agenda - Heart of England NHS Foundation Trust

Transcription

AGENDA
for a meeting of the Board of Directors of Heart of England NHS Foundation Trust
to be held in the Education Centre, Birmingham Heartlands Hospital on 6 January 2016
at 12.30pm
12.30PM – 2.30PM:
Indicative
Timings
(Minutes)
1.
APOLOGIES (JS/KS)
1
(Oral)
2.
DECLARATIONS OF INTEREST (JS)
1
(Enclosure)
3.
MINUTES (JS) – 7 Oct & 4 Nov 2015
2
(Enclosure)
4.
MATTERS ARISING & DECISIONS/RECOMMENDATIONS TRACKER (KS)
2
(Enclosure)
5.
CHAIR’S UPDATE (JS)
5
(Oral)
6.
CHIEF EXECUTIVE’S UPDATE (DJM)
10
(Oral)
7.
PERFORMANCE REPORT (KB/HG)
10
(Enclosure)
8.
CLINICAL QUALITY REPORT (AC/DR)
10
(Oral)
9.
CARE QUALITY REPORT, INCL. INFECTION CONTROL (SF)
10
(Enclosure)
10.
FINANCE REPORT (JM)
10
(Enclosure)
11.
OPERATIONAL STRUCTURES (KB)
10
(Oral)
12.
BOARD STRUCTURES (JS/KS)
5
(Enclosure)
13.
BOARD ASSURANCE FRAMEWORK AND RISK REGISTER (SF)
5
(Enclosure)
14.
ANNUAL SAFEGUARDING REPORTS (SF)
10
(Enclosure)
15.
BOARD COMMITTEE MINUTES & REPORTS
15.1 Audit Committee (25.11.15) (AL)
15.2 Donated Funds Committee (20.11.15) (KS)
15.3 Monitor Standing Committee (29.10.15) (KS)
5
16.
17.
POLICIES FOR APPROVAL
Consultant and SAS Job Planning Policy (AC)
(Enclosure)
(Enclosure)
(Enclosure)
(Enclosure)
ANY OTHER BUSINESS PREVIOUSLY ADVISED TO THE CHAIR
Date of next meeting – 2 March 2016 Harry Hollier Lecture Theatre, Good Hope Hospital.
PRESS AND PUBLIC ARE WELCOME TO ATTEND THIS MEETING AS OBSERVERS ONLY
EXCLUSION OF THE PRESS AND PUBLIC
The Board will be asked to resolve “That representatives of the press and other members of the public be excluded
from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity
on which would be prejudicial to the public interest”.
REGISTER OF DIRECTORS and REGISTER OF DIRECTORS’ INTERESTS
VOTING DIRECTORS
NAME
DATE OF
APPOINTMENT
INTEREST (if any)
DATE OF
NOTIFICATION
Mr Jonathan
Brotherton
04.03.15
Nothing to declare
04.03.15
Mr Darren Cattell
19.01.15
Director & Shareholder - Mill Street
Consultancy Limited.
19.01.15
Dr Andrew Catto
01.03.14
(Interim CEO 14.11.14 to
16.02.15)
01.10.14
Nothing to declare.
01.03.14
Couch Perry & Wilkes. In receipt of
annuity following business sale until
May 2019.
01.10.14
Nothing to declare.
01.09.13
Professor / Head of School, University
of Birmingham
Senior Fellow, NIHR School for Social
Care Research
Member
of
Birmingham
Health
Partners Executive Group
01.10.15
Nothing to declare.
04.03.15
CEO of Criminal Cases Review
Commission
Part time judge Social Entitlement
Chamber Fitness to Practise
Member for General Dental Council
Director (unremunerated) of BRAP, an
equalities think tank.
01.10.14
Mr Andrew
Edwards
Mrs Sam Foster
01.09.13
Prof Jon Glasby
01.10.15
1.
1.
2.
3.
Ms Hazel Gunter
04.03.15
Mrs Karen Kneller
01.10.14
1.
2.
3.
4.
Mr David Lock
01.07.13
1. Practising barrister and a member of
2.
3.
4.
5.
6.
7.
8.
9.
Landmark chambers. Providing legal
advice and representation to a wide
range
of
individuals,
NHS
organisations,
local
authorities,
charities and commercial organisations
mainly on public law issues. These
frequently involve issues concerning
the rights of patients to NHS treatment
as well as structural and management
issues involving NHS bodies.
Member of Amnesty International.
Member of the BMA Ethics Committee
(unremunerated).
Member of the Labour Party and
occasional legal advice to Labour Party
and elected Members of Parliament on
NHS policy issues.
Mr Lock’s wife, Dr Bernadette Gregory,
is a medical doctor employed by
Redditch and Bromsgrove Clinical
Commissioning Group and is Clinical
Lead for the Worcestershire Integrated
Care Project.
Chairman of Innovation Birmingham
Limited.
Representing NHS England in relation
to specialised services.
Receives instructions from the CQC
from time to time.
Receives instructions from NHS
England from time to time
DATE OF
TERMINATION
OF INTEREST
01.10.15
01.10.15
01.10.14
01.10.14
01.10.14
Updated Jan 14
01.07.13
01.07.13
01.07.13
01.07.13
Oct 2015
05.11.13
06.01.14
04.07.14
07.10.15
Oct 2015
NAME
Ms Alison Lord
DATE OF
APPOINTMENT
01.05.13
INTEREST (if any)
1.
2.
3.
4.
Dame Julie Moore
Dr Jammi Rao
Rt Hon Jacqui
Smith
CEO and Shareholder of Allegra Ltd.
Voluntary role as a business mentor
for the Prince's Trust.
In her professional capacity as a
'turnaround executive' Ms Lord has
relationships from time to time with
major accountancy firms, legal firms,
banks and venture capital providers.
Company Secretary - Adente Limited
(unremunerated).
DATE OF
NOTIFICATION
01.05.13
22.01.14
13.05.14
26.10.2015
1. Birmingham Systems Ltd
2. Innovating Global Health China Ltd
3. Member of Birmingham Business
School Advisory Board
4. Court of the University of Birmingham
5. Governor – Birmingham City University
6. Non-Executive Director – Precision
Medicine Catapult (PMC)
7. CEO – University Hospitals
Birmingham NHS Foundation Trust
01.07.13
1. Sole director of Gorway Global Ltd. a
private company and owning 50% of its
share capital. A consulting company
offering management support, training
and bespoke public health analytical
support to public sector organisations
involved in health, well-being and
health care.
2. Board Director of Welcome CIC - a
Community
Interest
Company
supporting minority and disadvantaged
communities by working with statutory
and other agencies.
3. Trustee of the Faculty of Public Health
as an elected General Board Member.
Term of office from 2010 to July 2013.
4. Visiting Professorship in Public Health
in the School of Health, Staffordshire
University.
01.07.13
1.
2.
01.12.15
01.12.15
01.12.15
3.
4.
5.
Chair – The Precious Trust
Chair – Public Affairs Practice for
Westbourne Communications
Associate – Cumberledge Eden &
Partners
Associate, Global Partners
Governance.
Chair
–
University
Hospitals
Birmingham NHS Foundation Trust
DATE OF
TERMINATION
OF INTEREST
01.07.13
01.07.13
01.07.13
01.12.15
01.12.15
01.12.15
Jul 2013
Minutes of a meeting of the Board of Directors
of Heart of England NHS Foundation Trust
held in Partnership Learning Centre, Good Hope Hospital
on 7 October 2015 at 9.30am
PRESENT:
L Lawrence (Chair)
J Brotherton
D Cattell
A Catto
A Edwards
J Glasby
H Gunter
K Kneller
D Lock
A Lord
J Rao
IN ATTENDANCE:
M Cooke (Dir. of Strategy)
K Eccles (Head of Comms)
S Hyland (Dep. Chief Nurse)
I Philp (Dep. Medical Director)
K Smith (Co. Secretary)
Governors and the Public
R Hughes (Lead Governor)
Members of the public
A Hudson (minutes)
15.134
APOLOGIES & WELCOME
L Lawrence welcomed Professor Jon Glasby to his first Board meeting as a Non-executive
Director.
Apologies had been received from P Cadigan, A Foster, S Foster and D Whittingham.
15.135
DECLARATIONS OF INTEREST
The declarations of interests were received and the following amendments noted:
D Lock’s wife was no longer employed by Redditch & Bromsgrove CCG, nor Clinical Lead for the
Worcestershire Integrated Care Project (no.5), and D Lock no longer represented NHS England in
relation to specialised services (no.7) but did represent them in relation to other matters from time
to time.
J Rao was no longer a trustee of the Faculty of Public Health, nor an elected general board
member (no. 3).
15.136
2020 VISION – HEFT STRATEGY
M Cooke presented the staff and public version of the 2020 Vision draft launch document which
outlined the strategy for the Trust over the next five years and contained references to the Trust’s
patient-centred approach, and its focus on partnership working and integration of services. The
document had been developed as a result of a comprehensive engagement process with both
internal and external stakeholders over the summer and subsequent work and feedback from
Executive and Non-executive Directors. Page 10 ‘Investing for the future’ had appeared in error
and would be removed.
Page |2
M Cooke noted that there was considerably more detail behind the strategy than that outlined in
the launch booklet that would continue to be developed in the coming months.
D Lock thanked M Cooke and his team for the work undertaken to produce the document.
In response to a question from A Edwards, M Cooke advised that the document would be
published in booklet format which would be distributed with payslips to all staff; also that it would
be discussed further at future staff engagement events.
M Cooke was working with
Communications on a communications plan for the public.
In response to a question from J Glasby, H Gunter confirmed that the Trust’s values had been
generated through staff engagement events held over the summer and they would continue to be
embedded through upcoming staff engagement events.
L Lawrence recorded his thanks to M Cooke and his team for the work undertaken to produce the
strategy.
The Board agreed to the publication of the 2020 Vision public and staff document, subject to
formatting and minor corrections.
15.136
SOLIHULL URGENT CARE CENTRE – MEMORANDUM OF UNDERSTANDING
D Cattell apologised for the lateness in circulating the papers to Board members. He then gave a
brief overview of the history. The Solihull Urgent Care Centre (UCC) concept had been jointly
developed between the Trust and Solihull CCG over a two year period. Prior to and following
major public consultation there had been significant clinical, operational and financial commitment
from the Trust to work with Solihull CCG to support the programme which would shortly be at the
stage of finalising both the facility development and the service procurement approach.
Finalisation of a Memorandum of Understanding (MoU) was an outstanding issue for the Trust and
Solihull CCG. The MoU would not be legally binding but aimed to set out the framework for the
strategic relationship between the Trust, Solihull CCG and any third party service providers.
In response to a question from A Lord, D Cattell advised that the capital spend would be around
£3.5m, which would be recovered over time. D Cattell confirmed that should the Trust need to
borrow money to fund the capital, interest accrued over the term of the loan would also be
recovered.
D Lock advised that he had been involved in reviewing the documentation and recognised the
amount of work done by all of the teams involved to get to the current position. He was supportive
of the recommendations and saw this as an interesting opportunity to take a strategic role in the
provision of services in Solihull.
The Board agreed to the completion of the MoU in principle and delegated authority to the Director
of Finance & Performance to agree specific pricing detail on behalf of the Trust.
The Board delegated authority to the Chief Executive to sign the MoU on behalf of the Trust.
15.137
INTEGRATED QUALITY AND PERFORMANCE REPORT
S Hyland presented the quality aspects of the report. The number of injurious falls and the falls
rate had continued to reduce, which correlated with the introduction of ‘open visiting’; work to
progress improvement would continue. C.diff incidence was on target. There had been one case
Page |3
of MRSA due to non-compliance of screening; this had been addressed. The number of avoidable
grade 2 pressures ulcers had continued to decrease but the number of grade 3 pressure ulcers
had increased; further work around education would continue. The Trust was compliant with its
Unify nursing and HCA workforce return. There were 146 newly qualified nurses due to start
across September and October with 22 additional offers made. In addition around 34 nurses were
planned to start in theatres over the next two months. The overall vacancy position was reducing.
Bank and agency spend had reduced.
A Catto reported that the Trust had recently received unexpected correspondence from the Joint
Advisory Group (JAG) indicating that the Trust’s JAG accreditation for the three Endoscopy units
was being withdrawn. The Trust had responded and been in active discussion with JAG to address
this. Whilst a full patient service would continue, the loss of JAG accreditation may have an impact
on commissioning, and therefore income, in the future. In response to a question from D Lock, A
Catto advised that until the Trust could ascertain why the accreditation had been removed, action
plans to reinstate it couldn’t be developed. J Rao advised that the last Quality Committee (QC)
had received a very positive report on the Trust’s Endoscopy services.
H Gunter reported that Workforce had been concentrating on reducing the use of bank and agency
staff. The number of appraisals to be completed to achieve target remained high. Mandatory
training performance had improved. Sickness had reduced for the month of August at 3.96%,
reducing the moving annual average to 4.63% against a target of 4.51%. Voluntary turnover had
reduced slightly. Time to hire had increased due to the additional time required for newly qualified
nurses to receive their pins and the longer lead time for overseas recruitment.
J Brotherton gave an update on operational performance; he noted that there were three main
areas of concern 4-hour A&E, RTT, including diagnostics, and cancer waits. The urgent care
pathway had experienced a decline in performance against target and recovery trajectory in
August compared to July. The Trust had missed the 4-hour A&E trajectory three weeks out of four
in August. There had been an increase in ED attendances at both Heartlands and Good Hope
hospitals (compared to the same period in 2014). The non-delivery of trajectory in early August
had coincided with the changeover of junior doctors and over-reliance on locums. There had also
been an increase in AMU cycle time at both Heartlands and Good Hope compared to the previous
month. Cancer two week waits had shown early signs of improvement with the Trust on or just
above trajectory; demand remained high. 62 day cancer waits had deteriorated but were now back
on track. The Trust had agreed with CCGs that it would deliver the 85% standard by December
2015.
D Cattell advised that the Trust had an unsustainable financial situation that had been impacted by
the way it set about improving quality and performance. The Executive Directors were now
focussed on plans to reduce expenditure but without compromising patient care. J Brotherton
confirmed that additional capacity for elective pathways and ward based care had impacted on
costs. Pay costs had been above Plan and the Trust was behind Plan on identifying and delivering
Service Improvement Efficiency Plans (SIEP), sometimes referred to as Cost Improvement Plans
(CIP). Divisional recovery plans had been developed but needed focus to achieve delivery. The
unmitigated (or ‘do nothing’) projection indicated a deficit for the full year of around £63m; D Cattell
explained that mitigating actions could see this deficit reduce to around £30m but action needed to
be taken soon with immediate impact. Monitor had initiated an investigation into the Trust’s
sudden unplanned financial deterioration.
In response to a question from the Chair, A Catto advised that actions were in hand to involve
divisional colleagues in weekly meetings to manage the financial recovery and open and honest
messaging was being developed to cascade to all staff. The messaging would be multi-channel
Page |4
with the Executive team working with Communications and OD to ensure that staff were engaged
with the key cost reduction messages and initiatives.
In response to a question from J Rao regarding medical overspend, D Cattell confirmed that
agency costs had risen by 75% year on year and there was currently medical overspend of around
£1.6m per month.
D Lock gave an overview of the recent F&PC meeting which went through the figures in detail and
was satisfied that the Executives had serious focus and plans to address the position. The
messaging to staff was late starting but F&PC was pleased to see it was ramping up. The Trust
had serious issues with non-compliance with financial controls (e.g. excessive recruitment outside
of controls). D Lock was clear that the Trust had a duty to deliver the best care available within its
financial envelope – i.e. affordable care. It was recognised that this might not sit well with all
clinicians; therefore controls and compliance were necessary. The new plan was based on
running at break even for the remainder of year which would be very difficult but needed to be
done; however he noted that the level of challenge should not be underestimated.
In response to a question from L Lawrence, D Cattell was unable to advise the financial outturn for
September yet.
D Cattell advised that information was being cascaded to staff to enable them to understand what
