Agenda and Papers for Public Board Meeting April 2015

Transcription

Board of Directors’ Meeting – Part I In Public
09.00 30 April 2015
Maple House
AGENDA
Item
No.
15.78
Item
Outcome
Report type
Chairman’s Welcome and
15.79
Apologies for absence
Note
Verbal
15.80
Declarations of interest
Note
Verbal
15.81
Minutes of Public Board meeting 26 March 2015
Approve
Enc 01
15.82
Matters arising from Public Board meeting 26 March 2015
Note
Verbal
Note
Enc 02
Debate
Enc 03
Approve
Enc 04
Strategy
15.83
15.84
15.85
15.86
15.87
15.88
15.89
Next Generation Project Update David Melbourne, Deputy Chief Executive &
Chief Finance Officer
Corporate Social Responsibility Theresa Nelson, Chief Officer for Workforce
Development
Monitor Operational Plan 2015/16 Matthew Boazman, Chief Officer for
Strategy
Quality & Resources
Quality Report Michelle McLoughlin, Chief Nursing Officer and Fiona Reynolds, Note
Interim Chief Medical Officer
Performance Report David Melbourne, Deputy Chief Executive & Chief Finance Note
Officer
Resources Report David Melbourne Deputy Chief Executive & Chief Finance Note
Officer and Theresa Nelson, Chief Officer for Workforce Development
Executive Update
Enc 05
Chief Executive’s Report Sarah-Jane Marsh, Chief Executive
Enc 08
Note
Enc 06
Enc 07
Other
15.90
Any Other Business
Verbal
15.91
Questions from members of the public
Verbal
Next meeting of the Board of Directors: 20 May 2015, Education Centre, BCH
Part II of this meeting will be held in private as the information to be discussed is exempt from public disclosure under
the Freedom of Information Act 2000
*Only unstarred items will be discussed. If any Board members wish to have any items discussed, please notify
the Company Secretary before the meeting. In exceptional circumstances, it may also be possible for items to
be unstarred for discussion at the beginning of the meeting. Starred items will be approved or received as
appropriate without discussion.
Unconfirmed
BOARD OF DIRECTORS MEETING
Minutes of the meeting held in public on 26 March 2015 at 09.00
in the Education Centre, Birmingham Children’s Hospital
Present:
Attending:
Ref.
15.49
Christine Braddock
Tim Atack
Matthew Boazman
Alan Edwards
Jon Glasby
Colin Horwath
Michelle McLoughlin
David Melbourne
Theresa Nelson
Vij Randeniya
Fiona Reynolds
Judith Smith
Paul Faulkner
Paul Heaven
Sara Brown
Gwenny Scott
CB
TA
MB
AE
JG
CH
MM
DM
TN
VR
FR
JS
PF
PH
SB
GS
Chairman
Chief Operating Officer
Chief Officer for Strategy and Planning
Non-Executive Director
Chief Nursing Officer
Deputy CEO and Chief Finance Officer
Chief Officer for Workforce Development
Interim Chief Medical Officer
Associate Non-Executive Director
Associate Non-Executive Director
Head of Workforce
Company Secretary (minutes)
Item
Welcome from Chairman
The Chairman welcomed all Board members and members of staff attending to observe.
The Chairman also formally welcomed Alan Edwards and Fiona Reynolds who were attending
their first meeting as Board members.
The Chairman congratulated the Chief Executive who is featured in the HSJ as one of the top
NHS Chief Executives.
15.50
Apologies for Absence
Roger Peace, Will Murdoch, Sarah-Jane Marsh.
15.51
Declarations of Interest
None.
15.52
Minutes of the Board meeting held in public on 25 February 2015
The minutes were accepted as an accurate record of the meeting.
15.53
Matters arising from the Board meeting held in public on 25 February 2015
There were no matters arising that were not covered by the agenda items.
15.54
Diversity and Equality
Strategy
TN presented the report which described progress made on the strategy and areas still to
improve. TN highlighted the following areas of the report:
-
NHS Change Day at the hospital focused on the rich diversity within the organisation
and the benefits of learning diverse characteristics and different cultures. One area of
learning for staff was the impact of Ramadan on the work of Muslim staff.
-
The Trust is meeting its various statutory obligations but there are areas that need
improvement.
Page 1 of 7
Action
Unconfirmed
Ref.
MM added the following:
Item
-
Significant benefit was derived from a session with a diverse group of YPAG members
who stressed the importance of asking individuals for their views, not making
assumptions or worrying about saying or doing the wrong thing.
-
One of the hospital’s most diverse groups is the volunteers, who represent the Trust’s
service community in a way that is not reflected by the staff.
The Board was invited to discuss the recommended areas for focused action.
The Board discussed the following points:
-
It is important that focus on one group is balanced to avoid any unintended detriment
to other groups.
-
The data showing a drop-off between application, short-listing and appointment of job
applicants from a BME background is of concern. It was noted that at short-listing stage
the recruiting manager has no information about equality characteristics so there can
be no unconscious bias at this point. It was agreed, however, that there should be
further investigation into the reasons behind decisions not to appoint after shortlisting.
-
Are there other organisations in the public or private sector which perform better on
recruitment, from which the Trust could learn?
-
Attracting those of a BME background into child health academic programmes is a
national challenge.
-
The Trust’s BME Advisory Group has advised that the shortage of BME role models is an
issue.
-
Should the Board use its position to influence change? TN is working with universities
on recruitment strategies.
-
Some of the staff survey results from BME staff flagged areas for focus but others are
encouraging, for example in relation to the support provided through the appraisal
process.
-
The Board had previously agreed to include socio-economic status as an additional
characteristic in its own diversity and inclusion work. TN advised that much of the work
to encourage young people into NHS recruitment focuses on both BME and socioeconomic backgrounds.
-
The preparation undertaken in the bid for the 0-25 CAMHS contract highlighted a lack
of connections with some communities. It is important to develop ongoing
relationships with communities rather than single issue engagements.
-
The family plays a key role in education choices. The Trust is in a position to have some
influence through its work with families.
-
Should there be more focus on how it feels to be a lesbian, gay, bisexual or transgender (LGBT) member of staff?
The Board approved the next steps described in the report and agreed that further work should
Page 2 of 7
Action
Unconfirmed
Ref.
be undertaken in the following areas:
Item
• How it feels to be a LGBT member of staff.
• The reasons for drop-off between short listing and appointment of people from a BME
background during the recruitment process.
• A benchmarking exercise with other NHS trusts in the West Midlands in relation to
recruitment.
• Identifying organisations outside the NHS with a strong history of BME recruitment.
• Developing stronger links with community groups.
• Working with families to influence education choices.
It was agreed that progress will be monitored by the Quality Committee.
15.55
Staff Survey 2014 Results
SB presented the very positive staff survey results and focused on areas where the Trust is
doing well, where more work is required, benchmarking with other trusts and the areas for
focus in the next 12 months.
The improvements in staff engagement suggest the work of the last two years – Building Team
BCH and Caring for Team BCH – have been successful. This is particularly encouraging in the
context of an overall decline in staff engagement across the NHS.
One area that requires extra focus is the reporting of errors. The percentage of staff who say
they witnessed and error and either they or a colleague reported has reduced slightly from the
previous year and is below average. There also continues to be room for improvement in
relation to feedback following incidents.
The Board discussed the following:
•
The results in relation to incident reporting and feedback are surprising as there is a
strong incident reporting culture. It was noted that the Quality Committee have
commissioned a review.
•
There should be a more sophisticated approach to the content of notices around the
premises to ensure we capitalise on good messages such as this.
•
The focused work on staff engagement over the last three years has had a clear impact
and this has been recognised externally.
•
Changes to the way stress is managed have resulted in a decrease in stress related
absences despite the operational pressures being felt by staff.
•
Medical staff have been encouraged to attend a team maker course which has been
well received.
•
The results in relation to staff satisfaction about the quality of care they are able to
provide are surprising. This will be a focus of the Intent to Listen sessions.
The Board noted the report and approved the recommendations.
Page 3 of 7
Action
TN
Unconfirmed
Ref.
15.56
Item
Quality Report
Quality and Resources
Action
The Chairman advised the Board that the report had already been reviewed by the Quality
Committee and at the next Board development session consideration would be given to the
way in which the report should be reviewed by the Board. FR and MM were asked to present
the salient highlights:
•
Feedback from staff indicates that the Safety Strategy could be simplified and this is
under review.
•
Triangulation of the safety and patient experience data does not indicate any significant
areas of concern. All incidents will be investigated to ensure the organisation can learn
from them.
•
Further work will be undertaken on a summary of quality metrics to be included in the
report.
The Board discussed ways in which the report might be developed and presented. It was agreed
that the Board should if possible see more information about clinical outcomes in a more
focused way.
The Board noted the report.
15.57
Performance Report
DM presented the report, focusing on the red areas highlighted by the balanced scorecard. The
Finance and Resources Committee (FRC) had debated in detail the performance on diagnostic
waits which continues to be an issue despite measures taken. A range of factors have
influenced performance and FRC have asked for a deep dive review.
TA updated the Board about the decontamination of scopes, which had affected performance,
though it has been made very clear by the clinical staff that this has not had an impact on
quality of care.
It was agreed that in light of the longevity of the issue the review of diagnostic waits TA
commissioned by FRC should be reported direct to the Board.
DM informed the Board that although the Emergency Department 4-hour wait target was met
in February, the spike in demand which always occurs at this time of year for children, as well
as some complex and distressing cases, means that performance in March is likely to dip and
this could affect performance for the year.
MM advised the Board that a CCG representative attended in the previous week to observe
flows in ED and to audit patient records. On his estimate 40% of the children and young people
seen that day could have been seen in primary care. The CCG are looking at ways of working
together with the Trust to provide primary care provision at weekends, however, there are
workforce issues and a solution is not yet in place for winter.
The Board discussed the need to use the Trust’s leadership role to influence the system in this
regard.
DM advised that the opening of the new Theatre 10 will help reduce operational issues
influencing cancelled operations.
Page 4 of 7
Unconfirmed
Ref.
15.58
Item
Resources Report
It was noted that the report was reviewed by FRC and gives a similar picture to the last three
months. FRC will consider in April the level of surplus to post at year end.
15.59
2015/16 Budget
DM advised the Board on the following main points that arose from a detailed debate at FRC:
1. The Budget is based on assumptions as the tariff situation has delayed the timetable for
commissioner negotiations, so next year’s income has yet to be confirmed.
2. A financially robust organisation goes hand in hand with success in quality, safety and
staff engagement. DM recommended that the surplus next year is set at a more
realistic level under current circumstances.
3. Efficiency challenge: over the last five years the Trust has delivered 20% CIP, however,
the tariff decreases every year and any annual shortfall is cumulative. The Trust
therefore needs to deliver major change in 2015/16.
4. There is a degree of financial risk attached to the community CAMHS contract, though
protective steps have been taken.
CH, as Chair of FRC, advised that following a detailed debate FRC supported the strategy
adopted for the overall budget. FRC recommended the Board discuss the achievability of the
CIP programme in a private session.
The Board approved the draft Budget, noting that a final Budget will be presented in April
following completion of negotiations.
Executive Update
15.60
Chief Executive’s Report
DM, with input from the Executive members, reported verbally as follows:
1. There have been a number of visitors to the Trust during the month:
a. Steven Hay, the Director of Strategy at Monitor had a tour of the hospital and
met with the Chief Executive to discuss the tariff and funding of the new
hospital.
b. Jane Cummings, England’s Chief Nursing Officer met with MM about the Trust’s
innovative workforce programmes and the way in which the Trust manages to
avoid using agency staff. She also asked MM’s advice on taking forward the
recommendations of the Shape of Care review.
c. The Managing Director of Deutsche Bank sought to learn from the Trust
regarding staff engagement.
d. Siobhan Dunn of the Teenage Cancer Trust visited to look at how the TCT Unit
Page 5 of 7
Action
Unconfirmed
Ref.
Item
will be transferred to the new cancer block.
2. In response to the Freedom to Speak Up review the Trust is holding Intent to Listen
sessions with staff. This is an annual programme of small focus groups to collate
intelligence to inform the basis of the next Intent event.
Board members were encouraged to attend the sessions which are a powerful way to
hear directly from staff about how they feel.
3. The plans for Magnolia House have been unveiled. This is a calm, quiet place to deliver
difficult messages to families and to meet with bereaved families away from the clinical
setting. The plans have been developed based on engagement with families. It is
charitably funded and is already generating a lot of positive interest.
4. Dragonfly TV have just completed static camera filming within the hospital for a 10
programme series to be aired on Channel 4 in September. It is hoped that the
programme will have a positive impact on recruitment and fundraising. The Chief
Executive will fully brief the Board at a later date.
5. The Trust is now number one in the NHS for flu vaccinations of front-line staff (91%).
6. The West Midlands Genomics centre partnership bid was successful. UHB, the lead
partner is now finalising the contract negotiations with Genomics England and will
starting recruitment this month. BCH should start recruiting its proportion of patients
to the programme from April onwards which is important for patients with rare
diseases. Reputationally this is also significant in terms of research and development.
7. The Trust is also a core partner with UHB in the development of a Translational
Medicine Unit which is due to open in June. The Trust is also engaged in a regional
review of life sciences which is being led by Graham Silk.
8. The Big Hoot Art Exhibition was very successful. It is hoped that the owls will raise £1m
at auction.
Any Other Business and Questions
15.61
Any Other Business
CB advised that the due diligence work on the development with Birmingham Women’s
Hospital is ongoing and due for completion in May.
15.62
Questions from the Public
None.
Next Board of Directors meeting: 30 April 2015
Page 6 of 7
Action
Unconfirmed
Decisions and Actions
Item
15.54
Diversity and
Equality
Decision/Action
Responsibility
Decision/Action: The Board approved the actions described in the report and
agreed that further work should be undertaken in the following areas:
• How it feels to be a LGBT member of staff.
• The reasons for drop-off between short listing and appointment of
people from a BME background during the recruitment process.
• A benchmarking exercise with other NHS trusts in the West Midlands in
relation to recruitment.
• Identifying organisations outside the NHS with a strong history of BME
recruitment.
• Developing stronger links with community groups.
• Working with families to influence education choices
Action: Progress will be monitored by the Quality Committee.
TN
15.55
Staff Survey
Decision: The Board approved the recommendations.
15.57
Performance
Report
Action: The review of diagnostic waits commissioned by FRC shall be reported TA
direct to the Board.
15.59 Budget
2015/16
Decision: The Board approved the draft Budget, noting that a final Budget will be
presented in April following completion of negotiations.
Page 7 of 7
Item 15.84
Board of Directors
Public Meeting
April 2015
Strategic Objective/ Enabler
Trust Strategy
Report Title
Corporate Social Responsibility
Sponsoring Director
Author(s)
Previously considered by
Enc 3
N/A
Situation
Corporate Social Responsibility (CSR) at BCH means making a positive contribution to the
many societies we serve. Our services are at the heart of local, national and international
communities and it is essential that we help the young people who make up these
communities to thrive and be successful – This is at the heart of our Mission and Vision.
This report/presentation gives the Trust Board an overview of the many strands of our work
at BCH to provide assurance that we are a socially responsible organisation.
Background
The Trust Board received a report last year on Corporate Social Responsibility at BCH. The
Trust has further developments which demonstrate their social responsibility as an
organisation.
Assessment
The Trust meets its corporate social responsibility in a number of ways whether this be
locally, regionally, nationally or internationally. These are outlined in more detail in the
attached presentation. The key areas are:
•
•
•
•
•
Our People – how we provide sustainability within the community through
employment opportunities and training
Our Built Environment – how we ensure that we minimise our impact on the
environment through sustainable building development
Our Business – how we do business in the city, regionally and nationally, and how we
manage procurement in a sustainable
Our Population, Health and Wellbeing – how we support our population and staff to
self-care, manage their health and wellbeing and focus on prevention of chronic
health conditions
Our Presence in the City – how we maintain our reputation, especially around our
•
fund-raising to ensure BCH remains in the hearts and minds of our population
Our International Impact – how we take our clinical expertise to reach across the
world and support the development of health and care
The detailed report/presentation will be taken as read for the Trust Board, and the focus for
presentation and discussion will surround our work in Malawi.
Recommendations
The Trust Board is asked to:
1. Receive the report describing the range of activities influencing our role and reach
across the city, the region and the world.
2. Discuss the Trust Board ambitions in this area and agree key areas of activity for the
executive to explore.
3. Discuss the specific components of the Malawi partnership and in particular the role
the board wishes to have in relation to:
• A link on the Birmingham Children’s Hospital Website
• Inclusion in local induction
• Support the funding for the salary of the coordinator
Risk Description
As per above
Key Risks
Controls
Trust board sub
committees/SWC
Assurances
Regular reports to chief
officers, TLT, SLT, SWC and
the Trust Board.
Standards of compliance
and assessment
Key Impacts
Strategic Objectives
CQC Registration (state
outcome)
NHS Constitution
Other Compliance (e.g.
NHSLA, Information
The People Strategy
Education delivery, employment compliance, engaged staff
who deliver quality care.
This will support how the trust embeds the NHS constitution
and the BCH values
This will ensure that all legislative other requirements
pertaining to employment are met and monitored.
Governance, Monitor)
Equality, diversity & human
rights
Trust contracts
Other
Ensuring we have a productive workforce which aligns with
the financial forecasting outlined in the monitor plan.
This supports the delivery of the Equality Delivery System
and ensures that we embed inclusion into the core of
everything we do.
Corporate Social Responsibility
Making an impact locally and
around the world
Introduction
At Birmingham Children’s Hospital we put our children, young people and families
at the heart of all we do to make sure their experience and care is the very best it
can be.
In our role as advocates for children and young people our responsibility extends
much wider than our hospital walls and we acknowledge and embrace the
important role we play in Birmingham’s economy too.
As a large employer of 3,700 staff we’re committed to making sure that we do
business responsibly and where possible create more opportunities to improve
the health, wealth and environment of Birmingham, the West Midlands and
beyond.
We buy our services locally and ethically and set ourselves ambitious targets
around sustainability. Whether that’s reducing our water use or finding more
sustainable sources of power, we’re committed to doing all we can to make a big
impact on as many people’s lives as possible, with the least impact on our
environment.
We strive to be ‘a hospital without walls’ and work closely with local and
international health partners to share our expertise so that children’s healthcare
in this country and around the world is continually improving for all.
We provide additional support through our health promotion work to families to
make healthy life choices, and further afield we are helping doctors establish
better health services, in countries like Africa and South America, that is making a
real difference to the lives of children in some of the poorest parts of the world.
This report will be supported by a presentation by the Malawi Partnership team
to further explore the board role in support of this charity.
But there’s always more we can do and we will work with our stakeholders to
further crystallise our ambitions for the next 3-5 years.
Sarah-Jane Marsh
Chief Executive
2
Corporate Social Responsibility (CSR) at BCH means making a positive contribution to the many societies we serve. Our services are at the
heart of local, national and international communities and it is essential that we help the young people who make up these communities
to thrive and be successful – This is at the heart of our Mission and Vision.
Our Mission
To provide outstanding care and
treatment to all children and
young people who choose and
need to use our services, and to
share and spread new knowledge
and practice, so we are always at
the forefront of what is possible.
Our Vision
Birmingham Children’s Hospital is
the leading provider of healthcare
to children and young people in
the UK, whatever their condition
and wherever they need our
expertise.
Originates from Dr
Heslop’s statement when
he founded the hospital
in 1862.
CSR Components
1
Our People
This section will explore our provision for education, training and
employment ensuring our reach and impact is felt across the region
2
Our Built Environment
Stabilising and reducing our impact on the environment through sustainable development
3
Our Business
Procurement, the way we do business,
4
Our Population Health & Wellbeing
Public health opportunities, influence and reach across the local and national population
5
Our Presence in the City
Business partners, fundraising and provision for supporting region wide initiatives
6
Our International Impact
Spreading our clinical expertise both Nationally and Internationally
Our People – Caring for Team BCH
Our people are our most important asset and our work on Health and Wellbeing work supports our staff,
patients and families and is aimed at improving personal responsibility for health, and focus on the key health
risks around obesity and smoking. We also place significant importance on mental health. Many of our staff live
in the community that the hospital serves so our wellbeing approach has a positive community impact. We
provide our staff with psychological support in a range of ways. We also provide fitness classes, slimming clubs,
and have regular health and wellbeing events. We train our staff to support their patients and families around
improving their health and wellbeing and taking more responsibility.
The Voice of Young People –
How we ensure young people are at the heart of decisions about our services

YPAG was created in December 2009 to develop a forum that encouraged and empowered the voice of young people from our
local community, within the organisation.

The group is open to any young person between 11-19 years of age and draws on its membership from local community,
comprised of a combination of current patients, ex patients and those young people living within Birmingham who are
passionate about health care delivery for all children and young people.

Within Birmingham Children's Hospital (BCH) the group, its visibility and influence has grown significantly over the last 4 years
with the active recognition of the importance of participation of young people in the overall strategic direction of the
organisation.

The group's active participation and influence has widened beyond BCH into its community, developing working partnerships
locally and regionally. It has also received national recognition and Birmingham Children’s Hospital is seen as a current leader
in children and young people’s engagement.

This has led to broader community opportunities to work in partnership other organisations such as the police, clinical
commissioning groups, Healthwatch Birmingham, other NHS organisations, third sector organisations and education.

We have worked in partnership with education, working directly with a number of schools and colleges. examples include a
community gallery, where local schools exhibit their artwork and a fully funded and ethically approved research project, which
has led to bedside theatre performances from drama students - improving the health and well-being of children in hospital
through the use of the arts.

Through liaison with community police officers a member of YPAG has participated in a Princes Trust project, helping the
homeless within the West Midlands.
Volunteering





Birmingham Children’s Hospital has 270 volunteers who provide 25,000 hours of support each year. They
provide a unique and valuable contribution towards the experience of our patients and their families, and 32
wards and departments benefit from their support. Volunteers wish to be involved with the hospital for many
reasons, and represent our diverse community including students, members of YPAG, local residents, expatients and their families, retired employees and those looking to change career into the NHS.
Volunteers have directly contributed to improving the patient and parent experience, including Play Centre
activities, coffee afternoons, helping parents of children with learning disabilities to complete Hospital
Passports, supporting Health Promotion campaigns and visits from Pets as Therapy dogs. They have also
contributed towards the Friends and Family CQUIN, by receiving and collating patient and parent feedback.
We regularly welcome volunteers from Birmingham-based companies who assisted patients to write a Letter to
Santa, and Father Christmas joined us for the second year from Wesleyan Assurance whose Head Office is in
the city.
We have also set up a leadership mentoring partnership with an external private sector organisation
Links have been also been forged with local colleges and universities, and over the last year the demographics
of new volunteers joining the organisation have changed to reflect our patients, visitors and the local
community. This has resulted in volunteers being able to engage with BME families who have commenting that
they feel comfortable talking to volunteers and receiving support from them.
Volunteering at BCH

Every year Birmingham Children’s Hospital Fundraising Team work hard to facilitate volunteering and
engagement opportunities for local companies and groups to experience first-hand the work we do here at
the hospital. We continually look for opportunities that enable us to provide expertise from our corporate
partners to the Trust that will allow us to save money while truly aligning business objectives and expertise.
We are currently working with several law firms and financial organisations that wish to offer to support the
Trust and the patients and families that we support.
Christmas Ward Decorations: Each year in November, we invite our corporate supporters to decorate a ward or
department within the hospital.
Park View Gardening Project: We have hands on volunteering opportunities for our corporate partners ranging
from painting fences, tending to vegetable plots and garden landscaping projects.
Play Department Parties: Our play department is one of the busiest areas in the hospital and we often work with
clinical staff and play specialists alongside our corporate partners to provide ad hoc parties and activities for the
patients within our care. This can include providing food and drink, entertainment or just some hands on help on
the day to make our patients experience one they can enjoy and remember as part of their hospital experience.
A Volunteer Story – Liz Inchley
“While studying Psychology at Aston University, I decided to increase my experience working
with children to fulfil my future ambitions. Coincidentally, I received an invitation to attend a
presentation at the university about volunteering at Birmingham Children’s Hospital.
Lisa Robinson painted the picture of exactly what I wanted to do; arts and crafts activities.
My fellow students and I applied through the Student Outreach service at the university, and
I began my volunteering role in the summer of 2014. My first day in the Oncology Day Clinic
is something that I’ll never forget: being introduced to the staff, the children, and the work I
would be doing. I spent the whole shift smiling and I left with a huge amount of pen on my
hands! When I made it back home that day, I had to sit quietly for a moment and let it wash
over me that I was finally doing what I “want to do when I grow up”. I had created smiles
and brightened my own day in the process, and that felt incredible. Since then, my 2 hour
shift every Wednesday morning has been such a rewarding experience. Understandably,
patients may be quiet or tired, but it’s amazing to know that I can be there to help. The
children get to know that the person walking through the door with the bright red top on
will be the one they can play with, show their drawings to, and be a little more relaxed
around. This role has given me confidence, responsibility, trust, and a sense of pride in what
I do.
Soon, I am leaving the hospital to concentrate on university exams. I suspect my last day will
be a difficult one; I’m definitely going to miss those faces lighting up when I walk around the
corner with an armful of exciting things to create. On the brighter side though, this
experience has given me the opportunity to take my university placement year with a
company called City Year, who recruit volunteers to work in schools. I have no doubt that I
will use everything I’ve learned at the hospital in my future career.
I feel privileged to have been part of BCH, and perhaps my chosen career path will lead me
back here at some point. The experience I’ve had here has been invaluable to me, and I have
treasured every minute”.
Our youth offer - Aspire@BHC
Aspire@BCH is our umbrella brand for a range of programmes that support young and/or disadvantaged people to gain access to
work experience, traineeships and apprenticeships. We work closely with local schools and colleges and have seen a significant
increase in access and those going on to secure employment. Alongside this, we have our innovative employability scheme which, in
partnership with Calthorpe school, has provided four young people with a learning disability with employment at BCH.
These programmes have a positive impact on the community in terms of supporting young people into training or employment. This,
in turn, supports positive mental health and wellbeing, can support improved lifestyles, reduce reliance on benefits, provide improved
prospects and ultimately support future careers in the NHS.
“I enjoy working here as I have always wanted to work with children and in a hospital. I have gained loads of experience and learnt
new things while I have been working here. My department are all lovely and are all helpful. I am hoping that I can get a full
time job after within my department.”
Katie Grove (Clinical Apprentice in Radiology)
Programmes of Work
Employability
Programme
For young people
with a learning
disability – 5
opportunities
and 2 open days
Work Experience
Over 300
places in
2013/14
Traineeships
New
programme,
doubled intake
to 20
Apprentices
Interns
Growing now
have between
60-80 each year
and 85%
conversion to
permanent role
16 trust wide
and many
converting to
permanent
posts
All supported by the Information, Advice & Guidance service (IAG)
CSR Components
1
Our People
This section will explore our provision for education, training and employment ensuring our reach and impact
is felt across the region
2
Stabilising and reducing our impact on the environment through sustainable
development
3
Our Business
4
5
6
Energy Use in Our Buildings


The Trust reduced its total energy consumption in 2013/14 from the previous financial year (2012/13)*.
‘Sustainability in terms of sustainable development is making sure that we meet the needs of today, without compromising
the ability of future generations to meet needs of their own. This means stabilising, and then reducing, our impact on the
environment is essential in ensuring we live within environmental limits.
Oil
Gas
Electricity
TOTALS
2010/11
2011/12
2012/13
2013/14
18.03
16,637.7
5
71.51
226.80
22,035.0
2
-
7,518.36
24,174.1
4
7,238.90
10,044
32,305.3
7
10,085.91
13,247.72
20,558.13
15,141.43
Future Ambitions
A large proportion of the Trust’s carbon emissions come from
the use of fossil fuels to heat, light and ventilate the buildings.
Every effort will be taken to ensure that new buildings are
constructed sustainably (using sustainable materials) and that
renovations employ the highest possible standards available.
25,227.34
*Some of the data for energy and water has been estimated as at
the time of compiling this report the data is not yet available from
suppliers.
The Trust will aim to design the built environment to encourage sustainable development and low carbon usage in every aspect of
their fabric and function. Works will also be undertaken to the existing estate to improve the energy efficiency performance of
buildings (e.g. LED lighting, use of renewables where possible, etc.)
Table 1: Total energy consumption 2008/9 – 2013/14 (MWh)
Our Built Environment- Water Consumption
Water consumption has increased year on year
over last three years.
Future Ambitions
The Trust will monitor and reduce (where possible
and only when it is safe to do so) our water
consumption in accordance with water regulations,
targets and actions. All measures will be approved by
the Water and Air Safety Group prior to
implementation.
Waste Reduction and Recovery
The Trust has reduced general waste sent to landfill by 87 tonnes and
increased the amount of general waste that is sent for recycling by 60
tonnes.
Future Ambitions
The Trust will aim to minimise the production of waste through good
purchasing practice. Improvements in waste recycling are currently
being reviewed by the Trust.
Figure 2: Waste generation (tonnes) by treatment type 2011/12 to 2013/14
Travel and Transport
• The Trust is working to improve the use of alternative (i.e. more
sustainable and healthy) modes of travel (e.g. cycling, walking, public
transport). It facilitates a cycle scheme where staff can purchase cycles.
The trust is dependent on transportation systems for many of its functions
and this will remain a necessary part of the access to and delivery of
healthcare provision for the foreseeable future.
•
The Trust will endeavour to reduce the environmental impact of travel
associated with our activities, particularly through vehicle emissions, fuel
consumption and our impact on local congestion.
Carbon Management
• A sustainable, low carbon Trust offers an opportunity to save money while
helping to create a quality resilient healthcare service. The management of
carbon emissions across the Trust will save resources now, improve health
today and help to deliver high quality and sustainable services for the future.
•
The Trust is working to operate in an energy efficient way to continually
reduce carbon emissions, resources, consumption and costs and has
developed a Sustainability Action Plan to help us work towards this.
CSR Components
1
Our People
2
3
Our Business
4
5
6
Our Business – Ethical & local Procurement
Our Procurement Strategy’s principles require us to:
•
Pursue and demonstrate fair and open competition;
•
Operate legally and to the highest ethical standard;
•
Encourage environmentally products and services;
•
Have a reputation for fairness in the decision making process, commissioning and award of contracts.
Our key Procurement partners include:
•
NHS Supply Chain;
•
Health Trust Europe; and
•
Crown Commercial Services.
All the above partners have sustainable development procurement strategies.
For NHS Supply Chain, whose contract scope covers £5bn,
a Five Theme approach is followed – outlined opposite.
Carbon
and
Greenhouse
Gas Emissions
Community
Waste
Reuse,
Reduce,
Recycle
Health Trust Europe seeks to address sustainable procurement through:
•
Reducing fossil fuel usage to minimise climate change
•
Reducing usage of hazardous materials and reducing waste
•
Improving public health and quality of life
•
Increasing levels of employment, skills and equality in the geographical areas
covered by its customers
•
Ensuring fair pay and working conditions through the NHS Supply Chain
Corporate
Social
Responsibility
and Social
Value
NHS
Supply
Chain
Natural
Resources
Pollution
Prevention and
Environmental
protection
Crown Commercial Services, as with all Central Government bodies, operate under the
Greening Government Commitment targets and meet mandatory Government Buying Standards.
Ethics and
Responsibility
Labour
Standards
CSR Components
1
Our People
2
3
Our Business
4
Public health opportunities, influence and reach across the local and national
population
5
6
Public Health
There is now good evidence that the journey from birth to adolescence establishes a critical path for future life opportunities, not
only around health and wellbeing, but also education, employment and outcomes for future generations. Risk factors acquired
during this period are carried into adulthood, and if not addressed, limit quality and length of life.
BCH understands that the child is so much more than their illness, and that circumstances both within and outside of their family’s
control will be affecting this life course. The figure below, by Barton and Grant, and derived from seminal work by Dahlgren and
Whitehead, demonstrates the complex interplay of factors, and how health must be viewed through a much wider lens.
Population Health
Birmingham, and many of the communities that the hospital
serves, have high levels of challenge in many of these
domains. Over half of the children in the city live in
households in the most deprived fifth of areas nationally,
and the majority of children admitted to the hospital come
from these areas. Similar patterns of inequalities across the
social gradient exist for each of the factors affecting the
individual, and the combined consequences of these factors
mean that children and young people do not achieve their
full potential across their life course.
The early negative outcomes in behaviours can be easily observed in the young population of Birmingham.
These factors not only have immediate impacts, but will become the determinants of ill health and missed
opportunity for many decades.
You will see from the next page how our role in influencing these behaviours through schools and other public
health initiatives supports families to lead more health lifestyles.
Population Health – On-going actions

Aligned to this, BCH understands that, as well as the specific responsibilities about the health of members of staff, that those it employs are
themselves affected by this same wide range of factors, and experience their consequences in the same way.

