performance

16

The business case was approved by the Trust Board on 5th December. A work order with Atos signed to ensure that the HLD can be started straight away. Hardware will be ordered and installation plans being created now all governance is approved.

16

Paul Bannister

4197

16/0

8/2

019

Clinical Informatics Missing Patches - ICT Server Estate 1

6 Maintenance windows being negotiated and agreed

with Emergency Planning and Operational teams. This is key to allow the patching work to take place. A new patching policy has been created and the patching schedule features in this. Once schedule agreed, plans will be updated to align.

16

Paul Bannister

Clinical Support Services (3)

15

Tab 15 C

orporate Risk R

egister

8 of 236T

rust Board M


4082

01/1

0/2

018

Clinical Support Potential shortage of spare parts to repair AAU CT scanner impacting on patient care

16

Work has commenced on building new fluid store relocation and waiting area for CT Expected go live date 03/20

20

Sally Tucker 3965

11/1

2/2

017

Clinical Support Delays in imaging of patients requiring interventional radiology procedures

16

Discussions with RFH on-going Business case for new IR suite and development. Discussions with RFL re: potential OOH cover underway. Target to go live in April

16

Patrick Hennessey

2755

28/0

7/2

011

Clinical Support Risk of failure of the MRI scanner at HHGH and deterioration in image quality

16

In 2020 -Business case to determine location and development costs to install in March 2020. Contingency plan for HHGH developed hard standing from mobile MRI to be installed by March 2020. Standby contract for mobile scanner in negotiation. HHGH MRI scanner end of supported life 31/12/19

16

Sally Tucker

Corporate Services (6)

3120

09/0

7/2

014

Corporate Lack of Storage facility for Patient Medical Notes leading to missing, poor condition and delayed location

20

Business case currently being written for Clinic Prep at SACH to move into area occupied by Orthopaedics who are due to move into new area. Multi volume tracking on Patient centre still being tested, last test 30/08/2019 failed. 20 Patients who have multi or fat volumes have been sent for trial sanitizing pilot (re-volumisation) on 02/09/2019, these are due to be returned w/c 16/09/2019 and will be shown to clinicians for feedback. Hemel Library racking has completely broken, NHSP staff injured themselves DW124344, Estates have been asked to repair or replace.

20

Paul Bannister

15

Tab 15 C

orporate Risk R

egister

9 of 236T

rust Board M


3949

24/1

0/2

017

Corporate Patient experience and patient safety is compromised due to ongoing challenges with current non-emergency transport provider

15

The CCG continues to negotiate a contract for 2019/20. Current gaps whereby the Trust does not have a commissioned service to use: - Mental Health informal transfers - Mental Health formal transfer requiring mobility assistance - Out of Area Transfers/Discharges - London outpatient appointments - Transfers to providers within NHSE London area

15

Sally Tucker 3828

09/1

1/2

016

Corporate Patients may come harm and have a poor experience due to long waits for elective care

20

RTT performance continues to improve, although it is slightly below plan. 1

5 Sally Tucker

4190

10/0

7/2

019

Corporate Senior medical staff may alter working arrangements resulting in the Trust being unable to maintain consultant led services

20

This risk remains static as Trust is awaiting national guidance following consultation on this issue. Once further update provided on possible amendments to pension scheme, Trust will plan actions accordingly and communicate widely with staff. Currently we continue to monitor any impact on availability of senior clinicians to undertake additional sessions and on 18th November: a further imminent development was discussed in media reports that for this year only where doctors face large tax bills which can be paid from an individual’s pension fund under something called scheme pays with a co sequence reduction in pension when it is drawn, the government will make good the difference significant adverse impact has been identified.

15

Paul Da Gama

4191

10/0

7/2

019

Corporate Risk of a financial liability to Trust following outcome of legal case 'Flowers'

20

Awaiting National Directive further to outcome of the legal case. The Trust has calculated potential liability of circa £1.2million.

15

Paul Da Gama

15

Tab 15 C

orporate Risk R

egister

10 of 236T

rust Board M


4207

12/0

9/2

019

Corporate Inadequate post in-patient discharge appointment booking processes

20

Wider workstream looking at the role of ward managers underway in reducing the variation in the way they work

16

Sally Tucker

Emergency Medicine (1)

3995

06/0

3/2

018

Emergency Medicine Challenges in Recruitment of Emergency Medicine Medical Workforce

20

We are currently working with the Procurement Team to try and find an agency that we can work with to recruit 4 further ED consultants. We will be taking the results of these discussions to our regular meetings with the Exec to work with them to find a way forward We have recruited several MG into our CESR programme which will (in the long term) help to improve our consultant numbers In the short term, we are reliant on a small group of locum ED consultants who work here regularly; this helps to decrease some of the risk in using many locums, as they are more aware of our policies and procedures We have also had 2 of our substantive ED consultants return to work (after sick leave and maternity leave, albeit not full time) which has eased some of the burden

16

Michael Van der Watt

Environment (4)

4135

15/0

2/2

019

Environment Lack of A E & CP's across Safety Groups in accordance with HSE and DoH Managing safely guidance and accepted Codes of Practice

20

AE post-potential strong candidate identified, interviews scheduled end of November 2019.