actions had resulted in penalties being levied against the Trust. J Brotherton believed that the
move from the JMRA to the PbR contract would allow staff to have greater visibility of actions and
consequences. More rigour in conjunction with clear protocols and monitoring systems for bank
and agency spend for nursing and clinical staffing were now in place on wards.
A Catto confirmed that the concept of ‘safe staffing’, that was fairly well understood in nursing, was
less well developed for medical staffing but the same rigour would be applied to medical staffing
going forward.
The challenge of moving from short term measures to longer term strategic actions and ‘business
as usual’ was noted.
The Board endorsed the recommendations set out in the finance section of the report.
15.138
INTEGRATED IMPROVEMENT PLAN
A Catto advised that the report reflected the continued stable position. The IIP programme board
had met on 16 September; the plan was largely on track. Five of the seven programmes were
green rated; two were red rated (urgent care and surgery reconfiguration). Verbal update sessions
had been held weekly by the PMO and provided an opportunity for all IIP programme leads,
Executive directors and operational staff to report against progress and highlight any risks and
issues; these meetings had now ceased as part of the transition to service but reporting would
continue by way of the standard reporting tool in place.
A Catto went on to give a brief update on each of the programme work streams and it was noted
that:
The key issue around the reporting of Doctor Foster mortality data had been resolved. A Board
development session on mortality was scheduled for later in the day.
The Governance Recovery Programme was on track to deliver.
Page |5
IM&T had been discussed at the recent Monitor PRM meeting and Monitor was content with the
high level strategic intent.
Scheduled Care remained green and would move to ‘business as usual’.
Culture and Engagement work would continue notwithstanding changes in the team.
Surgery Reconfiguration – a detailed response had been sent to the Clinical Senate addressing all
of the initial concerns that had been raised. The second round of Clinical Senate feedback had
wanted more information on staff engagement. Cataract surgery had been removed as this was
likely to be available locally. More clarity was required on emergency pathways. The Trust had
again responded to each of the issues raised.
A Lord welcomed the update on culture and staff engagement and the Board’s commitment to
deliver the Plan. H Gunter advised that there had been some feedback from staff around concerns
that staff engagement would stop when A Foster left; she reassured the Board that the message to
staff was that staff engagement was a Board policy delivered by A Foster not an individual’s policy
and it would therefore continue. D Lock noted that the staff engagement and culture agenda was
recognised as an issue before A Foster arrived and confirmed that it should continue after he left.
15.139
DATE OF NEXT MEETING
4 November 2015, St Johns Hotel, Solihull.
15.140
ANY OTHER BUSINESS
There was none.
The Board resolved “That representatives of the press and other members of the public be
excluded from the remainder of this meeting having regard to the confidential nature of the
business to be transacted, publicity on which would be prejudicial to the public interest”.
PART TWO
.......................................
Chairman
Minutes of a meeting of the Board of Directors
held at St. Johns Hotel, Warwick Road, Solihull
on 4 November 2015 at 9.30am
PRESENT:
L Lawrence (Chair)
J Brotherton
D Cattell
A Catto
A Edwards
S Foster
J Glasby
H Gunter
K Kneller
A Lord
J Moore
J Rao
IN ATTENDANCE:
M Cooke (Dir. of Strategy)
K Eccles (Head of Comms)
A Hussain (DIPC)
J Smith (Chair Designate)
K Smith (Co. Secretary)
Governors and the Public
R Hughes (Lead Governor)
J Thomas (Governor)
Members of the public
A Hudson (minutes)
15.151
APOLOGIES & WELCOME
L Lawrence welcomed Dame Julie Moore and Rt Hon Jacqui Smith to the Trust and Julie Moore to
her first Board meeting as Interim Chief Executive. Jacqui Smith would become interim Chair on 1
December 2015.
The Chair explained that P Cadigan had resigned with effect from 30 October 2015 and recorded
thanks and best wishes from the Board for his contribution during his term of office.
Apologies had been received from D Lock and D Whittingham.
Governors were invited to remain for the item of the private Board session regarding the Financial
Recovery Plan.
15.152
DECLARATIONS OF INTEREST
The declarations of interests were noted.
15.153
CHIEF EXECUTIVE’S REPORT
J Moore explained that she had been delighted by the welcome that she had received from the
Executive team and clinical colleagues, and was impressed with the dedication shown by a large
number of staff.
15.154
INTEGRATED PERFORMANCE REPORT
S Foster presented the quality aspects of the report. There had been no new cases of MRSA
bacteraemia in September; there had been five cases of post 48 hour toxin positive C. Diff, giving
the Trust 23 against a year to date target of 32 cases. There had been a total of 90 avoidable
grade 2 pressure ulcers against a maximum threshold of no more than 185 for the year, and 26
Page |2
avoidable grade 3 pressure ulcers against a threshold of 29; there was an element of lack of record
keeping that had resulted in the rise. A review of current reporting and changes to the
performance framework had commenced and all divisions would now formally report any
incidences of pressure ulcers and lessons learned. The number of falls incidences remained low
which coincided with open visiting. The CCG had undertaken a falls themed review at Good Hope
and Solihull hospitals that included looking at the times of falls to see if there was any correlation to
breaks and handovers. The increase in the number of HCAs seemed to be having a positive
impact. A review on the Heartlands site would take place in November. There had been 94%
positive responders for the Inpatient Friends & Family Test (FFT) which was 2% below the national
average. The complaints improvement plan had been presented to the Quality Committee and was
being presented to the Governor led site based groups. The revised policy for complaints was also
going through the committee structure for comment and ultimately approval.
A Catto reported that a briefing on mortality to educate the Board had been held in October. The
HSMR mortality rate for the first quarter of 2015/16 was 91, the lowest for three years with data
demonstrating sustained improvement. The January to December 2014 SHMI was below 1 which
was within the expected band 2; however that period had included some inaccurate data due to the
previous PMS2 input errors, this would reduce over time. There was one CQC mortality outlier
alert in relation to gastrointestinal haemorrhage that was being reviewed.
H Gunter gave an update on Workforce. It was noted that sickness for registered nurses at 4.03%
was the lowest for 18 months; the moving annual average was 4.56% against a target of 4.46%.
Changes to rostering could see upwards of 200 additional nursing shifts. Around 160 qualified
nurses due to join the Trust over the coming two months resulting in a vacancy position of 100
posts compared to 200 at December 2014. A key priority had been to continue to support the
improvement of the financial position by ensuring resources were used efficiently and effectively.
The time to hire had increased from 11 weeks to 14.32 due to the length of time taken to recruit
newly qualified and overseas nurses.
J Brotherton gave an update on performance. There had been good progress in a number of
areas for patient access, including RTT and cancer. Progress against the 4-hour A&E target had
reached a plateau. The RTT admitted backlog reduction was on trajectory for September; the
incomplete pathway for September was at 87.64% and speciality recovery plans were under
review. Diagnostics had seen improvement at 94.1% and continued to improve, there were some
challenges and capacity was at maximum. Cancer 2 week wait performance for October was
90.15%, the best year to date this equated to a 10% increase on the prior year despite a 15%
growth in referral numbers. 62 day performance had deteriorated to 76.36% as projected owing to
the backlog reduction; there were focussed pathway improvement projects in place and a remedial
action plan had been agreed with CCGs. The 4 hour A&E performance was 90.9% for September,
3% below the agreed ‘best case trajectory’. ED activity was above the assumed levels in the
trajectory and the 3.5% Delayed Transfer of Care target was running 49% above target. The new
ED had opened on the Heartlands site creating an expanded and improved space. The new AMU
at Good Hope was due to open on the 5 November. The Trust was opening and reconfiguring as
much capacity as possible on wards to cope with increased activity from the seasonal spike.
D Cattell reported on the financial position. The Trust had received the draft Monitor s.106
undertakings following the completion of Monitor’s investigation into the Trust’s deteriorating
financial position. The Trust’s financial sustainability risk rating was 2. There had been a marginal
improvement in month 6 with a reduction in overspend from £7m for the month down to £6.4m.
The year to date deficit was a £35.9m. The nursing efficiency programme had begun to deliver
improvement however the medical efficiency programme had seen a slower start. A financial
recovery plan had been developed and agreed by the Board and Monitor; implementation of the
Page |3
plan had commenced. Ernst & Young (EY) had commenced within the Trust to support the
implementation of the recovery plan. The plan predicted a revised deficit of £32.8m at the end of
2015/16. Quality Impact Assessments on any financial recovery actions would be undertaken and
signed off by the Medical Director and Chief Nurse.
A number of financial controls had been put in place and EY were supporting those actions
including managing debtors and creditors, increased controls/ authorisation processes, improving
recording to enable billing for all activity and review of capital expenditure.
J Rao noted that staff should be commended for maintaining standards in challenging times and
noted reporting updates were received by the Quality Committee.
In response to a question from A Edwards, J Brotherton advised that demand and capacity
planning meetings had taken place and investments made to better cope with winter demand,
including the opening of additional base wards on each of the three sites, staff recruitment and he
was confident that the actions taken would enable the Trust to respond in a more effective way
than the previous winter; although there was no guarantee that this would be enough and the Trust
was heavily reliant on its partners in the local health economy. In response to a question from L
Lawrence, J Brotherton confirmed that more intervention from social care was required in order to
ease hospital pressures; discussions were being held with CCG and social services colleagues.
In response to a question from K Kneller, H Gunter advised that 37% of front line staff had received
the flu vaccine and all new nursing staff would receive it.
In response to a question from J Glasby about avoidable pressure ulcers and whether the
measures were sufficient, S Foster advised that every grade 2 and 3 pressure ulcer was subject to
a root case analysis and the key causes were dressings and the positioning of patients. These
gave rise to staff performance management measures. Nursing endeavoured to record properly
and take the right action.
In response to a question from J Glasby as to why the target for mandatory training in particular
resuscitation training was only 85%, H Gunter, advised that the figure was set by the CCGs as part
of contract negotiation but it took into account term sickness and maternity leave. A Catto added
that he had personally attended resuscitation training sessions, where a DVD was used to deliver
training but a member of staff was on hand to deliver training and correct technique, where
necessary J Moore explained that some mandatory training was transferable but not all; reporting
on mandatory training would be improved going forward.
15.155
INTEGRATED IMPROVEMENT PLAN
A Catto advised that the report reflected the continued stable position. The IIP programme board
had met on the 15 October 2015 and the intention was to transition all work streams to business as
usual. There were 4 green and 2 red rated work streams (Urgent Care and Culture and
Engagement). The Board had approved a decision to pause the Surgical Reconfiguration
Programme until further notice and agreed to remove it from the IIP; each of the Executive Leads
went on to give a brief update on each of the programme work streams.
A Catto advised that there were no major issues with the Mortality programme which was
progressing well.
S Foster noted that Governance Recovery Programme focussed on the Deloitte governance
review and remained on track to deliver; the pre-circulated slide pack gave an overview of the
Page |4
programme. There was some residual work going through Board committees in relation to the
Kennedy work stream. Governor Engagement was being led by K Smith and had transitioned to
business as usual.
J Brotherton advised that Urgent Care was red rated due to the 4-hour A&E performance against
trajectory; the milestones had largely been delivered and activity was now owned by the Divisions.
D Cattell reported on IM&T; PMS2 was in place and had been tested, there were still a number of
issues to be resolved including staff training. A review of the internal function of ICT was
underway.
H Gunter reported that Culture and Engagement was now red rated in respect of leadership;
engagement and values work was due to commence. H Gunter was due to meet with T Jones
from UHB to look at how HEFT could mirror UHB’s practice, once a way forward had been agreed
a budget would be required. In response to question from J Glasby, H Gunter confirmed that the
leadership work had been held back in order to discuss it with the new leadership team.
M Cooke advised that although the Surgical Reconfiguration Programme had been paused, those
components that related to safety had been passed back to the Divisions for action.
J Brotherton advised that Scheduled Care was progressing and rated green; work to identify gaps
and subsequent business cases had been progressed. The financial challenge had focussed
attention and was driving efficiencies including the tightening up of internal processes. In response
to a question from L Lawrence, J Brotherton advised that the Trust continued to work through the
System Resilience Group, however there were various levels of quality of input and he was not
confident that the Trust would see any reduction in demand; despite continually raising concerns
with its partners. The Chair reminded the meeting that the programme had been agreed with
Monitor; and the Trust was only one part of the wider health economy.
D Cattell confirmed that the Trust was working through the benefits realisation to ensure the
benefits flowed from the actions taken. The PMO was planned to transition to a Project
Management Assurance role and assist the Divisional delivery.
J Glasby observed that the Culture and Engagement Programme seemed to have paused to take
on a small number of key people and suggested that this needed to be an organisation wide
function. J Moore confirmed that engagement was everyone’s job and that she would be reviewing
this.
15.156
BOARD COMMITTEE – TERMS OF REFERENCE
K Smith reported that the following the presentation of draft terms of reference (ToR) at the 8
September 2015 Board meeting the draft ToR had been referred back to committee chairs for
further review and were now presented for Board ratification. A Lord advised that the Audit
Committee had not yet reviewed its terms of reference and went on to note her concerns on the
low attendance of Non-Executive Directors at meetings. The meeting considered the possible need
to increase the NED membership and quorum of the Audit Committee. J Moore advised that a full
review of the Board committee structure would be undertaken shortly and that the need to review
the membership of the Audit Committee would be included.
After due consideration the terms of reference for the following committees were approved, pro
tem:
 Finance and Performance
Page |5