In response to this, we commit to continuing to develop how we use our place and voice in the city, our connection with many thousands of
families, our buildings, and our people, to address these inequalities and to ensure that all children have a fair and good start to their life
course.
Specifically, we will;
















Continue to use and evolve the 'Making Every Contact Counts' to ensure that both can support children and families to take positive steps
towards improving their health
Develop appropriate services or referral pathways to enable parents to go smokefree, improve their physical activity, and enjoy a healthier
diet, and continue to challenge any failure of quality in these services where they are provided by any organisation
Ensure that we provide opportunities for families to be signposted to support services outside of health, including housing, financial support
and local community development
Seek to advocate and influence on key policy areas that affect the health and wellbeing of children, young people and families
Proactively engage with other local and national organisations, including Birmingham City Council, on consultations that affect children, young
people and families, across the wider determinants of health and wellbeing
Ensure we consider the wider health and wellbeing impacts of major investment projects, including their accessibility by active transport, and
by communities in higher areas of deprivation
Ensure our buildings and physical spaces provide opportunities and nudges to take healthy actions, not limited to increasing stair usage,
reducing nicotine usage, and feeling positive about healthy eating
Use our resources to develop the assets and abilities of the people that connect through the hospital to enable young people and families to be
agents of positive change within their own communities of interest
Maximise the potential health benefits through fundraising and group activities, for example through support of charity marathons and fun
runs
Ensure staff, patients and visitors are aware of the evidence based steps to achieving wellbeing
Explore the role of art and other creative activities in improving health and wellbeing
Actively participate and consistently promote citywide initiatives aimed at improving health, for example the Birmingham Cycle Revolution
Support staff and patient led activities that benefit health and wellbeing, for example a community allotment project
Develop our work with local schools to include a clear health and wellbeing curriculum component supported by the Birmingham Children's
Hospital identity
Ensure that our investments and commitments as an organisation are not linked to the tobacco industry, and consider the appropriateness of
potential sponsors and partners to us as an organisation in terms of their impact on health and its key determinants
Undertake research to understand the role of the paediatric hospital in improving the health and wellbeing of children, young people and
families.
CSR Components
1
Our People
2
3
Our Business
4
5
6
We run many fundraising initiatives across the city that both develops the brand of BCH and our role as ambassadors for child health
together with continuously exceeding our fundraising ambitions.
Our latest project The Big Hoot is a partnership between BCH and Wild in Art. It aims to promote local artists, is sponsored by local
businesses, will attract families to visit and promote health and wellbeing, and will fund-raise for BCH through the sale of the owls in
Autumn.
We have linked this with our Aspire@BCH work when a number of our apprentices, trainees and interns undertook challenge week
to seek to promote the Big Hoot to children and families as an exciting day out and to promote physical activity.
CSR Components
1
Our People
2
3
Our Business
4
5
6
Supporting Children’s healthcare around the world
Many of our talented teams and individuals have very
important international links that support the
development and improvement of children's healthcare
around the world.
We also very proud to have an established and very
successful relationship with the Queen Elizabeth Central
Hospital in Malawi, Africa, which has created a strong
educational link and the sharing of best practice,
knowledge and skills.
25
Malawi Partnership
The Malawi Partnership with the Queen Elizabeth Central
Hospital Paediatric Department is unique as it crosses
department and professional boundaries and involves staff from
a wide variety of disciplines and backgrounds.
Malawi is one of the poorest countries in the world, (ranked 170
out of 187 on the Human Development Index) with 74% of
people living on less that 80p per day. UNICEF estimates that
there are a mere 56 nurses per 100,000 people; this lack of
qualified and motivated healthcare staff combined with poverty,
the HIV epidemic and lack of resources means that 1 in 10
children will die before their 5th birthday.
Dozens of our doctors, nurses, technical staff, administrative
staff and medical students have worked and taught in Malawi
since 2004, with many of their teams visiting our hospital to
observe and learn from our staff.
There are now five fully trained paediatric consultants at the
Queen Elizabeth Central Hospital - in 2004 there were none.
Benefits of this partnership for BCH
•
•
•
•
•
Enhanced reputation internally and externally. The BCH Malawi Partnership is considered one of the leading
paediatric global health partnerships, this can enhance our existing prestigious reputation as one of the UK’s
leading children’s Hospital’s and make the organisation more attractive when being considered for service
contracts, education and research grants, and recruiting new staff.
Higher levels of cultural competence following placement at QECH. Culturally appropriate services for NHS
patients are essential in reducing health inequalities in the UK.
BCH staff on longer secondments have developed professionally and personally. They have developed resilience,
learnt how to deal with adversity, developed leadership skills, improved awareness of resource management
and increased motivation.
A more highly skilled workforce with staff who have experience and knowledge of managing diseases that are
becoming increasingly common in the UK such as TB and HIV
Many staff returning from Malawi have gone on to receive promotions and further their careers within BCH
The Trust Board And the Partnership
The Malawi project team are keen to involve the board in the on-going development of the partnership and the board is
specifically asked if this can be demonstrated by the following:
1. Confirmation that the BCH Malawi Partnership is supported at the highest level
2. An organisational commitment to encourage BCH employees to take part and support the BCH Malawi Partnership
through promotion
3. Ongoing support from a member of the Executive Management Team, currently Theresa Nelson
4. Other practical considerations to include:
• Pick up the small salary of the coordinator – currently paid at minimum wage from the partnership charity funds
27
Other expertise that is shared around the world
•
Anaesthetist Doug Johnson and Plastic Surgeon, Hiroshi
Nishikawa, are regular visitors to Ethiopia to support
craniofacial reconstructive surgery for children suffering
from the devastation skin condition, Noma, and those with
tumours, trauma and congenital abnormalities.
•
Nephrology Consultant, David Milford, has spent time in
Trinidad in the West Indies to help develop paediatric
kidney services. His two missions to date have already
resulted in six children receiving life changing transplants
from their parents.
•
Liam McCarthy, Urology Consultant, has spent time in
Zanzibar to support their team and operate on children
with congenital and traumatic genital abnormalities.
David Milford, far right
Doug Johnson
Liam McCarthy, top right
Sharing our expertise around the world
•
David Barron, Consultant Heart Surgeon, has been
working with hospitals in Spain and India has performed
operations on two of their complex patients. He is also
helping the Australian Health Authority review its national
Hypoplastic Left Heart Syndrome service provision.
•
Bill Brawn CBE, Consultant Heart Surgeon, has been
helping Munich in Germany review their cardiac surgery
programme.
•
And Consultant Heart Surgeon, Tim Jones, has been
helping set up an ECMO life support programme at the
Red Cross Hospital in Cape Town, South Africa.
David Barron, left
Bill Brawn CBE
Tim Jones
Supporting our wider aspirations
Benefits for the City
Broader Health
Economy and Region
Globally
Supporting our
people
Providing
economic growth
A unique offer for
the UK
Improving health
and wellbeing
Creating jobs &
future
opportunities
Spreading our
clinical expertise
Enhancing the
City profile
Protecting our
environment
Enhancing our
reach
What is the scale of our ambition?
Individual Focus
Supporting
our people
Health
Information
Individual Focus
Population Focus
Health
Education &
Skill
Development
Population
Health &
Wellbeing
Presence in
the City
Individuals Impact
Population Impact
CURRENT PROVISION
BCH POTENTIAL OFFER
National
impact
International
Impact
Population Focus
Global Impact
FULL STAKEHOLDER
INFLUENCE
This report has detailed a number of work streams that demonstrate that BCH is not only aware of the broader impact we
have on our environment and the communities we serve, but we are striving to increase this positive impact.
We have the unique opportunity to also make an impact around the world and the examples included in the report are just a
snap shot of the brilliant contribution that BCH staff are making.
The Trust Board is asked to discuss and consider how ambitious we want to be with this agenda, the above model is just one
way to frame the discussion .
How involved do we want to be and what resources do we want to commit?
‘Optimised’ Status Quo..
Advocacy, Policy & Topic Commentary
Community Resourcing / Small Scale Asset Interventions
Stewarding +/- Resourcing of wider networks of change
National and Global Interventions
DIALOGUE & COPRODUCTION
Status Quo
Recommendations
The Trust Board is asked to:
1. Receive the report describing the range of activities influencing our role and
reach across the city, the region and the world.
2. Discuss the Trust Board ambitions in this area and agree key areas of activity for
the executive to explore.
3. Discuss the specific components of the Malawi partnership and in particular the
role the board wishes to have in relation to:
• Support the funding for the salary of the coordinator
33
Board of Directors
30th April 2015
Item 15.85
Report Title
Sponsoring Director
Author(s)
Enc. 04
Monitor Annual Operational Plan 2015/16
Matthew Boazman, Chief Strategy Officer
Matthew Boazman, Chief Strategy Officer
Finance & Resources Committee – 22nd April 2015 (Approved)
Situation
The Trust is required to submit an operational plan to Monitor on an annual basis as part of the Annual
Planning Review (APR) process- this is a requirement for all NHS Trusts.
Background
The APR framework for 2015/16 has again changed when compared to the previous year’s planning
requirements. Some of the key differences are summarised briefly below:




No requirement for a strategic planning submission for 2015/16
Only an operational plan is required for 2015/16
Key focus for current APR is one year - 2015/16 only
Continued requirement to self-declare organisational viability throughout 2015/16
Overall, the planning requirements from Monitor have been reduced significantly for 2015/16. There is
no requirement for a strategic plan submission and the primary focus is on organisational viability
throughout 2015/16 with a clear emphasis on establishing whether or not organisations are in
“distress” – financially or performance related.
The other key change to the planning cycle this year was the requirement to submit an initial
shortened (5 page) draft operational plan for primary evaluation by Monitor before completing the
more detailed operational version for the 14th May 2015. As with previous years the format of the
plans (both draft and final) in terms of content, key areas that need covering, heading and length are
prescriptive and this is reflected in the attached planning document and areas covered.
The timetable and dates for submissions have also been amended as a result of the delays nationally
regarding both contracting and tariff negotiations with the key dates outlined below. It is important to
note the additional challenges this presents in terms of Board and sub-committee approval, especially
given uncertainty about the timing of the Monitor feedback to individual providers.
-
Submission of summary operational plans - 7th April (originally 27th February)
Monitor draft plan feedback to providers – between 7th April- 13th May
Submission of final operational plans - 14th May (originally 10th April)
Assessment
In order to comply with the planning requirements set out by Monitor the draft and full operational
plans must cover the following key areas within the document.
Summary Operational Plan
-
Maximum 5 pages
Brief Narrative
Setting out major assumptions on:
-
 Activity
 Tariff and financial projections
Statement on organisational sustainability throughout 2015/16
A brief overview on the organisational response to the 5 Year Forward View
Final Operational Plan – 14th May 2015
-
Maximum 20-25 pages (excludes declaration and front sheet)
Establishing the Strategic Context
 External environment
 Commissioning and funding
 National and local commissioning priorities
 Changes to organisational performance
 Government policy
 Response to the Five Year Forward View
-
Delivery and operational requirements
 Key performance areas and mitigations
 Operational capacity
 Workforce
-
Quality Priorities
 Overview of any specific quality concerns
 Overview of quality priorities
-
Financial Forecasts
 One year financial projections and narrative
 Key assumptions
 Overview of capital programme
 Cost improvement programme
 Impact on risk ratings
Recommendations
At this stage it is unclear when we will receive feedback, if at all, from Monitor to our earlier summary
submission. However, in order to comply with the revised planning timetable for the final submission it
is necessary to approve the Operational Plan at the April Board recognising that some amendments
may be necessary between the Board meeting and final submission deadline of 14th May 2015.
It is worth noting that we do not expect to receive any feedback from Monitor on our summary plan
and our two previous year’s submissions have both been green rated with no amendments necessary.
The Board of Directors is asked to approve the Operational Plan for 2015/16
Key Impacts
outcome)
The operational plan 2015/16 contributes to all of the strategic
objectives
NHS Constitution
NHSLA, Information
rights
Other
None
The Operational Plan is a core component of the Monitor annual
planning and compliance requirements
None
None
Operational Plan 2015/16
Birmingham Children’s Hospital NHS Foundation Trust
Version Control: Version 3.0
1
Operational Plan - 2015/2016. This document completed by (and Monitor queries to be directed to):
Name
Job Title
e-mail address
Tel. no. for contact
Date
Matthew Boazman
Director of Strategy and Planning
[email protected]
0121 333 8533
22/04/2015
1. Declaration of sustainability
Based on our analysis the Board of Director’s declares that Birmingham Children’s Hospital NHS Foundation
Trust will be financially, operationally and clinically sustainable according to current regulatory standards
throughout the operational period 2015/16.
The rationale for this assessment is summarised below and covered in detail within the remainder of this
planning document.
2. Evidence of organisational sustainability – summary of key factors 2015/16
2.1. Clinical sustainability
Our future clinical workforce is critical for ensuring that we are able to continue to provide sustainable clinical
models over the next five years. We have a good understanding of the specific challenges that we will face over
the next five years and are confident that we will be able to respond to these. As an organisation we continue to
invest heavily in the development and expansion of our workforce through the Next Generation people work
stream to ensure that we are able to deliver viable clinical services in the future.
2.2. Operational sustainability
In order to ensure that we are able to continue to be operationally sustainable it is important that we are able to
manage the predicted growth in demand. To meet this challenge we launched the Next Generation programme
in April 2014, and have subsequently approved investment in a new mobile operating theatre to provide
additional term capacity (2015/16) and approved the Outline Business Case (OBC) for a larger £35 million
investment to support the medium term estates strategy. Based on our detailed capacity and demand analysis
this will provide us with the required capacity throughout both the short and medium term to be able to manage
our current and predicted growth in demand.
Longer term we continue to develop proposals for the planned new children’s hospital, either on our existing
Steelhouse Lane site or on our preferred location at Edgbaston within the healthcare and life sciences campus.
Our overall programme of investment will provide us with the capacity required to ensure that we will continue
to be operationally viable between now and the planned new hospital in 2022.
2.3. Market demand
As with previous years demand for our services continues to be strong both in terms of NHS England and CCG
commissioned activity with minimal risks identified from current or emerging competitors. During 2015/16 we
expect demand and market share to grow in line with the trajectory that we outlined in our strategic planning
submission that was completed in 2014 and this was reinforced in our latest refresh of both the demographic and
2
market share data trends developed as part of the Next Generation OBC.
2.4. Financial sustainability
Our financial plan demonstrates that the Trust will remain financially sustainable over the period 2015/16.
Whilst there is a significant overall reduction in income assumed through 2015/16 (£6.0m) mainly as a result of
new tariff proposals, reduced educational income, the reduction in Community CAMHs and reduced donated
asset receipts income there is also an associated reduction in total expenditure levels which mitigates the
majority of this risk (£4m). The remaining difference will result in a reduction of the planned in year 2015/16
surplus from £4.01m to £2.11m compared to the original plan that was developed before the new tariff
arrangements were released. The reduction in anticipated donated asset receipts has had a significant bearing on
the previously planned 2015/16 surplus with anticipated receipts now due to be realised in future years.
The key financial planning assumption, which forms one of the Trust’s key financial risks, was the acceptance of
the Enhanced Tariff Option (ETO). Although this was financially preferable to the Default Tariff Rollover (DTR) in
2015/16, the nature of the Trust’s services (75% of Clinical Income received via NHS England) combined with the
growth of clinical activity and drug/device pass through arrangements, will be to the Trust’s detriment in future
years. Although we have mitigated for the impact of increased drug and device in 2015/16 further modelling is
required for future years to assess the longer term impact of this.
The overall risk ratings remain strong and unchanged throughout the planning period.
3
3. Our vision & strategy
Our overall Trust strategy for 2015/16 remains largely unchanged from the framework that we set out in our
strategic planning submission for 2015-2019. The strategy continues to be based on our mission, which is “to
provide outstanding care and treatment to all children and young people who choose and need to use our
services, and to share and spread new knowledge and practice, so we are always at the forefront of what is
possible.” This is supported by a clear set of strategic goals and our vision of being the leading provider of
healthcare to children and young people in the UK, whatever their condition and wherever they need our
expertise.
Our Mission
To provide outstanding care and treatment to all children and young people who choose and
need to use our services, and to share and spread new knowledge and practice, so we are
always at the forefront of what is possible.
Our Vision
To be the leading provider of healthcare to children and young people in the UK, whatever their
condition and wherever they need our expertise
Our Strategic Goals
Figure 1: The Trust Vision for 2014-2016
We will be undertaking a full review of our priorities during the April and May 2015 Board development sessions
in order to refresh our strategic objectives going forward in light of our successful performance during 2014/15
and also following the positive feedback that we received from the well-led Board review undertaken by Deloitte
in early 2015.
4. Understanding our strategic context
For effective strategic planning, an organisation must maintain a good understanding of the key factors that
impact on its future strategy. In the context of the Trust, this is to ensure that it can both meet future demand for
services, and ensure that it is able to mitigate against any potential risks due to changing policy and service
models. Threats to the future strategy of healthcare organisations include;
4



Changing demand for services due to population change
Impact of market trends and emerging competition
Changes in national policy, including service designation
The key challenges that influence the Trust and its ongoing strategy are outlined in figure 2 and our assessment
of their impact on the Trust has already been explored in detail within the strategic plan that was submitted to
Monitor during 2014. These were refreshed for the 2015/16 operational plan and also to support the completion
of our Next Generation OBC in February 2015 in order to take into account the proposals outlined within both the
5 year Forward View document and the revised ETO tariff for 2015/16.
Demographic
Change
Clinical
Evolution
and
Technology
Changes in
Patient Flows
BCH
Patient and
Family
Expectations
Policy and
Finance
Workforce
The changing
face of
secondary
care
Figure 2: Key Strategic Factors affecting Birmingham Children's Hospital
As part of our assessment it is clear that these elements will impact at different rates with some factors having a
much greater immediate impact on our planning than others. As a result we have only considered in detail those
areas that are likely to impact during the 2015/16 planning year within the remainder of this document, in line
with the Monitor planning guidance.
5. Modelling our future demand- 2015/16 impact
We undertook a detailed demand analysis as part of our Next Generation OBC development in February 2015 in
order to understand the future activity for our services in the short, medium and long term as a result of both
demographic and market share changes. We have refreshed this to support the operational plan for 2015/16 and
the key highlights from this analysis in terms of population growth and market shifts are summarised below.
5.1. Demographic & population changes
Demographic changes continue to be one of the key factors that will impact on our future hospital model with
the birth rate in the West Midlands currently rising. This trend is set to continue with the age profile reducing
further across both Birmingham and the broader West Midlands- ONS data predicts an increase of almost 8% (016 year olds) between 2014 and 2021 in Birmingham with similar figures for the West Midlands region.
At an organisational level we have developed an adapted trend model that adjusts for local authority specific
population projections derived from the ONS data. This provides us with both a short and long term forecast on
5
likely activity change and is based on 2013 data, with forward projections to 2021 by year, and a long term
forecast to 2030. This shows a 7.1% increase in total hospital activity by 2021 from 2013 baseline, rising to a total
increase of 8.5% by 2025 through demographic changes and associated demand (Figure 3).
Figure 3: Demographic Changes for West Midlands 2013-2030 (ONS Data)
During 2015/16 we will continue to see increased demographic pressures across our services with particularly
noticeable growth across the 0-5 year old age cohort.
5.2. Market share growth
Maintaining a strong market share is an important element of the Trust’s longer term strategy of developing a
world-class paediatric centre in Birmingham. As part of our recent OBC development we undertook a detailed
market assessment in order to understand our market opportunities and current and future competitor risks.
The strategic analysis provides good evidence that market share will continue to increase, with more activity
transferring to the Trust within the planning period. There is no anticipated change to this assessment that would
impact on our activity during 2015/16.
The assessment used the Monitor and PWC guidance issued during the 2014 strategic planning round and
covered an assessment of:‒
‒
‒
BCH historical market share and forecast trends in market share
Competitor analysis (PESTLE, Porter 5 Forces & organisational SWOT analysis)
Impact of market growth on future demand
The detailed analysis illustrates that the Trust has experienced a significant increase in market share and an
increased penetration into the market. Following correction for seasonal factors, a statistically significant shift in
market share towards the Trust has consistently occurred over the last eight years. By regression, this equates to
an approximate 0.7% shift in the number of admissions from the West Midlands towards the Trust on an annual
basis, or an estimated 3.4% change in market share over a five-year period, following correction for demographic
changes within the same area of analysis.
6
Figure 4: Forecast changes in Market share based on time series
Subgroup analysis identifies specific types of activity where this growth is particularly prominent, for example
short stay electives have shown consistent growth of 1.25% per year. We have developed both out strategic
planning and 2015/16 planning assumptions to take into account this predicted future trend in market share.
5.3. Market share and demographics combined- implications for future demand
As part of our demand planning we have developed a model to illustrate the combined impact of the
demographic growth and projected market share shifts outlined above. The model uses forward projections and
statistically significant trends to generate synthetic estimates of ‘maximum reasonable’ growth in our activity.
Using our 2014 base, we have added demographic growth, and market shift. We have reduced our market shift
by the relative proportion of demographic growth across the West Midlands during the previous 5 year period to
reduce the impact of double trend counting within the estimate. The combined impact is illustrated in figure 5
which shows the potential impact across the 2015/2016 planning period.
Figure 5: Maximum growth projections- demographics and market share combined
6. National policy- responding to the Five Year Forward View
NHS England released the Five Year Forward View (5YFV) in October 2014 which outlined the challenges faced by
the NHS and set out how the health service needs to change. The document outlined a series of future possible
provider models for supporting the delivery of this vision and the relevant areas are briefly explored below and
have been considered by our Trust Board and will form the basis of future Board development sessions;
7
The 5YFV outlined a series of future clinical models for supporting the delivery of the future vision;






Multispecialty Community Providers (MCPs)
Primary and Acute Care Systems (PACs)
Urgent & Emergency Care Networks
Retaining viable smaller hospitals
Specialised care
Supporting modern maternity services
In the context of the Trust, this provides evidence that the hospital is likely to have the opportunity to participate
and lead diffused networks of care. This would give it increased responsibility for centralised delivery of
specialised functions such as surgery, whilst also increasing access to network sites for the delivery of pre-surgical
and post-surgical care. It is however unlikely that there will be any significant changes or impacts during the
2015/16 planning period to Trust activity in these areas.
6.1. Concentration of specialised care
The provision and growth of the Trust’s specialised services portfolio is a key component of the future strategy,
and has been developed in line with a persistent national direction of travel to rationalise the number of
providers delivering specialised and complex care. The policy trajectory is illustrated in figure 6, below.
Specific 5YFV proposals on the approach to achieving the rationalisation of specialised provision of care include;
 Concentration of care: a strong relationship between the number of patients and the quality of care
 Standardisation: Focus on greater standardisation of care
 Consolidation: NHS England will develop networks of services
 Contractual models: prime contractor and/or delegated capitated budgets will be developed
There is strong evidence that the Trust has potential to increase the volume of care that it delivers to these
patients, providing it has adequate resources and planning to do so. It can achieve this through quality,
contracting and choice mechanisms.
Figure 6: Developing Model for Specialist Service Provision
8
At a regional level, the Trust is effectively the monopoly provider for the majority of NHS England commissioned
services with no other major competitor. Competition for the specialist paediatric market is therefore primarily at
a national level and continues to be influenced by service designations and direct competition with specialist
nationalist providers. The strategic analysis undertaken by the Trust has not identified any major threats to its
position within the market, providing it sustains the capacity and capability to deliver quality care within financial
constraints.
6.2. Urgent & emergency care networks
The 5YFV outlined proposals for supporting urgent and emergency care networks which are consistent with
previous national policy and builds upon the work of established approaches in areas such as trauma and stroke.
This is consistent with the Trust policy and strategy that has been implemented to date. The relevant elements of
the national policy are;




Access to care: Evening & weekend access to GPs and community nurses
Networks: developing networks of linked hospitals for specialist emergency care (drawing on the success
of major trauma centres)
Acute care: Ensuring hospital patients have access to 7 day services
Mental Health: integration of mental health crisis services
This area of policy is unlikely to have a materially significant impact on future activity flows during 2015/16.
6.3. Viable smaller hospitals
A key theme within the 5YFV document is the focus on retaining viable smaller local hospitals and DGHs. A range
of models are proposed and these all enable local hospitals to remain viable through a series of partnership
and/or networked models. The key elements are outlined below:



Amending the Payment structure: NHS England & Monitor will review the NHS payment regime
(Foundation Trust EBITDA 5% vs -0.4% smaller providers)
Staffing: Redesign of the workforce model to support sustainable cost structures, particularly for smaller
providers
Organisational structure: creating new organisational models for smaller providers, building on
recommendations from the Dalton review:
- Shared management or back office functions
- Provision of specialised services by another provider (e.g. Moorfields Hospitals NHS Foundation
Trust providing eye services through satellite clinics across London NHS sites)
- Create viable local hospital through a PACS model
This is an important area within paediatrics as there is evidence to suggest that some providers are starting to
withdraw from providing the full range of paediatric services and there are many areas where the future viability
of paediatric provision is potentially at risk. The impact of provider withdrawal can be significant and potentially
destabilising as it can lead to dramatic activity shifts above and beyond those projected through demographics
and market share growth alone. From a Trust perspective, any significant activity increase above demographics
and market share growth could present a significant challenge to the sustainability of the Next Generation Phase
1 development in terms of capacity.
9
6.4. Short to medium term opportunities
Whilst it is unlikely that any of these potential new models will have any significant impact on either service
delivery or activity during 2015/16 we have briefly considered their relevance and fit with our strategy below.
These will also be explored in more detail at our Board development session in May due to their relevance to our
longer term organisational strategy.
6.4.1. Multispecialty Community Providers (MCPs)
The 5YFV clearly outlines the expectation that organisations start to deliver care across traditional organisational
boundaries with a particular focus on integration across primary and secondary care. As part of this thinking two
different future clinical models are proposed and both present new challenges and opportunities to the current
Trust organisational strategy. The first area is Multispecialty Community Providers (MCPs), which outlines the
future vision for primary care and a series of radical changes which would see secondary care activity delivered in
primary care with secondary care clinicians potentially being directly employed by expanded GP practices.