16

Patrick Hennessey

15

Tab 15 C

orporate Risk R

egister

11 of 236T

rust Board M


Finance (2)

4154

08/0

4/2

019

Environment Non-compliance with HTM00 (safe systems of work) 1

6 ATR being presented to vacancy panel to recruit to

Health and Safety Manager role - Review January 2020 New Head of Compliance recruited October 2019 (Fixed Term Contract). Substantive role to start in Jan 2020

16

Patrick Hennessey

2795

15/1

2/2

011

Environment Management and control of - Asbestos Containing Materials (ACMs)

20

Capital team governance procedures implemented Summer 2019 - to be reviewed Jan 2020 Permit to work system and contractor induction to be reviewed by Jan 2020 All lift shafts have now been surveyed awaiting reports - Project Team to advice on dates for reports - Review End of Jan 2020.

16

Patrick Hennessey

4155

09/0

4/2

019

Environment Potential lack of Assurance across the Trust for Fire Safety 1

2 Agreed at RRG (16/12/19) to review all fire related

risks with a view to amalgamate them into 1 or 2 risks. This will be done in conjunction with Head of Compliance during a governance review in Jan 2020

15

Patrick Hennessy

15

Tab 15 C

orporate Risk R

egister

12 of 236T

rust Board M


4205

05/0

9/2

019

Finance Risk of not receiving Financial Recovery Fund as a result of failure to meet base criteria

20

Drivers of the deficit are in its closing stages. The Trust achieved its year to date deficit target as at month 6 (September) and it is expected that a payment of some sort is payable. Ongoing uncertainty around the precise criteria against which the Trust is being measured means this cannot be confirmed at the time of writing. The risk remains at corporate levels for this reason, and also because the margin by which this achievement occurred was narrow, and later parts of the financial year are more challenging as efficiency expectations in particular increase. The agreement of a Minimum Income Guarantee (MIG) between the Trust and HVCCG will not necessarily improve the chances of the Trust satisfying the FRF criteria. It will, however, effectively fix a significant part of the Trust's financial position and enable a greater focus on cost improvement / recovery actions.

15

Don Richards

15

Tab 15 C

orporate Risk R

egister

13 of 236T

rust Board M


4204

05/0

9/2

019

Finance Risk of not receiving Provider Sustainability Fund income as a result of failure to achieve financial plans

20

The Trust achieved its year to date deficit target as at month 6 (September) and therefore expects to receive the relevant portion of PSF income. The risk remains at corporate levels as the margin by which this achievement occurred was narrow, and later parts of the financial year are more challenging as efficiency expectations in particular increase. The agreement of a Minimum Income Guarantee (MIG) between the Trust and HVCCG will not necessarily improve the chances of the Trust meeting its financial plans. It will, however, effectively fix a significant part of the Trust's financial position and enable a greater focus on cost improvement.

15

Don Richards

Medicine (1)

4129

25/0

1/2

019

Medicine Unreliable functioning of central cardiac monitor 1

5 On placement of order, the equipment came out as

being much more expensive than originally budgeted for and agreed. Now going back through finance for approval of additional funding.

15

Michael Van der Watt

15

Tab 15 C

orporate Risk R

egister

14 of 236T

rust Board M


1

Agenda Item: 16/79

Report to: Trust Board

Title of Report: Assurance report from Trust Management Committee

Date of Board meeting:

06 February 2020

Recommendation:

For assurance

Chairperson: Christine Allen, Chief Executive

Purpose

The report summarises the assurances received, approvals, recommendations and decisions made by the Trust Management Committee at its meetings on 08 January 2020 and a development session on 22 January 2020.

Background

The Committee meets monthly and its areas of responsibility are:-

Delivery of the clinical strategy

Revenue investment up to £1m

Operational performance

Operational risk

Safety and business continuity

Information technology

Internal and external communication strategy

Clinical quality

Business planning

Environment

Business undertaken

Topics covered at the meeting on 22 January, included:

The committee received information on the arrangements for a forthcoming CQC inspection. In preparation for the visit, the Committee considered a self-assessment of outpatient services across the Trust which were not located within the main department. The review included cardiology, diabetes and endocrinology, dermatology, respiratory, clinical haematology, surgery and ophthalmology.

An update on the acute redevelopment programme was received and the programme plan was discussed.

A summary report which set out the progress being made against the two year corporate objectives was received. This report was discussed by the Board in January 2020.

The Committee received feedback from the clinical advisory group and the professional advisory group.

16

Tab 16 Assurance report from Trust Management Committee


2

In addition to the regular meeting in January, a development session was held on 22 January 2020 at which the Committee considered the actions needed to be taken to achieve a ‘good’ rating by the Care Quality Commission, as well as reviewing the embargoed results of the national staff survey and discussing the draft five year strategy. The Committee agreed that the frequency of meetings would reduce from twice to once a month and a Good Place Programme Board would be held in place of the second meeting. It was agreed that any urgent Committee business would be discussed at the end of the Good Place Programme Board meetings as required. This new arrangement would be effective as from 01 February 2020.