IM&T
Quality
Research
Workforce
The terms of reference for Audit Committee would remain outstanding for review and referral back
to the Board.
15.157
MINUTES
8 September 2015
The minutes of the meeting held on 8 September 2015 were received and the following changes
were noted:
15.118 First sentence, penultimate paragraph – delete the word ‘properly’ from the end of the
sentence.
15.131 paragraph 16 – replace the words ‘innovation framework’ with the words ‘Divisional delivery
framework’
15.131 Third sentence, paragraph 18 – replace the words ‘show results sooner’ with the words
‘take effect sooner’.
Subject to the foregoing revisions the minutes were approved as a true record.
15.158
BOARD ASSURANCE FRAMEWORK
S Foster referred to the pre-circulated paper noting that it reflected work done at the Board ‘Away
Day’ in July and the assistance received from Deloitte. It highlighted the risks to the current
strategic objectives, key controls, sources of assurance, gaps and potential mitigation actions.
This was the first draft of the new style Board Assurance Framework that would evolve over the
coming months.
Following discussion it was agreed that this was an improvement on what had previously been
brought to the Board but it would be subject to further review and regularly be bought back to the
Board.
15.159
EMERGENCY PLANNING
J Brotherton referred to the pre-circulated paper and reported that the Trust had met all of the
required standards with no concerns. The report was received with approval.
15.160
ANNUAL INFECTION PREVENTION AND CONTROL REPORT 2014/15
Dr Abid Hussain, Director of Infection Prevention and Control, joined the meeting to present the
annual report. Overall the Trust had performed well over the 12 months ended March 2015
compared to other trusts within the region.
During 2014/15 there had been 1 post-48 hour case of MRSA, which had been identified as
avoidable, against a target of 0; there had been 75 post-48 hour C. Diff cases against a target of
Page |6
78; E coli was being investigated in more detail following the rise in the number of cases in the
community. MRSA screening rates had not been as good as they should have been but it was
thought that this may have been a coding issue, which was now being addressed.
A Hussain commented that there were lessons to be learned from the Salmonella outbreak in June
2014, as highlighted by Professor Bolton’s subsequent report. He confirmed that the source came
from outside of the Trust but staff needed to carefully follow Trust policies and procedures to avoid
the spread of such diseases. J Moore confirmed that management would be having tough
conversations with any staff that didn’t comply.
The outlook so far for 2015/16 included 2 post-48 hour cases of MRSA, 25 cases of post-48 hour
C. Diff against a target of 38 and some sporadic cases of CPE which was likely to become the
focus of the TIPC going forward.
J Rao congratulated A Hussain for the work he and the team had done.
The meeting questioned what action could be taken with primary care and GPs to mitigate the
increase in the number of bacteria resistant to antibiotic treatment; it was noted that discussions
were already taking place to educate these groups.
15.161
BOARD COMMITTEES
Audit Committee
A Lord referred to the pre-circulated minutes of the meeting held on 29 July and advised that there
had been a further meeting on 30 September, also that recent meetings had focussed on adding
value.
Finance & Performance Committee
L Lawrence, on behalf of D Lock, advised that the last two meetings had focussed on financial
controls. There had been a presentation from Solihull Community Services that had highlighted the
issues created by the rolling forward of budgetary deficits. Colleagues had been reminded of the
importance of CIP/ SIEP in financial control. Dr Phil Bright had attended the last meeting and
given a presentation on aspects of clinical spend that he was investigating. There was a need to
ensure that demand capacity and job planning for senior medical staff were right, especially during
the transition from JRMA to PbR.
Information Management & Technology Committee
A Edwards referred to the minutes of the meeting on 7 July 2015. The October meeting had been
rescheduled for November. He had met with J Rex, in the interim, to discuss the recording of data
on PMS2 in the context of accurate PbR invoicing; staff training was underway in this regard.
There had also been a wider discussion about potential ICT system changes, investment
permitting.
Monitor Standing Committee
The committee had met on 29 October 2015 to approve the quarter 2 return to Monitor.
Quality Committee
The minutes of the meetings held 31 July, 21 August and 16 September were noted. The
committee was focussed on mortality, patient experience and complaints, as well as promoting
good quality care. There had been a discussion around the national audit and whether the Trust
was able to review and analyse its own data before the publication of the national results. Two
‘never events’ had been reported.
Page |7
J Brotherton noted that he was not a member of the committee and should therefore not be
recorded as sending apologies.
Research Committee
M Cooke commented on the 2 October meeting on behalf of P Cadigan; the minutes were noted.
Two years earlier the Trust experienced a serious incident that was investigated by the MHRA; the
investigation had now closed with the Trust’s process used as an exemplar. The Trust was still
one of the largest recruiters to clinical trials within the West Midlands; there were several large
trials due to commence.
Workforce Committee
K Kneller advised that a meeting had been held on the 30 September. It had been a challenging
first year for the committee with a number of changes due to the lack of clarity in the role of the
committee, this had now been resolved and there was confidence in its future working.
15.162
ANY OTHER BUSINESS
The Chair noted that this would be his last Board meeting and formally thanked Executive and
Non-executive colleagues for their support during his time at the Trust; he hoped that the Trust
would continue its journey of improvement and build on the work already done.
15.163
6 January 2016; venue to be confirmed.
The Board resolved “That representatives of the press and other members of the public be
excluded from the remainder of this meeting having regard to the confidential nature of the
business to be transacted, publicity on which would be prejudicial to the public interest”.
PART TWO
.......................................
Chairman
BOARD OF DIRECTORS
Matters Arising & Decisions/Recommendations Tracker
Date
raised
7 Oct
2015
Minute
No
15.141
Detail
Report back on financial modelling for
and progress with Priority Programme
for Frailty
Action
IP
Due
Feb
2015
Status
Completed
HEART OF ENGLAND NHS FOUNDATION TRUST
BOARD OF DIRECTORS
WEDNESDAY 6 JANUARY 2016
Title: Performance Indicators Report
Attachments:
From: Kevin Bolger, Interim CEO - Improvement
1
To: Board of Directors
The Report is being provided for:
Decision N
Discussion
Y
Assurance Y
Endorsement Y
The Committee is being asked to:
Note the content of the report and note the action being taken to achieve compliance with
the Trust’s performance indicators.
Review the paper (Attachment 1) which provides an assurance statement on the Trust
position against the ‘NHS Preparedness for a Major Incident Statement of Readiness
(Gateway ref 04494)
Key points/Summary:
Exception summaries have been provided where there are current or future risks to
performance for targets and indicators included in Monitor’s Risk Assessment Framework,
national and contractual targets and internal indicators.
The Trust’s position against the ‘NHS Preparedness for a Major Incident Statement of
Readiness (Gateway ref 04494) is one of assurance.
Recommendation(s):
The Board of Directors is requested to:
Accept the report on progress made towards achieving performance targets and
associated actions and risks.
Note the Trust’s position against the ‘NHS Preparedness for a Major Incident Statement of
Readiness (Gateway ref 04494).
Assurance Implications:
Strategic Risk Register
Resource/Assurance
Implications (e.g. Financial/HR)
Identify any Equality & Diversity
issues
N
Performance KPIs year to date
Y
Y
Information Exempt from
Disclosure
None
N
Outline how any Equality & Diversity
risks are to be managed
Which other Committees has this paper been to? (E.g. F & PC, QRC etc.)
None
Page 1 of 17
BOARD OF DIRECTORS
PERFORMANCE INDICATORS REPORT
PRESENTED BY INTERIM CEO - IMPROVEMENT
1.
Purpose
This paper summarises the Trust’s performance against national indicators and
targets, including those in Monitor’s Risk Assessment Framework, as well as local
priorities. Material risks to the Trust’s Monitor Provider Licence or Governance
Rating, finances, reputation or clinical quality resulting from performance against
indicators are detailed below.
In addition this month the paper provides an update on the Trust position against
the ‘NHS Preparedness for a Major Incident Statement of Readiness (Gateway ref
04494) - Attachment 1
2.
HEFT Key Performance Indicators
The Trust has a suite of Key Performance Indicators that includes national targets
set by the Department of Health (DH) and local indicators selected by the Trust as
priority areas, some of which are jointly agreed with the Trust’s commissioners. This
report is intended to give a view of overall performance of the organisation in a
concise format and highlight key risks particularly around national and contractual
targets as well as an overall indication of achievement of key objectives. The Trust
currently rates indicators as either green – meeting the target or red - failing the
target.
For this report all indicators that are failing to achieve compliance with targets have
been reported on.
The report also contains a short overview of performance against the Solihull
Community Contract.
3.
Material Risks
The DH sets out a number of national targets for the NHS each year which are
priorities to improve quality and access to healthcare. Monitor tracks the Trust’s
performance against a subset of these targets under its Risk Assessment
Framework. The remaining national targets that are part of the Everyone Counts
document from the DH but not in Monitor’s Risk Assessment Framework are
included separately.
3.1
Monitor
Of the 13 indicators currently included in Monitor’s Risk Assessment
Framework (RAF), 9 were on target in the most recent month. 2 cancer
Page 2 of 17
targets (reported a month in arrears); the A&E 4 hour wait target and the 18
week RTT incomplete pathways target were not met.
3.1.1 A&E 4 Hour Waits
Performance against the 4 hour A&E target in November was 87.38%
similar to the performance of 87.34% in October. There were no 12
hour trolley breaches.
Attendances during November were 8% higher (for BHH and GHH)
compared with the same month last year and admissions from the
Emergency Department were 12% higher. Alongside this there has
been a significant increase in the number of delayed transfers of care,
with significant issues relating to failed discharges due to patient
transport delays. There is a need to revisit the improvement trajectory
with the Systems Resilience Group (SRG) given these factors and the
current performance.
Actions being taken to improve performance include:
•
•
•
•
•
Expansion of the majors and minors ED areas at BHH to support
increased demand.
Opening an expanded AMU department at GHH, co-located with
the Short Stay Unit.
Expanded Ambulatory Emergency Clinics (AEC) to further reduce
avoidable admissions.
New Medical Rotas to better match patient demand profiles.
Opened full discharge lounge provision at BHH and GHH.
A full review of the winter plan has been undertaken in December
and additional contingency measures put in place in light of the
above plan activity being seen.
A financial penalty of £120 for every breach under the 95% target
applies within the Trust contract. The impact of this in November was
£209,880
3.1.2 Cancer Targets
In October the Trust missed 2 of the national cancer targets. The
cancer 2 week wait from referral to appointment and the 62 day
urgent GP referral to first treatment target.
62 day standard
Performance against the 62-day standard deteriorated slightly in
October to 79.29% which is below the operational standard.
This was expected, as the directorates continued to tackle patient
backlogs that had developed earlier in the year and prioritised
patients who have been waiting the longest amount of time. This is in
Page 3 of 17
line with the Trust’s improvement trajectory which has been agreed
with the commissioners as part of the Remedial Action Plan (RAP).
November’s unvalidated position is showing an improvement in
performance to 86.79%, above the 85% target. It should be noted that
this performance may not be sustained through December as more
patients from the backlog are treated. Urology remains a significant
concern and further work is being undertaken to improve the position.
Table 1: Cancer Performance against Target and Planned
Trajectory for 62 day cancer target
Target
Cancer – 62 day
urgent GP referral
October
Performance
October
Trajectory
Target
Resolution
Date
79.29%
79.20%
85%
January 2016
Table 2: 2015/16 Year to Date 62 day GP Cancer Performance by
Tumour Site
Tumour Site
Breast
Gynaecology
Haematology
Lower GI
Head & Neck
Lung
Skin
Upper GI
Urology
Oct-15
88.9%
88.2%
60.0%
94.7%
62.5%
50.0%
93.6%
70.0%
76.9%
YTD 15/16
92.0%
83.7%
87.2%
86.5%
44.4%
60.4%
98.7%
54.7%
70.1%
Total
79.3%
80.6%
2 week cancer wait
Performance against the cancer 2 week wait referral from GP to first
appointment was 90.09%, a slight decrease against September’s
performance of 90.50%. November’s unvalidated performance is
showing an improved performance of 93.06%. The Trust hasn’t
achieved the 93% standard since December 2013.
The Trusts trajectory to recover performance against the 2ww
operational standard is December so this may be achieved a month
early.
Conversely performance against the 2 week wait for breast symptom
patients was achieved in October, 93.55%, however November’s
unvalidated position is currently showing performance at 90.69%.
This is primarily due to a persistent fault with the mammography
machine at Solihull; this resulted in patients needing to come back for
Page 4 of 17
a second appointment impacting on capacity. The fault, on the 6
month old machine, has now been rectified and the backlog of
patients has been cleared.
Performance against the national cancer targets continues to be
associated with a contractual penalty in 2015/16 if they are not
achieved over the quarter. This equates to £1000 per additional
patient below the 62 day target and £200 for the 2 week target. The
year to September penalty for the 2 week cancer targets is £114,200
and for the 62 days standard £39,000.
3.1.3 Referral to Treatment Time
Incomplete pathway performance improved to 91.34% in November,