Expert generalists: extended group practices will be able to form as federations, networks or single
organisations
Expanded services: directly employing consultants, paediatricians, social workers etc.
Changing delivery of care: majority of outpatient and ambulatory care delivered outside of hospital
settings
Hospitalist model: direct admitting rights
Pooled funding: combined health & social care budgets
In terms of the Next Generation phase 1 development, the most important element to consider is the intention
to shift activity (outpatient and ambulatory) into primary and community care. As part of the Trust’s strategy,
there is clearly the potential to develop a primary and community offer which would mitigate any potential
activity transfer as we would be the provider either as a MCP partner or as a Primary and Acute Care System
(PAC) provider.
6.4.2 Primary and Acute Care System (PACS)
PACS models deliver improvement through vertical integration, where a single organisation delivers both listbased GP services and hospital services, alongside mental health and community care. It is a population based
approach, with the PACS provider taking accountability for the whole health needs of a registered list of patients,
creating Accountable Care Organisations.
The strategic analysis identifies two mechanisms for implementation within the NHS;


New ownership of GP services: Hospitals could be permitted to open up their own GP surgeries with
registered lists
Extension of MCP model: the MCP tales over the running of its main district general hospital
The risks associated with this area are similar to those outlined above with regards to future activity shifts.
However, the analysis suggests that the risk of loss of market share to another PACS provider is minimal. The
more likely outcome would be that the PACS model provides the Trust with an additional opportunity to increase
market share and expand service provision outside of the hospital site through development of a paediatric PACS
service. At this stage, the Trust is considering its approach to the PACS and MCP elements of the 5YFV, as both
10
cover areas of provision that have not previously been considered in detail as part of the overall Trust strategy.
7. National & local commissioning priorities 2015/16
It is important that our operational plan is aligned with both national and local commissioning priorities and to
ensure that it seeks to address some of the challenges that are being faced across our Local Health Economy
(LHE) during the next twelve months. Having an affordable and realistic financial offer from local, regional and
national commissioning bodies continues to be important for the organisation to ensure financial viability
throughout 2015/16. Within our LHE we have engaged through the local Joint Clinical Commissioning Group and
with both CCG and NHS England contract negotiations in order to progress our contract discussions for the
2015/16 financial year.
We have also undertaken an assessment of the proposed commissioning intentions going forward and have
evaluated our experience of the 2014/15 commissioner/provider discussions in order to consider the potential
implications for the 2015/16 plan and the key headlines are summarised below:
-
National service specifications
Risk share arrangements for specialised and highly specialised services
Provider led networks
Funding for high cost drugs and devices and new treatments
Impact
Risk/Opportunity
Mitigation/Action
National service specifications are now in place
for all prescribed services- previously there
were no such arrangements.
Compliance exercise
highlighted a small number of
specifications where the Trust
was not compliant. There is
an associated risk that there
will need to be investment if
specifications are not
changed.
Actions identified for all specifications
where there are gaps however several
of the specifications there would need
to be significant investment.
There are approximately 60 service
specifications that are applicable to the Trust.
Risk share arrangements come into effect with
st
NHS England from 1 April 2015.
With the exception of CAMHS, performance
above/below an agreed threshold is subject to
a 70% marginal rate. This includes drugs and
devices.
Issues have been raised directly with
commissioners and through clinicians
that sit on the Clinical Reference
Groups.
Opportunity to increase
market share for services that
are able to demonstrate full
compliance with service
specifications
Derogations currently in place but not
yet received clear feedback on the
future impact, the issues raised are not
unique to BCH.
Represents a significant
change in payment
mechanism.
Negotiation of threshold with Local
Area Team to include agreed service
developments as a minimum.
Financial risk if the threshold
is not set at an appropriate
level.
NHS England has advised that the threshold
will be based upon 2014/15 plans.
11
Move to provider led networks for some
specialised services.
As a specialist trust this will mean that BCH will
be acting as the lead for the network and so
commissioning services from other providers
e.g. Cystic Fibrosis where a shared
arrangement with BCH as the host has been in
st
place from 1 April 2013.
High cost drugs and devices and innovative
treatments not on the approved list which
previously would have been funded through
individual funding requests are difficult to gain
approval for use causing delays.
Trust is accountable for the
performance of all members
of the network and if
standards are not met the
Trust would be responsible
for improvement.
Consolidates position as
specialist provider. Increases
the opportunity to improve
standards and care across
network and drive innovation.
For Cystic Fibrosis work stream an
internal project group has been
established which considers:


Contracts and finance
Quality standards
In addition a wider stakeholder group
is in place which will look at the
development of the network.
BCH is heavily engaged in a range of
national networks and is also leading
on the development of regional
network models for surgery
Delays in treatment or
treatment not authorized.
Internal process strengthened to
identify new drugs and treatments as
well as process for Individual Funding
requests.
Financial risk if drugs are
authorized for use and
funding not secured.
Internal group established for BCH
staff who are members of Clinical
Reference Groups
Figure 7: Commissioning Changes & Implications 2015/16
Under the current commissioning arrangements approximately 75% of services are prescribed services and
commissioned directly by NHS England. Contract negotiations for 2015/16 are based on forecast outturn for
2014/15 with 2% growth on ED, inpatients and outpatients included. Given the demographics for the region
there is an expectation that there will continue to be an increase in demand. This is acknowledged by
commissioners. However, there is limited opportunity for new developments except where these can deliver
QIPP.
7.1. Service reviews and reconfigurations
There are also a range of other commissioner led initiatives and proposed service reviews that are relevant for
the 2015/16 plan and these are outlined below.
Impact
Risk/Opportunity
Mitigation/Action
Presents a significant to improve
capacity across the region and
support improved flow across BCH
BCH is fully engaged in the review
both clinically and operationally.
Critical care review
As part of the national Clinical Utilisation
Review CQUIN NHS England
commissioners are going to undertake
out a review of critical care provision
across the region. This will include
intensive care and high dependency care
provision across all providers.
12
QIPP and demand management
NHS England are proposing two CQUIN
schemes linked to the delivery of
transformational QIPPs. This includes the
delivery of the nationally mandated
Clinical Utliisation Review (worth 0.4% of
CQUIN monies) and a ‘Right Care, Right
Setting’ CQUIN (worth 1.1%), which
focuses on reducing hospital outpatient
attendances.
NHS England has previously
refused to fund non face-to-face
outpatient appointments. The
‘Right Care, Right Setting’ CQUIN
provides an opportunity to
redesign the way in which
outpatient services are delivered to
improve capacity.
Joint Neonatal & Paediatric Transport
Service
There is an expectation from NHS
England that the merger will
deliver QIPP. However, the current
NTS is under-staffed and failing to
meet the neonatal service
specification. Therefore, additional
investment from commissioners
will be required.
The region is currently served by two
separate transport teams – KIDS (hosted
by BCH) and NTS (hosted by BWH).
Commissioners are keen to configure a
joint service, hosted entirely BCH.
BCH is actively engaged in the QIPP
process and is working with
commissioners to identify where
QIPP could be safely delivered for
commissioners.
BCH is currently exploring options
for a dedicated HDU facility, which
would fit with the Clinical
Utilisation Review CQUIN and
improve patient flow on PIC.
BCH is awaiting approval of the
business case and confirmation of
the funding arrangements from NHS
England.
It is possible that a single
ambulance contract would deliver
cost savings but this will not be
clear until the tender process is
underway.
Figure 8: Service Reviews 2015/16 and Impact Assessment
8. Delivering our operational plan in 2015/16
The Trust continues to experience increasing demand for operational capacity due to the factors outlined earlier
within section 4. The combination of demographic and market pressures has resulted in more activity having to
be delivered through our facilities and by our workforce. This impact affects our organisational performance,
access to services and ultimately the quality of our patient experience.
8.1. Demand and the impact on patient experience
The growth in Trust activity in recent years has exceeded the expansion in physical estate, and this has begun to
impact on the patient and family experience of care, particularly through delays and cancellations, as well as the
time taken to receive definitive treatment due to both increased diagnostic waiting times (6 week standard) and
access to theatres for surgical patients.
8.1.1. Operating theatre capacity and cancellations
The number of cancellations at the Trust has risen in the last twelve months, as shown in figure 9 below;
13
Figure 9: Number of cancellations at Trust by type, by month, for last twelve months
Despite additional investment and initiatives to protect patient flow, this has been accompanied by a gradual rise
in Trust waiting list size, as shown in Figure 10.
Figure10: Total Trust waiting list size on rolling weekly basis since April 2014
In Winter 2014/15, the highest number of emergency attendances and general paediatric admissions created
further pressure on the Trust’s capacity, and elective surgery needed to be cancelled for consecutive weeks to
release capacity for unplanned admissions. Root cause analysis of these surgical cancellations highlights a lack of
physical capacity, both in terms of ward beds and operating theatres, as well as problems with mixing of
emergency and elective surgical flows. This supports the need for an estate development that not only adds
capacity, but also provides discrete pathways of care for different types of patient and formed the basis of the
Next Generation proposals.
The importance of maintaining sufficient operating capacity is also important in terms of the impact it has on the
18 week referral to treatment performance for admitted patients. Whilst we have continued to meet the
standard this has regularly been by small margins and our inpatient and outpatient waiting lists are above the
ideal maximum levels (as defined by IMAS) to ensure that all children and young people are treated within 18weeks. In the short-term we will be investing in additional mobile theatre capacity which will allow us to operate
on 35 additional surgical cases per week enabling us to clear our current inpatient backlog by Q4 of 2015/16.
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8.1.2 Diagnostic waiting times
Access to diagnostics and meeting the six week waiting time target, driven by demand for MRI scans, remains our
most difficult operational challenge. Despite increasing the capacity significantly throughout 2014/15 demand
has continued to increase at a faster rate with an annual increase of 15.5% in terms of new referrals per annum
(Figure 11). This has been due to a combination of higher patient volumes, increased patient complexity and
increasing utilisation of MRI scans for clinical decision making. As a result the Trust has not achieved this key
performance target since January 2013.
Additions to WL
700
600
500
400
300
200
100
0
Figure 11: Demand for MRI 2012-2015
In order to address diagnostic performance in 2015/16 the operational team will be focusing on three key areas:
 Demand management – working with our top 6 referring specialties to improve demand management
controls (i.e. follow-up scans at local hospital, reducing scans through implementation on new clinical
protocols such as the headache protocol, tighter controls on levels of authorisation for scan requests)
 Increasing capacity – the options are outlined in section 8.2.2 and will potentially provide up to 200
additional scans per week.
 Productivity- increasing the throughput of scans through the current scanners by improving scheduling
and optimising patient flow
Assuming that the demand continues to increase at the current 15.5% per annum we expect to have cleared the
current backlog and to be routinely meeting this performance standard by June 2015. However, it is important to
note that if demand increases beyond this level or capacity reduces below plan for any reason then this will
potentially impact on delivery beyond this date.
8.2. Increasing our capacity- responding to demand
Whilst it has been possible to mitigate some of this increasing demand through redesigning our clinical pathways
and improving operational productivity it is clear from our analysis that we needed to invest in the estate and
workforce in order to increase the capacity across the organisation to address both in the short and medium
term.
15
8.2.1. Medium term
The medium and longer term investment proposals were outlined within our strategic plan submitted in 2014
which considered our proposed development of a new ambulatory care and haem-oncology facility (Next
Generation Phase 1) – this was subsequently approved at Outline Business Case stage by the Board in February
2015 with Full Business Case review later this year.
8.2.2. Short term 2015/16 capacity
As part of the short term challenges the Trust has also supported investment in a range of clinical areas in order
to increase available capacity for 2015/16. This is particularly relevant for the key performance challenges we are
facing with regards to the 6 week diagnostic waiting time and operating theatre capacity outlined earlier. The
key areas of additional support include:
-
Installation of mobile Vanguard operating theatre Vanguard- operational March 2015
Purchasing of additional MRI Capacity @ Aston Brain Centre – operational January 2015
Increased operating of existing 3T research scanner- operational March 2015
Using spare MRI capacity within the independent sector – May 2015
Commissioning Newton work on clinical variation- May 2015
9. Our workforce priorities for 2015/16
As well as investing in our estate and physical capacity is it also essential that we are able to develop an effective
workforce that is able to respond to both the increased demand and increasing complexity of the care that we
deliver. Some of the particular challenges that we face in terms of both increased demand and the overall
reduction in workforce supply have been explored in detail within our strategic plan and Next Generation OBC.
9.1. The future for paediatric nursing
The Trust has considered the future of the paediatric nursing workforce in detail given the particular risk that is
presented by that element of workforce supply. Whilst the forecast workforce supply developed by Health
Education England (HEE), figure 12, indicates that the volume of future training programmes being commissioned
should be adequate, this has been assessed as being overly optimistic. It is likely that the national supply and
demand predications do not reflect the situation that is actually being experienced across paediatric services
nationally, and the Trust expects recruitment to continue to be challenging over the planning period.
Figure 12: Health Education England Forecast Workforce Supply
16
9.2. Responding to the challenge
Based on national and regional workforce predictions and our local analysis we have been able to identify and
fully understand our supply risks. This has enabled us to develop clear short and long term mitigation plans,
specifically around nursing, as well as reviewing our workforce models. We have engaged with our clinicians and
have established new governance arrangements to ensure we are strategically monitoring our risks, plans and
programmes of change. Key programmes of work for 2015/16 include:









Growth of advanced practice roles
Development of Trust funded pre-registration nursing cohort through the Open University via a workbased learning route.
Development of a redesigned practitioner framework to introduce the role of associate practitioner and
other support roles.
International fellowship programme for oncology nurses from Canada and the US.
Increased nursing commissions
Developing the assistant practitioner workforce
Creating new pathways for development and entry into qualification
Talent management and leadership development
Retention strategies
Underpinning this is a clear emphasis on creating the right organisational culture for change in order to support
our ambitious plans. Our People Strategy has a key focus on culture development and ensuring that we focus on
what is important to our staff, our patients and our business. The work that we launched in 2014 on our people
strategy has had a significant impact across the organisation and this is clearly reflected in our strong national
staff survey results.
Given the progress made over the last twelve months it has been important for us to revisit and ultimately
refresh our people strategy so that we can move to the next stage in our organisational development and
specifically increase our focus on supporting and embedding bottom up change and innovation across our clinical
teams. An overview of our refreshed People Strategy and the associated priorities for 2015/16 is outlined in
figure 13 below. This takes into account some specific feedback we have received on ensuring that our strategy
adequately supports the development of our bands 1-4/support workforce and also support our BME staff and
equal access to career progression opportunities.
17
Figure 13: Refreshed People Priorities 2015/16
10. Delivering high quality and safe care - priorities for 2015/16
One of our strategic objectives is that “Every child and young person cared for by BCH will be provided with safe,
high quality care and a fantastic patient experience.” In order to deliver this objective we developed our quality
strategy for 2014-2017. The strategy is built around five key themes and the individual priority areas within each
of these themes has recently been refreshed following both a review of our 2014/15 delivery and based on
feedback received as part of the well-led Board review undertaken by Deloitte.
10.1. Theme one: Ensuring that things go right- a proactive approach to safety
Safety has been traditionally defined as the absence of harm. Application of this definition to healthcare has
engendered a culture of reactive safety management and focused investigation efforts onto specific incidents
that resulted in serious harm. A paradigm shift is occurring where instead we need to consider safety as the
ability to succeed under varying conditions, so that the number of intended and acceptable outcomes is as high
as possible.
By looking at what goes right as well as what goes wrong with the clinical care we deliver, we learn from what
succeeds as well as from what fails. In order to support this approach we are developing an excellence reporting
system so that we can learn from events with a better than expected outcome and apply this across the
organisation. This “IR2” reporting system will allow us to learn from things going well as well as the traditional
learning from errors.
18
Improvement Initiative
Target to be achieved by 2016/17
Re-design incident investigation to promote
staff and parent carer participation - improved
feedback in terms or reporting back incident
outcomes and findings
To improve patient/carer satisfaction with the
process to 95% against the agreed metrics
Implement Favourable Event Reporting (IR2)
Trust wide to learn from what succeeds.
To deliver a 50% increase in favourable event
reporting Trust wide
Understanding everyday performance
adjustments- creating systems that are fit for
purpose
50% of reported system workarounds to be
designed out of our systems
Responding to commonly reported clinical
incidents
10% reduction in clinical incidents causing
harm
To improve staff satisfaction with the process
to 95% against the agreed metrics
Figure 14: Theme 1 Improvement Initiatives
10.2. Theme two: Building capability - embedding quality improvement and patient safety science
We have a range of expertise in Human Factors Science, Quality Improvement Methodology, Safer Clinical System
Design, Risk and Safety, Resilience Engineering and Coaching already within the organisation. We plan to build a
patient safety and quality improvement faculty, bringing all this expertise together with patient representatives
into a multi-professional team. The faculty will deliver training in quality improvement and patient safety science
to the rest of the workforce in order to embed quality improvement and patient safety science into everyday
practice across the organisation.
We will establish a quality improvement and
patient safety science training programme
30% increase in workforce trained in quality
improvement and patient safety science
We will develop a coaching programme to
support frontline teams to deliver quality
improvement and patient safety projects
30% increase in safety improvement initiatives
that are supported by a named coach and able
to demonstrate an improvement in patient
safety
We will increase the use of patient and parent
co-design in supporting service improvement.
We will demonstrate an increase in codesigned service improvement and patient
safety initiatives across the organisation
10.3. Theme three: Designing safer systems - understanding human factors
Human performance is influenced by a range of factors including workload, distractions, team cultural norms and
cognitive biases. Human Factors refers to the science of understanding these performance influencing factors.
Application of human factors science in other industries, particularly aerospace, has significantly improved
safety.
19
To date in healthcare, application of human factors science has largely been limited to strategies for individuals
and teams to recognise and attempt to mitigate their variable performance. We plan to take the application of
human factors science a stage further and use it to design safer clinical systems. The system components that we
are targeting are detailed below.
Full implementation of the Paediatric Sepsis 6
Trust wide
75% of patients with sepsis to receive
antibiotics within 3 hours of diagnosis
Introduction of a re-designed neutropenic
sepsis pathway
90% of patients to achieve a door to needle
time of <1hour
Develop a targeted programme to reduce the
level of blood stream infections on ward 15
Implementation of a new clinical system with
reduced preventable BSI rates
Improve the reliability of medication error
measurement
Implementation of the “Medication Safety
Audit” Trust wide
Improve medication error classification
Implementation of the MERP classification
Implement a paediatric electronic prescribing
system
System will be rolled out in 2016 across the
organisation
10.4. Theme four: Continual learning – better use of patient safety and quality information
We have a wealth of patient safety and quality information across the organisation. We plan to enhance our
analysis of this information so that it can better inform decision makers and provide greater assurance to the
organisation and children, young people and their families. In partnership with NHS England, we are developing
the NHS Safety Thermometer© for the paediatric population and plan to implement this across the organisation.
Develop a set of proactive safety measurement
performance indicators
To achieve a 1:1 ratio of past harm: proactive
safety measures
Enhanced analysis of patient safety and quality
information.
A new quality and safety dashboard will be
developed and introduced in 2015 to support
the Board and Quality Committee
Paediatric NHS Safety Thermometer©
Full Trust wide implementation
10.5. Theme five: Openness & transparency – enhancing the culture of safety
Openness and sharing of our patient safety and quality performance data is essential for ensuring that we are
able to create the right culture to support and enhance our approach to patient safety. Such openness will
engender trust from the children, young people and families that we serve which in turn will promote the safety
culture within our organisation in order to drive continual service development.
20
We plan to actively engage in the sharing of our patient safety and quality data with our staff, users of our
services, other NHS organisations and the wider public.
Aims to achieve by 2017
Increased transparency of patient safety and
quality measurement performance indicatorsreporting of Quality Committee dashboard and
KPIs
100% of reported patient safety and quality
measurement KPIs will be made visible to staff.
Developing safety cases- publishing safety
cases and learning from experience.
We will implement a safety case methodology
to enable us to publish learning from safety
case reviews within the public domain
100% of reported patient safety and quality
measurement KPIs will be made visible to
children, young people and families in the
public domain
11. Financial strategy 2015/16
The Trust’s organisational strategy and future development plans are predicated on striking a balance between
the short and the long term; the need to invest today whilst also securing the required resources to meet the
future requirements of the Trust and the development of the new hospital.
In order to do this, the Trust has established a financial strategy based on delivering a surplus every year and in
order to consistently deliver this it is important that the future income and expenditure profile for the
organisation is described, and that potential changes to it are examined. Analysis of the external policy and
economic environment suggest the following themes outlined below will be critical for our strategic financial
planning.
11.1. Resource prospects
The NHSE Five Year Forward View document was supported by a several policy papers including the direction of a
new payment system (Reforming the Payment System for NHS Services: Supporting the Five Year Forward View:
Monitor December 2014). This confirmed that the objectives of any new payment system should be to facilitate:



Continuous quality improvement.
Sustainable service delivery.
Appropriate allocation and management of risk.
21
Figure 19: Proposed development of payment models (Source Monitor 2014)
For many of the elective and specialised services provided by the Trust, the policy that is emerging suggests
payment approaches that:




Are standardised nationally, to ensure equity of access.
Allow patients to choose provider with money following the patient.
For some specialised services allow approaches tailored to their characteristics e.g. where fixed costs are
high and demand is unpredictable.
Use payments to incentivise best clinical practice.
Based on the initial analysis of the information available the future strategy of the Trust is aligned and fits well
with the funding models that are being proposed. As part of these proposals it is likely that there will be a move
to HRG4+ payment mechanism over the medium term. The advantage of this system in classifying the services
provided across the NHS is that it better reflects the costs of delivering more complex care. The Trust is part of
the NHS England / Monitor working group examining the impact of this shift and the impact that this would have
on the paediatric ‘top-up’ system.
Commissioners will continue to put pressure on activity growth across the system; market share increases will
have to show substitution of activity from other providers across the health economy if they are to be affordable.
New developments will be limited to those areas that can show that they provide value across both the Trust and
broader health economy.
Inflation in the health sector will continue to be a challenge. The Trust’s supplier base in some key segments
continues to withdraw from specialist markets with the prospect of reduced competition and increased cost. In
terms of managing the pay bill national measures to reduce the cost of staff are counter balanced by a scarcity of
staff in the more specialist groups.
22
11.2. Revenue expenditure
The Trust is a relatively high cost provider and this is expected to continue given the nature of services delivered.
However, improving flow and pathways through the hospital will provide scope for further efficiencies to be
delivered. The Trust will need to continue to deliver greater efficiency in terms of supporting costs and
overheads during the next five years- looking at how it can share services and explore how technology and
partnerships can deliver support to clinical teams at lower cost will become a key theme.
The basis of a sound financial position is continued and persistence scrutiny on cost control and delivering agreed
efficiencies. The Trust is committed to continuing this approach over the course of this financial plan
11.3. Capital expenditure
Traditional Private Finance Initiative (PFI) funding will continue to be an expensive mechanism to deliver new or
major capital schemes and the Trust will need to seek out best value commercial funding for planned major
development. Internally generated cash will have to be a significant source of capital funding, and this will need
to be supported by fundraising to deliver maximum value and quality.
The asset base of the Trust will also need to be used as a lever for funding. Maximizing value of the Steelhouse
Lane site through its inclusion in the Local Enterprise Zone and proximity to the Colmore Business District of
Birmingham and future HS2 Curzon Street developments will form a key element of this.
11.4. Clinical engagement in the resource challenge
Clinical engagement is central to delivering the financial agenda; having clinical leadership at the centre of
resource management will help make the right decisions to generate value for patients and the taxpayer.
Developing a clear narrative explaining the direction of travel and engaging with staff will be central to successful
delivery
11.5. Strategy for Trust resources
The resources strategy has been developed from this analysis and underpins the five-year financial plan. It has six
key components:






Using a mixed funding strategy for major infrastructure investments to reduce the weighted cost of
capital to close to the Public Works Loan Board (PWLB) rate +1.25%
Developing a clear financial management framework, providing clarity and allowing staff at the right level
to make the right decisions based on up to date information and support
Delivering the necessary revenue efficiency savings through:
o Continued and persistent focus on cost control
o Improving patient pathways and flow
Using the built environment to facilitate change and clinical efficiency
Continuing to focus on the composition of Trust workforce, ensuring that staff with the right skills are
undertaking the right roles
o Exploiting the benefits of new technology
o Improving financial literacy across the organisation
Growing fundraising income, embedding this approach within service planning, and ensuring it is a core
component of the funding mix of major developments
23
11.6. 2015/16 Tariff assumptions and implications
One of the other key areas that impacts on our operational planning for 2015/16 is the proposed new tariff
arrangements. The Trust has selected to proceed with the proposed Enhanced Tariff Option (ETO) and its
financial plan for 2015/16 is built upon a number of key planning assumptions.

Growth, as agreed with Commissioners, is included- 75% (£1.9m) of this will be subject to the marginal
specialised rate of 70%;

Significant reduction in income levels









Deflator built into the national tariff (£3.9m)
Reduction in Education income as 2015/16
Adjustment to donated asset income
Implied impact of marginal rate on 2014/15 growth
Underlying changes in the structure of the tariff reducing profitability on services
Reduced Community CAMHs income from 1 October 2015
Removal of winter/RTT monies
Reduced Road Traffic Accident income
Income levels will increase through the impact of revenue generating efficiency schemes
2014/15 2015/16
+/Outturn
Plan
£m
£m
£m
%
NHS Clinical Income
226.6
225.8
-0.8
-0.4%
Non-NHS Clinical Income
0.4
0.4
-0.0
-8.9%
Category C Income
14.4
13.6
-0.7
-5.2%
Donated Assets
0.2
0.5
0.3
110.1%
Education
8.8
6.3
-2.5
-28.2%
RTA
0.6
0.2
-0.4
-63.7%
Total
251.1
246.9
-4.2
-1.7%
Figure 20: 2015/16 Income levels compared to 2014/15 outturn
The financial plan for 2015/16 has also built in a range of expenditure reductions and assumptions around cost
pressures which reduce the total expenditure. These are summarised below and the impact is outlined in Figure
21.
•
Efficiency set at 4% of total budget
•
Pressures and provisions made in respect of:








£2.7m pay awards
£2.5m Community CAMHs
£2.0m Costs associated with growth
£1.9m non-pay inflation reserve
£1.2m CNST impact
£0.5m Nursing Commissions
£0.5m cost pressures
£0.45m to offset ETO drug and device impact
24
2014/15
Outturn
£m
159.6
82.9
6.9
249.5
Pay
Non-Pay
"Below the Line"
Total
2015/16
Plan
£m
159.7
77.6
7.4
244.8
+/£m
0.1
-5.3
0.5
-4.7
%
0.1%
-6.4%
7.2%
-1.9%
Figure 21: 2015/16 Expenditure summary compared to 2014/15 outturn
The overall impact of this on our financial plan is summarised below.
Total Income from Activities
Other Income
Operating Expenses
EBITDA
Interest Receivable
Depreciation
PDC Dividend
Interest Paid
Net Surplus/(Deficit)
2015/16
2014/15 Annual Provisional Plan 2015/16
Plan
Year 2 of 2014/15 Provisional Plan
Op Plan
£'000
£'000
£'000
217,785
215,159
225,799
19,877
21,086
21,088
-225,841
-223,855
-237,334
11,821
12,390
9,553
243
188
150
-4,624
-5,291
-4,559
-2,762
-2,979
-2,730
-300
-300
-300
4,378
4,008
2,113
Figure 22: 2015/16 Summary Financial Plan
The forecast Continuity of Service risk ratings remain unaffected as a result of the financial planning assumptions
for 2015/16.
Statement
SOCI
SOCI
SOCI
SOFP
SOFP
SOFP
Risk rating
COSRR
COSRR
COSRR
Metric
EBITDA
EBITDA margin
Cash and Cash Equivalents
Net Current Assets (Liabilities)
Total Assets Employed
Liquidity ratio score
Capital servicing capacity score
OVERALL Continuity of Service Risk Rating (CoSRR)
Actual
Outturn
2014/15
8.6
3.4%
1.6
51.5
27.5
134.6
Original
Plan
2015/16
9.0
3.8%
4.1
37.7
18.0
137.3
Revised
Plan
2015/16
9.1
3.7%
2.1
40.8
16.9
133.7
4
4
4
4
4
4
4
4
4
Figure 23: 2015/16 Summary COSRR Ratings
25
11.7. Capital expenditure
The Board approved the financial strategy in March 2012 and reviewed it again in 2014. This indicated that given
the cost of capital and the continuing global banking and sovereign debt crisis, traditional bank and bond funding
alone would no longer be affordable. As a result if the Trust wants to develop and invest in its infrastructure in
order to compete successfully then it is necessary to develop a financing plan that is affordable and sustainable
by utilising a range and combination of resources.
The 2015/16 capital programme has been developed in this context and will have to be accommodated within
the resource envelope set out as part of the Trust’s financial strategy. The Trust’s Capital Programme has been
developed via the following process:
-
Specialty and Corporate Department Business Plans outlining capital requirements for the short-medium
term
Identification of trust-wide capital requirements that fell outside of specific specialty plans
Prioritisation process led by nominated Executive leads with full Quality Impact Assessment taken for
unsupported schemes
The single largest element of the capital programme over the duration of the operational plan is the proposed
new clinical block on the Steelhouse Lane site. The £35m set aside for developing the site will be spread over
2015/16-2017/18 and is linked to the Trust’s fundraising strategy. Prior to this the Trust has committed to
supporting a number of short-term plans, outlined earlier, which will deal with immediate capacity issues using a
combination of revenue and capital schemes.
The planned capital spend in 2015/16 remains within the overall forecast contained within the 5 year Capex
Forecast submitted to Monitor in January 2014, which was subsequently updated in January 2015. The 2015/16
Capital Programme, as approved by the Finance and Resource Committee in April 2015 is as follows:
Capital Expenditure
Building - Non-Clinical Departments
Building - Clinical Groups
Carry Forward - Building Schemes
Carry Forward - Medical Equipment
Carry Forward - Estates - Backlog Maintenance
Carry Forward - Facilities
Carry Forward - IT Strategy
Carry Forward - Patient Experience
Carry Forward - Strategic Schemes
Donated Assets
Medical Equipment
Estates - Backlog Maintenance
Facilities
IT Strategy and Replacement
Other
Patient Experience
Strategic Investment - Next Generation
Strategic Investment - Forward Thinking Birmingham
Gross Capital Programme
less Grants and Donations
Net Capital Programme
2015/16 Plan
£'000
50.0
250.0
623.5
550.5
287.3
157.8
2598.0
283.7
324.9
500.0
1950.0
1500.0
80.0
907.2
700.0
225.0
6457.0
2000.0
19,444.8
-500.0
18,944.8
Figure 24: Forecast capital expenditure 2015/16
26
Outside of the proposed Next Generation development the other key aspects of the programme are:
-
-
Completion of Phase One of the CAMHs Tier IV development
Continued implementation of the IT Strategy (assisted by funds received from the Safer Hospitals, Safer
Wards Technology Fund - Wave One and charitable monies for the development of an e-prescribing
system)
CT scanner and Gamma Camera projects concluded
Adding additional physical capacity at the Steelhouse Lane site
Backlog estates maintenance programme
Replacement medical equipment programme including replacing one of the Trust’s 3 MRI scanners in
2016/17 (procurement process will commence in 2015/16);
A reduced level of donated assets. This will increase as the year progresses and schemes are finalised.
11.8. Cost improvement schemes and governance
As part of the operational planning for 2015/16 there has been an increased shift towards more transformational
and Trust wide Cost Improvement Programmes (CIP). The historical performance of NHS Trusts across the FT
sector and the past performance of BCH against annual CIP targets is an important driver for supporting this
move towards a more transformational approach. The historic CIP performance for The Trust is illustrated below
in figure 25.
Plan £k
Actual £k
Shortfall £k
% Delivered
2010/11
5,559
5,313
-246
-4.4%
2011/12
9,488
9,212
-276
-2.9%
2012/13
10,730
8,118
-2,612
-24.3%
2013/14
8,436
5,358
-3,078
-36.5%
2014/15
9,460
6,910
-2,550
-27.0%
Figure 25: Historic CIP delivery BCH 2010-2015
The level of CIP achievement has reduced over the last five years due predominantly to an increasing overreliance on traditional CIP programmes and cost-cutting which has become increasingly more challenging on an
annual and cumulative basis when compared to more sustainable and transformational programmes of service
improvement and redesign. In 2014/15 a more transformational approach was taken to developing our CIP
programme for a number of large schemes and these were generally more successful than the more traditional
CIP schemes within the plan, although the longer lead times for some projects resulted in lower levels of CIP
performance than planned.
Building on the Trust’s forecast outturn position we have tracked Monitor’s assumptions around the level of
efficiency required on an annual basis, but also assumed levels of inflation and key financial pressures. These
assumptions have been benchmarked with other FTs and Trusts and have been tested through an ongoing due
diligence process. In generating the financial plan an overall CIP target of £10.0m is required for 2015/16. This
incorporates legacy CIPs carried forward from 2014/15 and will provide funding to offset key internal cost
pressures. The constituent parts of this and the size of the challenge in % terms is outlined in figure 26.
27
% of Spend
NHS Clinical Income
Pay Inflation
Non-Pay Inflation
Cost Pressures
Legacy CIP
Total
£m
3.4
2.3
2.3
1.0
1.0
10.0
Total
1.4%
0.9%
0.9%
0.4%
0.4%
4.0%
Influenceable
1.7%
1.1%
1.1%
0.5%
0.5%
4.9%
Figure 26 CIP requirements for 2015/16
The approach for 2015/16 is to continue with the transformational approach and structure the programme in
two elements- hospital wide schemes and schemes at individual clinical group or service levels. The Trust is also
identifying schemes with a total value in excess of the £10m full year target as it is recognised that there will
always be some schemes that fail to deliver the full planned value.
-
Hospital wide schemes account for £6.1m. A number of these form part of the Next Generation project
Clinical Group and Corporate specific schemes account for £3.9m
Clinical Groups - 2%
Corporate Departments - 2%
Drug Expenditure Group
Procurement Initiatives
IT and Data Quality
Pathways
Workforce Initiatives
Commercial Schemes
Reducing Variation
Other Reduction Schemes
Technical Gains
Others
CIP "buffer"
Total
£m
3.3
0.6
0.5
0.8
0.6
2.7
1.0
0.2
0.5
0.5
0.5
0.6
-1.7
10.0
Figure 27 CIP programme for 2015/16
11. Board Assurance Framework 2015/16
The Board Assurance Framework (BAF) provides a structure and process to enable the Board to understand and
focus on the risks to achieving the organisation’s strategic objectives and to assist the Board in discharging its
responsibility for internal control. The BAF is presented to the Board for review at each monthly Board meeting.
The content of and process surrounding the BAF were reviewed by the Internal Auditor in 2012/13. The review
gave significant assurance, but a number of recommendations were made for improvement, and these were
implemented in 2014. Each risk that is identified on the BAF is now explored in detail through a deep-dive review
by the relevant Board sub-committee as well as being considered by the Audit Committee.
*** END OF DOCUMENT ***
28
Item 15.86
Report Title
Sponsoring Directors
Contributors
Board of Directors
30th April 2015
Enc 05
Quality Report
Dr Fiona Reynolds, Chief Medical Officer & Michelle McLoughlin,
Chief Nursing Officer
Governance Services, Corporate Nursing, Education, Infection
Prevention and Control, PICU & Cardiac Services
Quality Committee, CRAQA, SLT
Situation
The enclosed report provides an update on key clinical safety and quality topics.
Background
The report is collated from a number of information sources and provides assurance that key
risks are being escalated and monitored until sufficient action has been taken to address the
concerns.
The report includes information on key risks, serious incidents, mortality data, cardiac arrest,
respiratory arrest, other acute life threatening events, infection control data, Net Promoter
Question results, and data from the PED database. Information on Never Events and other
safety information is included by exception.
Assessment
SIRIs & Never Events
There were 2 new Serious Incidents Requiring Investigation (SIRIs) in March.
•
Concern that a laminoplasty carried out in July 2014 may have been done on too
narrow a range and the patient will now require an additional procedure as a result.
•
A patient who underwent a cervical fixation procedure has lost some function in the
lower limbs.
There were zero new Never Events.
Complaints
There were 9 new formal complaints.
PALS
There was a peak in PALS contacts over a 2 week period in March. A high proportion of these
contacts related to cancelled operations due to bed shortages.
Infection Control
•
There were zero MRSA Bloodstream Infections
•
There were zero MSSA Infections
•
There were zero C-diff Infections
•
There was 1 E. Coli pre-48 hour bacteraemia case which was unpreventable
We saw only one MSSA bacteraemia during the last 3 months, which is our best ever three
month performance. Last summer we introduced antiseptic skin washes for children with
central lines, which appears to have been highly effective; the last hospital-acquired MSSA
line infection that we diagnosed was in June 2014.
Mortality
There were 9 Inpatient deaths (<3 per 1000 admissions). They will be individually reviewed
through the normal specialty Morbidity & Mortality meetings.
Recommendations
•
Review the enclosed report
Risk Description
Failure to correctly identify the
greatest risks to the quality of care
and safety of our patients.
Key Risks
Controls
• Directorate Governance
systems
• Board Assurance
Framework
• Risk Register
• Safety Strategy
• Safety Dashboard
Key Impacts
Strategic Objective
Strategic Priorities
CQC Registration
NHS Constitution
Assurances
•
•
•
•
Monthly Board Safety Report
Mortality Review
Monitoring of incident trends
Monitoring of complaints
trends
Every child and young person cared for by Birmingham Children’s
Hospital will be provided with safe, high quality care, and a
fantastic patient and family experience
3. Further develop our approaches to gaining feedback from staff,
children, young people and families to ensure that their voice is
heard at every level of the organisation.
4. Further innovate our systems to promote and enhance patient
safety and reduce avoidable harm.
Standard 16 - Assessing & monitoring the quality of service
provision could be affected by a failure to manage risks
highlighted by the report. Risks to compliance with other
standards may be highlighted by the reports.
Patient Rights
• Quality of Care and Environment
•
Treatments, Drugs
•
Respect
•
Consent and Confidentiality
Other Compliance
rights
•
Informed Choices
•
Complaint and Redress
The report supports compliance with NHSLA and Monitor
requirements
Right to life
Quality Report:
Safety & Patient Experience
April 2015
Fiona Reynolds, Interim Chief Medical Officer
Michelle McLoughlin, Chief Nurse
1
Summary March 2015
Complaints
There were 9 new formal complaints.
SIRIs
Zero new Never Events
There were 2 new Serious Incidents Requiring Investigation (SIRIs) in March.
• Concern that a laminoplasty carried out in July 2014 may have been done on too narrow a range and the patient will
now require an additional procedure as a result.
• A patient who underwent a cervical fixation procedure has lost some function in the lower limbs.
Infection Control
Zero C-diff cases
Zero MRSA cases
Safeguarding
Zero new safeguarding
complaints
Patient Experience
78% of Patient Experience feedback is positive.
Monthly in-patient CYP F&F – 80 (81% response rate)
Zero MSSA pre-48h
Zero new position of trust cases
1 E-coli pre-48h
Training above the Trust KPI
Zero E-coli post-48h
Monthly ED CYP F&F – 70 (26% response rate)
ED F&F response rate was on target at moving from 18% in
February to 26% in March
Mortality
9 in-patient deaths - < 3/1000 admissions
2
Quality Report -New Events & Concerns
There have been no new Never Events since 27/12/14
There has been 2 new SIRIs
14/15:88 A letter of complaint has highlighted a concern
that a laminoplasty carried out in July 2014 may have
been done on too narrow a range and the patient will
now require an additional procedure as a result.
14/15:87 A patient who underwent a cervical fixation
procedure has lost some function in the lower limbs.
25
20
No. Complaints
15
Issues with communication with a
Consultant Hepatologist. Mother
feels unsupported in managing her
daughter's condition.
10
5
2
2
1
2
1
Mar-15
Feb-15
Jan-15
Dec-14
Nov-14
Oct-14
Sep-14
Aug-14
Jul-14
Jun-14
0
May-14
0
Quality of Treatment
Communication
Other
Q3
Q4
Jan-15
Mar-15
Jul-14
Sep-14
Mar-14
Nov-14
Concerns about the level of care provided
through the Complex Care team.
Quality of medical care received over the past year from the Neurosurgery team. Issues with
communication concern that a procedure has resulted in a deterioration of the child’s condition.
Staff Attitude
Q2
A father believes that the child’s
mother is being given priority over
him in relation to care.
Concerns about the cancellation of an exercise tolerance test, as the family had not brought the child’s
inhaler. Mother was unhappy that BCH could not offer a replacement inhaler and the family were sent
home without the test.
Waiting delays and cancellations
Q1
May-14
Concerns about the quality of care provided in
managing a procedure and the placement of a plaster
cast. This is the second complaint from this family.
Complaints top 5 categories
50
45
40
35
30
25
20
15
10
5
0
Jan-14
Nov-13
Jul-13
Sep-13
May-13
Jan-13
3
Mar-13
3
Sep-12
3
May-12
3
Nov-12
0
4
Jul-12
SIRIs
Apr-14
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Linked to completed SIRI 14/15:52 Unexpected death
during craniofacial surgery.
Following the inquest mother has
raised concerns that their son's
death was preventable.
There have been 9 new Formal Complaints
Mum feels that the service provided by CAMHS has been
slow to offer a realistic care plan for her daughter and not
taken her daughters mental health problems seriously.
Mother has raised concerns about the medical advice
received in 2002/2003 to not operate on her son's
undescended testicle.
Peak in PALS Contacts
In March we experienced bed
shortages due to record levels
of emergency activity and
tertiary demand, and essentially
running with 20 less beds due
to an increase in our longer stay
children.
The bed pressures have led to
high cancellations, an increase
in our inpatient waiting list and
a sharp increase in children
waiting over 18-weeks
Waiting delays & Cancelations by location
PALS Categories 11/03/15 – 25/03/15
Ward 5
Surgical Day Care
Respiratory
Radiology
Plastics
Paediatric Surgery & Urology
Orthotics
Main Out-Patients Dept
General Paediatrics
Gastroenterology
ENT
Cardiac Surgery
Audiology
Waiting, Delays & Cancellation
Quality Of Medical Care
Provision Of Written Info To P
Provision Of Oral Info To Pts,
Parent Facilities And Accommod
Lost/ Missing Records
Attitude Of Nursing Staff
Attitude Of Medical Staff
Admission, Discharge & Transfe
0
5
10
15
20
0
1
2
3
4
5
4
Completed SIRI & Complaint Investigations
There were 2 completed SIRI reports in March
Conclusions
14/15:66 A patient under the respiratory team suffered with a misplaced
nasogastric tube. The patient received 6mls of milk (and some medication totalling
approximately 11mls of liquid) before starting to show signs of respiratory distress
and so the milk was stopped and further review requested. The patient required an
admission to PICU for ventilation support and monitoring, but has since been
discharged from PICU with no permanent consequences expected.
Other similar incidents:
We had a misplaced NGT which was used and caused significant harm in April 2013.
14/15:51 Personal staff information inadvertently disclosed to an external
company. Immediately identified and deleted.
There were 7 Closed Complaints in March
A bandage was removed too early following an ear pinning procedure.
This event has been classed as a Never Event.
The RCA concluded that the incorrect test was used to confirm placement of the NGT
and that this resulted in inappropriate assurance that the tube was correctly placed.
This arose because The launch of the NGT guidelines was focused on the staff that
have the greatest involvement in the insertion and testing of NGTs. The role of
consultants in this task was not sufficiently recognised.
Recommendations: We will re-launch the guidance for placement and testing of a
NGT and will raise awareness of this guidance across all staff groups.
The root cause of the incident was a failure to recognise how pivot tables worked
and therefore to appreciate that hidden pivot tables were included in the document.
Recommendations: Our information governance training and in-house training into
the use of pivot tables will be developed. Good practice that is in place within the
Informatics Team will be shared with other key corporate areas.
Key Actions
•
•
•
•
Father disagrees with the reasons given that his daughter was discharged
from ED without being given medication.
•
The family were asked to leave the parents accommodation and security
and the Police were called following reported incidents. The family
believe that they have been misunderstood and treated unfairly.
Mother was told in ED that it was not normal to give a sedative to remove •
a bead from a child’s ear an urgent referral to ENT would be made but did
not get an appointment for 2 weeks. The child was taken to City Hospital
where the bead was removed under sedation..
•
A family feel that they were provided with inadequate information at
discharge and that a delay in diagnosis has damaged the patient's kidneys.
•
Concerns about the communication between the General Paediatric team •
and Ward 7 Nursing staff, the quality of Medical and Nursing care and
•
delay in treatmentand a follow up appointment.
•
•
Father was unhappy that a room at Ronald McDonald House was given to •
another family.
Apology given to family from Consultant and Directorate Management.
All staff have received training on pinnaplasty procedures and post-operative care.
Ward 5 now have a leaflet containing information on different ear correction surgery.
A full explanation was provided to the complainants satisfaction and an apology provided.
Explanation and apology.
Apology given.
A meeting was arranged with a Consultant General Paediatrician who provided a detailed
explanation and reassurance.
Apology given.
Concerns have been raised with the Clinical Lead for Medicine to highlight the need for clear
communication.
The Medical Directorate gave an apology to the family for the experience.
Ward 7 will continue to be audited in line with the Nursing Care Quality Indicators.
Safety and Quality Walkabouts are being conducted by the Lead Nurse and Ward manager.
An explanation of room allocation and prioritisation was given together with an apology.
5
Enhancing Patient Experience
March 2015
The patient experience (PE) report aims to present a rounded picture of the experience of children, young people and families at Birmingham Children’s
Hospital (BCH). The report presents information from different sources including, including feedback cards, e mail, ward walkabouts, verbal feedback;
all collated on the Patient experience Database (PED), the Friends and Family (F&F) Questionnaire, the Feedback App, Patient Opinion and more
qualitative feedback from patient experience and participation projects such as patient stories and quality walkabouts. Utilising a toolkit approach
enables the Trust to better understand the patient and family experiences and helps prioritise where to focus efforts on action planning for
improvements.
Children’s inpatient and day case survey
The survey activity for the CQC led in-patient and day case survey, being undertaken by Picker Institute Europe closed at 29.5%
The National average was 27.5%. The fieldwork closed in February and the final reports were made available in March – the results are currently being
reviewed and analysed. A report will be presented, in the first instance to the Patient Experience Committee and Quality Committee for discussion and
prioritising for improvement, prior to wider dissemination.
Initial review suggests the areas identified as areas of improvement are within our existing work streams.
The results will be published Nationally by the CQC in June.
Combined PED and Friends & Family data The ratio of positive v need to improve comments are ……. 78%
Top 5 overall positive and need to improve
Positive
My son come in today.
From the minute we
walked into ward the staff
were friendly, inviting
Mr McCarthy operated on my
son spoke to me
before and after
procedure and
talked in detail of
what he was going
to do
Waiting time was
too long and not
knowing when your
going to be seen. ED
Mark - theatre
porter / took my
son down to
theatre and
made it fun for
him on a
aeroplane he
was happy and
helpful made it
brilliant for him.
Cleaning and
timing. ED
Cleanliness of the bathrooms need to
improve. Heathlands Ward, Parkview
22%
Need to
improve
Themes from the need to improve comments
related to waiting in ED reflecting what has
been another incredibly busy period.
There were also a number of comments
relating to the environment at Parkview,
cleanliness and food – the Patient Led
Assessment of the Work Environment (PLACE)
due to be undertaken in April will incorporate
these issues as part of the assessment process.
Meeting F&F CQUIN targets for Q4
1. Target response of 20% for ED and 30% in-patient
(based on CYP responses )

2. Introduce Friends and family to inpatient CAMHS –

Following the initiatives to improve the uptake of the Friends and Family questionnaire in ED include, we saw an improvement in March,
enabling us to meet the monthly Target and overall Q4 target.
Monthly ED CYP F&F Net Promoter Score
CYP In-patient
197
Overall Trust Discharges
723
Total number of responses in
period
159
Total number of responses in
period
187
Number of promoters
132
Number of promoters
147
Number of passives
22
Number of passives
23
Number of detractors
5
Number of detractors
80
70
60
50
100
90
80
70
60
50
17
I Disagree a bit
0
I Disagree a bit
2
I Disagree alot
1
I Disagree alot
3
30%
Undecided
4
Undecided
12
25%
Response Score (20% Target)
90
Mar-15
Overall Trust Discharges
Net Promoter Score
100
CYP ED
Mar-15
Monthly in-patient CYP F&F Net
Promoter Score
80
81%

Net Promoter Score
Response Score (15% Target)
70
26%
Monthly in-patient CYP F&F Response rate
100%
80%
60%
40%
20%
0%