Risks to refer to the risk register

None

Items to escalate to the Board

None

Attendance

Christine Allen Chief Executive

Freddie Banks Associate Medical Director, Clinical Strategy

Paul Bannister Chief Information Officer

Andy Barlow Divisional Director, Medicine

Mary Bhatti Divisional Manager, Women and Children’s

Howard Borkett-Jones Associate Medical Director for Education

Helen Brown Deputy Chief Executive

Tracey Carter Chief Nurse

Paul da Gama Chief People Officer

Fran Gertler Director of Integrated Care

Sean Gilchrist Director of Digital Transformation

Louise Halfpenny Director of Communications

Patrick Hennessey Director of Environment

Jean Hickman Trust Secretary

Stephanie Johnson Divisional Manager, Medicine

Martin Keble Divisional Director, Clinical Support

Jeremy Livingstone Divisional Director, Surgery, Anaesthetics and Cancer

Jason McKee Divisional Manager, Surgery, Anaesthetics and Cancer

Natalie Miles-Kemp Head of Programme Delivery Support

Esther Moors Acute Redevelopment Programme Director

Elaine Odlum Divisional Manager, Medicine

Rodney Pindai Director of Contracts, Efficiency & Commercial Development

Sally Tucker Chief Operating Officer

Karen Walker Head of Nursing, Children’s

Angela Wellman Head of Nursing, Medicine and Emergency Medicine

Karen Walker Head of Nursing, Children’s

Anna Wood Deputy Medical Director

In attendance Julia Alderman Business Coordinator for CEO and Chairman

16

Tab 16 Assurance report from Trust Management Committee


1

V1

.


Title of Report: Assurance report from Finance and Performance Committee

Date of meeting: 06 February 2020

Recommendation: For information and assurance

Chairperson: John Brougham, Non-Executive Director

Purpose

The report summarises the assurances received, approvals, recommendations and decisions made by the Finance and Performance Committee at its meeting on 30 January 2020.

Background The Committee meets monthly and provides assurance on scheduled reports from all Trust operational committees with finance, investment and access performance brief according to established work programmes.

Access Performance

The Committee reviewed the waiting time performances in November, for ED, ambulance handovers, cancer treatment, elective care referral to treatment (RTT) and diagnostic tests.

RTT

The RTT 18 week wait performance was unchanged from November at 87.4%. Whilst this is below the national standard of 92%, and the recovery plan for December of 88.4%, it is better than the latest reported national median of 84.2%. The Committee was assured that actions to improve performance are in place, including ongoing outsourcing and, following recent discussions with commissioners, agreement to work more collaboratively to identify additional capacity in the private sector and other NHS organisations with the aim of increasing capacity further. The Committee was assured that these actions were primarily targeted to improve waiting times in the most challenged specialities. There were no patients at the end of December with waiting times in excess of 52 weeks, and the Committee was again assured that an appropriate harm review process is in place for all patients exceeding the national wait times.

17Tab 17 Assurance report from Finance and Performance Committee


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V1

A&E December is traditionally a very difficult month for A&E across the NHS, and attendances at the Trust were up by 11.3% compared to last year, and by 13.1% from November, with the highest attendances this year at Watford. Performance against the 95% 4 hour waiting standard fell from 82.2% in November, (which ranked the Trust 29th of 94 providers, with a national median of 79.2%), to 79.4%. National comparators for December will not be known until February, but the national median is expected to be lower than in November. In December both the MIU at St Albans and the UTC at Hemel Hempstead matched performance in November at more 99%, whilst at Watford, Majors was down from 58.9% to 53.9%, CED was down from 87.7% to 83.9%, and Minors was down from 94.3% to 92.4%. The Committee was assured that the SMART pilot, implemented in October, with senior clinicians from a range of medical specialities working in ED, has made a significant improvement in flow of patients, and consequently reduced waiting times. Ambulance Turnarounds There was a significant increase in ambulance waiting times in December. Ambulance arrivals increased by more than 9% in December, but waiting times in excess of 30 minutes increased by 38%. A major factor in the increased delays was the arrival of ambulances in clusters, and the outcome of the imminent joint handover improvement meeting with EESAT is awaited. Cancer December performance matched November with 7 of the 8 national waiting time targets met. There were month on month improvements against 5 of the standards, with the other 3 maintaining the 100% performance achieved in November. The maximum 62 day waiting time performance from GP referral for suspected cancer to first treatment is still provisional, at 83.1%, up from 77.1% in November, in line with the recovery plan for December, ahead of the latest national median of 78.5%, and behind the standard of 85%. Performance against this standard, and the recovery plans, to improve to achieve it on an ongoing basis, remains a key focus for the Committee. The Committee also noted that harm reviews will now take place for all cancer patients exceeding 62 days waiting compared to 104 days previously. Diagnostic Tests The Committee noted the strong performance in achieving the National Standard of 99% of patients waiting no more than 6 weeks for diagnostic tests recording 99.7% in December.