which although just below the national target of 92%, is an
improvement on October’s position of 88.75%. Performance for the
former Referral to Treatment Time (RTT) targets for admitted and
non-admitted patients is 78.6% and 89.7% respectively.
A significant amount of work has been undertaken to deliver the
improvement in the Trust’s performance these include an increase in
theatre utilisation, an increase in the number of patients being seen
earlier in their pathway in out-patients and validation with a strong
focus on clinical and pathway administration. This improvement is set
in the context of a vast reduction in the use of private sector capacity.
The contractual penalty for the incomplete target in November is
£157,932.
3.2
National Targets Monitored Locally Through CCG Contract
Of the 15 national targets that are not included in Monitor’s Risk Assessment
Framework but are included in the CCG contract the Trust is on target for 9
and not delivering against 6. The Trust has 1 Remedial Action place with the
CCG in relation to the diagnostics indicator
3.2.1 6 Week Diagnostics
In November the Trust’s performance against the 6 week diagnostic
target was 97.97%. (233 breaches). There has been a significant
improvement in delivery of this target in the last 3 months, in
September the Trust performance was 94.1% (663 breaches)
The underperformance against this target sits within the endoscopy
diagnostic group and a separate delivery trajectory is in place for this.
They are currently slightly under delivering against trajectory but are
showing a month on month improvement in performance. There is a
risk to delivery of the 99% standard in December as per the RAP and
trajectory.
Page 5 of 17
This is a contractual target with an associated financial penalty which
in 2015/16 is £200 per additional patient below target. The penalty
associated with November performance will be £24,200.
3.2.2 Ambulance Handover
Due to discrepancies between the Trust and West Midlands
Ambulance Service (WMAS) data a validation process for over 60
minute breaches has commenced from November.
In November there were 11 breaches reported by WMAS, the Trust
has validated this to 7 breaches for the 60 minute target.
The Trust achieved 94.28% for the 30 minute handover target (353
breaches) against 95.03% in October. There were 328 breaches in
November 2014.
This is a contractual target with an associated penalty of £1,000 per
over 60 minute handover and £200 per handover longer than 30
minutes. Based on the validated figures the Trust’s total penalty in
November will be £77,600
3.2.3 Safer Staffing
Table 3 shows the Divisional break down for the November 2015
monthly nurse staffing level information for adult inpatient ward areas,
including critical care. This information is published on the NHS
Choices website for all Trusts with adult inpatient services and is
reported to NHS England as part of the monthly UNIFY return
Table 3: Divisional Breakdown of Staffing Levels
BHH
GHH
SOL
W&C
TRUST
% fill rate
Qualified
Days
99%
96%
103%
100%
99%
% fill rate
Unqualified
Days
102%
98%
117%
90%
101%
% fill rate
Qualified
Nights
97%
98%
100%
98%
99%
% fill rate
Unqualified
Nights
113%
104%
112%
92%
103%
All areas were compliant with staffing during November 2015. Where
there are individual clinical areas within a division that are not
compliant the Head Nurse submits an exception report to the Chief
Nurse that articulates risk mitigation and assurance of safe care.
Further information is provided in the Care Quality Report.
All staffing compliance is measured weekly and is discussed with the
CN or DCN. This includes ‘flex’ areas enabling decisions to be made
about the safety of opening additional beds at times of high demand.
Page 6 of 17
Workforce reviews have been undertaken for all in patient areas and
AMU’s which highlighted no areas of concern. These will be repeated
again in February 2016.
The most significant challenge for safer staffing is the number of
vacancies that there are for registered nurses and midwives across
the Trust. Further detail is provided in section 4.8 of this report.
3.2.4 Consultant Upgrade
Performance against this indicator deteriorated in month from 75.4%
in September to 64.29% in October. There were 8 breaches in total 7 lung 1 urology.
Pathway improvement groups are in place for both Lung and Urology
and action plans to improve the overall pathway to mitigate any
process or capacity delays have been developed.
3.2.5 Sleeping Accommodation Breach
There was one sleeping accommodation breach in November
affecting 5 of patients (1 female and 4 male).
This occurred in where there was a 9 hour delay in locating a side
room for a Type 1 patient who was fit for transfer from ITU.
This is a contractual target with an associated penalty of £250 per
patient this equates to £1,250 in month.
3.2.6 Urgent Operations cancelled for the second time
There were 2 breaches of this indicator in November relating to
trauma patients. Both were operated on within 24 hours of the second
cancellation.
A review of the classification of patients that fall into this category is
being undertaken, the Trust will liaise with other local Trusts to gain
an understanding of how they monitor compliance with this
contractual target.
This is a contractual target with an associated penalty of £5000 per
patient equating £10,000 in month.
3.2.7 52 week breach
In line with the Trust's zero tolerance to 52 week breaches, there
have been no genuine 52 week breach patients due to a prolonged
clinical pathway. There was one incomplete pathway 52 week breach
(Urology) who is a legacy patient from the previous open clock cohort.
The financial penalty for this breach in November is £5000.
Page 7 of 17
3.2.8 Duty of Candour
The requirements for reporting Duty of Candour changed for this
contractual year. The Commissioners agreed that the Trust could
have time to put in place processes to meet the requirements with
reporting to begin from September, reported 2 months in arrears.
Performance will be reported from December.
3.2.9 Never Event
There was one never event in November at Solihull where a patient
due to undergo a left anterior cruciate ligament repair had a right
sided nerve block administered by the anaesthetist. The error was
identified prior to surgery and correct side then blocked.
The Trust has had 3 never events year to date.
There are financial penalties associated with never events whereby
the commissioner can recover the costs of the procedure or episode
(or, where these cannot be accurately established, £2,000) plus any
additional charges incurred by the commissioner for any corrective
procedure or necessary care in consequence of the Never Event. The
financial penalty for this patient is still to be calculated.
4.
Local Indicators – contract/local
Local indicators continue to be monitored that reflect the Trust’s priorities and
contractual obligations. Of the Trust’s 53 local contract indicators, 22 are reported
monthly, of these 16 (73%) are currently on target, 6 (27%) are below target.
Details of those indicators failing to meet the target are provided below:
4.1
Babies at risk of TB receive vaccination
Current performance for November was 35.06% against a target of 98%.
There has been a national shortage of the vaccination which has impacted
on performance. The Trust have now received a supply of the vaccine and
have been holding a number of ‘catch up’ clinics to clear the backlog of
children who were unable to be vaccinated earlier in the year. The last of
which is being held on 19 December, it has been agreed with NHSE that any
child not attending the clinics will be vaccinated by their GP.
The Trust has a supply of the vaccine and is generally able to vaccinate
babies at birth. However as one vial of the vaccine can be used for a number
of babies, in order to make the most effective use of the supply, where
numbers of babies requiring vaccination are small, e.g. at GHH, babies are
being asked to come back to the ward 2-3 days post-delivery to be
vaccinated.
It is anticipated that performance will be back on track by the end of
December, assuming the supply of the vaccine continues.
Page 8 of 17
4.2
Breast feeding rates
The definition of this target is the percentage of mothers who have initiated
breast feeding or babies who received expressed breast milk within 48hours
of delivery.
In month performance has improved to 68.51% against a target of 72%. The
Trust has not met this target all year, there is a remedial action plan in place
with the CCG and the Trust has delivered all of the agreed actions including
the development of HCA breast feeding support workers and an enhanced
breast feeding team.
The Women’s and Children’s Division believe that it is unlikely that they will
achieve the target due to our high number of patients from ethnic
backgrounds who will not culturally put their babies to the breast in the first
48 hours. They will however continue to work with commissioners to identify
ways of improving compliance.
4.3
Compliance with nursing care indicators (tissue viability/SSKIN bundle) –
total score and repositioning frequency adhered to for 3 days.
The overall performance against this indicator is measured against an
aggregated score of 3 sub-indicators. Poor performance against
repositioning frequency adhered to for 3 days had a detrimental impact on
the overall performance. Current performance is at 81% against an expected
score of 90%.
There has been a review of trust wide reporting and mandatory actions
against a revise performance framework. Any area underperforming for
repositioning will be referred to the Chief Executives RCA forum for action
from January 2016.
4.4
Appraisal rates
The appraisal rate remains below the target of 85%. The rate has risen
slightly from the previous month and is now level with the appraisal rate from
last year.
The low appraisal rate indicates missed opportunities to enhance
engagement with staff and the ability to communicate objectives and provide
constructive feedback as well as listening to staff concerns before they
escalate.
Divisional Human Resources Managers in all areas have been asked to
ensure that the Divisions have plans in place to achieve the target by the
end of the year. The Appraisal Policy has been updated to provide more
clarity on those employees that are included /excluded in the appraisal
figures (e.g. new starters, staff on maternity leave etc.).
Page 9 of 17
4.5
Mandatory Training
The Trust is delivering its overall mandatory training performance. However
it has been noted that Information Governance Training is not currently one
of the Trust’s mandatory training requirements. This is deemed to be a risk
for the Trust and the workforce department have been asked to include this
going forward. In order to mitigate the risk the Information Governance (IG)
Team have completed a training needs analysis for 2015/16, which forms
the basis of the training plan for IG and which has been approved by the IG
Committee.
Local Indicators - Internal
The Trust has a number of internal KPIs that it reviews on a monthly basis,
these are classed under the headings of workforce and quality and safety
Details of those not being achieved are provided below:
4.6
Staff in post v budget established (excluding nursing)
The target is between 95% - 100% and currently stands at 91.5% in
November. In some part this is due to new control processes for approving
non-clinical posts being introduced resulting in a reduction of appointments
to these posts.
This KPI includes medical vacancies. The current level of medical vacancies
as at the end of November 2015 stands at 61.1 wte. This is split between
41.54 consultants and 19.56 non-consultant posts. This vacancy level has
improved throughout the year from its highest point in June 2015 when the
vacancy level was 100.30 wte.
4.7
Nursing staff in post v budget established
Nursing vacancies continue to decline following successful and ongoing
nurse recruitment. This has focused on local and EU recruitment campaigns.
There are currently 156 registered nursing vacancies across all adult
inpatient and AMU areas. There are a further 41 planned starters over
December and January with an average attrition rate of 11 registered nurses
per month.
Theatres continue to face significant challenges with their recruitment with a
further EU campaign currently being undertaken.
Emergency Department recruitment is progressing however there are
challenges within these departments due to the lack of experienced nurses
resulting in large numbers of newly qualified nurses being recruited and
requiring intensive support and development.
There is ongoing Midwifery recruitment; however this continues to be
insufficient for demand. The possibility of EU recruitment is currently being
considered.
Page 10 of 17
The Chief Nurse and Director of Workforce are currently considering a
potential solution for the provision of fit for purpose nurses from Romania
over the longer term (circa 100 per year). This is being scoped as a
collaborative project with UHBT.
4.8
Average time to recruit – hiring manager and total time to recruit
Performance against this target has improved during November to 13.7
weeks compared with 14.1 weeks in October. This is against a Trust target
of 11 weeks. The key area to focus on is time to hire in order to speed up the
improvement in overall staffing levels thus reducing reliance on bank,
agency and locum bookings.
The central recruitment team and Divisional teams continue to focus on their
processes in order to meet time to hire targets. This target is likely to
improve as the newly qualified nurses that have started receive their PIN
numbers.
4.9
Voluntary turnover
The level of voluntary turnover is steadily reducing with performance in
November at 8.99% against 8.86% in October and a Trust target of 8.70%.
The Trust is going through a period of change which could potentially have
an impact on staff morale. Turnover levels and reasons for leaving will be
monitored closely over the next few months to assess any impact.
Operational Human Resources staff continue to work with Divisions to
identify issues, hotspots and problems and find solutions. As well as
supporting longer term issues the Workforce Directorate are also focusing on
developing a positive experience for new starters
4.10
Trust wide Agency Spend
The Trust continues to overspend against its Trust wide Agency Spend
indicator. The in-month position is 8.76% against last months of 9.45%.
Work to address this is being undertaken through the finance recovery
programme.
4.11
Delayed Transfers of Care
The reporting specification for Delayed Transfers of Care (DToC) has been
revised to ensure it is in line with the methodology set by NHS England.
Levels of DToC have been above the 3.5% target and the revised stretch
target of 2.5% for some months. Current performance is 5.6% against
current improvement target of 5.5%
A plan has been agreed with the System Resilience Group (SRG) which will
focus on the following:

The immediate implementation of the new patient choice/bed utilisation
policy
Page 11 of 17





4.12
Demand and capacity planning for the Trust and Local Authority staff
involved in complex discharge
Streamlining of the Continuing Healthcare process
Reduction of length of stay in enhanced assessment beds
Increased provision of reablement capacity
Daily Multiagency review of all patients referred into the discharge hubs
MRSA Emergency Screening Rates (% patients screened)
MRSA emergency screening performance remains below the 90% target at
82.54% in November.
A number of actions have been implemented to improve overall compliance
in MRSA Emergency Screening. These include pocket reminder cards for
staff, inclusion in mandatory training and ward based teaching. The MRSA
policy is currently being reviewed as part of Trust’s two yearly policy review
process. The updated policy will include details of the revised procedure for
emergency screening but no other changes to the policy are planned.
4.13
Patients receiving their first definitive treatment for cancer within 100 days of
GP or dentist urgent referral for suspected cancer
There are currently five patients without confirmed treatment dates that have
been waiting longer than 100 days (2 Breast patients, 2 Urology patients, 1
Lung patient). This cohort is down from 9 patients last month as directorates
continue to tackle their longest waiting patients. All of these patients are
complex cases, some spanning multiple providers and having significant
complex needs. There have also been a number of patient-initiated delays.
A weekly patient level update is now sent from the Lead Cancer Clinician to
MDT Leads to ensure that all appropriate steps are in place.
In line with the recent ‘Cancer Backstop Policy’ issued by Monitor and NHS
England, the Trust is required to establish a process for undertaking both an
RCA and a Potential Clinical Harm Review for any cancer patient waiting
longer than 104 days. Cancer Services are currently in the process of
scoping such a process, although it should be noted that every patient is
already tracked and reviewed as soon as cancer is suspected.
4.14 Operations cancelled on the day
In November there were 88 operations cancelled on the day of surgery for
non-clinical reasons. Performance against the 0.8% target was 1.05% in
November.
There have been no breaches of the contractual target requiring patients to
have surgery within 28 days of cancellation of surgery since August.
4.15
Nursing Metrics – quality of care
Performance dipped in November to 94% from 95% in October. During
November there was a rotation in nominated auditors to ensure senior ward
sisters were following process.
Page 12 of 17
The two indicators that reduced the score for November were:


Adherence with repositioning patients as per frequency suggested
Fluid balance completion particularly 6hrly input /output totals and
cumulative balance.
Action to date: Implementation of mandatory tasks to ensure improved
compliance with reposition frequency. Revised fluid balance charts to be
implemented by January 2016.
4.16
Admissions, Discharges and Transfers (ADT) recorded within 2 hours
The Trust has a requirement for 90% of ADTs to be recorded within 2 hours
performance in November was 76.48%
Solihull have recently commenced a pilot of improving ADT’s to real time of
10 minutes, there is no data as yet to measure the impact although as a site
the overall performance is higher than both BHH and GHH with admission at
84% and transfers at 93%.
Focus for quarter 4 is to understand why compliance is poor during core
hours and for all clinical areas to develop actions to improve compliance
which are monitored through site.
4.17
Dementia CQUIN
Trust performance against the dementia CQUIN indicator of the percentage
of eligible patients aged over 75 asked the dementia question was 87.41%
deterioration on October’s position of 88.66%. The Trust has only achieved
this target in two months year to date.
A daily e-mail is circulated to all consultants identifying those patients that
have not been screened.
5.
CQUINs
The Trust currently has 12 CQUINs ( 7 relating to the Acute Contract, 3 to the
Specialised Services Contract, 1 to the Solihull Community Contract and 1 to the
Public Health Contract.
All CQUINs were delivered for Q2
For Q3 the Trust is currently confident of delivery of the maternity safety
thermometer and cancer survivorship framework in gynaecology.
There are risks to the delivery of all others CQUINs for Q3 with a full risk value of
£2.57m
Further detail on CQUINs is provided in the in Care Quality Report
Page 13 of 17
6.
Solihull Community Contract
The Solihull Community Services contract has a value of approximately £20 million,
commissioned by Solihull Clinical Commissioning Group (CCG), Solihull
Metropolitan Borough Council (SMBC) and NHS England. In total there are over 40
Services, ranging from Health Visiting, Community Paediatrics, Community
Respiratory, Speech & Language Therapy to the You + shop that provides advice
and health care checks.
As part of the 2015/16 contract, the Trust currently submits the following
information on working day 20 each month to the Commissioners:




Solihull CCG 37 key performance indicators (KPIs), 83 information requirement
reports (IR)
Health visiting 17 KPIs
SMBC 37 KPIs, 12 IR.
Solihull SMBC / CCG 6 KPIs, 8 IR
The KPIs and Information requirements are a mixture of monthly, quarterly or
annual reports. The majority of the performance requirements are locally agreed
rather mandated by national targets, however Community Paediatrics is included in
the Trusts 18 weeks submission because it is a consultant led service.
This contract is reported a month in arrears in October a short overview of
performance against the contract is provided below:
6.1
Community Service KPIs - Solihull CCG
The only exception was staff receiving appraisal / PDR, 66.04% during Q2
vs. a target of 85%. Work to improve performance against this indicator is
as reported for the acute contract above.
6.2
Solihull Metropolitan Borough Council (SMBC)
The SMBC KPI targets are all quarterly, in Quarter 2 there were two targets
that Trust failed to achieve:

Breastfeeding initiation for Solihull residents (66.72%) was below the
70% target. A detailed action plan was created by the Service to improve
the performance in future months, this was presented to the
Commissioners at the Maternity LIG meeting