20%
15%
10%
5%
0%
Monthly ED CYP F&F Response rate
Feedback App & Social Media
BCH App Comments - March
Need to improve comments included
Finalist
•Cleanliness
•Waiting in ED
•Concern about treatment
•Staff attitude
All the comments were responded to and the issues
addressed.
27%
Other
73%
Positive
“Would just like to say a massive thank you to all the staff in
a&e was terrified bringing my daughter in on Thursday, all
staff were so helpfulland supportive. Bradley was so good to us
made us feel special and supported us all the way,”
“If it hadn't been for the play specialist I truly
believe his operation would have been cancelled
– thank you x”
Negative
“after arriving in an ambulance
with my son I waited 5 hours
and still wasn't seen by a
doctor!” ED
NHS Choices
There were no comments made
on NHS choices in March.
Social Media
In March there were 162 comments between facebook and twitter – the majority were positive but
there were a couple of negative comments about smoking at the front of the hospital – A consultation
on how we can improve and address this issue was launched on ‘No Smoking’ day, 11th March – the
consultation closed on 8th April with 345 participants having their say!
Smoking outside the hospital drives me mad. People stand under the 'no smoking with within 6 metres
of this sign', sign puffing away. You shouldn't have to walk through a wall of smoke to get to the
hospital!
8
Participation headlines March 2015
Bedtime reading
A new volunteer-led bedtime reading service was launched on World Book Day.
In partnership with Heartlands Academy and Birmingham Library, the service will welcome volunteers to our wards
at bedtime to read stories to children to enhance their experience and support their development.
All volunteers have passed through our recruitment process and the Heartlands Academy students (16-18 years old)
will volunteer in small groups accompanied by a teacher for additional support.
Change Day
There were a week long number of events and activities with a key focus on ‘Knowing team BCH’ and the emphasis
on inclusion and diversity. During the week four pieces of artwork by local artist Nicky Dowd and pupils from four
schools in the area were unveiled in the Community Gallery situated in the Rainbow Corridor - the art is focused
around characteristics of diversity including culture, age and belief.
Magnolia House
Chief Nurse, Michelle McLoughlin, was joined by two bereaved families to unveil artist
impressions of Magnolia House, a state-of-the-art facility that will be built within the grounds
of our Steelhouse Lane site this year. Magnolia House will offer a dedicated space where we
can hold difficult and often life-changing conversations with families. Magnolia House will be a
calm and natural environment where we can support families at the time they need it most.
There were a number of positive comments from families on social media about the new
facility…
This will be fantastic I wish it had been built last
January when we lost our baby boy there x
As a mother myself I couldn't imagine the pain an heartache that
goes through this hospital every day. I will be donating, it's a
beautiful cause and will help so many! Xx
Monitoring Infection control
March 2015
Infection
No.
MRSA Bloodstream Infections (BSI)
0
MSSA BSI (pre 48 hour)
0
MSSA BSI (post 48 hour)
0
E. Coli bacteraemia (pre 48 hour)
1
E. Coli bacteraemia (post 48 hour)
0
Glycopeptide-resistant enterococci
0
C. Difficile
0
MSSA pre 48 Hours 2013/14
The E. coli case was
a baby admitted
from home with a
UTI and was
unpreventable.
We saw only one MSSA bacteraemia during the last 3 months, which is our best ever
three month performance. Last summer we introduced antiseptic skin washes for
children with central lines, which appears to have been highly effective; the last
hospital-acquired MSSA line infection that we diagnosed was in June 2014.
MSSA pre 48 Hours 2014/15
3.5
3
2.5
2
1.5
1
0.5
0
E-Coli - pre 48 hours 2013/14
5
4
3
2
1
0
We are currently undertaking an evaluation of a rapid
(1 hour) test for gastrointestinal pathogens. Patients
who test negative are allowed out of isolation which
frees up cubicles at least two to three days earlier than
with conventional testing.
MSSA post 48 hours 2013/14
MSSA post 48 hours 2014/15
3.5
3
2.5
2
1.5
1
0.5
0
E-Coli - pre 48 hours 2014/15
E-Coli - post 48 hours 2013/14
E-Coli - post 48 hours 2014/15
5
4
3
2
1
0
10
Respiratory Arrests, ALTEs and
Unplanned Admissions to PICU
Explanation of Data
Unplanned admissions to PICU are a
measure of how well we are monitoring
patients on the wards. Good monitoring
on the wards means that we will pick up
deteriorating patients more quickly,
allowing us to admit them to PICU when
required. A combination of high levels of
unplanned admissions and low levels of
cardiac arrests, respiratory arrests and
acute life threatening events (ALTEs)
means that we are monitoring and
escalating clinical deterioration in a
timely manner.
Details of Cardiac Arrests
Number of Emergency Events
3 Cardiac arrest outside PICU, all
were out of hospital and not
preventable (all ED).
The figures from PICU are not yet
available.
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
No of Cardiac Arrests (ex PIC)
No of Respiratory Arrests
No of Cardiac Arrests (PICU)
No of ALTEs
11
Safeguarding
Key Figures
Child Protection Training
(includes vulnerable
adults)
Level 1
98.1
Level 2
91.9
Level 3
89.9
There has been 0 Safeguarding SIRIs
There has been 0 new Safeguarding Complaints
There has been 0 ‘Position of Trust’ cases
There have been no new recommendations from Serious Case Reviews
100% of BSCB Meetings attended by BCH Executive lead or representative
90% of cases which require peer review /clinical supervision have had this
There has been 1 child death related to suspected physical abuse/neglect
There has been 0 reported cases for Female Genital Mutilation.
MASH ( Multi-Agency Sharing Hub )
28 new referrals to Bham MASH have been recorded during March.
3 Bespoke Training Sessions – Improving the Quality of Interagency
Referrals to MASH have been arranged in the BCH Lecture Theatre
Speaker: Brendan Seward Interim Assistant Head of Service City Wide
Services/MASH.
Birmingham Safeguarding Children Board:
BSCB has provided a revised online audit tool for Children Act 2004
Section 11 Audit . BCH will complete the annual Audit by 30th April
2015.
A child’s Journey through the Safeguarding Process:
A 10 week old baby was brought to Emergency Department by his
parents. This was their first child and mother was a said to have
qualified as a doctor in her own country but was not practicing in the
UK. Mum had noted a bruise on baby’s right knee a few days prior to
bringing him to ED. She had decided to “observe "the bruise at home
before bringing him to hospital. She also thought baby was not moving
his right knee.
Safeguarding Process:
A detailed history was taken from his parents by the doctor. An x-ray of
his knee was normal, however, there was no explanation for the
bruising. Blood tests were normal and did not any identify any medical
causes for the bruise. A full medical examination was conducted with
parent’s consent. Baby was admitted for a further medical opinion
under the care of General Paediatrics. A referral was made to MASH
Voice of the Child:
• The voice of the child was heard through the following:
• Unexplained bruises in a non mobile baby are of a concern.
• To promote baby’s safety and welfare , further discussion was
required to rule out Non Accidental Injury.
• The Consultant felt that the bruise could be a Mongolian Blue Spot
and therefore decided to seek a Dermatologist Opinion.
Lessons Learnt:
The bruise was a Mongolian Blue Spot .
The case illustrates the importance of recognising the causes of
unexplained bruises in children, seeking further medical opinion to rule
out N.A.I. prior to discharging baby from hospital.
There was good interagency working with MASH.
Mortality
Past Harm
Mortality data is presented in a number of ways, and
an overall picture can only be gained by using a
number of indicators. These are:
•Absolute number of deaths per time period.
•Number of deaths per time period per 1000
admissions.
•Standardised mortality ratio (See next slide)
•Cumulative sum (CUSUM) charts.
•Review of individual deaths.
Inpatient deaths per 1000 admissions
This is a simple calculation to overcome any
variations in admission numbers over time (e.g.
the hospital may have more admissions in the
winter months) or between hospitals of different
sizes.
Data can be compared between
organisations by this method as it allows for
different admission numbers but it is limited as a
tool for comparison as there is no modification
for case mix. The graph on the right shows the
number of inpatient deaths per 1000 inpatient
admissions at BCH since June 2012. Please note
that the data does not include deaths which
occurred in the Emergency Department.
Absolute Number of Deaths
The simplest way to represent mortality is as an
absolute number of deaths in a particular time period;
however it does not take into consideration either the
number of admissions to the hospital or the case mix of
patients. It is useful only as a sense guide to other data
as it has not been modified in any way. Data cannot be
compared between organisations in this format.
Deaths
Deaths per 1000 Admissions
12
10
8
6
4
2
0
13
Standardised Mortality Ratio (SMR)
In order to account for differences in case mix for different organisations the idea of standardised mortality ratios
has been developed. This attempts to account for differences in patients, such as diagnosis, age and pre-existing
medical problems, and allows for comparisons between hospitals.
A standardised mortality ratio (SMR) is the ratio of the actual number of deaths in a hospital within a given time
period, to the number that might be expected if the hospital had the same death rates as a larger reference
population (e.g. all English Hospitals). The SMR scores can be presented in a number of ways.
Run Chart
This shows how the standardised mortality
rate of a hospital changes over time. If
there are a small number of deaths in each
time period then the month to month
variation can be quite wide (as is the case
with BCH where there are on average 4-12
deaths a month).
Important Note!
Unfortunately, the standardisation that is
performed to calculate SMR is based on adult
diagnoses and data, and doesn’t lead to an
appropriate risk adjustment for children.
Therefore, in children, the SMR data is not an
accurate measure as it does not provide an
effective trigger for concern and does not allow
appropriate comparison between hospitals.
14
Bar chart presenting data
comparing a number of hospitals:
This shows the position of an individual hospital
in comparison with its peer group. The graph
presented below shows 6 months’ worth of data
rather than 12 as previously presented.
It is important to remember that since the SMR
is not appropriately risk-adjusted for children,
meaningful comparison between hospitals is not
possible.
Funnel plot
This shows the standardised mortality ratio on the Y axis, and the number of
expected deaths on the X axis. Control limits can be applied, so that it is possible to
see how likely that the variation from a score of 100 is by chance only. In the
example below an amber dot occurs if there is between a 0.3% (1 in 330) and 5% (1
in 20) likelihood that the score is different from 100 by chance and a red dot if there
is less than a 0.3% likelihood that the score is different from 100 by chance. Such
warnings should be investigated as to cause. The funnel plot below is presented
using 6 months’ worth of data. Although we are in the red section of the funnel plot
it is important to remember that since the SMR is not appropriately risk-adjusted for
children, it does not provide an effective trigger for concern, or reassurance. Such
warnings should trigger investigation, by reviewing individual deaths - all deaths
occurring at BCH are individually reviewed as standard practice.
Movement in last month
15
Deaths in the Paediatric Intensive Care Unit
(PICU)
CUSUM Charts
Another way of representing outcome
data is by cumulative sum charts.
These can be used where the risk of
mortality is calculated for each
individual patient based on diagnosis
and severity of illness. Currently this
method is in use at BCH for intensive
care.
The charts use data from all PICU
patients, not just deaths, and is
appropriately risk adjusted using
paediatric data and diagnoses. It is
therefore much more powerful than
SMR in detecting problems.
For BCH, the PICU CUSUM is a good
reflection of overall hospital mortality
as over 70% of deaths at the hospital
occur on PICU. There is no evidence of
systemic care failures which could have
contributed to deaths on PICU.
16
Deaths in Cardiac Services
CUSUM Chart
One of the Trust’s highest risk specialties is Cardiac Services. The nature of the activity means that proportionally
more of our mortality is related to that specialty than others. The team carefully monitors clinical outcomes to
ensure that that we are providing high quality care.
The CUSUM chart is a graphical representation of the outcome data
for the specific procedures which are nationally monitored (70-80% of
our patients fall into this group).
In addition, the team also monitors overall mortality for all surgical
patients.
An upward movement in
the chart means that the
outcome for a specific
patient was better than
expected. A large increase
means that the outcome
was significantly better
A downward movement
means that the outcome for a
specific patient was worse
than expected, again the size
of the decrease is a measure
of how much worse the
outcome was than expected
Overall our outcomes are better than
expected. However, please note that
the baseline will be reset on a regular
basis, so we do not expect to move
further and further from the x-axis
17
Deaths in Liver Transplant
CUSUM Chart
7 month lag time
Another of the Trust’s higher risk activities is Liver transplantation.
Although we do not carry out a large number of these, the team monitors the outcome rates posttransplant. The graphs below show that our outcome rates are comfortably within acceptable limits.
Interpretation of the charts
The O-E chart is a useful tool for
observing performance over time.
A downward trend indicates a
lower than expected rate of
mortality compared with the
baseline period, whereas an
upward trend points to an
observed mortality rate that is
higher than expected.
To identify statistically significant
changes the tabular CUSUM chart is
used to complement the O-E chart.
A significant shift in the underlying
mortality rate is evident when the
chart crosses the limit and
generates a signal. The tabular
CUSUM chart can be used to
forewarn of possible future signals
as the chart approaches the limit.
Such ‘signals’ may be due to one of
a number of different reasons. A
signal may be due to
transplantation of patients of
higher risk than previously, a short
run of adverse events, or it may
occur just by chance with no
underlying cause (i.e. a false
positive result).
18
Item 15.87
Board of Directors
Thursday 30th April 2015
Enc 06
Every child and young person requiring access to
care at BCH will be admitted in a timely way, with no
unnecessary waiting along their pathway
Report Title
Performance to End March 2015 - Report
Sponsoring Director
Deputy Chief Executive Officer and Chief Finance
Officer
Author(s)
Head of Health Informatics, Performance Manager
Situation
This report provides the update for the position to end March 2015 and year end on the Trust
Performance supporting improving our patient experience. The report highlights performance
and in particular where performance is not being met and any concerns and improvements
planned. The attachment provides further details on our current and comparative
performance
Background
Performance in 2014/15
Regarding access to our services, the most significant concern throughout the 2014/15
financial year has been access to diagnostics, in particular for MRI scans but latterly for the
endoscopy service also. Increasing referrals for MRI across the year has placed pressure on
this service.
Emergency Department access was a major concern in Nov and Dec 14, with
unprecedented levels of demand. Performance returned to normal seasonal levels in
January and February 2015 but it was anticipated that March would be a challenging month
as usual, although we were confident that the four hour wait target would be met for the
whole year and in total for quarter 4.
We have continued to meet our 18 weeks waiting times targets, albeit only by a narrow
margin. Elective demand for our services remains high and finding the capacity to treat all
out children and young people within the targets has been a challenge
In terms of our facilities and utilisation we had bed and flow issues in particular in the first
quarter of 2014/15 leading to lots of ‘on the day’ cancelled operations. This issue then eased
although the high winter emergency demand did again affect flow in particular in December
2014.
Assessment
Summary of Performance in March 2015
There were significant pressures in ED and on our inpatient beds in March. Overall it
has proved a challenging month, as is usually the case given the seasonality of our
emergency demand in particular. The activity in ED in March 2015 was the second
highest monthly total on record. This has had an impact on our performance in the
month.
The key highlights include;
•
•
•
•
•
•
•
•
•
•
We again failed to meet the diagnostic waits 6 week target. The position in
diagnostics continues to be exacerbated by the ongoing problem within the
endoscopy service relating to decontamination of equipment
RTT and 18 weeks continues to remain very tight, although we met our national
targets for the month by a small margin
March 2015 saw an increase in ED attendance and breaches in month, in line with
the end of year predicted increase. The four hour wait target was not met in month
and but was met for year end and in quarter 4
There were 45 nationally reportable cancelled operations which is below the monthly
average
There was 1 breach of the 28 day cancelled operations standard
The number of long stay patients remained relatively constant in March, but at a
higher level than average. A typical day in March saw 120 patients in the hospital
who had been here for 7 or more days which is historically a very high figure. Early
indications for April show this increasing further.
3 tertiary and urgent patients were not found a bed, one was out of region
8 KIDS patients could not be supported in our PICU network; and
CAMHS continue to meet 18 weeks targets, with performance at 97.2%
There has been one breach of the Oncology patients to receive first treatment within
31 day from diagnosis.
(a) Access to Services
Diagnostic waits
There were 92 patients at the end of March who had been waiting over 6 weeks for a
diagnostic test. This amounts to 92.9% of all patients versus a target of 99%.
The longest wait for a diagnostic test is over 13 weeks and these are Gastroscopy patients.
There are also 4 at 11-13 weeks, 31 at 9-10 and 40 at 7-8 weeks. For MRI, there are 7
patients waiting over 10 weeks, 16 at over 9, 14 over 8 and 19 over 7.
There are 503 patients waiting for MRI in March and currently under 6 weeks. This
compares to 432 in the previous month, which reflects the increase in referrals for MRI.
MRI
Breaches are predicted to continue for MRI, with 66 MRI and 2 CT in March and a predicted
98 MRI in April and 133 in May. The main driver behind this is the demand for MRI and the
total additions to the waiting list hit its highest number in March with 182 added to the list in
mid March. Of this 182, 61 were GA additions which again is an increase and one of the
highest number of GA additions in the last 2 years. The number of GA patients on the
waiting list is reducing however as focus is being placed on treating these, however, as
previously reported, this is impacting the GA to non GA slot ratio and is resulting in the
number of non GA breaches increasing. In March of the 66 breaches, 63 were non GA and
in the predicted figures for April and May, the non GA breaches are predicted to be 84 and
111.
Managing within 6 weeks remains a challenge across MRI and Gastroenterology. Support at
Aston continues but SPIRE support has been suspended (on their side) pending further
discussions, which equated to 10 patients per week and had previously been built into the
predicted figures. As this is now suspended it is not built into the predictions and is another
contributory factor to the increase in predicted breaches. There are other external
possibilities being explored, but nothing confirmed at this point. The planned increase in
cases per list of the 3T scanner is now operational on most but not all lists and will result in
an extra 20-30 scans per month.
Endoscopy
We are continuing to see endoscopy breaches but this is reduced to 23 gastroscopy and 1
colonoscopy breach at the end of the month. The in house equipment is now fully
operational and this, combined with Theatre 10 introduction is planned to reduce the
breaches of gastroscopy and colonoscopy to 0 by April/May.
Regarding ultrasound scans, performance against target in this area remains challenging,
and the Radiology Department have identified some risk around ensuring all patients are
seen in 6 weeks. The number of patients waiting 5 weeks or more for an ultrasound has
increased from 7 in December to 14 in March.
18 weeks waiting time
The 18-week standards were met in March with a very tight margin. Performance for
admitted was 90.2%, for non-admitted 95.1% and for incomplete 92.1%.
Slide 10 in the Performance Report shows that there are 103 patients either waiting over 30
weeks at the end of March, or whose clock stopped after 30 weeks in month. This had
decreased slightly but remains high in comparison to previous months.
The total inpatient waiting list remains high and has increased to 4,366. The number of
patients who are still waiting after 14 weeks on the list without a TCI date has remained
relatively constant across March but remains at its highest levels following the sharp
increase reported last month.
Regarding outpatients, the numbers on the outpatient waiting list remain very high at 6,661.
Emergency Department
Attendance in ED increased to 5076 in March from 4212 in February, and performance was
at 92.8% against the 4 hour wait standard (367 breaches). We did meet the 4 hour wait
target in quarter 4 (96.2%) and at year end (95.2%).
Looking at emergency admissions for quarter 3 and 4 2014/15 vs the same period in
2013/14 activity levels have risen quite significantly (8%)
Tertiary referrals and Home Referrals
Activity levels increased from 178 in February to 185 in March. There were 3 refusals (1 from
Redditch, 1 from north Staffs and 1 from Plymouth) and 26 patients had to wait over 24
hours to be offered a BCH bed.
PICU (Paediatric Intensive Care Unit) referrals
PICU demand – There were 116 referrals to KIDS in March, which follows the seasonal
increase in this month and 35% of which were avoided (41 patients). Of the 75 referrals that
needed admission, 51% (38) were admitted to BCH, 39% (29) were referred to other WM
hospitals and 11% (8) went out of the region.
CAMHS Access
The CAMHS Tier-4 (Child & Adolescent Mental Health Service) West Midlands service is
provided by BCH and other providers (some private) with BCH providing the assessment of
all requests, ideally within 4 weeks.
CAMHS 18 week performance is met at 97.2% in March. There are 15 learning disability
(LD) patients, out of a total 17, waiting over 18 weeks without a planned date. The staff
vacancies in the LD team, which were reported previously, have now been recruited to and
the 3 band 6 nurses will begin working over April to June. It is anticipated that these new
posts will help clear the over 18 weeks patients still waiting, but as they do this it will have a
negative impact on the 18 weeks performance as they are then included in the overall
performance figure.
The average waiting time to first appointment in March is 6.5 weeks from 6.1 weeks in
February.
9 patients were referred to T4 and not admitted.
(b) Utilisation of Facilities
Cancelled operations
In March, 45 patients (2.05%) were cancelled on the day of operation or after admission by
the hospital for a non-medical reason. 36% of these were due to bed shortages and 31%
were due to emergencies. The remaining cancellations were due to equipment failure and
ICU/HDU beds unavailable, list overrun and staff shortage
There was 1 breach of the 28 day cancellation standard in March. This was a trauma and
orthopaedic patient who was cancelled due to lack of beds. Going forward, potential
breaches of the 28 day target will be managed in the clinical groups to reduce the number of
the 45 cancellations going on to be 28 day breaches.
Bed Availability - Long stayers and delayed discharges
The overall number of patients who have been in the hospital over 7 days at any point in
time was on average higher in March than in the previous 24 months. Levels of bed
utilisation were also very high in month and the average inpatient length of stay was also
above average. So taken together this is indicative of a month when there was a lot of
pressure on beds.
In March, there were 4 children who were fit for discharge but waiting for non-hospital related
actions before they could be discharged. They had spent 381 days in hospital after being fit
for discharge. The longest single wait after being fit for discharge was 216 days (approx. 7
months), with a total stay of 320 days and is due to care package and social care.
In CAMHS, 3 patients remain as inpatients with a delayed discharge and collectively account
for 866 delayed discharge days. All patients continue to await placement and the longest
wait is 415 fit for discharge days out of a total 693 days length of stay.
Oncology
The oncology figures are reported 1 month in arrears and in March we are reporting 1
breach to that patients receive first treatment within 31 day from diagnosis target in
February. This was a patient who was due to be treated within 31 day, but then contracted
scarlet fever and was then unable to be rescheduled within 31 days. In month performance
was 92.3% against the 96% target. In year, there have been 2 breaches to this target.
Recommendations
-
to continue to monitor the ED activity and referrals into the department.
-
alongside the need to manage the ED position we need to monitor inpatient flow
through the hospital particularly around long stay patients, where increased long
stayers will impact the discharge rate and flow of the hospital.
-
Further emphasis on actions needed to meet the diagnostic wait target. This covers
getting performance against the trajectory for meeting the MRI target back on track,
but also resolving the endoscopy decontamination unit problem and continuing to
manage ultrasound performance within 6 weeks. It is currently anticipated this will be
resolved by the end of April;
-
to implement recovery plan and explore all avenues to maintain elective throughput
and continue to meet our 18 weeks RTT performance. It is anticipated that admitted
performance in particular will continue to be challenging.
-
Board is asked to note the performance and our plans for further improvement
Key Risks
Risk Description
Controls
Escalating demand for our Discussions
with
inpatient elective services, commissioners to be held
potential risk of failing access about demand management
/ 18 weeks targets
Bids against operational
resilience moneys
Assurances
Maintaining
scrutiny
on
performance against various
RTT targets
Validation of waiting lists
stepped up
Recovery plans in
across specialties
place
Insufficient capacity in place Non GA capacity identified Daily, weekly and monthly
to meet diagnostic waiting including additional session reporting in place.
times
at Aston.
Modelling and projection of
Continued
issue
with More GA capacity on site performance in place
endoscope decontamination
coming on line with extra
anaesthetic
and
theatre
staffing time and flexibility
provided by mobile theatre
City hospital assistance with
decontamination unit for
scopes
Second
ED
‘spike’ Winter plan moneys can help
anticipated
Mid Feb to alleviate, plan for anticipated
March ‘spike’ in place
March 2015
Discuss demand
management with
commissioners
Failure to meet 28 day Case by case management
cancelled operations target
Key Impacts
CQC Registration
outcome)
NHS Constitution
Maintaining
scrutiny
on
performance against target.
Clear and major operational
priority, with huge amount of
effort on behalf of the staff to
deliver noted
Close scrutiny.
plans in place.
Escalation
This reports covers progress against meeting the strategic
objectives linked to supporting improving our patient
experience.
(state 4: Care and welfare
Yes – treatment within 18-weeks is a requirement within the
NHS Constitution.
Other Compliance (e.g. Many of the indicators are local or national standards
NHSLA,
Information monitored by the Department of Health, Monitor and our
Commissioners.
Equality, diversity & human The report considers any particular impact on patients with
learning disabilities, and on different ethnic groups.
rights
Trust contracts
Non-delivery of NHS standards can result in financial
penalties
Other
Meeting the strategic objectives raises the profile of Trust
locally, regionally and nationally
Operational Performance Report
Month 12 2014/15
Performance for March 2015
David Melbourne
Paul Franklin
Victoria Penfold
Deputy Chief Executive Officer and Chief Finance Officer
Head of Health Informatics
Performance Manager
1
How our patients access care
18 weeks
RTT
Diagnostic
waits
Tertiary and
urgent home
CAMHS
Access
PICU
Operational
Performance
Indicators
ED access
Oncology
Utilisation of our facilities
Cancelled
operations
Theatres
RAG ratings in these areas are
calculated by the balanced scorecard
Clinics
Beds
Trend in Overall Performance
Balanced Scorecard
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
50%
51%
44%
51%
68%
63%
62%
48%
43%
59%
61%
43%
2
Month 12 2014/15
How our patients access care
3
: Activity in ED increased in
March, in line with previous patterns. Performance against the 95% target
was not met in month but has been met in Q4 and the year.
Future risk: No short term risk identified but we are continuing to monitor
activity levels and working on staffing plans to mitigate against long term
risks and winter activity 2016
The issue
•92.8% of patients were seen within 4 hours, against the 95% target in March.
•14 days in March fell below the 95% target and these days had an average attendance of 170.
•The four hour wait target has been met for Q4 at 96.2% and year end at 95.1%
•Activity levels increased from around 1100 per week in February to 1200 towards the end of March.
•Ambulance triage time continues to be high (40 minutes in March) and is presumed a data quality issue, but it has been an issue since
the introduction of patient first.