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Integrated Performance Report The Committee reviewed the effectiveness of the IPR and concluded that it provides a very good overview of the Trust’s performance, and improvement actions, covering safe care and Improving outcomes, caring and responsive services, workforce and finances. The Committee also commended the recent addition of key messages from each of the chief officers.

Financial Performance (i) I&E The Committee reviewed the December results and the latest forecast for the year to seek assurance that the full year budget would be met. The deficit of £2.0m in December was in line with budget, and £0.2m better than forecast, resulting in a year to date deficit of £20.7m, which is £0.1m better than budget. Compared to budget year to date, revenues of £283.8, are £0.8m lower, mainly due to lower pass through high cost drugs which are offset by lower other costs, pay costs are £2.6m higher, primarily in medical and nursing, and other costs in total are lower by £3.3m, with lower high cost drugs the main contributor. Over the past six months the Trust has taken actions to reduce the rate of medical and nursing pay, without impacting patient care, including reducing high cost agency consultants and improved management and controls over medical and nursing rotas. The Committee continues to review the outcomes and was assured that many of the actions are now embedded, which is essential to the delivery of not just this year’s deficit target but also next year’s plan. The Committee noted the continued strong performance in achieving CIPs, with a further £1.9m in December bringing year to date to £11.0m, £2.4m ahead of budget. The forecast for the year is now £15.3m, compared to the budget of £15.0m, with more than 85% recurrent savings, which is well ahead of previous years and the national average. The latest forecast for the year still requires delivery of defined, but not yet underpinned, actions but the Committee was assured that this challenge has now reduced from £1.4m last month to £1.0m. Following the review of risks, opportunities and actions, the Committee was assured that, although achievement of the full year budget is not guaranteed, the Trust remains on track to deliver the £22.7m deficit target. The Committee recommends that a paper on the forecast deficit for the year, including recovery plans and risks, is presented to the February Board. (ii) Capital Spend



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The Committee reviewed capital spend to date and the programme of spend for the year. Capital spend of £1.0m in the month brought year to date spend to £6.2m, leaving a significant challenge to deliver the full year authorised spend in the year of £20.9m. The Committee was concerned that the full year spend, all on much needed facilities at the Trust, would not be achieved, and was assured that plans are in place to deliver the £20.9m. The Committee supported initiating essential work to upgrade the Trust’s underlying operating software from Windows 7 to Windows10 as a key project in the fourth quarter, and taking the opportunity to apply to NHS to fund it. The Committee recommends that a paper on capital spend in the fourth quarter is presented to the February Board. (iii) Revenue Funding Funding of revenue spend is subject to monthly approval by the NHS and

following review the committee recommends ratification by the February

Board of an NHS Revenue Support Loan of £2.6 million to meet the

funding requirements in January.

(iv) Divisional Finance Review The Committee reviewed a presentation by the Director of the Clinical Support Services Division. The Division has an annual budget spend of £28m, and year date is £0.7m overspent on a budget of £21.5m. Revenues are on budget, and forecast to be on budget for the year. The majority of the spend variance is due to agency premium covering scientific and technical vacancies in pharmacy, radiology, pathology and therapies, and outsourcing. The Committee reviewed the plans to reduce the rate of costs in the final quarter, including accelerating CIPs from £0.8m year to date to hit the budget of £1.4m for the year. The Committee was assured by the glowing endorsements, from its Executive members, of the excellent quality of service provided by the Division to the Trust’s clinical divisions. (iv) 2020/21 Budget and 5 year plan The Committee was updated on progress of finalising the budget and plan. National planning guidance is expected to be received shortly, with initial submission of the plan to NHS by March 5, and final submission by end April.



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The plan will be reviewed by the February Committee, and March Board, prior to the initial submission, and by the March Committee and April Board prior to the final submission. The presentation covered the work underway to draft all elements of the plan, both within the Trust, and together with HVCCG, including, activity levels, minimum income contract, quality and performance plans, people resources, levels of costs and efficiencies, capex and funding. Areas of risk and opportunity were reviewed on the Trusts ability to deliver the agreed I&E control total for 2020/21, and planned break even by 2022/23. The Committee recommends that an update on the status of the budget and plan, including risks and opportunities, Is presented to Part 2 of the February Board. (v) Business Cases The Committee reviewed the Strategic Outline Business Case ( SOC) to deploy an Electronic Patient Record( EPR) solution for the Trust. This is an underpinning platform in delivering digital transformation throughout the NHS to achieve its strategic direction for new care models. The Committee agreed the urgent need to enhance the Trusts digital capabilities and fully supports the need to move towards paper free care, and introduce an EPR solution. This would enable benefits in patient care and experience, through optimising clinical pathways, reducing unwarranted variations in care and outcomes, and also improving waiting times. An EPR solution also provides significant cost saving opportunities in the Trust. The Committee reviewed the options to deliver an EPR solution and agreed with the preferred route, at this stage, of an enterprise wide solution which involves selecting one fully integrated software solution supplier from the NHS list of accredited suppliers. The Committee reviewed the financial case, recognising that at this is based on top down assumptions and asked for additions to the supporting narrative to give greater clarity. The Committee recommends that, with the changes noted above, the SOC is presented to the February Board for approval to proceed to an Outline Business Case (OBC), which will assess the case in greater depth in all areas, including clinical, operational, procurement, and financial. Watford Theatres Reconfiguration Project The Committee received an update on the project, which is now on course for review of the Full Business Case (FBC) by the June Committee, and for review and approval by the July Board.