29.41% of the weight management patients achieving 5% weight loss at
3 months, this was below the >30% target in Q2; however the
performance increased to 40% in October.
Page 14 of 17
7.
NHS Preparedness for a Major Incident Statement of Readiness (Gateway ref
04494)
Dame Barbara Hakin, National Director of Commissioning Operations at NHS
England, has requested via Public Trust board an assurance statement against 4
specific elements identified with her letter dated 9th December 2015 (gateway ref
no: 04494).
This is in addition to the annual Emergency Preparedness, Resilience and
Response (EPRR) core standards assurance that was accepted at board in
November 2015.
The paper (Attachment 1) provides assurance to the 4 elements requested and an
overarching final statement of readiness
8.
Recommendations
8.1
Accept the report on progress made towards achieving performance targets
and associated actions and risks.
8.2
Confirm that they are assured on the Trust’s against the ‘NHS
Preparedness for a Major Incident Statement of Readiness (Gateway ref
04494)
Kevin Bolger
Interim CEO – Improvement
Page 15 of 17
Attachment 1
NHS Preparedness for a Major Incident Statement of Readiness
For
Trust Board 6th January 2016.
(Publications Gateway Reference No.04494)
1.
Introduction
This paper provides details of the Heart of England NHS Foundation Trusts
readiness for a major incident in light of the tragic events in Paris on 13th
November 2015.
The threat level for the UK remains unchanged since 29th August 2014 and
therefore remains at SEVERE; this means that an attack is highly likely. SEVERE is
the second highest level with CRITICAL being the highest. CRITICAL means an
attack is imminent.
Dame Barbara Hakin, National Director: Commissioning and Operations, NHS
England has written to all Trust asking them to provide a statement of readiness to
their Public Boards against the following areas:-
2.
•
You have reviewed and tested your cascade systems to ensure that they can
activate support from all staff groups, including doctors in training posts, in a
timely manner including in the event of a loss of the primary communications
system;
•
You have arrangements in place to ensure that staff can still gain access to
sites in circumstances where there may be disruption to the transport
infrastructure, including public transport where appropriate, in an emergency;
•
Plans are in place to significantly increase critical care capacity and
capability over a protracted period of time in response to an incident,
including where patients may need to be supported for a period of time prior
to transfer for definitive care; and
•
You have given due consideration as to how the trust can gain specialist
advice in relation to the management of a significant number of patients with
traumatic blast and ballistic injuries.
HEFT readiness against the identified areas above
Our call in cascade system (confirmer) is tested quarterly across the trust and
following the Paris events has been reviewed. A new mass casualty specific
cascade will be in place imminently which will have all medical staff populated
within it. Confirmer itself has 3 layers of resilience in addition to our
communications systems which also has 3 layers of resilience. Confirmer also has
the benefit of being able to be activated by either ICT or telecommunication lines
and from both internal and external lines which means unless we lose both internet
and telecoms we are still able to use our cascade system. Loss of all
Page 16 of 17
communications, whilst possible, is mitigated against to the best of our ability. In
the event of a total loss we would utilise the communications department media
management plan and get messages out to staff via local TV and radio stations.
Arrangements are already in place as part of our Cold Weather and Fuel plans to
utilise Trust shuttle buses to assist with staff getting to work along with the
reallocation of staff to their nearest sites as opposed to base sites where
appropriate. With the activation of NHS England’s incident response plan we also
have plans to work in liaison with West Midlands Police and arrange rendezvous
points for staff collection and transportation if required and will be identified at the
time.
All of our emergency incident plans have been reviewed in 2015 and link into NHS
England West Midlands – Birmingham, Solihull & Black Country Incident Response
Plan. A strong emergency preparedness, resilience and response (EPRR) network
within our area ensures we both liaise and work well with other local trusts. Our
mass casualty plan (part of the Heartlands Major Incident Plan) details how we will
expand our critical care capacity and capability during such incidents. These plans
are due their annual review in the first quarter of 2016 and will be done in line with
the latest NHS England Assurance Framework published in November 2015.
Due to our strong EPRR network acute providers have a presence not only within
the NHS England Incident Control Centre but also within the Police Events Control
Suite. These provide us with direct access to many specialists from whom we can
gain any specialist advice required depending on the incident. This includes the
trauma network, critical care network and military liaison officers as well as Public
Health England and Hazardous Area Response Teams etc.
3.
Assurance statement
Having reviewed and taken into account all of the current plans following the tragic
events in Paris Heart of England NHS Foundation Trust can provide assurance that
it is ready, to the best of its ability, to respond in the event of a major incident.
Paper prepared by Kellie Jervis
Head of Emergency Planning & Business Continuity
Page 17 of 17
BOARD OF DIRECTORS
Title: Care Quality Board Report
Attachments: 0
From: Sam Foster
To: Trust Board
Decision
N
Discussion
Y
Assurance
Y
Endorsement
N
Note the content of the report and the required onward actions.
Key points/Summary:
This paper summarises the Trust’s performance against national quality indicators and targets including those
in Monitor’s Risk Assessment Framework as well as local priorities. It outlines the current position with
performance and actions required in six key areas to build on the care provided to patients in our hospitals:
Infection Control: Performance remains within trajectory for Clostridium Difficile with 2 Trust attributable
MRSA bacteraemia YTD
Patient Experience: Friends and Family test (FFT) All areas remain within or slightly below the national
picture, with Maternity and Emergency Departments as the current focus for improvements. Complaints:
following the external review previously reported to Trust Board, the revised process for recording, grading
and responding to complaints is now live; the Board should expect to see an improvement in closure of
complaints within 25 working days over the coming months.
Harm: 15/16 performance YTD for both harm from falls and pressure ulcers has improved- the paper
details specific improvements required to further reduce harm from pressure ulcers.
Discharge: The local Health and Social Care economy for HEFT share concerns in respect of the
deteriorating position of delayed transfers of care and have indicated commitment to resolve this through
an agreed 7 point action plan. The report details a current DTOC position of circa 6% against an existing
3.5% target with a higher number from February 2015 with a higher proportion attributable to Health.
Nursing and Midwifery staffing: All areas reported compliance with their planned vs. actual staffing
levels. The Trust vacancy position is improving with circa 100 wte vacancies as of December – an
improved picture to this time last year with circa 200 Vacancies. Particularly difficult to recruit to specialties
are Theatres, Emergency Department and Midwifery – where planning is currently taking place to scope
options.
CQUIN Delivery: Q2 delivery was achieved, with a financial plan to achieve 75% in Q3&4 areas of focus
are detailed in the report.
Recommendation(s): Note the content of the report and the required onward actions.
N
Y
Resource/Assurance Implications (e.g.
Financial/HR)
Identify any Equality & Diversity issues
N
Disclosure
Nil
Which other Committees has this paper been to? (E.g. F & PC, QRC etc.)
None
N
BOARD OF DIRECTORS
CARE QUALITY BOARD REPORT
PRESENTED BY THE CHIEF NURSE
1.
Purpose
This paper summarises the Trust’s performance against national quality
indicators and targets including those in Monitor’s Risk Assessment
Framework as well as local priorities.
It outlines the current position with performance and actions required in key
areas to build on the care provided to patients in our hospitals.
2.
Infection Control
The annual objective for Methicillin Resistant Staphylococcus aureus (MRSA)
bacteraemia is zero avoidable cases. There have been two Trust apportioned
bacteraemias so far this financial year. The annual objective for Clostridium
difficile infection (CDI) for 2015/16 is 64 cases all of which will be calculated
as Trust apportioned.
C.Diff cumulative post 48 hours toxin positive
Trust performance until November 2015 was a total of 32 reported cases,
seven of which were deemed avoidable. Reasons for these occurrences
being deemed avoidable include inappropriate sample testing and
antimicrobial prescribing. These 32 cases were reported to Public Health
England (PHE) in accordance with Department of Health guidance. All of
these cases were reviewed jointly with the commissioners monthly to
ascertain avoidability, based on clinical and antibiotic reviews.
Page 2 of 20
2.1
Actions to improve performance of CDI and MRSA








2.2
Increased education and observational audit of health care worker’s
hand hygiene, in particular medical staff, as well as Personal
Protective Equipment (PPE).
A different method of MRSA screening has been introduced in the
Trust to improve laboratory diagnosis. This will require an extensive
campaign of training and blended education.
Decolonisation bundles are to be reinvigorated to allow prompt
prescription and administration.
Careful attention to device insertion, both through appropriate
prophylaxis and documentation, as well as intensive training on
aseptic non-touch technique.
The current antimicrobial stewardship programme has maintained
an improving compliance with antimicrobial stop dates and
indications.
Continue with current post infection reviews (PIR) of Trust
apportioned cases as well the monitoring of clinical areas where
concurrent infections has occurred through the period of increased
incidence (PII) process. This involved a rapid review by a
Consultant Microbiologist and a Senior Infection Control Nurse.
Relaunch of octenisan anti-microbial hair and body wash for all
adult inpatients not colonised with MRSA
Award of a £210,000 research grant from the Health Foundation
investigating factors that may modify hand washing behaviour.
Outbreaks
There have been no outbreaks of diarrhoea and/or vomiting so far this
financial year that have resulted in ward closures. In line with the PHE
national toolkit on the screening and diagnosis of Carbapenemase-producing
Enterobacteriaceae (CPE) there have been two defined outbreaks across
HEFT this financial year. Each outbreak involved transmission between two
different groups of patients, with three patients in each group. The index
cases were defined on identification of a CPE from a clinical specimen. There
was no failure of screening patients in line with the Trust policy. Action plans
were devised and reviewed jointly with the commissioners and PHE. The
outbreaks area reflection of the complexity of patients admitted to HEFT as
well the multiple transfers between different clinical areas.
Page 3 of 20
3.
Patient Experience
3.1
Friends and Family (FFT) Test November 2015
3.1.1 Positive responses
The graph below shows the proportion of both positive and
negative responders by service area in November 2015. The
yellow diamonds represent national performance.
Proportion of Friends & Family Test positive and negative responders for
November 2015
Comparison with national performance
All areas are either consistent with or below national standards for both positive or
negative responders.
Areas of concern are in Maternity and ED as they are reporting an under compliance
with national standards for both positive and negative responders.
Actions to improve
Patient experience is a key driver and measure within the provision of high quality
healthcare. To enable improvements in the number of positive responders there is a
focus on the hotspot areas within each of the divisions as follows
(i)Emergency Department Birmingham Heartlands Hospital (BHH)
A high number of responders have identified concerns with long waits along with
staff attitude. To address this and improve personal interactions with staff there has
been a focus on leadership with a change in uniform for the Shift Leaders and
Matron clearly identifying the Nurse in Charge role.
(ii)Emergency Departments-All Divisions
Benchmarking against top performing organisations to observe and implement good
practice and behaviours around communication with patients and families.
Page 4 of 20
(iii)
Maternity Services
The introduction of SMS response service in Quarter 3 whereby patients can
respond by text message and commentary for improvements.
Two additional actions include a newly formed Patient Community Panels for each
division. The panels will be working with the triumvirates on key projects to improve
the patients experience, an example of this is mock CQC visits and actions required.
Secondly there has been the introduction of a Patient Experience dashboard which
provides FFT data at ward, site and trust level.
3.1.2 Response Rates
The graph below shows response rates for each service area.
Response rate by service area
The internal trust target for responders for all areas is at 30%. In-patient areas are
currently over performing all other areas are underperforming.
Actions to improve this include:
(i)
Emergency Departments-All Divisions
Response cards have been introduced in the newly formed minors area at BHH to
encourage on the spot responses that can be monitored by the staff in the
department.
Initial discussions have taken place with regards to increasing the number of
volunteers in all divisions to assist with data collection on the day of care
(ii)
Maternity Services
The introduction of a new SMS service to encourage the number of responses in a
timely manner was introduced in quarter 3. Early indicators have shown an improved
number of responses.
(ii)
Outpatient Services
Focused work commenced in October to ensure that staff were tracking the number
of response cards received each day; this has resulted in a slight improvement in
November s results.
It is clear that in the three areas discussed above there is a need for improvement in
FFT response rate and positive responders. This will be a priority in quarter 4
Page 5 of 20
3.2
Complaints
The graph below shows the number of formal complaints received by month
(line) and the proportion of these complaints based on their initial grading
(bars).
Formal complaints received by month
The graph below shows the number of complaints responded to within 25
working days.
Number of complaints responded to within 25 working days
The updated complaint policy with agreed timeline for complaint responses is
awaiting ratification. Weekly escalation of complaint progress against
timescale to Divisional leads has been implemented. Overdue complaints are
now escalated to Executive level for action. The trajectory for improvements in
complaint response rates, agreed with Monitor, is 40% of complaints
responded to within negotiated timeframe by March 2016, 50% by November
2016 and 60% by March 2017.
The top seven complaint themes during the previous 12 months were clinical
care, poor communication, staff attitude, nursing care, delays or cancellations
in OPD and inpatient areas and admission and discharge.
Page 6 of 20
Top seven complaints themes
*as at 18th December 2015
3.2.1 Actions to Improve
(i)
Corporate actions
There has been an introduction of a weekly complaints meeting where all open
complaints are discussed and required actions are coordinated. Following this
meeting the escalation of complaints is circulated to the divisions for action including
highlighting current position of complaints per site and speciality. Complaints
overdue by 30 days are escalated to the Chief Executive for action.
In addition to this there has been an introduction of a monthly complaint meeting with
each of the Divisional Head Nurses to discuss outstanding complaints.
A new complaint policy has been drafted and is expected to be ratified at the newly
formed Chief Executive Advisory Group (CEAG) in January 2016.
A Quality assurance process has been implemented to ensure that accurate and
timely responses are coordinated.
A newly formed Chief Executive Officer response letter has been implemented with a
requirement for embedded with lessons learnt identified.
(ii)
Divisional Requirements
To ensure that this new process is embedded divisions must adhere to these
requirements and have a clear understanding of how to embed lessons learnt from
complaints and poor patient experience from ward to board level.
Page 7 of 20
Currently there are action plans available as a result of trust wide complaints,
however, there is limited assurance that the actions have been completed and
shared to ensure improvements in the patients experience across all divisions.
3.2.2 New and Open Cases to Ombudsman (PHSO)
In November the Trust was notified of 5 new referrals to the PHSO. The PHSO also
issued 2 final reports relating to HEFT complaints. Both of these complaints were
not upheld.
The table below shows the numbers of referrals to the PHSO and the numbers of
cases upheld.
Indicator
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
No of referrals to
ombudsman
0
2
1
2
0
1
2
5
No of complaints
upheld/partially upheld
by Ombudsman
0
2
0
0
0
2
0
0
Number of referrals to PHSO and number of cases upheld
The below gives detail of the one current PHSO case where actions remain
outstanding.
Ref
Division
Directorate
13.15400 BHH
Elderly
Action required
 Acknowledge failings
identified.
 Apologise for the
impact these had.
 Action plan by
05.01.16.
PHSO cases with action outstanding
3.3
CQC Maternity Survey 2015
The CQC have released the 2015 Maternity Survey which benchmarks
each trust against other trusts. There are three overarching categories
which are labour and birth, staff during labour and birth and care in
hospital after birth. Two hundred and seven women who gave birth in
February 2015 out of a possible responded to the survey. Out of those
who responded it can be clearly seen that HEFT has been
benchmarked with other organisations as being about the same. The
scores range from 9.4 out of 10 to 5out of 10 with most scores being in
the 8 out of 10 range.
Page 8 of 20
Areas to celebrate are partners being involved as much as they wished
in the Intrapartum period, and 9.1 out of 10 for being treated with
respect and dignity and 9.3 out of 10 for being spoken to in a way they
could understand during labour and birth. Areas that scored the lowest
7.1 out of 10 for being left alone by midwives or doctors at a time that
worried them and 6.9 out of 10 for length of stay and the lowest score
of 5 out of 10 for feeling like their Partner who was involved in their
care was able to stay with them as much as they wanted.
It is disappointing that HEFT received a required improvement when
the majority of scores were around 8 out of 10. There is always room
for improvement and the team will continue to work on the key areas.
4.
NHS Safety Thermometer
The National Safety Thermometer is a point prevalence audit to measure
harm in four key areas:
 Pressure Ulcers, both hospital and non-hospital acquired
 Falls within the preceding 72hrs of the audit being completed
 Urinary Tract Infection and Urinary Catheter use
 Venous Thromboembolism (VTE) Measuring assessment, appropriate
prophylactic treatment and the development of a PE or DVT.
Within HEFT the audit data incudes both acute and community care. The
current month position for November 2015 demonstrates HEFT achieved
93.6% that is just below the national average of 94.3%.
Although a national data collection tool the purpose of this methodology was
to be as a local improvement tool and not as national benchmarking and
these are the principles of how it is utilised across the organisation.
Proportion of patients receiving harm free care
Whilst harm from pressure ulcers remains our biggest cause of harm within
this data set, November achieved 4.19%, which is in line with national
reporting average of 4.20%.
There was increase for November of
catheterised patients developing a urinary tract infection this rose from 0.77
Page 9 of 20
to 1.77 with the national average at 0.71.Whilst, this is a harm to patients the
value in actual number of patients rose from 8 in October to 14 in November.
On completion of the safety thermometer the data is translated from a Trust
wide to site and most importantly down to ward based scorecard so the local
improvement can be implemented and lessons learnt.
5.
Inpatient Falls
Trust wide work continues to reduce the overall numbers of patients falling.
The Trust 2015/16 year end trajectory is set at 6.36 against 1000 occupied
bed days (OBD).
Current performance demonstrates compliance within the agreed trajectory
with November achieving 6.13 this has been sustained through quarter 1 and
quarter 2 achieving 6:24 and 6:12.respectively. It is felt that the introduction of
open visiting has improved our patient’s opportunities to eat, drink and move,
therefore having a positive effect on falls reduction. .
Trust Falls rate per 1,000 occupied bed days
5.1
Injurious Falls
All falls have the potential to be injurious and cause significant harm to
patients and whilst we have data to demonstrate this with year to date
this being a total of 49 where patients have sustained a head injury or
fracture compared with 55 for the same reporting timeframe of
2014/15. All injurious falls are subjected to an RCA process which is
presented at local site forum and then additional quality assurance is
undertaken at corporate level to ensure all lessons learnt have been
captured and acted upon.
5.2
Repeat Fallers
Whilst falls are considered unpredictable events many patients can be
prevented from falling and certainly from having repeat falls by
ensuring appropriate interventions are embedded into practice. In
2014/15 for quarter one and two 234 patients had more than one fall
Page 10 of 20
whilst receiving inpatient at HEFT in some instances patients had in
excess of 4 falls. For this reporting year significant emphasis has been
placed on reducing the number of repeat fallers and this has achieved
almost 30% reduction for the same period.
5.3
Falls Metric
The nursing care indicators measure compliance with the falls bundle
and assessment every month using the 10 patient sample size. Overall
falls metric score and compliance with falls bundle level 1 and level 2
are reportable each month through the HEFT Contract to the CCG.
The year-end target is to achieve 95% or above in all three
components. Year to date for bundle 1 is 96% and Falls Bundle level 1
is currently at 93%. Overall falls metric currently at 94%. All elements
achieved 95% by year end for 2014/15. Both elements were achieved.
5.4
Falls Practitioner Role
The lead nurse for falls prevention is supported by two falls
practitioners who are site based at Good Hope and Solihull. The role is
to support the clinical areas in falls prevention and provide resources
when dealing with complex patients as well as ward based education.
The site based practitioners are posts which have been established
within the financial year and have made a significant impact to the
reduction of falls and reducing patient harm.
6.
Pressure Ulcers
The priority for HEFT is to reduce the overall number of patients who acquire
avoidable pressure ulcers whilst in hospital during the 2015/2016 financial
year. The agreed reduction trajectory for HEFT, set with the commissioners,
was to achieve a 10% reduction for avoidable hospital acquired grade 2
pressure ulcers and a 50% reduction for avoidable hospital acquired grade 3
and necrotic pressure ulcers based on the Trust’s overall performance in
these areas for 2014/2015.
In addition to this the following three KPI’s are outlined within the contract;
documented repositioning, actual repositioning and daily skin inspection, all of
which are to achieve compliance of 90% in the overall metrics by the end of
Quarter 2 and 95% by the end of quarter 4. Whilst it is important to achieve
the target the priority is to ensure that incidents of patient harm caused by
pressure ulcers is minimised through robust root cause analysis and shared
learning.
6.1
How is the priority monitored and what has been achieved?
Data is monitored daily by a ‘harm alert’ that provides all clinical areas
with an overview of pressure ulcers that have been reported in the
Page 11 of 20
preceding 24 hour period. Monthly pressure ulcer compliance within
nursing care indicators are recorded across all adult inpatient areas.
The overall score for the nursing care metrics from the end of Quarter 2
has been sustained at 94% up until November 2015. Performances
against the three KPIs are:



Compliance with documentation for the frequency of repositioning
at the end of Quarter 2 was 95%Trust wide and has improved to
96% in November 2015.
Compliance with the frequency of actual repositioning at the end of
Quarter 2 was 79% Trust wide and has improved slightly to 81% in
November 2015.
Compliance with daily skin inspections at the end of Quarter 2 was
91% Trust wide and has improved to 93% in November 2015.
These results show that improvement is required in performance
against the KPI for the frequency of actual repositioning as this
currently sits at 81% compliance.
There are Divisional Tissue Viability Steering Groups held monthly to discuss areas
of non-compliance and share good practice providing updates to all clinical areas.
The divisional Tissue Viability leads then attend a monthly Trust Tissue Viability
Steering Group chaired by the Deputy Chief Nurse. At this forum, each Division
submits their monthly divisional performance against the overall trajectory, KPI’s
performance data is discussed, and the Deputy Chief Nurse assigns
recommendations and actions to divisions.
Through this structure and at the end of Quarter 2 the Deputy Chief Nurse has
mandated the implementation of three practice changes across each of the three
divisions to ensure improvement in compliance with actual repositioning of patients.
These are:

6.2
The introduction of repositioning clocks above each patients bed on
those wards where compliance improvement with actual patient
repositioning is required
 Daily metrics on actual repositioning to be completed and checked
by the nurse in charge and the metrics results are presented to the
Deputy Chief Nurse through the Trust Tissue Viability Steering
Group
 Those wards that are achieving 90% or above on their actual
patient repositioning metrics are undertaking a daily safety huddle
to ensure performance is sustained
Performance to date
The following graphs outline performance to date against avoidable hospital acquired
grade 2 pressure ulcers and avoidable hospital acquired grade 3 and necrotic
pressure ulcers.
Page 12 of 20
6.2.1 Grade 2 Pressure Ulcers
Current performance at the end of November 2015 for Trust wide avoidable hospital
acquired Grade 2 pressure ulcers equates to 120 against a target of 187.
Performance against numbers last year has improved from
141 in November 2014 compared to 120 in November 2015.
Avoidable hospital acquired grade 2 pressure ulcers
6.2.2 Grade 3 Pressure Ulcers
Performance against hospital acquired grade 3 and necrotic pressure ulcers is 39
against a target of 29 breaching the trust trajectory. This breach is indicative of the
current poor compliance with the actual repositioning of patients and the
implementation of the three mandatory practice changes at the end of Quarter 2
were expected to improve compliance with this trajectory. This trajectory is broken
down by division, during August and September this was breached however is
compliant in November.
The divisional breakdown of total numbers is as follows:
 Heartlands- Total 24,
 Good Hope- Total 8,
 Solihull - Total 7.
Performance against numbers last year has improved from
41 in November 2014 to 39 in November 2015
Page 13 of 20
Avoidable hospital acquired grade 3 and necrotic pressure ulcers
6.3
Initiatives Implemented in Quarter 3 2015




A 12-month tissue viability re-energising campaign
commenced in September 2015 with a different focus of
pressure ulcer prevention each month supported by our
media and communications team.
A review of current reporting mechanisms and changes to
the performance framework commenced in November 2015,
whereby all clinical areas of concern are formally presenting
incidents of avoidable pressure ulcers and lessons learnt to
encourage shared learning and peer confirm and challenge.
Any concerns with continued poor compliance will be
referred to the Chief Nurse for consideration at the CEO
RCA Meeting commencing January 2016
Continuation of bespoke ward and speciality based training
where there are trends that are causing concern or complex
education needs for the management of patient devices
Mandate that daily skin checks are carried out before midday
to encourage contemporaneous documentation
Page 14 of 20
7.
Discharge / Delayed Transfers of Care
The local Health and Social Care economy for HEFT share concerns in
respect of the deteriorating position of delayed transfers of care and have
indicated commitment to resolve this through an agreed 7 point action plan.
The deteriorating position is reflected in the graph below which shows a
current DTOC position of circa 6% against an existing 3.5% target with a
higher number from February 2015 with a higher proportion attributable to
Health.
A recent review of the DTOC position (weekly snap shot 30/10/15) provided
an overview and baseline from which to start discussions with partner
agencies. This informed the discussions at SRG meeting on 10/11/15 with key
partner agencies. The snap shot showed:
 Over 50% of delays for social care relate to placement and 28% relate to
assessment
 Only 15% of the overall delays are within HEFT’s gift to resolve
independently
 46% delays sit with Local Authorities – BCC and SMBC predominantly but
not exclusively
 29% sit with other Health providers
The apportionments of the delays for each organisation were:
 15% HEFT (1.76% if compared to OBD)
 46% LA’s
 29% CCG- other health providers
A further analysis over a longer period of time is provided below and shows
the increased level of health related delays across 3 sites over the last 12
month period and demonstrates the need for system wide commitment to an
improvement plan and supportive actions to realign performance to 3.3% and
then achieve the expected stretch target of 2.5%
Page 15 of 20
The 7 point improvement plan agreed at SRG is:
1.
A number of HEFT plans- demand and capacity modelling for
appropriate staffing including Social Workers (SW) and Complex
Discharge Nursing Service (CDNS)
2.
Develop triage and reject for inappropriate requests and
integrated working/pathways, integration of the CDNS service
into the Discharge Hubs at BHH and GHH
3.
13 virtual beds- BCF funded scheme
4.
Increase home based enablement capacity
5.
Action plan from EAB session on 16 November to plan for
reduction in LOS and reviewing processes and responsibilities
for initial assessment
6.
Daily board round for all patients on Transfer of Care
7.
Involvement of senior colleagues from community health and
social care on daily board rounds for min 4 weeks
All HEFT actions are in progress. Whilst in comparison the HEFT attributable
delays are low, the available analysis from UHB would suggest that actions in
relation to Discharge Hub and TOC had a high impact in reducing overall
delays to <2% therefore the HEFT specific plans will play a significant part in
the delivery of the improvement plans generally.
Current performance is circa 6% against a target of 3.5% - 90 patients
delayed for a target of 49. NHSE are applying a stretch target of 2.5% (35
patients)
Page 16 of 20
Suggested overall improvement trajectory
8.
Safe Staffing
The table below shows the Divisional break down for the November 2015
monthly nurse staffing level information for adult inpatient ward areas,
including critical care. This information is published on the NHS Choices
website for all Trusts with adult inpatient services and is reported to NHS
England as part of the monthly UNIFY return.
% fill rate
Qualified
Days
99%
96%
103%
100%
% fill rate
Unqualified
Days
102%
98%
117%
90%
Heartlands
Good Hope
Solihull
Women &
Children
TRUST
99%
101%
Divisional breakdown of nurse staffing levels
% fill rate
Qualified
Nights
97%
98%
100%
98%
% fill rate
Unqualified
Nights
113%
104%
112%
92%
99%
103%
All areas were compliant with staffing during November 2015. Where there
are individual clinical areas within a division that are not compliant the Head
Nurse submits an exception report to the Chief Nurse that articulates risk
mitigation and assurance of safe care.
All staffing compliance is measured weekly (and with a look back at the
previous six months) and is discussed with the Chief Nurse or Deputy Chief
Nurse. This includes flexible additional areas enabling decisions to be made
about the safety of opening additional beds at times of high demand.
Workforce reviews have been undertaken for all in patient areas and AMU’s
as per national guidance which highlighted no areas of concern. These will be
repeated again in February 2016 and biannually.
Page 17 of 20
The most significant challenge for safer staffing is the number of vacancies
that there are for Registered Nurses and Midwives across the Trust.
The Nursing vacancy position continues to improve following the
implementation of a robust recruitment workforce strategy. This has focused
on local and EU recruitment campaigns. There are currently 156 registered
nursing vacancies across all adult inpatient and AMU areas. There are a
further 41 planned starters over December and January with an average
attrition rate of 11 Registered Nurses per month.
Adult theatres continue to face significant challenges with their recruitment
with a further EU campaign currently being undertaken.
Emergency
Department recruitment is progressing however there are challenges due to
the lack of experienced nurses resulting in large numbers of newly qualified
nurses being recruited and requiring intensive support and development.
There is on-going Midwifery recruitment; however this continues to be
insufficient for demand. The possibility of EU recruitment is currently being
considered. The Chief Nurse and Workforce Lead Nurse are currently
considering a potential solution for the provision of fit for purpose nurses from
Romania over the longer term (circa 100 per year). This is being scoped.
9.
CQUINS – Q2 targets were delivered with a number of actions required
to meet Q3/4 Performance- there is a financial plan to deliver 75% in
Q3/4