•Time to seen is increasing, in line with seasonal patterns, but higher than in the previous 2 years and in our busy November and
December months.
Why has it
occurred?
•In March, ED saw 5,076 attendances, compared to 4,212 in February and 4,944 in March last year (17% increase from
February). Activity for March has been above normal seasonal levels but followed the predicted increase
•Increase in tertiary specialist admissions
Our response
•Continued support for ED staff and management of daily discharges
•Engaging with Newton to review inpatient flow
•Continued escalation of additional medical workforce in the ED and General Paediatrics in line with winter plan
•Review of ED medical workforce cover and continued monitoring of ED attendance
•Extended cover from on-call managers including evening and weekends
Expected
impact of our
response and
responsible
persons
•Managing the discharges from our inpatient beds will improve the flow of patients in need of admission, out of the ED
service.
•Improved flow through the emergency department.
•Achieving 95% in Q1 and cumulative for the new year
Timescales (of
actions and
expected
impact of those
actions)
•Matt Train leading the collated GP service and it is being looked at for Autumn winter 2015
•Management of ED and discharges is an on going and daily activity
•Review of inpatient flow is an 8 month project
•Review of ED, General paediatric and medical workforce cover is expected to be in time for next winter
4
Total Time Spent in A&E
Standard ≤ 4 hours (95th Percentile)
6.50
95th
% time in A&E: 4.0 hours – 92.8% seen in
four hours
95th
% time to triage (all): 48 minutes
Time to be Seen
Standard ≤60 minutes (Median)
150
5.50
100
4.50
50
3.50
0
A M J
0 Patients deflected
J
A
S O N D
J
F M
A M J
J
A S O N D
J
2012-13
2013-14
2012-13
2013-14
2014-15
Target
2014-15
Target
F M
95th% time to triage (ambulance):
40 minutes
Median time to seen: 103 minutes
Time to Triage - Ambulance Only
Standard ≤ 15 minutes (95th Percentile)
% Patients Who Left ED Without Being
Seen
Standard < 5%
70
60
Left without being seen: 3.86%
ED re-attenders for related condition: 6.90%
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
50
40
30
20
A M J
10
A M
J
J
A
2012-13
S
O N D
J
F M
J A S O N D J
2012-13
2013-14
2014-15
Target
F M
2013-14
5
ED attendance
ED attendances SPC chart (1.5 st deviations)
ED attendances
6000
6000
5000
5000
4000
4000
3000
3000
2000
2000
1000
1000
Emergency Department (ED) attendances
increased
significantly in March 2015, with the total being the second
highest monthly figure on record, and 9% above the planned
level.
For the full year 2015/16 activity was 6.4% above plan and 5.6%
up year on year.
Attendance
Total breaches
LCI
Mar-15
Jan-15
Feb-15
Dec-14
Nov-14
Oct-14
Sep-14
Jul-14
UCI
Aug-14
Jun-14
0
Apr-14
2014/15
May-14
M
Mar-14
F
Jan-14
J
Feb-14
2013/14
D
Dec-13
N
Oct-13
O
Nov-13
2012/13
S
Sep-13
A
Jul-13
J
Aug-13
2011/12
J
Jun-13
M
Apr-13
A
May-13
0
Mean
The SPC (statistical process control) chart above shows that the
activity levels in March 2015 were slightly above the upper
confidence limit and above the mean illustrating activity has
been above normal seasonal levels.
Therefore growth in ED activity in 2014/15 was significantly
higher than historical precedents.
6
18 weeks RTT
: All targets met, but it continues to be by a very small margin. The number of patients not treated within 18 weeks due to
insufficient capacity remains high and has increased from the previous month. The spike in additions to waiting lists for scope patients and backlog
that has been formed is likely to have an impact on Aprils 18 week performance.
The issue
Why has it occurred?
Our response
•18 weeks targets have been met for admitted (90%), non admitted (95.1%) and incomplete (92.1%) in March
•200 patients were not seen within 18 weeks due to insufficient capacity compared to 186 patients last month
•103 patients waiting over 30 weeks compared to 117 last month (ENT, Plastics, Ophthalmology and T&O, have the highest number
of patients still waiting)
•0 patients waiting over 52 weeks
•Seeing a reduction in the long waits and overall inpatient waiting list size.
•The number of patients waiting over 14 weeks spiked in February and continues to be high (figure 2 on page 9)
•18 weeks pressure being put on Cardiac, Gastroenterology and ENT
•Working through backlog within Endocrinology and Gastroenterology
•Spike in additions to waiting lists for scope patients following reinstatement of normal endocrinology service
•Additional beds opened to help with patient flow, in line with winter plans
•Theatre 10 opened 23rd March. This will allow us to see an additional 30-35 patients per week
•Reviewing RTT processes to improve our ability to predict 18 week performance
•All specialties to formulate recovery plan by end of April to achieve 18 week admitted target by specialty and Clinical group
•Gastroenterology are going back to 1 additional patient per list, which will become working practice
•18 week and forward look meetings consolidated and chaired by Deputy COO
•Recovery plans developed by end April 15 by Deputy COO
Expected impact of
our response and
responsible persons
•18 weeks will continue to be a challenge. Focusing on reducing patients over 14 weeks without a date, should help to reduce our future
problem.
•Continued validation of lists will ensure accurate reporting of the 18 week standards. (Directorate management and operational teams)
•Focusing on reducing patients over 14 weeks without a date, should help to reduce our future problem.
Timescales (of
actions and expected
impact of those
actions)
•Actions are on going and will expect to see the impact of those, particularly validation and reducing backlog, immediately and in the
future.
7
18 week waits
18 weeks admitted performance
94.0%
93.0%
92.0%
91.0%
Admitted: 90.2%
90.0%
89.0%
88.0%
87.0%
Non admitted: 95.1%
86.0%
A
M
J
2012/13
J
A
S
O
N
2013/14
D
J
2014/15
F
M
Target
Patients not treated within 18 weeks due to insufficient
capacity
Incomplete: 92.1%
11
14 14
10
12
46
82
89
74
69 97
Admitted
Feb-15
Dec-14
Oct-14
Aug-14
Jun-14
4 4
Apr-14
Feb-14
Dec-13
Aug-13
Jun-13
Apr-13
Feb-13
Oct-13
8
1
2
128
3 0 8
2
105 118 1189711290 87 90 9711211611210689124117103
3
83
75
61 56 62 73
41 54
7
8
60
90 81
Non admitted
8
18 week waits
Performance for patients still waiting for their initial
treatment (either admitted or non admitted pathway) is still
just above the 92% target at 92.1% (Fig 1.).
% still waiting for clock stop (incomplete) under 18
weeks
Patients waiting for an admission (Fig. 2), the green line,
(which is the total of the red and blue lines) illustrates the
overall potential problems we have in managing our 18
weeks admitted demand.
100.0%
The blue line illustrates patients with a date to come in who
are already over 18 weeks or whose TCI date is over 18
weeks.
94.0%
The red line illustrates patients who are waiting 14 plus
weeks and do not have a TCI date yet. This has now
increases to 442 and indicates a future problem. .
98.0%
96.0%
92.0%
90.0%
88.0%
A
M
2012/13
Figure 2
J
J
A
2013/14
S
O
N
D
2014/15
J
F
M
Target
CURRENT PROBLEM: patients with a TCI who have already breached 18 wks & patients at 14 - 18 wks with a TCI >18 wks on Lorenzo
FUTURE PROBLEM: patients without a TCI who have already breached & patients at 14 - 18 wks without a TCI on Lorenzo
TOTAL SIZE OF PROBLEM
30.03.14
06.04.14
13.04.14
20.04.14
27.04.14
04.05.14
11.05.14
25.05.14
01.06.14
08.06.14
22.06.14
29.06.14
06.07.14
13.07.14
20.07.14
27.07.14
03.08.14
10.08.14
17.08.14
31.08.14
07.09.14
14.09.14
5.10.14
12.10.14
12.10.14
09.11.14
16.11.14
23.11.14
07.12.14
15.12.14
22.12.14
05.01.15
19.01.15
26.01.15
02.02.15
09.02.15
16.02.15
23.02.15
01.03.15
08.03.15
15.03.15
22.03.15
29.03.15
05.04.15
12.04.15
800
700
600
500
400
300
200
100
0
9
Whole Inpatient waiting list and long waits
120
Dentistry
1
100
Cardiology
10
Paediatric
Thoracic Surgery
1
ENT
9
Ophthalmology
17
Plastic surgery
17
Surgery
9
Trauma and
Orthopaedics
14
Urology
7
Paediatric
Neurosurgery
1
Neurology
1
Total
87
Inpatients
Surg/Cardiac Inpatient
73 69 72
Feb-15
0
0
73
Dec-14
1000
20 41 39
54 49 54 57 61
121
109 117
103
Oct-14
2000
40
Aug-14
60
Jun-14
3000
140140
116
109 107
104
94 99
92
Apr-14
80
Apr-13
4000
Feb-14
5000
Speciality
Dec-13
6000
140
Oct-13
7000
160
Aug-13
8000
Specialty break down
of the 87 patients still
waiting over 30 weeks
All Patients Still Waiting or Whose Clock Stopped
Over 30 Weeks
Jun-13
Whole Waiting List Size (not just RTT
patients)
Outpatients
The overall waiting list for surgical and cardiac
has increased to 2,482, inpatient up to 4,366
and outpatients decreased to 6,661. Waiting
lists remain high when compared with previous
periods and whereas in previous month
outpatients has been the increasing trend, in
March, it is inpatients which has increased and
outpatients decreased.
At end of March, there are 103 patients waiting over 30
weeks (either still waiting or who had their clock stopped
in the month), compared to 117 last month.
Of the 103 patients, 16 had their clock stopped over 30
weeks and 87 are still waiting.
10
Diagnostic waits: We continue to fail to meet this target and saw a rise in referrals for MRI in March. Overall there were 66 MRI breaches
and 2 CT, this is higher than the predicted value of 63. The predicted breaches going forward have risen significantly to 98 in April and 133 in March,
made up of predominantly Non GA. Spire support is not going ahead as planned, leading to last minute cancellations. There have also been 24
breaches of patients awaiting a gastroscopy or colonoscopy in month which is significantly lower than February which saw 59 breaches. It is
anticipated the issue should be resolved by April and breaches won’t continue for these patients.
Future risks: As previously reported, the ultrasound waiting list performance continues to be close to 6 weeks. Predicting MRI breaches to increase.
The issue
Why has it
occurred?
Our response
•Overall diagnostic waits performance against 99% target is 92.9%
• Against the 99% target, MRI was at 88.4% (66 breaches) and Scopes was at 54.4% (24 breaches)
•Of the 66 MRI patient breaches, 3 were GA and 63 were non
•There were 2 patient breaches for CT (both MRI patients)
•There was another spike in demand for MRI (182 mid march which is above the upper confidence – see graph on slide 12 )
•An increase in emergency MRI requests that has meant rescheduling of the non emergency MRI’s.
•Patients were booked to have their MRI’s done at SPIRE but SPIRE cancelled at the last minute, which led to these patients being
cancelled. Anticipated support at SPIRE has been suspended at this time.
•Previous months predicted figures has included SPIRE support, equating to around 10 patients per week. Going forward, SPIRE
support will not be built into the predicted figures so are anticipated to be higher than previous predictions.
•Decontamination equipment is fully operational which is leading to reductions in the breaches for Gastroscope and colonoscope
•Continued management of the waiting list and breaches
•Continued support with Aston
•Additional GA activity is continually being scoped through Waiting List Initiatives both for in-week and Saturday sessions. This is
subject to the availability of both anaesthetic and theatre staffing however diagnostic sessions are being prioritised through the
‘Forward look’ group.
•Non-GA capacity is being reduced through the necessity to convert sessions to GA. Priority is being placed on treating GA patients.
•Through a deep dive into MRI, the speciality is trying to understanding of changes to clinical pathways within top 5 referring
specialties
•Engaging discussions with SPIRE to try and regain their support and are reviewing additional external support options.
Expected impact of our
response and
responsible persons
•Continue to manage the waiting lists and explore all opportunities to list as efficiently as possible
•Joint working with Aston to reduce patients waiting.
Timescales (of actions
and expected impact
of those actions)
•Waiting list management is on going.
•With the onsite system operation, we expect to clear the backlog in Gastroenterology in 6 weeks (0 by April/May)
11
Diagnostic waiting lists
MRI Waiting list
Patients waiting >6 wks for MRI / CT diagnostic
test - actual & forecast
Patients
140
120
1400
1200
1000
800
600
400
200
0
100
80
GA WL
NON GA WL
2012-03-19
2012-05-09
2012-06-25
2012-08-13
2012-10-01
2012-11-19
2013-01-07
2013-02-25
2013-04-15
2013-06-03
2013-07-22
2013-09-09
2013-10-28
2013-12-16
2014-02-03
2014-03-24
12/05/2014
2014-06-23
2014-08-11
2014-09-29
2014-11-17
2015-01-05
2015-02-23
Total WL
160
Total MRI waiting list additions by week
63
60
200
Patient numbers
40
20
0
150
100
50
0
MRI
CT
TGT (10)
Total external referrals
Total Additions by week
UpperCI
CAMHS Access: Targets have been met by an increased margin
this month.
Future risks: Using the staff recruited, treating LD patients who are already
over 18 weeks across April to June may negatively impact the 18 weeks
performance
The issue
Why has it
occurred?
Our response
•18 weeks performance in March was 97.20% and for the year was 95.5%.
•Currently there are 24 breaches of which 16 are within the LD team. There are 17 cases waiting over 18 weeks without a planned date. 15 of these
are learning disability patients.
• The average waiting time to first appointment in March is 6.5 weeks from 6.1 weeks in February. This is the highest since September with the
average for the whole year staying at 6.2 weeks.
• There has been a significant increase in T4 gateway referrals from last month (There have been 42 gateway referrals in March in comparison to 30
in February). 17 cases have been recommended for a T4 bed.
• 9 patients have been referred to T4 and not admitted due to bed capacity problems
•There are currently 3 delayed discharges in Tier 4 – 1 patient due to be discharged on 5th May, the other 2 have plans in place
•Staff pressures, sickness and vacancies add to the waiting list pressures in learning disabilities
•Patients were not admitted to T4 due to no beds being available.
•There has been an increase regionally for inpatient care for eating disorders (Irwin ward). This is a ward where patients usually
experience a high length of stay, which impacts on the availability of these beds and flow.
• Increasing the number of choice clinics being run at Park view from May as an on-going additional capacity to improve first appointment waits.
•There is a daily escalation process in place, currently being revised to identify clinical priorities.
•Continue to monitor the capacity issues in LD closely and have a trajectory that is supported by the additional staff recruited as they come into post
over the next few months (3 band 6 nurse posts coming into post between April and May). Additional Choice clinics commence in May in LD to support
access to first appointment.
• Referrals, admissions and discharges are reviewed at the daily CAMHS inpatient HOC.
•Following on from the work that the Birmingham complex care nurse undertook in Tier 4, a Tier 4 deputy ward manager has been seconded for six
months to manage the delayed discharges in line with the process, working closely with the clinical teams and the NHSE Commissioner.
Expected impact
of our response
and responsible
persons
•Would expect the actions to reduce the patients breaching 18weeks.
•As noted in future risks, as LD patients who are already over 18 weeks are treated, this could have a negative impact upon CAMHS
performance against 18 weeks.
•A new member of staff has started in Learning disabilities and they have successfully recruited and awaiting a start date for an
additional 2 posts.
•Managing delayed discharges will be discussed with commissioners but early conversations indicate a positive response to the
proposed process
Timescales (of
actions and
expected impact
of those actions)
•Management of CAMHS patients is on going and done by the CAMHS operational management teams
13
Access to CAMHS
CAMHS 18 Weeks Performance
Community CAMHS
Breakdown of Waiting Time to Assessment
105
100
100%
95
80%
238
519
60%
840
90
20%
80
68
177
929
1048
896
1129
58
538
736
936
40%
85
483
315
706
815
976
616
0%
549
2010/2011 2011/2012 2012/2013 2013/2014 2014/2015
75
Apr
May
Jun
Jul
Aug
2012/13
Sep
Oct
2013/14
Nov
Dec
Jan
2014/15
Feb
Mar
Target
Financial Years
A:- 0-4 wks
B:- 4-8 wks
C:- 8-13 wks
D:- >13 wks
CAMHS Patients that requested a T4 bed and were not admitted
(month trend)
20
15
10
5
0
Apr
May
Jun
Jul
Aug
2012/13
Sep
Oct
2013/14
Nov
Dec
Jan
Feb
Mar
2014/15
14
Oncology
Overall position: There have been two breaches for first treatment pathways in the year. The first being in May 2014
and the second in February 2015. The patient breach in February occurred due to the patient being diagnosed with
Scarlett fever and therefore not being able to receive scheduled treatment.
Our performance against the operational standard (>96% patients to receive first treatment within 31 days from
diagnosis) is 92.3% in month and 99% against the 96% target YTD.
15
Urgent Tertiary and Home Referrals
185 referrals for specialist beds, 166
admitted
Overall position: 185 referrals were made and 166 were admitted. 3 patients
were refused a bed in March. In the year 45 have been refused a bed which is
114% of the entire 13/14 reporting year. 26 patients waited over 24 hours for a
bed in March and 81.9% of requests were met within clinical timescale, up from
80.4% last month.
2 in region patients unable to
get a bed
Future risks: The next few months of the same period last year saw increased
referrals to the services, this could be a seasonal increase we could see again in
2015.
1 out of region patients
unable to get a bed
Home
Waiting time vs. clinical target time
Clinicians can request the patient to be
admitted in up to 48 hours, dependent on their
assessment. The graph shows the timescales
requested for admittance and time of decision
to admit.
81.9% of requests were met within clinical
timescales in March compared to 80.4% in
February.
100
Tertiary
230
Mar-15
Feb-15
185
170 184 159 178
Jan-15
189
Dec-14
Oct-14
Sep-14
Aug-14
159 163
Nov-14
179
Jul-14
Jun-14
209 217
May-14
225
Apr-14
Mar-14
Feb-14
Jan-14
Dec-13
Nov-13
177 188 181 173 163 169
Oct-13
Aug-13
Sep-13
197
172 182
Jul-13
Jun-13
188 191
May-13
26 patients waited over 24 hours to
get a BCH bed
250
200
150
100
50
0
Apr-13
16 patients no longer required
a bed
Total
Performance vs clinical target time for patients provided a bed - home
and tertiary referrals
94%
88%
100%
72%
50
50%
0
0%
within 12 hours
Met
12-24 hours
Up to 48 hours
Target Time
Not met
% patients meeting tgt time
16
Referrals Sent Elsewhere
Referrals Waiting over 24 Hours
Tertiary and Home Urgent Referrals sent elsewhere
Total
Rheumatol…
Trend - Tertiary and Home Referrals Waiting Over 24
Hours for a Bed
T&O
Surgery
50
Neurology
45
40
Medical…
35
Clin Haem
30
Hepatology
0
10
20
YTD 14/15
30
40
50
Long Term Trend Tertiary Refusals
25
20
15
10
9
5
8
0
7
6
Mar-15
Feb-15
Jan-15
Dec-14
Nov-14
Oct-14
Sep-14
Aug-14
Jul-14
Jun-14
May-14
Apr-14
Mar-14
Feb-14
Jan-14
Dec-13
Nov-13
Oct-13
Sep-13
Aug-13
Jul-13
Jun-13
May-13
Apr-13
Mar-13
Feb-13
Jan-13
Dec-12
Nov-12
Oct-12
10
Over 24 Hr Waits
5
Avge
lower ci
upper ci
4
3
There were 3 tertiary refusals – average for the month. 2 were
in Paediatric Surgery and the other in cleft lip and palate
surgery. One of the paediatric surgery patients was an out of
region request from Plymouth.
2
0
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
Dec-13
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
1
Total
avge
17
PICU Demand and KIDS Service
4 WM patient could not be supported within region
PICU demand – There were 116 referrals to KIDS in March 2015 of which
35% of referrals were avoided (41 patients). Of the 75 patients/admissions
that needed admission, 51% (38) were admitted to BCH, 39% (29) were
referred to other WM hospitals and 11% (8) went out of the region.
4 non WM patients could not be supported within region
Future risks: Bed availability across the country remains a problem.
14 additional non WM patients were supported at BCH
250
Referrals to KIDS Service Taken Out of Region
(Leics or Other Non WM Provider)
Year on Year Comparison of Total Referrals to KIDS
30
25
20
15
10
5
0
200
150
100
Feb-15
Dec-14
Oct-14
Aug-14
Jun-14
Apr-14
Feb-14
Dec-13
Oct-13
Aug-13
Jun-13
Total
Outcome of Referrals to KIDS (excluding admissions
avoided) - Trend
80%
Apr-13
Feb Mar
Feb-13
Apr May Jun Jul Aug Sep Oct Nov Dec Jan
2012/13
2013/14
2014/15
Dec-12
0
Oct-12
50
Avge
Outcome of Referrals to KIDS - (including admissions
avoided) Trend
60%
50%
60%
40%
30%
40%
20%
20%
Jan-15
Feb-15
BCH
Dec-14
Nov-14
Oct-14
Sep-14
Aug-14
Avoided Admission
Jul-14
Jun-14
May-14
Apr-14
Mar-14
Jan-14
Feb-14
Dec-13
Oct-13
Sep-13
Nov-13
Out of Region
Aug-13
Mar-15
Jan-15
Feb-15
Dec-14
Oct-14
UHNS and Other WM
Nov-14
Sep-14
Jul-14
Aug-14
Jun-14
Apr-14
May-14
Mar-14
Jan-14
BCH
Feb-14
Dec-13
Oct-13
Nov-13
Sep-13
0%
Aug-13
0%
10%
18
Month 12 2014/15
Utilisation of our facilities
19
Cancelled operations:
45 patients were cancelled in March, which was 2.05% of elective work in month and 1.63% at year
end. There was 1 breach of the 28 day standard. Bed shortages and high emergency demand have caused the most cancellations in
March. There were high levels of total cancellations as well as high reportable incidence.
Future risks: Possible 28 day breaches in next months figures as the 45 cancellations this month are rebooked.
The issue
•45 (2.05% of electively admitted) patients had their operation cancelled on the day of admission in March.
•YTD in 2014/15, 415 patients (1.63%) have had their operation cancelled on the day of admission (and are nationally reportable)
compared to 1.94% in the same period last year.
• 1 patients breached the 28 day standard
•There were 317 total hospital cancelled operations
Why has it
occurred?
•36% of operations (16) were cancelled due to bed shortage in March.
•‘lack of theatre time’ and ‘list over run’ accounted for 16% of cancellations on the day and 31% were due to emergencies.
•Bed pressures in PICU remain an issue but in the figures only accounted for 11% of cancellations.
•Plastics, Surgery, ENT, Urology and radiology were the highest cancelling specialities for all hospital cancellations.
Our response
•Continued management of patients from the operational and medical teams, particularly for patients who may breach the 28 day
standard
•Theatre 10/Ward 17 has been operational since opening on 23rd March, a meeting has been scheduled to reflect on month one of
theatre 10’s use so on-going issues/themes can been identified and plans can be put in place to improve these. Early review shows
the model used for theatre 10 works In terms of a very low number of cancellations in this theatre.
• A surgical escalation process is in development to co-ordinate surgical admissions when there are bed pressures within the Trust.
Expected impact of
our response and
responsible persons
•Extra beds should help with patient flow
•Managing patients are risk of breaching 28 days may help to reduce and avoid breaches where possible
•Theatre 10 (ward 17) will increase capacity, help clear patient backlogs and reduce cancelled operations
•Service Managers, COO and DOT are managing this
Timescales (of
actions and
expected impact of
those actions)
•All actions are being continually implemented with expected immediate response
20
Cancelled operations trends
Cancelled Operations On The Day - National Definition
Avge for 3 years
Data
Percentage of Operations Cancelled on the Day
0.5
As a % of Electives
Avge % Cancelled
3/1/2015
1/1/2015
11/1/2014
9/1/2014
7/1/2014
5/1/2014
3/1/2014
1/1/2014
11/1/2013
9/1/2013
7/1/2013
5/1/2013
0
10
0
6
4
2
0
3
1
2
Mar-15
Feb-15
Jan-15
Dec-14
Nov-14
7
5
4
3
4
2
3
2
0
2
0 0 0 0
0
Feb-15
20
6
1
Mar-15
1
7
8
Jan-15
30
10
May-13
% Cancelled
40
1.5
11
12
Dec-14
14
Nov-14
60
Oct-14
2.5
16
Sep-14
16
Jul-14
70
50
lci 2stdev
Aug-14
3
Total Cancelled
18
2
uci 2stdev
Breaches of 28 Day Cancelled Operations Standard
80
3.5
mean
Jun-14
2014/15
May-14
2013/14
Oct-14
Aug Sep Oct Nov Dec Jan Feb Mar
Apr-14
2012/13
Jul
Mar-14
Apr May Jun
Sep-14
10
Aug-14
13
Jan-14
20
24
Feb-14
24
18
Jul-14
26
Dec-13
28
Nov-13
28
30
Oct-13
40
Jun-14
45
40
May-14
48
Sep-13
50
Aug-13
54
60
Jul-13
70
400
350
300
250
200
150
100
50
0
Apr-14
66
Jun-13
80
All Hospital Cancelled Operations
Contract Trajectory
Nationally Reported Cancelled Ops
21
All Hospital cancelled operations year to date by specialty
Other Dir 3,
1.2%
Other, 2.7%
Other Dir
4, 7.4%
Plastic Surgery,
11.4%
T&O,
4.8%
Other Dir 2,
8.5%
Cardiology,
4.2%
Urology, 7.1%
Cardiac Surgery,
6.2%
Radiology, 9.3%
Haematology,Ophth, 5.1%
4.6%
Hepatology,
3.7%
Paed Surgery,
13.6%
All Hospital cancelled operations year to date by reason
Anaesthetist
unavailable,
Theatre
staff 1.2%
Administrative
unavailable,
Error, 3.8%
Equipment
1.3%failure, 0
Surgeon
unavailable,
2.8%
Lack of theatre
time, 3.4%
ICU/HDU
beds
unavailable,
3.9%
Other, 4.2%
Emergencies/Tra
uma, 22.9%
Unfit with acute
illnes (Hosp
Canc), 8.2%
Bed Shortage,
18.3%
Anaesthetist
necessary (Hosp
Canc), 12.5%
Patient not
suitable for OP,
17.4%
ENT, 12.8%
Nationally reportable cancellations by reason – March 2015
Plastics, Paediatric Surgery and ENT continue to be the largest single specialties. The
biggest reason for the cancellations in the year is emergencies and trauma (22.9%), Bed
shortage (18.3%), patient not suitable for operation (17.4%) and operation not necessary
(12.5%)
Bed shortage: 16
ICU/HDU beds not available: 5
List Overrun: 6
Equipment failure/unavailable: 2
Emergencies/Trauma: 14
Lack of theatre time: 1
Surgeon Unavailable: 1
22
Discharges and Flow
Fit For Discharge Days
CAMHS Long Stay Patients (March) – Fit for Discharge
Long stay patients
After fit for discharge
The number of over 7 day patients increased in March but the graph below
shows that the numbers are started to decrease again at the beginning of
April. As we have seen in previous months, the increase is in patients currently
waiting between 7 and 30 days (red line). The graph below also shows a slight
increase in the number of patients waiting over 90 days.
160
Inpatient Long Stayers
Patient 3
226
Patient 2
226
Before fit for discharge
101
210
140
Patient 1
120
415
279
100
Long stay patients (March) - Fit for discharge
80
Before fit for discharge
60
40
Patient 4
34 0
20
Patient 3
27
10/04/2014
26/04/2014
12/05/2014
28/05/2014
13/06/2014
29/06/2014
15/07/2014
31/07/2014
16/08/2014
01/09/2014
17/09/2014
03/10/2014
19/10/2014
04/11/2014
20/11/2014
06/12/2014
22/12/2014
07/01/2015
23/01/2015
08/02/2015
24/02/2015
12/03/2015
28/03/2015
0
Sum of GT7
Sum of GT7to30
Sum of GT30to90
Sum of GT90
54
Patient 2
Patient 1
After fit for discharge
169
104
111
216
23
Item 15.88
Board of Directors
Thursday 30 April 2015
Enc 07
Every child and young person requiring access to
care at BCH will be admitted in a timely way, with no
unnecessary waiting along their pathway
Report Title
Resources report period 1st April 2014 – 31st March
2015
Sponsoring Director
Deputy Chief Executive / Chief Finance Officer
Author(s)
Director of Finance and Procurement, Chief Officer for
Workforce, Head of Informatics
FRC and SLT
Situation
This report is to communicate the various aspects of Trust performance for the financial
year ending 31 March 2015, and to identify any key risks that are evident within the
organisation.
The contents of this report will form the basis of the Trust’s Quarter 4 (Q4) Return to
Monitor.
The Trust is also required to report its predicted status for Governance and Mandatory
Services.
Background
The Trust is required to comply with the finance related legal issues contained within our
Terms of Authorisation as well as other key financial targets. This includes:
•
Performing at plan for Monitor’s Continuity of Service Risk Rating leading to an overall
CoSRR of 4; and
•
Risk Assessment Framework, which may result in formal discussions with Monitor.
Delivery against these targets is driven by:
•
•
The volume and mix of demand experienced by the Trust; and
How the Trust uses its most valuable resource, its staff, in responding to that
demand.
The report explores each of these areas in turn and the impact on the financial position
and performance.
Assessment
Monitor Declarations
The key ongoing governance issue which impacts upon the Trust’s Monitor Governance
rating is the performance against the 18 week target for admitted patients. Performance
in month was, at 90.2%, fractionally above the 90% threshold. This, and the continuing
level of performance of the other metrics, enables the Trust to forecast a Green
Governance rating.
From a financial perspective the ratings will be a 4 under the Continuity of Service Risk
Rating. Under the old Compliance Framework a FRR of 4 would also have been
reported. These remain strong performances.
Activity
Activity performance in the year to date against plan and compared to 2013/14 is as
follows:
Activity Type
Against Plan
Against 2013/14
+6.4%
+5.6%
Emergency/Non-Elective
-2.5%
-1.1%
Planned Care
+1.0%
+2.1%
Outpatients
+2.3%
+6.1%
From a financial perspective income has overperformed in the month. This is the tenth
month of above plan performance and continues the strong positions experienced since
the early summer months. Performance in month has been enhanced by an increasing
level of drug and device recharges.
Workforce
As outlined above, demand remains high and this has brought into sharp focus the short
to medium term capacity issues faced by the Trust. Sickness levels in the month stood at
3.65% with the cumulative rate decreasing to 3.34%. Both measures are above the
Trust’s 3% target although both show considerable improvement on the previous month.
The combined substantive and bank staff level usage increased in March with a 14wte
movement, of 6wte which was in substantive staff. Compared to March 2014 substantive
wte have increased by 6.2%, which is above the levels of activity increase reported
above.
Engaging with staff, especially during periods of pressure, is important and appraisals are
one indication of how well this is working in the Trust. The reported appraisal rate is now
85%, a similar position to that reported in February.
Finance
The 2014/15 financial year has concluded with a financial position warranting detailed
explanation. The headline surplus is £1.612m. However, following the interim revaluation
of the estate (an audit requirement every 3 years) the value of the Trust’s assets has
been reduced (impaired) by £2.785m. This technical adjustment directly impacts upon the
Trust’s I&E position and was not something that could have been readily forecast.
Excluding this technical adjustment the surplus was £4.397m which was exactly where
we were forecasting to be at year-end. Although the impairment is an accumulation of
revised revaluations across the whole site the predominant causes are the impact of the
decision to demolish the car park to enable the building of the new £35m clinical block
and the actual value added following the electrical infrastructure work that has been