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Watford Multi Story Car Park (MSPC) Business Case The Committee was given a verbal update on progress in finalising the FBC for the MSCP at Watford, and recommends an update is given to the February Board Corporate Risk Register (CRR) and Board Assurance Framework (BAF) The Committee reviewed the latest status of the rating and mitigating actions, of the three risks under its remit on the CRR and the seven on the BAF. The Committee was assured that all the risk ratings should remain unchanged, that actions to mitigate the risks were up to date and appropriate and recommends that the risks as reviewed should be incorporated in the Trust wide CRR and BAF at the February Board.

Risks to refer to risk register

See above

Issues to escalate

The Committee recommends the following:

To part 1 of the February Board

For Ratification

NHS revenue support loan of £2.6m to meet the funding requirements in January

To part 2 of the Board

For approval

The Electronic Patient Record SOC

For discussion and comment

Forecast and deficit for the year, recovery and risk

Capital spend 4th quarter

Update on status 20/21 budget and 5 year plan

Update on multi storey car park FBC



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Attendance record

Present

John Brougham, Non-Executive Director (Committee Chair)

Christine Allen, Chief Executive

Don Richards, Chief Financial Officer

Phil Townsend, Trust Chair



Tracey Carter, Chief Nurse

In attendance

Stephen Dunham, Associate Director of Efficiency, Costing and Financial Risk

Rodney Pindai, Director of Contracting, Efficiency & Commercial Development

Soheb Rafiq, Associate Director, Financial Management

Jane Shentall, Director of Performance

Minutes

Laura Abel, Assistant Trust Secretary

Attended for specific items:

Martin Keble, Chief Pharmacist and Sue Daniels, Radiology Services Manager – Divisional Update, Clinical Support Services, Phyllis Dasilva, Management Accountant, Clinical Support Services.

Tim Duggleby – Head of Strategy and Redevelopment – Update on Business Case for Car Park

Paddy Hennessy – Director of Environment – Update on Business Case for Reconfiguration of Theatres

Sean Gilchrist, Director of Digital Transformation, Paul Bannister, Chief Information Officer, Mark Richards, Deloitte

Apologies

Tom Drabble, Patient Panel



1

.


Title of Report: Assurance report from Quality Committee

Date of Board meeting:

06 February 2020

Recommendation: For information and assurance

Chairperson: Jonathan Rennison, Non-Executive Director

Purpose

The report summarises the assurances received, approvals, recommendations and decisions made by the Quality Committee at its meeting on 19 December 2019.

Background The purpose of the Quality Committee is to provide the Board with assurance that high standards of safety and compliance, harm free, high quality, safe and effective services/clinical outcomes that are provided by the Trust and in particular, that adequate and appropriate governance structures, processes and controls are in place throughout the Trust.

Assurances

received / areas of

challenge

Quality Assurance Report from Surgery and Anaesthetics:

The committee received a quality assurance report from surgery and

anaesthetics. The presentation and report were both clear, and evidence-

based in their approach, providing high degrees of assurance on key

areas of performance, as well as highlighting areas of concern and

providing assurance of actions and activities to address concerns and

mitigate risks. Key areas reported include:

Well Led:

Appraisal rate at 89.9% with a clear plan to improve performance to above 90%.

Core training compliance at 94% and essential training at 89%

The divisional strategy is being refreshed and strong leadership in place that meets weekly to discuss performance, risk and issues to ensure all are sighted on good practice and are aware of key concerns and how they are being addressed.

Robust governance with well-attended governance meetings and clarity on assurance and risk management – issues, complaints and risks discussed and addressed through governance meetings to ensure learning is shared and disseminated.

Responsive:

The complaints response rate is lower than the Trust target at just 75%. This is due to vacancies within the department. A revised process has been agreed with a clear recovery trajectory.

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Tab 18 Assurance reports from Quality Committee


2

Vacancies should be filled from February 2020, with new arrangements in place to ensure recovery until that time.

Issues arising from the urology issue which was previously reported are being proactively addressed. Harm reviews of patients have been undertaken, with three patients identified with harm. This is being investigated further. A review group is overseeing changes to the pathway as a result of this issue. A locum consultant has been recruited to help clear the backlog of patients.