undertaken over the previous 2 years.
The £4.4m surplus was per the Trust’s Monitor Plan. Quarter 4 can be financially
challenging and there were some major issues dealt with at year-end. These will all be
subject to audit so until that process concludes this will remain a draft position. Without
these exceptional items the surplus would have been would have been closer to the top
end of the range we were predicting earlier in the financial year. However, there remain
some major financial challenges ahead for the Trust so the delivery of this financial
outcome is crucial.
Controlling the costs of care that we provide remains central to our financial success as
downward pressure will continue on the tariffs we are paid. It is important that we deliver
on efficiency plans so that we can begin 2015.16 ‘on the front foot’.
Our year-end cash balances were, as expected, strong. A year-end catch-up on capital
spend has caused a small reduction in the overall cash balance but this only served to
reduce the above plan level to 13%. Capital spend ended the year within 5% of the
reforecast position.
Monitor Monthly Data Collection
On September 15th all FTs were written to outlining a new monthly data collection
exercise predicated on the emerging signs of pressure on NHS finances. This required a
return to the DH confirming the Trust’s Forecast Outturn positions on revenue and the
overall level of capital expenditure. On 13 March Monitor wrote to all FTs stating that
“Monitor no longer require trusts to submit this return (starting from the March 15 DEL
return) until further notice.”
No return is therefore included in this month’s report.
Recommendations
The Board of Directors review, discuss and approve the Resources Report.
The Board is asked to approve a forecast Governance (Green) and Continuity of Service
Risk Rating (“4”) for inclusion in the Monitor Q4 Return, which must be submitted by April
30.
Key Impacts
Staff and finance are key enablers to meeting the Trust’s strategic
objectives.
outcome)
N/A
NHS Constitution
NHS Constitution has a pledge regarding 18-week waits.
NHSLA, Information
Monitor metrics are considered in the report.
rights
N/A
Trust contracts
N/A
Other
N/A
Resources Report
April 2015
Phil Foster
Theresa Nelson
Paul Franklin
Director of Finance and Procurement
Chief Officer for Workforce
Head of Informatics
1
Reporting on resources use.
1. Summary
2. Governance - Monitor Assessments and Declarations
3. Financial Performance
4. Income and Expenditure
5. Efficiency
6. Liquidity
7. Workforce
2
Summary.
April 2015
The 2014/15 financial year has concluded with a financial position warranting detailed explanation. The headline surplus
is £1.612m. However, following the interim revaluation of the estate (an audit requirement every 3 years) the value of
the Trust’s assets has been reduced (impaired) by £2.785m. This technical adjustment directly impacts upon the Trust’s
I&E position and was not something that could have been readily forecast. Excluding this technical adjustment the
surplus was £4.397m which was exactly where we were forecasting to be at year-end.
The £4.4m surplus was per the Trust’s Monitor Plan. Quarter 4 can be financially challenging and there were some major
issues dealt with at year-end. These will all be subject to audit so until that process concludes this will remain a draft
position. Without these exceptional items the surplus would have been would have been closer to the top end of the
range we were predicting earlier in the financial year. However, there remain some major financial challenges ahead for
the Trust so the delivery of this financial outcome is crucial.
Controlling the costs of care that we provide remains central to our financial success as downward pressure will continue
on the tariffs we are paid. It is important that we deliver on efficiency plans so that we can begin 2015.16 ‘on the front
foot’.
Bank staff usage in March was 8.2% lower than the equivalent period last year although March 2014 was an exceptionally
high usage month. With substantive staffing levels 6.2% higher in overall terms this is a net 5.4% increase with the
combined position once again resulting in a record workforce level at the Trust. Appraisal rates are at 85%, which is
equivalent to the February position. In-month sickness increased by 0.17% to 3.65%. Year to date sickness has decreased
slightly to 3.34%.
Our year-end cash balances were, as expected, strong. A year-end catch-up on capital spend has caused a small reduction
in the overall cash balance but this only served to reduce the above plan level to 13%. Capital spend ended the year
within 5% of the reforecast position.
3
2. Governance –
Monitor Assessments and Declarations
4
Our Month 12 regulatory position remains strong.
Quarter 3 - 2014/15
The ratings for Quarter 4 have now been confirmed.
Monitor Quarter 3 2014/15 (Confirmed)
Finance risk rating - Continuity of Service Risk Rating
Governance risk rating
Finance risk rating - Compliance Framework
Plan
Actual
G (4)
G (4)
G
G
G(4)
G(4)
Month 12 – Quarter 4
Monitor Quarter 4 2014/15 (Predicted)
Based on this performance the predicted measureable
Month 12 performance is Green.
Finance risk rating - Continuity of Service Risk Rating
Governance risk rating
The Continuity of Service Risk Rating for March and
therefore 2014/15 is a 4 (the highest level).
Finance risk rating - Compliance Framework
Plan
Actual
G (4)
G (4)
G
G
G(4)
G(4)
For information under the old Compliance Framework
regime a FRR of 4 would have been reported in Month
12.
A continuation of the above will result in the Trust
achieving its planned Risk Ratings for 2014/15.
Forecast ratings for the year are included in Section 3 –
Financial Performance.
5
Monthly Reporting Collection Data.
On 15 September Monitor wrote to all FTs outlining the requirement for a new monthly data collection process. This has been a
feature of the Resource Report since September.
On 13 March Monitor wrote to all FTs stating that “Monitor no longer require trusts to submit this return (starting from the March
15 DEL return) until further notice. But please be aware that this return may be required again in the future.”
No return is therefore included in this month’s Resource Report.
6
3. Financial Performance
7
Financial Summary.
Governance
The Monitor Financial Risk rating is 4 per plan, with liquidity remaining strong.
This 4 is per the Continuity of Service Risk Rating (CoSRR) and also the former Compliance Framework.
Income and Expenditure
The I&E position ended the year with a surplus of £1.612m. This included a £2.785m technical adjustment
following the revaluation of the estate. Excluding this exceptional item would increase this surplus to £4.397m
just £0.02m ahead of the Monitor plan.
This £4.397m is per the forecasted position given the one-off items and known year-end adjustments which had
been reported during the final quarter.
Efficiency
Excluding the technical adjustment the EBITDA and Income Surplus margins are 4.6% and 1.8%, respectively.
The EBITDA margin was marginally below plan whilst the I&E surplus margin was per plan.
CIP at a Directorate level and Trust-wide level ended the year below plan. Performance is reported at 73%
although further work is being undertaken to assess the final benefit of the Trust-wide schemes so this position
may increase. In value terms the £6.9m was £1.4m higher than 2013/14.
Productivity measures associated with income were strong in March due to an improved income performance.
Liquidity
Cash balances remained above plan in March. Some of the previous gains experienced through the delays in the
capital programme were reduced in March as a year-end surge in programme spend was experienced.
8
Financial Balanced Scorecard.
FINANCIAL BALANCED SCORECARD - MARCH
Category
Governance
Sub-Set
CoSRR
I&E
I&E and
Profitability
Metric
Period
Plan
Actual
Variance
Weight
Score
Continuity of Service Risk Rating *
YTD
4
4
0.00
50%
50%
100%
Forecast
4
4
0.00
50%
50%
100%
Debt Service Cover Rating *
YTD
4
4
0.00
0%
0%
CIP
Efficiency
Productivity
Temp Spend
CQUIN/
Penalties
OVERALL
100%
100%
4
4
0.00
0%
0%
YTD
4
4
0.00
0%
0%
100%
Liquidity Rating *
Forecast
4
4
0.00
0%
0%
100%
I&E Position (£m)
In-Month
-0.40
-1.14
-0.74
10%
-8%
-82%
I&E Position (£m)
YTD
4.38
4.40
0.02
30%
30%
I&E Position (£m)
Forecast
4.38
4.40
0.02
30%
30%
I&E Position (£m)
Underlying
2.10
2.10
0.00
30%
30%
In-Month
-0.59
-0.65
-0.07
15%
13%
YTD
11.82
11.53
-0.29
35%
34%
Forecast
11.82
11.53
-0.29
50%
49%
Profitability - EBITDA (£m)
Capex
100%
Metric
Forecast
Profitability Profitability - EBITDA (£m)
Liquidity
100%
Sub-Set
Liquidity Rating *
Cash
Category
82%
88%
100%
100%
100%
88%
96%
98%
98%
113%
Cash (£m)
YTD
45.49
51.55
6.05
50%
57%
Cash (£m)
Forecast
45.49
52.32
6.82
50%
58%
Capital Expenditure (£m)
YTD
12.74
12.14
-0.60
50%
48%
Forecast
12.74
12.14
-0.60
50%
48%
CIP Achievement (£m)
In-Month
1.32
0.47
36%
10%
4%
36%
YTD
9.46
6.91
73%
20%
15%
73%
Forecast
9.46
6.91
73%
35%
26%
Recurrent
9.46
6.42
68%
35%
24%
68%
YTD
1.56
1.57
101%
50%
50%
101%
Income per wte (£)
In-Month
70.27
80.94
115%
50%
58%
% of Pay Bill on Temporary Staff (%)
in-Month
5.0%
5.5%
110%
25%
23%
% of Pay Bill on Temporary Staff (%)
YTD
5.0%
5.3%
106%
75%
71%
Contract Penalties/CQUIN Target (£m)
YTD
5.01
4.93
-0.08
50%
49%
Contract Penalties/CQUIN Target (£m)
Forecast
5.46
5.23
-0.23
50%
48%
Income per £1 Pay Expenditure (£)
114%
109%
95%
68%
85%
108%
93%
97%
115%
95%
95%
73%
115%
110%
106%
98%
96%
96%
9
Financial Balanced Scorecard – Performance Tracker.
FINANCIAL BALANCED SCORECARD - 2014/15 TRACKER
Actual
Sep
Governance Continuity of Service Risk Rating *
I&E
Liquidity
Efficiency
Oct
Predicted
Nov
Dec
Jan
Feb
Mar
YTD
Forecast
Governance Risk Rating
YTD
Governance Risk Rating
Forecast
I&E Position (£m)
In-Month
I&E Position (£m)
YTD
I&E Position (£m)
Forecast
YTD
Forecast
YTD
Forecast
Cash (£m)
YTD
Cash (£m)
Forecast
YTD
Forecast
Liquidity Rating *
YTD
Liquidity Rating *
Forecast
In-Month
YTD
Forecast
Income per £1 Pay Expenditure (£)
YTD
Income per wte (£)
In-Month
Contract Penalties/CQUIN Loss (£m)
YTD
Contract Penalties/CQUIN Loss (£m)
Forecast
* Note - for those Monitor Ratings - 4 is the Highest Rating
10
4. Income and Expenditure
11
Income and Expenditure against Plan.
The Trust’s headline I&E position has reduced significantly in
March as a result of the impact of the interim revaluation of
the Trust’s estate which was an audit requirement. This
singularly caused a £2.785m reduction in the position.
Excluding this would mean a year-end I&E position of
£4.397m.
The £4.397m surplus was 0.5% above the planned surplus.
Given the one-off issues and pressures the Trust has faced
this year, this was a very strong financial performance.
Headlines are:
• Following the revaluation of the estate the Trust has
incurred an impairment of £2.785m. The key areas where
this has been impacted are:
• Car park – impaired due to its impending
demolition;
• Electrical infrastructure;
• ED, Parkview and Respiratory developments.
• The Trust reported a strong surplus against Clinical
Income;
• Part of this is associated with drugs and devices income
for which there is a direct offsetting cost. However, a
repetition of this in 2015/16 will see the Trust lose
income under the ETO;
• There were a number of exceptional items incurred in
March which the Board and Finance Committee have
been sighted on as part of the forecasting work
undertaken;
• Additional Directorate pressures have been experienced
through the delivery of CIP targets and the costs of
agency staffing. CIP performance is detailed in 5.
Efficiency section.
2014/15 I&E toMarch 2015
Income from activities
Other Income
Operating Expenses
EBITDA
Interest Receivable
Depreciation
Profit/(Loss) on Asset Disposal
Impairment
PDC Dividend
Interest Paid
Annual
Revised
YTD Plan
Plan per Annual Plan per LTFM
LTFM
£'000
£'000
£'000
217,995
220,125
217,995
19,666
23,737
19,667
-225,841
-232,081
-225,842
11,820
11,782
11,820
243
247
243
-4,624
-4,559
-4,624
0
0
0
0
0
0
-2,762
-2,762
-2,762
-300
-326
-300
4,377
4,381
4,377
Revised
YTD Plan
£'000
220,125
23,737
-232,081
11,782
247
-4,559
0
0
-2,762
-326
4,381
YTD Actual
£'000
227,475
23,626
-242,356
8,745
176
-4,530
0
0
-2,498
-282
1,612
Variance
£'000
7,349
-110
-10,275
-3,036
-71
30
0
0
264
45
-2,769
• The continued use of temporary staffing is adding unfunded costs into the
system. The spend in this area over the 12 months is £8.5m and equates to
5.3% of the overall pay bill for the period (which is a slight increase on the
Month 11 position);
• A detailed I&E breakdown is included as Appendix One;
• A detailed breakdown of expenditure by cost category is included as
Appendix Two.
• Being the year-end position this will only be finalised once audited in
April/May.
12
Emergency activity profile
ED attendances
Emergency Department (ED) attendances
increased significantly in March 2015, with
the total being the second highest monthly
figure on record, and 9% above the planned
level.
6000
5000
4000
3000
For the full year 2015/16 activity was 6,4%
above plan and 5.6% up year on year.
2000
Therefore growth in ED activity in 2014/15
was significantly higher than historical
precedents.
1000
0
A M J
J
A
S
O N D
J
2011/12
2012/13
2013/14
2014/15
F M
2014/15 Emergency department
activity against plan
Despite the ED growth, emergency
admissions on the face of it did not
experience a similar increase in 2014/15. This
is due to some extent because the first part of
2013/14 reflected previous working patterns
when we admitted more zero length of stay
emergency patients who now would go to
CDU.
If looking at variation on a month on month
basis this zero length of stay issue is not a
factor when comparing the second half of the
year as the change had occurred in the
baseline by then too. So we see that we start
go get big year on year increases from Q3
onwards. In the 2nd half of the year
emergency admissions are 8% above
2013/14 levels.
6000
5000
4000
3000
2000
Emergency /Non Elective FCEs
2000
1500
1000
500
0
A M
J
J
A
S
O
N
D
2011/12
2012/13
2013/14
2014/15
J
F M
2014/15 Emergency/non elective FCEs
activity against plan
2000
1500
1000
1000
500
0
A M J
J A
S O N D
2014/15 actual
J
F M
2014/15 plan
0
A M J J A S
2014/15 actual
O
N D J F M
2014/15 plan
13
Planned activity profile
All elective FCEs
2014/15 All Elective FCE activity against
plan (incl Reg Day Admissions)
3000
2500
3000
2000
2500
2000
1500
1500
1000
1000
500
500
0
A
M
J
2011/12
J
A
2012/13
S
O
N
2013/14
D
J
F
M
0
A
M
J
J
A
S
O
N
D
J
F
M
2014/15
2014/15 actual
2014/15 plan
Elective activity in March increased by 3.6% compared to March 2014. The final year end position shows a 2.5% increase
over 2013/14.
Elective activity finished at 1% above the plan for 2014/15, with activity being 3.3% below plan in month. For the full year
day cases over-performed by 500 and overnight electives under-performed bv 350.
Haematology/Oncology/Haemoglobinopathy over-performed by 350 combined. Dermatology by 155, Gastroenterology by
118, Neurology by 145 and Paediatric Surgery by 137.
14
Outpatient activity profile
New OP attendance
There was an 11.7% increase for
new attendances in March and
5,6% increase for follow up
patients when compared with the
same month in 2014.
4000
3500
3000
2500
2000
The final 2014/15 position for
activity
shows
that
new
attendances have increased by
0.5% and follow ups have
increased by 6% when compared
to 2013/14.
1500
1000
500
0
A
M
J
J
2011/12
A
S
2012/13
O
N
D
J
2013/14
F
Follow up OP attendance
With regards to Outpatient
Procedures, there is a 37% YTD
increase from 2013/14.
Against plan, all outpatient
activity was 6.6% above plan in
March 2015 and overall 6.1%
ahead of plan for the full year.
High volume specialties with big
increases include Paediatrics (7%),
Paediatric
Surgery
(24%).
Cardiology (12%), Neurosurgery
(13%), Oncology (18%) and
Respiratory Medicine (38%)
12000
10000
8000
6000
4000
2000
1600
1400
1200
1000
800
600
400
200
0
A M
M
2014/15
Outpatient Procedures
2011/12
16000
J
J
A
S
O
2012/13
N
D
J
2013/14
F M
2014/15
2014/15 outpatient activity
against plan (excl AHP CNS and Phone)
14000
12000
10000
8000
6000
4000
2000
0
A M
2011/12
J
J
A
2012/13
S
O N D
2013/14
J
F M
2014/15
0
A M J
J
A
2014/15 actual
S
O N D
J
F M
2014/15 plan
15
5. Efficiency
16
Profitability against Target.
Note – the margins opposite exclude any technical impact of the
£2.8m Impairment.
EBITDA Margin
8.0%
The EBITDA (Earnings Before Interest, Taxation, Depreciation and
Amortisation) Margin ended the year 0.4% behind the 5.0%
target. This is a reduced margin compared with February and
reflects the increased costs and year-end adjustments incurred in
the month. In monetary terms EBITDA was also below the
Monitor Plan, with a small in-month movement.
7.5%
Including the impairment reduces the EBITDA margin to 3.5%.
4.5%
6.8%
7.0%
6.5%
6.0%
6.0%
5.8%
6.2%
5.8% 5.9% 5.7% 5.7%
5.5%
5.1% 5.2%
Actual
5.4%
5.0%
4.6%
Plan for
Year
4.0%
Apr May Jun
The I&E Surplus Margin ended the year on plan at 1.8%. The
lower than anticipated depreciation levels offset the EBITDA
shortfall.
As with the EBITDA margin, the expected reduction in the I&E
margin during March occurred as financial pressures and year-end
issues typically experienced in quarter 4 took effect.
The inclusion of the impairment reduced the I&E surplus margin
to 1.3%.
Jul
Aug Sep Oct Nov Dec
Jan
Feb Mar
I&E Surplus Margin
5.0%
4.5%
4.0%
3.5%
3.0%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
3.9%
2.7%
3.0%
3.2%
2.8% 2.9% 2.9% 2.8%
2.1% 2.2%
2.4%
1.8%
Actual
Plan for
Year
Apr May Jun
Jul
Aug Sep
Oct Nov Dec
Jan
Feb Mar
17
Productivity.
Income Generated per £1 of Pay Expenditure
Two productivity metrics were produced for the first time in
September. These are updated monthly and assess the:
• Income Generated per £1 of Pay Expenditure; and
• Monthly income per wte.
With staff costs equating to over two thirds of the Trust’s
operating expenditure the return on pay expenditure is vital to
the Trust’s productivity and profitability.
1.75
1.70
1.65
£
1.60
Cumulative income per £ of pay expenditure performed behind
the 2013/14 level.
There were a number of year-end of one-off pay adjustments in
March which have suppressed the 2014/15 position. Further
analysis will be undertaken to assess whether the underlying
position reflects the reduced productivity experienced in January
and February.
1.55
1.50
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Inc/£1 Pay In-Month 2014/15
Inc/£1 Pay - Cumulative 2013/14
Inc/£1 Pay - Cumulative 2014/15
Inc/£1 Pay - Cumulative Plan 2014/15
Mar
Monthly Income per wte since April 2013
Income per wte was high in month due to a favourable position
being reported for clinical and non-clinical income in March.
84
82
80
78
76
74
72
70
68
Income per wte - actual
Mar-15
Jan-15
Feb-15
Dec-14
Oct-14
Nov-14
Sep-14
Jul-14
Aug-14
Jun-14
Apr-14
May-14
Mar-14
Jan-14
Feb-14
Dec-13
Oct-13
Nov-13
Sep-13
Jul-13
Aug-13
Jun-13
Apr-13
66
May-13
£
Income per wte - plan
18
CIP.
The overall target reflects the following:
• Directorate targets;
• Trust-wide scheme targets; and
• Residual balance of the underlying legacy position from 2013/14.
Headlines from Month 12 are as follows:
• 3 Directorates over-delivered on their CIP targets;
• Corporate and Surgery were the areas furthest from target for overall schemes with Surgery being by far the worst performing;
• The shortfall on the trust-wide schemes was within the IT Strategy, Future Fit where workforce savings are not materialising in line with the
plan and the Pathways Project;
• The Drug Expenditure Group’s target of £0.5m was achieved in full;
• Overall achievement for 2014/15 exceeded the level achieved in 2013/14.
• The recurrent position has not deviated from the value reported previously.
Directorate Annual Target
CAMHS
Corporate
CSS
Medicine
SSD
Surgery
Trustwide
Totals
£389,526
£723,251
£666,136
£1,324,237
£1,390,984
£725,583
£4,240,000
£9,459,716
YTD Plan
YTD Actual
£389,526
£723,251
£666,136
£1,324,237
£1,390,984
£725,583
£4,240,000
£9,459,716
£399,912
£402,369
£738,902
£1,407,243
£877,627
£252,824
£2,831,366
£6,910,243
YTD Variance % Plan To Date Recurrent Plans
£10,386
-£320,882
£72,767
£83,006
-£513,357
-£472,759
-£1,408,634
-£2,549,473
103%
56%
111%
106%
63%
35%
67%
73%
£350,050
£359,726
£451,101
£992,784
£937,792
£220,938
£3,110,000
£6,422,392
19
6. Liquidity
20
Cash and Capital.
2014/15 Plan
Mar-16
Jan-16
Feb-16
Dec-15
Oct-15
Nov-15
Sep-15
Jul-15
Aug-15
Jun-15
May-15
Apr-15
Mar-15
Jan-15
Feb-15
Dec-14
Oct-14
Nov-14
Sep-14
Jul-14
Aug-14
Actual
Rolling Forecast
2014/15 Cumulative and Forecast Capital Expenditure against Plan and Monitor Margins
The cash position is included within the Balance Sheet which is
included as Appendix Three.
The Capital performance to the end of March was only £0.6m
behind the revised internal/Monitor plan. The forecast spend
for the year of £11.2m was exceeded as work in progress was
above estimated levels. Year-end capital expenditure was
£12.1m.
However, there were still a number of major carry forwards
into 2015/16 and these are reflected in the Capital Plan for that
year.
Jun-14
The graphical analysis includes a cash forecast through to
March 2016. This period sees a reduced cash balance as the
Parkview development continues along with the first year of
the clinical block.
Apr-14
60,000
55,000
50,000
45,000
40,000
35,000
£k 30,000
25,000
20,000
15,000
10,000
5,000
0
May-14
The Trust’s Liquidity remains significantly above the Continuity
of Service threshold of 4.
2014/15 Cash Position and Rolling Forecast
Mar-14
Cash finished the year 13.3% above plan. This equates to
£6.1m and is primarily a result of reduced capex against the
original plan, the receipt of PDC for the funding of a major IT
project and changes in working capital driven by year-end
adjustments. Cash reduced in March as there was a greater
level of capex spend incurred as the programme moved to
within 5% of the revised plan.
16,000
14,000
12,000
10,000
£k
8,000
6,000
4,000
2,000
Apr
May
14/15 Actual
Jun
Jul
14/15 Forecast
Aug
Sep
14/15 85%
Oct
Nov
14/15 115%
Dec
Jan
Feb
Mar
14/15 Plan - Original
21
Debtors and Creditors.
Debtors over 90 days have reduced significantly in March in both
actual and % terms.
The Private Patient debt remains a high risk of recovery. The
outcome of legal proceedings from November are continuing. A
report on this will be presented to the Audit Committee in early
2015/16.
Of the total £1.7m debtors over 90 days, £1.3m relate to NHS
organisations. Although a proportion of these debts result from
the early raising of invoices during November prior to a significant
period of system down-time, these are being managed
appropriately in conjunction with the Trust’s contracting team to
ensure money is recovered prior to year-end. These will be
progressed as part of the end of year Agreement of Balances
process.
The Creditors position over 90 days has deteriorated in month. A
significant number of unpaid invoices received in December have
triggered the 90 day threshold. The vast majority of these are
other NHS organisations and will be progressed as part of the end
of year Agreement of Balances process.
% Debtors and Creditors over 90 days
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Apr
May
Jun
Jul
Aug
Sep
Debtors>90 days %
Top 5 Debts Over 90 Days Old
Customer
Oct
Nov
Dec
Creditors>90 days %
31st March 2015
Jan
Feb
Mar
Target
28th February 2015
Age
(Days)
153
Value
(£k)
143
Age
(Days)
122
Value
(£k)
143
Private Patient - MK
1337
139
1306
139
NHS Nene CCG
150
83
119
83
Birmingham Cross City
106
52
HEFT
367
49
336
49
119
46
NHS SE Staff & Seisdon Penninsula CCG
NHS Nottingham City CCG
466
461
22
7. Workforce
23
Workforce Report Summary March 2015
Sickness Summary – In month sickness has increased and is now 3.65%, this is lower than this time last year (3.76%). Long term sickness (LTS) has
remained constant at around 1.95%, this has been the result of very active management and support. Short term sickness (STS) has increased between
January and February 2015 and is at 1.70%. CSS, Specialised and Surgical directorates have seen an increase in their sickness % compared to January 15.
The top 3 reasons for sickness during February are, Anxiety/Stress (550.03 WTE days lost), Gastrointestinal problems (525.38 WTE days lost) and Urinary
& Gynaecology (270.76 WTE days lost). There is some evidence to suggest that gastrointestinal absences are linked to stress related absences (e.g. IBS
exacerbated by stress). A number of support mechanisms have been put into place to reduce stress and improve emotional wellbeing and the new
Confidential Care Service is receiving very good feedback.
Bank/Agency Usage – Bank usage has increased to 187.30 WTE, compared to February (179.34). Admin usage has decreased to 79.61 WTE, work is
being done to make sure that bank shifts are coded to the correct areas so that we can analyse usage in more depth. The figures are showing that there is
still an over reliance to use vacancy as the reason when booking a bank shift. This increase is in line with increases in operational pressure over the same
period
PDR Summary - PDR % has decreased slightly in March and is now 84.53% (February 84.88%). Clinical Support Services , Specialised Services , Medical,
Surgical and Corporate all remain above 80%. CAMHS % has decreased and is now at 69.49%. Directorates are continuing to identifying hotspot areas,
sending out email reminders to managers and supplying their DMT’s with monthly figures. HR workshops have taken place in CAMHS during February and
March with positive feedback and the team are looking at rolling out these workshops to other Clinical Groups.
Turnover Summary - 12 month Turnover % for the Trust has decreased slightly for the 12 month period ending March 2015 and remains above the Trust
KPI (9%) at 10.62%. The turnover % has decreased slightly for all Directorates apart from Specialised Services, however they all remain above 9%. The
main reasons for leaving during March 2015 are voluntary resignation due to relocation (4.00 WTE) and dismissal (1.53 WTE). Exit interview
questionnaires are being reviewed and logged on a monthly basis and this report provides a further analysis to inform additional actions.
24
Trust Level Workforce Trends
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
2013
4.13%
3.57%
3.32%
2.85%
3.13%
3.39%
3.58%
3.22%
3.36%
3.74%
3.65%
3.43%
2013
2014
3.73%
3.76%
3.69%
3.67%
3.24%
2.98%
3.02%
3.10%
3.06%
3.22%
3.34%
3.97%
2014
9.81% 10.33% 10.97% 11.63% 11.12% 10.90% 11.47% 11.64% 11.01% 10.75% 11.47% 10.96%
2015
11.27% 11.16% 10.62%
2015
3.48%
3.65%
8.37% 7.95% 8.04% 8.00% 8.61% 8.65% 8.69% 8.31% 8.74% 8.88% 9.21% 9.68%
Sickness (%)
Turnover %
15.00%
5.00%
4.00%
10.00%
3.00%
2.00%
5.00%
1.00%
0.00%
0.00%
Jan
Feb
Mar
Apr
May
Jun
2013
Jan
Feb
Mar
Apr
May
Jul
2014
Jun
Aug
Sep
Oct
Nov
Mar
Apr
Jul
Aug
May
Jun
2013
Sep
Oct
Nov
0.63%
0.58%
0.57%
0.44%
0.62%
0.67%
0.84%
0.93%
0.82%
0.90%
0.97%
2014
0.97%
0.91%
0.82%
0.79%
0.76%
0.69%
0.52%
0.61%
0.63%
0.68%
0.68%
0.73%
Feb
2015
2013
2015
Jan
Dec
Jan
Dec
Feb
Mar
Apr
May
Jul
2014
Jun
Aug
Sep
Oct
Nov
Dec
2015
Jul
Aug
Sep
Oct
Nov
Dec
0.86%
2013
80.96% 80.97% 83.20% 83.13% 83.65% 82.70% 84.13% 84.10% 85.38% 84.63% 84.94% 82.97%
0.77%
2014
82.82% 84.68% 83.66% 82.93% 81.16% 81.70% 83.51% 82.92% 84.75% 84.01% 84.52% 83.78%
2015
86.25% 84.88% 84.53%
0.58%
Stress %
PDR % Comparison
1.20%
88.00%
1.00%
86.00%
0.80%
84.00%
0.60%
82.00%
0.40%
80.00%
0.20%
0.00%
78.00%
Jan
Feb
Mar
Apr
May
2013
Jun
Jul
2014
Aug
2015
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
2013
Jun
Jul
2014
Aug
Sep
Oct
Nov
Dec
2015
25
Directorate Workforce Dashboard
Indicator
Trust
Target
CSS
Medical
Specialised
Surgical
CAMHS
Corporate
Trust
(Previous
Month)
Trust (Current
Month)
Trend
Sickness % (YTD)
<3.00%
3.15%
3.85%
3.24%
3.07%
3.41%
3.18%
3.38%
3.34%
▼
Sickness %
(Month)
<3.00%
4.28%
3.42%
4.38%
3.40%
2.71%
3.09%
3.49%
3.65%
▲
Episodes
LT Sickness %
ST Sickness %
115
117
149
89
41
79
652
590
1.97%
1.91%
2.73%
1.55%
1.54%
1.46%
1.94%
1.95%
2.31%
1.51%
1.65%
1.85%
1.17%
1.63%
1.55%
1.70%
▼
▲
▲
Stress Sickness %
0.67%
0.25%
1.01%
0.11%
0.96%
0.51%
0.73%
0.58%
▼
MSK Sickness %
Cost of sickness
0.44%
0.63%
0.78%
0.19%
0.46%
0.44%
0.46%
0.53%
£44,136.49
£49,897.93
£71,704.66
£30,828.38
£17,564.04
£36,939.93
£278,689.19
£251,071.43
▲
▼
PDR's %
90%
86.06%
85.71%
88.23%
88.36%
69.49%
82.15%
84.88%
84.53%
▼
Mandatory
Training %
95%
84.79%
81.18%
84.99%
81.55%
75.41%
70.92%
77.52%
79.62%
▲
Rolling Turnover
%
<9%
9.35%
11.37%
9.27%
12.00%
9.92%
11.96%
11.16%
10.62%
▼
WTE in post
526.18
691.53
789.77
463.78
306.34
592.80
3364.79
3370.40
Budgetted WTE
531.52
688.59
840.65
443.15
347.40
573.74
3389.28
3425.05
▲
9.34
42.94
59.36
21.82
11.52
42.32
179.34
187.30
▲
3.52%
4.86%
3.95%
3.56%
5.02%
2.04%
3.84%
3.77%
▼
Temporary
Workforce
Maternity Leave
%
Please note that sickness is still one month behind so we are currently reporting on Februarys data
Current months WTE may be slightly lower due to new starters from the 2nd induction still being inputted onto ESR.
Turnover % is based on permanent staff leavers only
26
Sickness Absence
BCH Sickness Absence - Feb 2015
BCH Total
Clinical Support Services
Medical Directorate
Specialised Services
Surgical Directorate
CAMHS Services
Corporate
Priority
3
Number of
Episodes
Monthly
Sickness %
Cumulative 12
Month Sickness
%
590
3.65%
3.34%
115
4.28%
3.15%
117
3.42%
3.85%
149
4.37%
3.24%
89
3.40%
3.07%
41
2.71%
3.41%
79
3.09%
3.18%
Long and Short Term Sickness %
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
1.95%
1.97%
1.70%
2.31%
BCH Trust
Sickness
284 Dir 1
Clinical
Support
Services
1.91%
2.73%
1.51%
1.65%
284 Dir 2
Medical
Directorate
284 Dir 3
Specialised
Services
Short Term Sickness
1.55%
1.85%
284 Dir 4
Surgical
Directorate
1.46%
1.54%
1.63%
1.17%
284 Dir 5
CAMHS
Services
284 Dir 6
Corporate
Long Term Sickness
BCH Sickness Comparison
13/14
April
2.85%
May
3.13%
June
3.39%
July
3.58%
August
3.22%
September
3.36%
October
3.74%
November
3.65%
December
3.43%
January
3.73%
February
3.76%
3.67%
3.24%
2.98%
3.02%
3.10%
3.06%
3.25%
3.34%
3.97%
3.48%
3.65%
March
3.69%
14/15
Clinical Support Services – Sickness has increased from 3.32% in January to 4.28% in February. There has been 17 LTS cases of which 7 have now
returned to work. The outstanding LTS cases relate to urinary/gynaecology, anxiety/stress, injury/fracture, gastro and endocrine/glandular problems.
Sickness continues to be monitored closely by management and HR intervention.
Medical Directorate – The in month sickness has decreased from 3.57% in January to 3.42% in February. 23 are LTS cases of which 7 have now returned
to work. The outstanding LTS cases relate to pregnancy, injury/fracture, stress/anxiety, MSK and genitourinary problems. Complex Care and Oncology
Day Care have been highlighted as hotspot areas and monthly meetings have been arranged to review sickness and take any actions required. 2 sickness
cases have triggered for a stage 3 review.
Specialised Services – Sickness has increased from 3.75% in January to 4.37% in February. There has been 31 LTS cases of which 19 have returned to