RTT is improving and currently is at 80.55% with an ongoing focus on further improvement and recovery to achieve targets.

High rate of band-5 nursing vacancies in theatres across WGH and SACH – currently 23% vacancy rate. A proactive recruitment and development plan is in place to address this, and safe staffing protocols are followed daily with clear escalations to ensure safe staffing at all times.

Effective:

CIP Plan – the division has identified saving schemes to achieve its target of £4.64 million – they are performing well against the plan and on track to deliver in line with monthly and YTD forecasts.

The division highlighted their non-compliance with the majority of RTT pathways and highlighted the robust harm review process that is in place for all patients waiting longer than 48 weeks. Assurance was received on the process to ensure patients do not come to harm, and that ensures that there is a clear focus on improving performance in a timely manner.

Assurance was received on their active audit programme, the sharing and dissemination of learning from audits and how their audit programme is an integrated part of divisional governance and performance improvement.

Follow-up calls – the division have been having follow-up calls with patients since July, and this is proving successful at identifying and addressing issues and concerns from patients in real-time. The issues being raised in the follow-up calls are being reviewed, and themes identified. Any themes will be reviewed and where appropriate actions put in place to address these and implement learning.

Safe/Caring:

The division has successfully developed and implemented a learning disability surgical pathway. This involves close working with the safeguarding team, patients and families to ensure that admission and treatment are well managed, safe and as easy as possible for the individual and families concerned. Several areas within the division have achieved Purple Star Accreditation to support patients with learning disabilities.

The governance team have a proactive approach to reviewing all Datix reported incidents, completing an investigation, ensuring learning is captured and shared, as well as following clear lines of

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escalation when relevant.

Safe staffing – the division proactively monitors staff daily through the Trust’s approach to safe staffing and ensure that they have a clear plan to provide safe staffing across all parts of the division daily. In addition to this, the division takes part in the Trust's biannual establishment reviews. This contributes to its ongoing approach to providing a safe and caring environment for patients.

The division has a proactive approach to learning and ensures that learning is shared through well attended governance meetings, using governance boards on each ward, and highlight learnings, risks and issues for staff to be aware of. These are discussed daily in safety huddles as well as being shared through relevant newsletters within the division. The aim is to ensure that all staff are aware of key issues and risks, and any learning from these.

Challenges & Concerns:

Ongoing non-compliance with RTT targets and standards – clear action plan in place to support recovery, though it is acknowledged that recovery will not be possible in all specialties. A proactive approach is taken to identifying patients at risk of breaching 52 weeks and ensuring that they are offered treatment dates to prevent breaches occurring.

Theatre productivity – the Trust is not achieving the recommended 85% target for theatre productivity. Current performance stands at 70%. A review has been undertaken, and a clear process and action plan are being developed to improve theatre productivity and work towards an 85% utilisation rate. Feedback from a visit from NHSI who provided a review of the elective site at SACH and a review of the Watford sites is now being incorporated into an action plan to support improvement in theatre productivity performance.

Anaesthetics staffing – high number vacancies at consultant and middle grades. This is reflective of local and national shortages for these posts. There has been a successful recruitment programme with one new starter in November 2019 and another in Jan 2020. A proactive and continuous recruitment programme is in place to address this issue. Robust mitigations are in place using locums, and increased agency spend is mitigated through the use of long-term locums wherever possible.

SACH Enhanced Care Programme – this pilot programme has been successful, but they have not been able to treat the expected number of patients. The team are reviewing this and are working closely with stakeholders to improve the identification of patients suitable for treatment at SACH. They expect to see improvements in performance in 2020.

Annual report on litigations claims:

The Committee received a report on annual litigations and claims for the

Trust during 2018/19. In that period the Trust received 50 new clinical

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claims, which was an increase of 4 cases when compared to the previous

year. Forty-three claims were closed, with payments being made to 70%

of claimants (total 30 claimants). The divisions with the highest payments

to claimants were:

WACS - £11,484,251

Surgery - £1,987,198

The Trust’s total contribution to all NHSR indemnity schemes was £16.9

million, which was a decrease of £754,010 from the previous year. The

trust received 65 letters before action, with Surgery and WACs receiving

the most LBAs. The Trust did not receive any Prevention of Future

Death's (PFD) notifications. In cases where the coroner was likely to

consider a PFD, the Trust was able to demonstrate that incidents had

been the subject of serious incident reviews or investigations, and that

action had already been taken.

The Committee was assured that we have robust processes in place to

track and monitor litigations and claims, with a transparent and open

approach to acknowledging failings where appropriate. We were also

assured that learning from cases is captured, shared and embedded to

help improve the quality of our care and prevent similar incidents from

happening again. The report asked that we take assured of compliance

with the legal processes – a question was raised as to what legal

processes we are required to be compliant with is in this instance. It was

requested that future reports list the relevant processes so that the

committee can take an informed view as to our compliance with those

processes.

Quality Assurance Framework - Getting to Good and Beyond:

The Committee received a report on moving to good and beyond which

provided an overview of activities of our quality improvement programme,

as well as our response to previous CQC inspection findings and our

preparations for our next CQC visit. We were informed of a number of

deep dives that have taken place to demonstrate progress against their

respective programmes of work. The areas reviewed were:

Human Resources – appraisals and training

DNACPR

MIU & UTC.

Assurance was received on the work delivered to date to address areas

of concern and ongoing work which is continuing to ensure high-quality,

safe care. The committee was informed that we are now moving from a

proactive monitoring programme to a proactive engagement programme

to ensure that staff, patients, service users and key stakeholders are

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aware of and understand the changes that we have made. The program

will support staff to reflect on their own successes and achievements in

their teams and divisions so that they can articulate what they have

changed and achieved, and what they are proud of. The team wish to

support staff to link their achievements to some of the key areas of

improvement at a Trust-wide level.

Internal Audit Report on Maintenance of Medical Devices:

The committee received a report from RSM, the Trust’s internal auditors

on the Maintenance of Medical Devices. The report presented a position

of partial assurance and highlighted concerns in

maintaining accurate records of medical devices within the Trust

ensuring an appropriate maintenance programme to ensure safety

having an appropriate renewal plan for medical devices (including decommissioning end of life devices).

Several actions are highlighted, with deadlines and a clear responsible

individual. However, at this point, the Committee was not assured that we

have an appropriate grip and control in our management of medical

devices. The Committee has requested that a further report comes back

to the committee once actions have been completed and additional work

delivered to improve our performance and to demonstrate more robust

management of medical devices within the Trust.

Report on a visit from the Local Authority Environmental Health

Officer:

We received a report on a visit from our Local Authority Environmental

Health Officer (EHO), which identified a series of failing in the Trust in

several areas, resulting in a score of 1 out of 5 (on a five-point scale, with

5 being a high or 'good' score). We were presented with a clear action

plan that has been developed to address the issues raised by the EHO.

Some actions have been completed, and others are in progress with

completion dates in early 2020. The Committee noted that several of the

issues could have been avoided through appropriate forward planning

and more structured management of our soft services. The Committee

has requested that progress on the action plan is reported to the

Committee to provide assurance that we have improved our food hygiene

and catering services management.

Corporate Risk Register and BAF:

We received a report on the Corporate Risk Register and were notified of

two escalated risks, both within the environment division:

Risk No 4155: Potential lack of assurance across the trust for fire safety.

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Risk No 4065: Non-complaint Georgian wired glazing in areas of the Trust.

The Risk Review Group approved one new risk for Clinical Informatics:

Risk No 4197: Missing patches – ICT server estate, a high number of security patches are missing from the WHHT server estate (cybersecurity risk).

One risk was de-escalated within the Environment Division:

Risk No 3958: Risk of condensate tank failing. The risk was de-escalated due to major works being completed to address the issue of the condensate tank failing.

The Committee received some assurance that the escalated and new

risks are being appropriately managed and that actions are in place to

address gaps in assurance and controls. These risks will continue to be

monitored and further assurance received on measures to effectively

manage them and to address any gaps in controls and assurance.

Quality Integrated Performance Report:

The Committee received the Quality Integrated Performance Report,

which provides a detailed presentation of our quality performance data

and performance metrics. Key areas of good performance include:

Prevent compliance training exceeds the 85% trajectory set by NHSE at 88%.

There were zero cases of category four pressure ulcers and a slight decrease in the overall number of HAPUs during October.

There were no cases of MRSAb.

While we are above our trajectory for C-diff, we received positive feedback from C-diff peer review undertaken by the CCG.

We continued to sustain improved performance in the number of falls with harm.

We continued to see an improvement in the overall attrition rate of women delivering within the Trust and have seen an increase in the number of women delivering in the birth centre.

Areas of poor performance highlighted in the report include:

A drop in our complaints response rate, dropping to 79% in October.

Our combined c-section rate is at 31.5%, which is above the Trust target of 28% and above the national average of 26.7%.

Harm Free Care as measured by the Safety Thermometer fell below the 95% national target; however, the new harm-free care within the Trust was above the national average at 98.2% against a national average of 97.7%.

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The home birth rate is below the trust target of 2%.

There was a good discussion, with questioning and challenge in several

areas within the report and good assurance received on actions to

address poor performance, including triangulating information from other

reports received at the Committee. Overall the Committee was assured

on areas of good performance as well as receiving assurance of clear

understanding of issues affecting poor performance and clear action

plans to address poor performance.

Bi-annual Quality Account:

The committee received a bi-annual report on progress against our

Quality Commitment. The committee reviewed the report and the

presentation of information and data to support progress. We were

assured that clear progress had been made, in areas of under-

performance, this was clearly understood, learning captured and clear

plans in place to improve our performance.

Committee Discussion:

At the end of each agenda item, the committee discussed the level of

assurance that it had for that item and agreed a high, medium or low

assurance view. At the end of the meeting, we discussed this approach.