work. The outstanding LTS cases relate to MSK, gastro and stress/anxiety. Sickness continues to be monitored closely by management/HR intervention and
Occupational Health advice is sought.
Surgical Directorate – Sickness has increased from 2.90% in January to 3.40% in February.. There are 9 LTS cases of which 3 have now returned to work.
The outstanding LTS cases relate to cancer, nervous system disorders, blood disorders and genitourinary problems. Cochlear implants and Wards 5 and
10 have been identified as hotspot areas. Monthly meetings are scheduled to review sickness and take action.
27
Bank/Agency Usage
Nov 14
Dec 14
Jan 15
Feb 15
Mar 15
CSS
6.44
7.61
8.77
9.96
11.03
9.34
Medical
44.95
40.25
32.03
32.63
36.23
42.94
Specialised
49.41
47.15
44.16
45.86
56.35
59.36
Surgical
20.92
22.20
19.38
21.92
22.18
21.82
CAMHS
3.78
3.80
4.98
5.42
9.19
11.52
Corporate
54.54
46.38
46.46
45.70
44.36
42.32
Total
180.03
167.39
155.78
161.49
179.34
187.30
Trust Bank/Agency Usage (WTE) Yearly Comparison
250
204
200
WTE
Oct 14
187.3
150
100
50
0
* The latest month is an indicative figure and about 95% accurate. The previous month figure will be updated
each month
Top 3 reasons for Bank/Agency usage
1. Vacancy – 129.38 WTE
2. Sickness – 22.00 WTE
3. Increase in Ward Beds – 9.90 WTE
Bank/Agency Usage by Staff Group (%)
2013/14
2014/15
Priority
7
Admin bank and agency usage = 79.61 WTE is a decrease of 1.15 WTE compared to last month
Top 3 reasons for Admin usage are Vacancy (77.61 WTE), Maternity (0.96 WTE) and Training
(0.28 WTE)
Directorate Admin bank and agency is as follows:
0.74
CSS - 2.42 WTE - Labs Management, Audiology and Surgical Day Care
16.18
Medical – 4.83 WTE - Medical Secretary Areas, Dietetics and Haemophillia Unit
42.50
Specialised – 10.43 WTE – Cardiology, Liver and PICU
40.58
Surgical - 16.77 WTE - Medical Secretary Areas & Ophthalmology
CAMHS – 5.89 WTE - East Locality and Tier 4 Management
A&C
Reg
Non Reg
Medic
Corporate – 39.26 WTE – Health Records, Patient Access Call Centre and Domestics
28
Turnover Analysis
The top 4 reasons for leaving for permanent staff for each
Directorate (excluding Other/Not known) are:
Permanent Staff Turnover %
The current turnover % for the period April 14 to March 15 is
10.62%. This excludes all staff on a fixed term contract (such
as apprentices, Interns, deanery doctors and other fixed term
employees).
There has been a slight decrease in turnover compared to
2013/14 which was 10.96%.
CSS
Specialised
10.43 WTE Relocation
7.77 WTE Promotion
4.40 WTE Work life Balance
3.60 WTE Education/Training
6.63 WTE Work Life Balance
5.00 WTE Health Reasons
4.63 WTE Promotion
Medical
Surgical
7.00 WTE Promotion
3.69 WTE Retirement
6.15 WTE Promotion
CAMHS
Corporate
6.00 WTE Relocation
2.50 WTE Promotion
2.00 WTE Health Reasons
17.80 WTE TUPE Transfer
9.27 WTE Promotion
4.70 WTE Relocation
We have identified that for 80.69 WTE of leavers the reasons for leaving is
Other/Unknown.
29
Appraisals
CSS
PDR’s have decreased slightly from last
month however they are still above the
Trust target at 88.69%. They continue
to be discussed at DMT meetings and
all managers are continually reminded
of the importance of expediting them
annually as well as ensuring staff have
quality appraisals.
Medical
Rates have increased from last month
and are now above 85%. Medical
Secretary areas for
Haematology/Oncology and
Rheumatology have all been identified
as hotspot areas for low PDR rates and
are being monitored. In addition,
adhoc support/training is provided for
managers where required.
Staff Group - Table 1
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
Add Prof Scientific &
Technical
87.50%
87.56%
85.52%
85.97%
81.65%
80.18%
Additional Clinical
Services
87.14%
89.81%
88.44%
87.16%
86.02%
83.28%
Admin & Clerical
75.54%
75.99%
76.76%
78.98%
77.72%
77.62%
AHP's
88.72%
92.54%
92.59%
95.49%
91.91%
90.37%
Estates & Anciliary
88.24%
82.84%
82.84%
88.89%
91.37%
93.62%
Healthcare Scientists
84.30%
85.00%
82.35%
90.68%
89.17%
85.47%
Nursing
86.24%
86.47%
85.57%
88.02%
86.90%
87.65%
Table 2
Oct-14
Nov-14
BCH
84.01%
84.52% 83.78% 86.24% 84.88% 84.53%
Clinical Support Services
90.23%
93.24% 92.27% 91.91% 88.69% 86.06%
Medical Directorate
84.73%
83.41% 80.85% 83.93% 83.23% 85.71%
Specialised Services
88.35%
89.49% 89.06% 89.48% 88.61% 88.23%
81.08%
83.50% 85.90% 91.05% 89.56% 88.36%
CAMHS Services
85.65%
84.35% 80.43% 76.27% 73.50% 69.49%
Corporate
74.08%
72.67% 77.12% 80.87% 80.69% 82.15%
Priority
3
Dec-14
Jan-15
Feb-15 Mar-15
Corporate
PDR’s are now showing an
improvement and have been above
80% since January. Reports
continue to be sent on a monthly
basis and managers are reminded
monthly about their PDR completion
rates and progress has been made in
the last quarter.
CAMHS
PDR rates have continued to
decrease since October 2014.
Ashfield Ward, South Locality and
Irwin Ward are identified as hotspot
areas for low PDR rates.
HR workshops took place during
February and March which trained
managers on how to input PDR’s
onto ESR. In addition, ad hoc
support/training is provided for
managers where required.
Specialised
Surgical
PDR’s have decreased slightly but are still above target at 87.23%. PDR reports
continue to be sent out on a monthly basis with links to additional
support/training and this will be followed up by the HR Advisory team to
ensure that outstanding PDR’s are diarised going forward.
Rates have continued to decrease since January 15. Paediatric Surgery, Renal Unit
and Medical Secretary areas for Dental, Cranio and Cleft have been identified as
hotspot areas for low PDR rates with support/training being provided for managers
where required.
30
Mandatory Training Update
Mandatory training reporting on Vesper has been aligned to the new clinical groupings effective 1st April 2015. Currently, the Vesper workforce dashboard is
presenting statistics for the old and new structure which encompasses thirteen groups. The old structure will be removed on 21st April. In order to provide the most
accurate mandatory training statistics, this report will utilise activity data reported on 25th March and prior to any changes taking place. Mandatory training
compliance on 25th March was 79.62% representing a 0.3% increase since the last report. The table below shows the Trust Level Breakdown as at 25th March and the
trajectory since Dec 2014. Thirteen out of twenty one topics are showing an increase.
Following the January launch of the refreshed Moodle modules, Education Reporting continue to see an increase in online course access and completions and the
access and reporting issues have been resolved. The “Moodle Amnesty” introduced during March did result in some staff coming forward but not as many as
expected and Education Reporting are therefore undertaking a Moodle Amnesty Review for the period of Aug 2014-Dec 2014 to ensure that mandatory training is
checked and recorded.
Looking back at training activity, attendances at face to face induction and mandatory training topics between 1/4/14 and 31/3/15 were 6176. During this period,
Education Reporting recorded 805 Did not Attends and 778 Withdrawals which is an average of 13%. In terms of the impact of winter pressures on training activity,
1802 courses places were booked between 1/11/14 and 27/2/15 and recorded 232 Withdrawals and 220 Did not Attends which is an average of 17% and an
increase of 4% on the annual average.
Actions to improve:
Improving Compliance - Managers need to consider how they allocate staff time to complete online or face to face training and reduce Withdrawals and Did not
Attends.
Targeting of Red Flags – Education Reporting will continue to focus on targeting departments and topics that are “Red Flags” to make sure any data issues are
resolved . This is escalated through DMT meetings/reports .
Data Query Management – Education Reporting are managing data queries within the KPI of 21 days (currently resolving queries within 48 hours). Plans to
introduce a web based query reporting system via the BCH Intranet.
Moodle Amnesty Review – Period Aug 14 to Dec 14 – checks and updates in progress.
Exclusions Update – Alignment to new clinical groups requires refresh of competency exclusion rules (90% complete).
Face to Face Training Updates – M&H foundation and refresher training updates to be implemented from 1st May 2015.
31
BCH Nursing Staffing:
• Capacity: Additional winter capacity has been used as required while normal winter activity continued. PICU had a challenging month with a
national pressure being reflected.
• Staffing: Sickness levels continued at February levels the overall vacancy level didn’t change. There was an increase in annual leave taken in
March ’15 due to staff taking outstanding annual leave before end of the financial year.
• Temporary Staffing: A year on year fall in Bank use although specific areas have shown spikes in requirements.
• During March no red shifts were recorded
Nursing Workforce Summary
Monthly Ave:
Act vs. Plan
Acuity
Skill Mix
Vacancy
Annual Leave
Mat Leave
Sickness
Jan-15
100.3%
95.8%
78.8%
0.1
18.1%
7.7%
7.2%
Feb-15
99.8%
91.8%
78.7%
0.2
16.5%
7.0%
6.0%
Mar-15
99.8%
92.2%
79.2%
0.1
20.0%
7.3%
6.0%
Nursing Workforce March 2015
Nursing Workforce
Dashboard: Ward
Nursing Staffing Actual vs Planned
Registered Care Staff Registered Care Staff
Day
Feb 15
Day
Night
Patient Acuity Level
Total
Night
Actual vs
Actual vs Actual vs Actual vs Actual vs Planned
Planned % Planned % Planned % Planned %
%
92.2%
101.2%
98.9%
87.4%
95.0%
No of No of No of
Green Amber Red
shifts shifts shifts
Unfille
Registere
d
d Skill
Roster
Mix%
%
Planned Resources
Unplanned: Actual & Response
Actual
Mat
Non
hours Vacanc Leave
Leave Clinical
vs Staff y WTE
%
%
%
in Post
Sicknes
s
Bank
Fill %
No of
Bank
Times
Used Raised to
HoN
87
6
0
76.4%
12.3%
58%
0.2
19%
7%
9%
9%
52.9%
9%
Neonatal Surgical
97.2%
110.3%
102.2%
103.0%
100.3%
88
5
0
83.0%
2.9%
68%
0.2
20%
5%
6%
1%
80.0%
0%
0
Ward 1
94.6%
104.6%
99.0%
N/A
97.8%
89
4
0
79.5%
17.1%
70%
0.1
17%
4%
5%
8%
33.3%
2%
0
Burns
0
Ward 5
90.0%
112.4%
95.9%
112.2%
97.3%
85
8
0
71.4%
8.1%
62%
0.1
17%
6%
7%
4%
56.8%
3%
0
Ward 9
95.7%
136.8%
97.6%
95.6%
100.5%
75
18
0
76.2%
10.6%
71%
0.1
14%
5%
13%
5%
26.7%
1%
0
Ward 10
96.9%
98.3%
97.4%
93.5%
97.0%
93
0
0
84.7%
5.4%
66%
0.2
17%
6%
8%
5%
73.3%
4%
0
ED
97.9%
97.4%
90.4%
112.5%
95.8%
80
13
0
76.4%
6.8%
71%
0.1
20%
7%
9%
11%
64.5%
17%
0
PAU
94.7%
95.6%
97.9%
99.9%
96.4%
82
11
0
77.4%
14.6%
69%
0.1
18%
7%
3%
5%
58.0%
0%
0
Ward 2
92.1%
82.5%
99.2%
93.2%
92.8%
87
6
0
77.6%
16.7%
69%
0.1
18%
7%
5%
6%
66.7%
6%
0
Ward 7
92.5%
91.1%
96.6%
117.9%
96.2%
88
5
0
84.2%
7.0%
82%
0.0
19%
3%
10%
6%
79.2%
4%
0
MHDU
95.1%
N/A
88.0%
N/A
91.8%
86
7
0
100.0%
3.7%
70%
0.3
20%
5%
13%
2%
58.5%
9%
0
Ward 15
90.1%
80.8%
96.4%
91.1%
91.0%
76
17
0
87.7%
17.4%
68%
0.2
20%
4%
6%
7%
53.9%
13%
0
ODC*
112.2%
97.5%
N/A
N/A
107.3%
93
0
0
72.6%
19.5%
67%
0.1
17%
13%
3%
11%
n/a
0.0%
0
Ward 8
88.2%
133.4%
98.0%
96.8%
95.3%
62
4
0
88.0%
8.8%
62%
0.3
19%
12%
8%
6%
70.0%
15%
0
Ward 11
94.4%
86.5%
97.9%
93.3%
95.0%
88
5
0
87.7%
2.6%
69%
0.2
20%
6%
5%
8%
61.4%
11%
0
Ward 12
92.5%
110.6%
91.1%
103.6%
94.4%
85
8
0
83.6%
6.6%
69%
0.1
22%
9%
5%
4%
65.7%
13%
0
PICU
103.2%
93.0%
106.4%
163.3%
105.1%
87
6
0
89.9%
43.3%
59%
0.3
21%
6%
12%
6%
47.5%
12%
O
MDC*
80.0%
99.0%
N/A
N/A
83.5%
62
4
0
83.8%
17.6%
77%
0.1
15%
16%
8%
1%
63.6%
4%
0
SDC*
88.8%
86.8%
N/A
N/A
88.2%
66
0
0
66.0%
28.3%
55%
0.1
20%
13%
3%
3%
87.2%
22%
0
Ashfield
108.6%
121.1%
106.6%
146.9%
113.6%
80
13
0
71.9%
27.8%
64%
0.1
22%
0%
15%
3%
81.8%
7%
0
Heathlands
107.2%
114.6%
87.3%
87.5%
99.0%
91
2
0
72.6%
31.6%
57%
0.2
16%
11%
10%
10%
91.2%
12%
0
99.0%
109.3%
123.8%
101.4%
106.0%
93
0
0
52.4%
26.0%
65%
-0.1
27%
9%
11%
3%
100.0%
5%
0
96.3%
100.1%
105.0%
99.8%
1823
142
0
79.23%
15.2% 66.7%
7.9%
6%
65.3%
8%
0
Irwin
Trust Average:
* Excluded from National Upload
99.4%
107.1%
112.7%
0.1
19.0% 7.3%
Nursing, Midwifery and Care Staff Staffing
March 2015 Submission to NHS England
Day
Main 2 Specialties on each ward
Ward name
Specialty 1
Specialty 2
Night
Day
Night
Registered midwives/nurses
Care Staff
Registered midwives/nurses
Care Staff
Average fill rate Average fill rate Average fill rate Average fill rate registered
registered
Total monthly Total monthly Total monthly Total monthly Total monthly Total monthly Total monthly Total monthly
nurses/midwives care staff (%) nurses/midwives care staff (%)
planned staff actual staff planned staff actual staff planned staff actual staff planned staff actual staff
(%)
(%)
hours
hours
hours
hours
hours
hours
hours
hours
171 - PAEDIATRIC 160 - PLASTIC
SURGERY
SURGERY
1482
1366
338
342
979
968
231
202
92.20%
101.20%
98.90%
87.40%
171 - PAEDIATRIC 171 - PAEDIATRIC
SURGERY
SURGERY
2223
2161
293
323
1562
1596
440
451
97.20%
110.30%
102.20%
103%
Ward 1
171 - PAEDIATRIC 361 SURGERY
NEPHROLOGY
1326
1254
436
456
1078
1067
0
0
94.60%
104.60%
99.00%
N/A
Ward 5
171 - PAEDIATRIC 100 - GENERAL
SURGERY
SURGERY
2048
1843
780
877
1353
1298
341
383
90.00%
112.40%
95.90%
112.20%
Ward 9
171 - PAEDIATRIC 100 - GENERAL
SURGERY
SURGERY
2145
2053
442
605
1364
1331
341
326
95.70%
136.80%
97.60%
95.60%
2106
2042
449
441
1353
1318
341
319
96.90%
98.30%
97.40%
93.50%
2698
2641
1177
1146
2442
2209
341
384
97.90%
97.40%
90.40%
112.50%
2061
1952
605
578
1452
1422
462
462
94.70%
95.60%
97.90%
99.90%
2080
1916
748
617
1386
1375
649
605
92.10%
82.50%
99.20%
93.20%
1996
1846
475
433
1375
1328
429
506
92.50%
91.10%
96.60%
117.90%
1190
1131
0
0
1012
891
0
0
95.10%
N/A
88.00%
N/A
3959
3569
1294
1046
3014
2904
220
201
90.10%
80.80%
96.40%
91.10%
2412
2128
312
416
1661
1628
341
330
88.20%
133.40%
98.00%
96.80%
2457
2319
325
281
1617
1583
330
308
94.40%
86.50%
97.90%
93.30%
2386
2206
436
482
1562
1423
308
319
92.50%
110.60%
91.10%
103.60%
11986
12368
702
653
9900
10532
330
539
103.20%
93.00%
106.40%
163.30%
Burns
Neonatal
Surgical
Ward 10
ED
PAU
Ward 2
Ward 7
MHDU
Ward 15
Ward 8
Ward 11
Ward 12
PICU
171 - PAEDIATRIC 150 SURGERY
NEUROSURGERY
180 - ACCIDENT &
420 EMERGENCY
PAEDIATRICS
420 300 - GENERAL
PAEDIATRICS
MEDICINE
420 300 - GENERAL
PAEDIATRICS
MEDICINE
420 300 - GENERAL
PAEDIATRICS
MEDICINE
420 192 - CRITICAL
PAEDIATRICS
CARE MEDICINE
303 - CLINICAL
420 PAEDIATRICS
HAEMATOLOGY
420 171 - PAEDIATRIC
PAEDIATRICS
SURGERY
CARDIOTHORACI
CARDIOLOGY
C SURGERY
CARDIOTHORACI
CARDIOLOGY
C SURGERY
420 192 - CRITICAL
PAEDIATRICS
CARE MEDICINE
711- CHILD and
ADOLESCENT
PSYCHIATRY
711- CHILD and
ADOLESCENT
PSYCHIATRY
1320
1433
618
748
1012
1079
275
404
108.60%
121.10%
106.60%
146.90%
711- CHILD and
Heathlands ADOLESCENT
PSYCHIATRY
711- CHILD and
ADOLESCENT
PSYCHIATRY
1242
1332
403
462
1034
903
396
347
107.20%
114.60%
87.30%
87.50%
711- CHILD and
ADOLESCENT
PSYCHIATRY
711- CHILD and
ADOLESCENT
PSYCHIATRY
943
934
631
689
385
477
528
535
99.00%
109.30%
123.80%
101.40%
Ashfield
Irwin
BIRMINGHAM CHILDREN'S HOSPITAL NHS FOUNDATION TRUST
Income and Expenditure Summary (Working Document)
For the Period Ended:
28/02/2015
Annual
Plan
to Monitor
£'000
Appendix One
Revised
Annual
Plan
£'000
In
Month
Budget
£'000
In
Month
Actual
£'000
In
Month
Variance
£'000
YTD
Plan
to Monitor
£'000
Revised
YTD
Budget
£'000
Year
To Date
Actual
£'000
Year
To Date
Variance
£'000
Income
NHS Clinical Income
Elective Inpatients
Elective Day Cases
Non-Elective
Outpatients
ED
Other
Royal Orthopaedic
Total NHS Clinical Income
25,894
16,964
33,478
23,029
4,843
113,102
475
217,785
25,685
16,705
32,831
15,858
4,868
123,491
475
219,914
2,228
1,519
2,965
1,434
455
12,094
(13)
20,683
1,904
1,605
3,010
1,569
462
12,163
(13)
20,700
(324)
86
45
135
7
69
0
18
19,264
12,529
24,623
11,894
3,651
145,467
356
217,784
25,685
16,705
32,831
15,858
4,868
123,491
475
219,914
24,314
17,546
33,102
16,803
5,038
129,616
475
226,894
(1,371)
841
271
945
169
6,124
0
6,979
211
211
211
211
18
18
5
5
(12)
(12)
211
211
211
211
581
581
370
370
7,038
2,300
(2,081)
2,546
1,696
1,843
1,021
1,049
4,254
0
0
19,666
7,038
2,300
0
3,198
1,791
2,276
748
1,339
5,047
0
0
23,737
587
230
0
394
149
174
60
118
723
0
0
2,436
1,025
43
0
404
233
139
129
127
1,189
0
0
3,290
438
(187)
0
10
84
(35)
68
9
466
0
0
854
7,038
2,300
(2,081)
2,546
1,696
1,843
1,021
1,049
4,254
0
0
19,667
7,038
2,300
0
3,198
1,791
2,276
748
1,339
5,047
0
0
23,737
7,372
238
0
3,402
1,907
1,912
873
1,233
6,689
0
0
23,626
334
(2,062)
0
204
116
(364)
125
(105)
1,642
0
0
(110)
237,663
243,862
23,137
23,996
859
237,662
243,862
251,101
7,239
Pay
Clinical Support Services Directorate
Medical Directorate
Directorate of Specialised Services
CAMHs
Corporate
Pay Inflation Reserve
Other Pay Reserves
Phasing Adjustment
Total Pay
20,381
31,397
40,377
22,854
14,605
19,154
4,158
0
0
152,926
21,195
33,557
40,938
23,124
14,296
20,658
0
1,207
0
154,973
1,804
2,995
3,414
1,992
1,207
2,155
0
1,221
0
14,789
1,880
3,141
3,463
2,120
1,357
4,471
0
0
0
16,433
(77)
(146)
(49)
(128)
(150)
(2,316)
0
1,221
0
(1,644)
20,381
31,397
40,377
22,854
14,605
19,154
4,158
0
(4,663)
148,263
21,195
33,557
40,938
23,124
14,296
20,658
0
1,207
0
154,973
21,518
34,408
41,243
24,936
14,322
23,179
0
0
0
159,605
(323)
(851)
(305)
(1,812)
(26)
(2,521)
0
1,207
0
(4,632)
Non-Pay
Medical Directorate
CAMHs
Corporate
Leases
Non-Pay Reserves and Developments
Impairment
Total Non-Pay
7,892
19,781
12,760
5,628
1,365
13,586
244
11,659
0
72,915
11,975
22,510
11,291
7,903
1,700
16,865
218
4,646
0
77,108
1,266
1,996
971
1,011
181
1,588
20
1,903
0
8,935
1,543
2,182
1,380
708
261
2,236
0
(92)
2,785
11,002
(277)
(186)
(409)
303
(80)
(648)
20
1,995
(2,785)
(2,068)
7,892
19,781
12,760
5,628
1,365
13,586
244
16,322
0
77,578
11,975
22,510
11,291
7,903
1,700
16,865
218
4,646
0
77,108
12,593
22,908
15,148
8,250
1,865
18,949
244
9
2,785
82,751
(618)
(397)
(3,857)
(347)
(165)
(2,084)
(27)
4,636
(2,785)
(5,644)
225,841
232,081
23,723
27,435
(3,712)
225,842
232,081
242,356
(10,275)
11,822
11,782
(587)
(3,440)
(2,853)
11,820
0
4,624
2,762
(243)
300
4,559
2,762
(247)
326
0
380
230
(21)
27
0
369
110
(18)
23
0
11
120
(3)
4
0
4,624
2,762
(243)
300
8,745
3.5%
0
4,530
2,498
(176)
282
(3,036)
Loss on Disposal of Fixed Assets
Depreciation
Dividends on PDC
Interest Receivable
Interest Payable
11,782
4.8%
0
4,559
2,762
(247)
326
Retained Surplus/(Deficit) For Period
4,379
4,381
(1,203)
(3,924)
(2,721)
4,377
4,381
1,612
(2,769)
Non NHS Clinical Income
Road Traffic Act (RTA) Income
Total Non NHS Clinical Income
Other Income
Teaching and Research
Donated Assets
Other Central Income
Medical Directorate
CAMHs
Corporate
Other Income Reserves
Other
Total Other Income
Total Income
Central income only
Operational Expenditure
Total Operational Expenditure
EBITDA
0
30
264
(71)
45
Appendix Two
Analysis of Expenditure by Cost Category
Plan
Actual
Variance
YTD
YTD
YTD
YTD
YTD
YTD
7.86
32.47
16.29
56.17
20.69
20.98
7.38
31.44
15.86
54.34
21.87
20.24
0.48
1.03
0.43
1.83
-1.19
0.74
YTD
YTD
YTD
YTD
YTD
YTD
0.00
0.06
0.10
0.26
0.06
0.04
154.97
0.00
1.80
1.16
4.13
1.05
0.32
159.59
0.00
-1.74
-1.06
-3.87
-0.99
-0.28
-4.62
YTD
YTD
YTD
Total Non-Pay
28.23
22.40
26.48
77.11
29.10
23.85
29.80
82.74
-0.87
-1.45
-3.32
-5.64
Total Operating Expenses
232.08
242.33
-10.25
4.56
2.76
0.33
4.54
2.50
0.28
0.02
0.26
0.04
239.73
249.65
-9.92
Pay
Substantive Staffing
Senior Management (including Board)
Medical Consultants
Other Medical Staffing
Nursing
Admin, Maintenance and Support Workers
Professional/Technical and AHPs
Bank, Agency and Locum Staffing
Senior Management (including Board)
Medical Consultants
Other Medical Staffing
Nursing
Admin, Maintenance and Support Workers
Professional/Technical and AHPs
Total Pay
Non Pay
Below the
Line
Drugs
Clinical Supplies
Other Operating Expenses
Depreciation and Amortisation
PDC Dividend Expense
Interest Expense on PFI
Total Expenditure
YTD
YTD
YTD
Appendix Three
Balance Sheet as at 28th February 2015
31st March 2015
£000
Non-Current Assets
PPE - owned
PPE - PFI
Intangible Assets
Non-Current Financial Assets
Other Receivables Non-Current
Total Non-Current Assets
106,307
3,122
424
500
1,572
111,925
31st March 2014
£000
99,713
1,079
303
600
1,399
103,095
Current Assets
Inventories
NHS Trade Debtors
Non NHS Trade Debtors
Debtor re Capital Receipts
Provision for irrecoverable debts
Prepayments
Accrued Income
Cash at GBS
Cash And Cash Equivalents - non-GBS
Total Current Assets
4,278
4,070
2,912
(1,698)
3,744
6,489
51,453
94
71,341
3,817
6,729
2,799
(1,757)
1,691
4,260
48,525
(9)
66,054
Current Liabilities
Deferred Income
NHS (Trade) Creditors
Non-NHS (Other) Creditors
Other creditors
Capital Creditor
Tax and Social Security
Provisions<12 Months
PDC Creditors
Accruals
(8,182)
(5,262)
(6,842)
(7,470)
(2,177)
(3,267)
(5,067)
(5,566)
(5,757)
(4,032)
(7,507)
(4,071)
(959)
(3,121)
(1,462)
(8,020)
Total Current Liabilities
(43,834)
(34,929)
Net Current Assets
27,507
31,126
139,432
134,220
Total Assets Less Current Liabilities
Accrued and Deferred Income Non-Current
Provisions for Liabilities and Charges
PFI Liability
Total Assets Employed
(1,031)
(2,233)
(1,614)
(1,417)
(3,827)
(1,738)
134,554
127,238
Taxpayers' Equity
Retained earnings
Public Dividend Capital
Revaluation Reserve
28,494
89,551
16,509
26,873
87,723
12,642
Total Taxpayers Equity
134,554
127,238
Financed by:
Appendix Four
Capital Programme - Year to Date and Forecast Positions
Area
Pre-Commitments Including
Parkview
CT Scanner
Gamma Camera
Electrical Infrastructure
Estates
Building
IT
Medical Equipment
Strategic Development
Other
Patient Experience
Facilities
Central Function
Other
Contingency
Total BCH Spending
Externally funded schemes
Respiratory Services
Sensory Garden
Theatre Project
Transnasal navigation system
ePMA
Cryoconsole
FibroScan
Incu Controller Unit
End Life Project Magnolia House
Total BCH Charity Funded
Total Capital Spending
Monitor Plan Resubmitted
Plan
Annual
Forecast
Forecast
Variance
£000's
5,818
2,098
866
754
800
1,728
360
3,395
1,650
0
620
170
150
300
0
0
13,571
£000's
5,985
2,098
866
754
800
1,603
370
1,102
1,675
0
737
280
150
307
0
0
11,472
£000's
6,076
2,306
1,137
0
1,287
1,728
135
1,642
1,530
0
706
50
78
578
0
0
11,818
£000's
92
208
272
(754)
487
124
(235)
541
(145)
0
(31)
(230)
(72)
271
0
0
346
YTD
Revised
Plan
£000's
6,414
2,098
866
754
705
1,603
250
1,033
1,315
0
1,329
280
150
307
592
0
11,944
0
0
0
0
1,469
0
0
0
0
1,469
15,040
1
9
0
0
786
0
0
0
0
796
12,268
(19)
9
12
24
136
18
100
18
19
317
12,135
(21)
0
12
24
(650)
18
100
18
19
(478)
(133)
1
9
0
0
786
0
0
0
0
796
12,740
YTD Actual % of Scheme
Total
YTD
Variance
£000's
6,505
2,306
1,137
0
1,287
1,728
135
1,573
1,170
0
706
50
78
578
0
0
11,818
£000's
109%
110%
131%
0%
161%
108%
37%
143%
70%
n/a
96%
18%
52%
188%
n/a
103%
£000's
(92)
(208)
(271)
754
(582)
(124)
115
(541)
145
0
623
230
72
(271)
592
0
126
(19)
9
12
24
136
18
100
19
19
319
12,137
-1510%
104%
n/a
n/a
17%
n/a
n/a
n/a
n/a
40%
95%
21
(0)
(12)
(24)
650
(18)
(100)
(19)
(19)
516
642
CEO Briefing notes
Tuesday 28 April 2015
Operational update
•
•
•
•
•
•
•
•
•
•
March turned out to be another record month for emergency demand.
This put significant pressures on our services and beds which led to a number of performance
challenges.
Our ED four hour performance was 92.8%, however, we exceeded the 95% standard for Q4 and the
year as a whole, which was our overriding aim.
Cancelled Operations were high at 45 - mainly due to beds, but also emergency theatre capacity.
We did meet both the non-admitted and admitted 18-week standards though.
Our new Ward 17/Theatre 10 opened on March 23rd which provides much needed capacity to help
ease our pressure and reduce our waits.
Whilst the problems with our Decontamination Unit were resolved in February, we are still clearing
the backlog built up over several months and at the end of March, 24 children were waiting over 6weeks for an endoscope.
We expect the backlog to be finally cleared in May.
MRI demand continues to grow (just under 16% per year) outstripping our MRI capacity, and at the
end of March, 68 children were waiting over six weeks for a scan.
We are working on a number of projects to (i) see how we can better understand and manage this
growth and (ii) increase our MRI capacity. More on this will follow in future months.
And for April so far, all was fine for the first two weeks, however, week three has been tight due to
a combination of an increase in our greater than seven day inpatients and we have seen especially
high levels of emergency admissions on some days.
Transport and car parking update
•
•
•
•
•
Following the news that our Whittall Street car park will be closing on Friday 22 May, we have held
two really successful transport information days to talk about all the options available to staff.
Various transport organisations have come along to support us, including NCP, our preferred car
park provider, and the Smarter Networks Team.
Hopefully we have addressed all questions and concerns, and presented a full range of options for
people to have a think about.
There are two further information sessions on Tuesday 5 May and Thursday 7 May
All the details of rates, locations of car parks across the city and ticket application guidelines are on
the intranet.
Transport survey now available on intranet
•
•
•
We are keen to continue building on and improving transport options for staff and have launched
an online transport survey to help us with this.
The results of this will be especially useful if we do decide to move our site in the future.
There is a link to the survey from the homepage of the intranet.
£30m new clinical building
•
•
•
•
•
We are excited to announce that Interserve will manage the huge project of designing and building
our £30m clinical facility on Whittall Street.
Interserve is the world’s leading support and construction company and we have no doubt they will
do a fantastic job of achieving our vision of creating something outstanding for children and young
people.
In the coming months we’ll be talking to lots of staff, young people and families about what they
want to see in this new building.
We are starting off with the big creative ideas – meerkats, pygmy goats and fishtanks have all been
discussed so far! The project team got the full YPAG experience a couple of weekends ago and they
got some really great ideas about themes and what they feel would make the building extra special.
We also need a name for the building and will be asking staff to get involved in this discussion.
Friends and Family Test
•
•
•
•
•
•
•
The results are in from our online staff survey, the Friends and Family Test.
The survey closed on 8 March and we’ve since been busy collating all the results and feedback.
The survey gives all staff the opportunity to tell us what they think and feel about working here so
that we can make their experience as enjoyable and fulfilling as possible. It also asks about whether
you would recommend a relative or friend for treatment here.
This year we had 124 responses to the survey which was very encouraging!
Of those who responded, 98% said they would recommend BCH as a place to receive care and
treatment, more than ever before.
Meanwhile 74% of staff would recommend BCH as a place to work.
Overall, these are very positive results, with staff responding more positively about working here
and also the standard of our patient care in comparison to previous years – but there is still room
for improvement.
New charity number
•
In order to meet the new guidelines set by NHS Charities, our hospital charity has updated its
registered charity number. This is being promoted across the hospital.
Cancer Centre Appeal Celebration Event
•
•
Last Wednesday I was incredibly proud to attend a celebration event to recognise the huge
fundraising efforts of over 60 of our biggest Cancer Centre Appeal donors.
In just 2.5 years they, and many others, helped us reach our very ambitious £4m target.
In other news
• YPAG tea party
• Our fantastic Young Persons’ Advisory Group (YPAG) is five years old and we held a lovely tea party
to celebrate in style! The group’s Chair Sophie and its two longest serving members, Ben Taylor and
Natasha Dhokiya joined me, Michelle McLoughlin, Janette Vyse and Iona Clayton from the Patient
Experience Team.
• Ben and Natasha are both previous patients and Ben has been part of the group since its first
meeting in January 2010.
• YPAG has achieved a huge amount over the past five years; they meet regularly and have previously
been involved in consultations, ward walkabouts and staff interviews, raising the voice of children
and young people and giving them a say in all of our important decisions.
•
•
•
•
•
•
•
•
•
•
•
Chamber of Commerce Awards
Our RAPID research study has been shortlisted - we will find out if we are a winner on Thurs 23 April.
Pride of Nursing Awards update
The Birmingham Mail closed nominations for the Pride of Nursing Awards at the end of last month
and we are now very close to hearing how many of our staff nurses and nursing teams have been
nominated for the award!
The award is the first of its kind in the West Midlands, and recognises all of the standout nurses in
the region that go the extra mile for their patients.
Our nurses have received quite a bit of news coverage this month on the back of the awards Stephanie Bryan, one of our PICU nurses, is the newly appointed face of the campaign and our PICU
nursing team also made the headlines as a former member of staff put them forward for their
outstanding patient care and – in her words - ‘hearts of gold.’
We are expecting the official announcement soon!
Give month
This month was ‘Give’ month, the third of our ‘Five ways to wellbeing’ months.
As part of ‘Give’ month, our Staff Experience team promoted all the ways you can ‘give’ and
‘receive’ every day and how this positively impacts on our health and wellbeing.
The team also held two successful self-care workshops this month to explore all the ways we can
show compassion for ourselves, what ‘giving’ means to us and practical ways we can give and
receive in our daily lives.
Coming up
•
•
•
•
May – new Irwin Unit opens - As of next month we will be opening our doors to our all new Irwin
Eating Disorders unit at Parkview. Children and young people will now have single ensuite rooms
for the first time. Next month, Dan O’Mara will be doing a presentation on it at a CEO Briefing.
Saturday 30 May – We are holding our annual Nurse Open Day. We have launched a campaign to
get as many nurses as possible signed up for the event and we are getting a great response. Please
pass on the details to any aspiring BCH nurses you might know!
Thursday 28 May – Our next Intent2Listen session will be held on Thursday 28 May giving staff the
chance to speak with me and the Executive Team about issues that are important to then and their
team.
Fitness classes – And don’t forget that free yoga classes are ongoing throughout May and June,
taking place every Thursday morning in the Education Centre from 7.30am – 8.30am. The sessions
will be suitable for all ages and abilities, so why not come along and try your hand at yoga!
Presentations held at the April CEO Briefing
• Hilary Brown (Partner Governor) and Carl Harris (Staff Governor) – The role of the Governor
• Sara Brown – Staff survey results
Star of the Month
• Winner is – Suzie Hewitt – Site Practitioner

Agenda and Papers for Public Board Meeting April 2015

Transcription

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