Committee members found it to be a useful committee discussion where

we acknowledged our level of assurance and were able to provide a

reason for our position using evidence from the committee papers and

presentations. We discussed if our assurance level should be recorded

as part of the minutes for the meeting, and the committee was not in

agreement on this issue. Some felt it is appropriate to record the

Committee's position in the minutes. In contrast, others thought it should

not be recorded until further work is done to understand this approach

and how it might best be used to strengthen our governance. The

committee is recommending to the board that we discuss this issue and

agree on a standard approach to discussions on assurance and the

recording of committee assurance positions for our governance structure.

Risks to refer to risk register

There are no new risks to escalate to the Board.

Recommendations to the Board

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Attendance record

Attended

Jonathan Rennison, Non-Executive Director (co-chair)

Ginny Edwards (co-chair)

John Brougham, Non-Executive Director

Christine Allen, Chief Executive

Tracey Carter, Chief Nurse and Director of Infection Prevention and Control

Marsha Jones, Associate Chief Nurse, Quality Governance

David Thorpe, Deputy Chief Nurse



Anna Wood, Deputy Medical Director

Attendees

Jean Hickman, Trust Secretary

Laura Abel, Assistant Trust Secretary (notes)

Attendees for specific items

Paula King, Head of Nursing, Surgery, Anaesthetics and Cancer

Jason McKee, Divisional Manager, Surgery, Anaesthetics and Cancer

Trisha McSkeane, Head of Legal and Clinical Effectiveness

Alison Fuller, Interim Associate Chief Nurse

Sam Abbas Manager, RSM Risk Assurance Services LLP

Liam Commins, Deputy Director of Environment

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Page 1 of 3


AGENDA

05 March 2020 at 9.30am – 12.30pm Executive Meeting Room, Watford Hospital

Apologies should be conveyed to the Trust Secretary, Jean Hickman on [email protected] or call 01923 436 283

Time Item

ref Title Objective Accountable

officer Paper or verbal

Link to

BAF

01/80 Opening and welcome


02/80 Patient story Information Chief Nurse Present-ation

INTRODUCTION TO THE MEETING

03/80 Apologies for absence


04/80 Declarations of interest


05/80 Minutes of the meeting held on 06 February 2020

Approval Chair Paper

06/80 Board action log from 06 February 2020 and previous meetings and decision log




08/80 Chief Executive’s report Information Chief Executive

Paper

09/80 Board assurance framework Approval Chief Executive

Paper

PERFORMANCE

10/80 Performance report on access standards

Information and

assurance


Paper 4a&b

11/80 Integrated performance report (month 9) Key messages from:


Chief Nurse




Information and

assurance


Paper 4a&b

AIM ONE: BEST CARE (OBJECTIVE 1 – 4)

12/80 Bi-annual establishment review of adult inpatient wards

Information and

assurance

Chief Nurse Paper

22

Tab 22 Draft agenda for next meeting


Page 2 of 3

AIM TWO: GREAT TEAM

13/80 Business case for overseas nurse recruitment

Approval Chief People Officer

Paper

14/80 Bi-annual freedom to speak up/whistle blowing report

Information and

assurance


Paper

AIM FOUR: GREAT PLACE

15/80 Strategy update Information and

assurance


Paper

16/80 Communications and engagement strategy

Approval Deputy Chief Executive

Paper

RISK AND GOVERNANCE

17/80 Detailed corporate objectives Approval Deputy Chief Executive

Paper

18/80 Corporate risk register report Approval Chief Medical Officer

Paper

19/80 Annual review of corporate governance structure

Information and

assurance

Trust Secretary Paper

20/80 Annual self-assessment of Board effectiveness

Approval Chair/ Trust Secretary

Paper

ASSURANCE FROM COMMITTEES

21/80 Assurance report from Trust Management Committee

Information

and

assurance

Chief Executive Paper

22/80 Assurance report from People, Education and Research Committee

Information

and

assurance

Chair of Committee/Chief People Officer

Paper


Information

and

assurance

Chair of Committee/Chief Financial Officer

Paper

24/80 Assurance reports from Quality Committee

Information

and

assurance

Chair of Committee/ Chief Nurse

Paper

CORPORATE TRUSTEE

25/80 Report from the Charity Committee

Information

and

assurance

Chair of Committee/


Paper

ADMINISTRATION

26/80 Any other business previously notified to the chair

N/A Chair Verbal

QUESTIONS FROM THE PUBLIC

27/80 Questions from Hertfordshire Healthwatch

N/A

Chair Verbal

28/80 Questions from our patients and members of the public

N/A Chair Verbal

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Page 3 of 3

CLOSING

29/80 Draft agenda for next meeting Approval Chair Paper

30/80 Date of the next board meeting: 02 April 2020, Executive Meeting Room, Watford


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Documents

TRUST BOARD MEETING IN PUBLIC AGENDA - West Herts College · HWE STP Hertfordshire & West Essex Sustainability and Transformation Parternship ... QIPP Quality, Improvement, Prevention