AKI – requires junior doctors training to complete information on discharge
summaries and IT work to be competed enabling discharge summaries to
collect data regarding AKI stage.
Sepsis screening and antibiotic administration- requires % of patients
screened and antibiotics administered within 1 hour of presentation to be
improved from the current % (screening 22%, Antibiotic administration
54%) to screening 50% and AA and 70%.
Dementia screening targets have been achieved for Q2 but focus needs to
continue including within the community.
COPD- GHH site has difficulties in access to COPD specialist support on
site affecting the ability for all COPD patients to receive specialist review
and all elements of the discharge bundle.
AEC- Work is on-going to resolve data recording issues with Solihull to
ensure all AEC activity can be captured in SUS.
Page 18 of 20
Page 19 of 20
Page 20 of 20
Attachments: 0
Title: Quarter 3 COMPLIANCE AND ASSURANCE REPORT
From: Sam Foster
Assurance Y
Decision N
Discussion
Y
Endorsement Y
Accept this report as assurance on the internal and external compliance processes of the
Trust
Key points/Summary:




The Trust has been rated as ‘Requires Improvement’ by the CQC. The action plan
has been presented to the Executive Management Board monthly
The Trust is currently doing a further audit of risk registers in preparation for the
internal audit which will take place from January 2016.
The central compliance team was not notified of any external inspection during
Quarter 3.
97 % compliance against NICE Technical Appraisals.
Recommendation(s):
Accept this report as assurance on the internal and external compliance processes of the
Trust
Y
Resource/Assurance
N
N
Disclosure
N
Which other Committees has this paper been to? (e.g. F & PC, QRC etc)
None
1. SUMMARY
The purpose of this paper is to provide the Board with an update on internal and external
compliance as at December 2015.
2. INTERNAL ASSURANCE
Quality Reviews
During quarter 3 the Trust has continued to implement its rolling programme of quality
reviews on wards and department using the quality review tool (based on CQC Regulations
and Key Lines of Enquiry). Action plans continue to be monitored via the divisional quality
and safety meetings.
There are currently no exceptions to report to Board in quarter 3.
Patient Safety Walkabouts
The existing programme of patient safety walkabouts has been reviewed and a revised
programme established. This will commence as of Friday 18th December at Solihull hospital.
It is envisaged that this report going forward will provide by exception any issues that arise
with mitigation plans to address them.
NICE Guidance
The Trust has a process in place to implement, review and record decisions where
recommendations are not being met. The current compliance against NICE Technology
Appraisals (TA) is 97%, the following presents the 2 TA exceptions: Both are being
monitored by the Clinical Effectiveness group
Ref
TA345
Published
Jul 15
Directorate
Gastroenterology
Title
Naloxegol
for
treating
opioid-induced constipation
TA335
Mar 15
Cardiology
Rivaroxaban for preventing
adverse outcomes after acute
management of acute coronary
syndrome
Reason for Non-Implementation
Discussed at the October 2015 Area
Prescribing
Committee
(APC).
Concerns raised relating to the use of
naloxogel in therapy. No decision was
made regarding its position on the
formulary. APC to write to NICE with
concerns.
TA335 has been considered, but the
senior consultant team not willing to
use the drug based on the single trial
to which NICE refer. Reference also
made to the European Society of
Cardiology 2015 ACS guidelines to
which the British Cardiovascular
Society are aligned which makes no
firm statement regarding the drug’s
use, but do refer to the trial.
Risk Register Audit
A quarter 3 audit of risk registers in accordance with compliance against the Risk
Management policy is currently being finalised. A further update will be provided in Q4
aligning to the outcome of the Risk/BAF internal audit which commences on the 11th January.
Meanwhile, compliance with the Risk Management policy continues to be monitored via the
weekly risk forum.
3. EXTERNAL ASSURANCE
Care Quality Commission
The action plan from the latest CQC inspection (December 2014) has been
presented monthly to the Executive Management Board for review. The Trust was
rated overall as ‘Requires Improvement’, with 11 requirement notices, 16 must do
actions and 22 should do actions.
An update on the overall action plan has been presented on a separate paper to the
Board. In future, exceptions against the plan will be included in this report. A mock
inspection to test the embedding of the actions is planned for January 2016.
CQC Themed Review
The Solihull team were included in the CQC themed review of End of Life Care in November
2015.
The teams were commended by CQC for their passion and commitment to this work and the
focus on patient centred care. Highlighted areas for improvement included, improvements to
silo working and the IT infrastructure to support the sharing of information more effectively.
The final report is still awaited and any exceptions will be included in the next compliance/
assurance update.
IMR
The CQC has confirmed that they will no longer be completing the Intelligent Monitoring
Report (IMR) for Trusts.
External Visits
The Trust has a process in place to ensure that there is coordination of actions arising from
external agency visits.
No external visits have been reported to the central compliance team in Quarter 3.
Internal and External Audit
The safety and governance team lead on a number of the quality audits which are part of the
annual internal audit programme. There are no updates for quarter 3 however, the team are
currently preparing for the quarter 4 audits of the Risk and BAF and the CQC compliance
process.
4. RECOMMENDATION(S)
The Board of Directors is asked to accept this report.
Title: ACTIONS FROM THE CARE QUALITY COMMISSION (CQC)
INSPECTION
From: Sam Foster
Attachments:
1
Decision
N
Discussion
Y
Assurance Y
Endorsement
Y
The Board of Directors is asked to receive this update on the actions following the CQC inspection.
Key points/Summary:
 The Care Quality Commission (CQC) completed an unannounced inspection at the Trust
on the 7th/8th December 2014. The draft and then final reports were received by the Trust in
June 2015.
 The action plan has been presented monthly to the Executive Management Board
 There are a number of actions where further work is required in order to provide full
assurance of compliance (Attachment 1)
Recommendation(s):
The Board of Directors is asked to receive this update on the actions following the CQC
inspection.
Y
Resource/Assurance
N
N
Disclosure
N
None
1
BOARD OF DIRECTORS
WEDNESDAY 6th JANUARY 2016
ACTIONS FROM THE CQC INSPECTION
1. Introduction
The Care Quality Commission (CQC) completed an unannounced inspection at the Trust
on the 7th/8th December 2014. The draft and then final reports were received by the Trust
in June 2015.
The CQC inspected urgent and emergency care, maternity, medicine, surgery and
outpatients on all three acute sites and stated that although there was some evidence of
progress since the last inspection, in other areas there were no improvements or
deterioration. The key findings are summarised as follows:
•
•
•
•
•
•
•
•
•
•
•
•
Widespread learning from incidents needed to be improved.
Appraisals for staff were not widely undertaken.
Staffing sickness and attrition rates were impacting negatively on existing staff.
Patient flow mainly in BHH and GHH was having negative impacts across all the core
areas inspected.
Referral to treatment times were not always met for people.
Discharge arrangements required improvement; only 35% of patients were discharged
on or before their planned date of discharge.
The care of the deteriorating patient was generally managed well.
Arrangements for patients with reduced cognitive function were not always effective.
This meant that some patients did not receive the level of care and support they
required.
The culture within the trust was one of uncertainty due to the number of changes
which had occurred.
Staff could not communicate the Trust vision and strategy.
Governance arrangements needed to be strengthened to ensure more effective
delivery.
IT systems required improvement to ensure reporting was accurate. The ability of the
Trust to report against activity was not always available for use at Trust level or to the
Commissioners.
Areas of outstanding practice were identified as follows:
 On the Acute Medical Unit (AMU) at Birmingham Heartlands Hospital (BHH) local
complaints resolution was very responsive to patient’s needs. The complainant was
invited to a meeting and given a recording of the discussion. This appeared to resolve
complaints quickly.
• AMU, Ambulatory Care, wards 10, 11 and 24 on the BHH site provided excellent local
leadership, services were well organised, responsive to patients individual needs and
efficient which resulted in excellent patient outcomes.
2
• The Practice Placement team provided excellent links between the Trust and the
University in supporting more than 600 student nurses across all three hospital sites.
• Sexual health team demonstrated how they used information such as audit and patient
feedback to improve services to patients.
• Caring was good across the Trust.
2. Ratings
The ratings are summarised as follows:
Heartlands
Emergency Care
Medicine
Surgery
Maternity
Outpatients
Overall
Safe
Requires Improvement
Not rated
Responsive
Inadequate
Not rated
Well-led
Inadequate
Not rated
Safe
Not rated
Responsive
Not rated
Good
Well-led
Not rated
Safe
Not rated
Good
Responsive
Not rated
Good
Good
Well-led
Not rated
Good Hope
Emergency Care
Medicine
Surgery
Maternity
Outpatients
Overall
Solihull
Emergency Care
Medicine
Surgery
Maternity
Outpatients
Overall
Overall the Trust was rated as ‘Requires Improvement’
3. Areas identified for improvement
The Trust received 11 requirement notices and a range of ‘must do’ and ‘should do’ actions. The
requirement notices are outlined as follows:
1. Lack of robust incident reporting and feedback which could result in learning
opportunities being lost;
3
2.
3.
4.
5.
6.
Management of patient handover, overcrowding and timely assessments in ED;
Patients waiting over 30 minutes in recovery;
Service delivery in OPD with the use of management reporting data;
Availability of emergency medication in maternity and staff unaware of its whereabouts;
Within ED cleaning practices need to be improved and staff not adhering to infection
control policies;
7. Lack of equipment and faulty equipment not being replaced in a timely fashion;
8. Safeguarding was not in place for patients wearing mittens within the Trust;
9. Nursing staff was insufficient in places having a direct impact on patients, for instance
the second obstetrics theatre at Good Hope;
10. The appraisal rate for staff within the Trust was 38%. This rate had the potential to impact
on the level of care patients received. Managers also lost the opportunity to support staff
and identify where additional support was required; and
11. The visibility of the Head of Midwifery continues to be an issue.
4. Action Plan
The attached quality improvement plan (Appendix 1) sets out the actions as identified. It shows
the actions that still require further work. All leads responsible for the assigned actions have
been required to provide monthly updates and submission of evidence of completion as
appropriate. Monitoring has been on a monthly basis via the executive management team
5. Next Steps



Actions owners will continue to be monitored and supported to deliver against their action
by the Trusts compliance team.
Where there is no movement ,by exception this will continue to be escalated to the lead
executive director and the divisional triumvirates.
A programme of internal mock CQC inspections, focussing on the key areas is planned
for January 2016.
6. Recommendations
The Board of Directors is asked to receive this update on the actions following the CQC
inspection.
4
Regulated
Activity/Must
Do/Should Do
Operational
Lead
CQC Finding
Current Measures in Place
Further action identified
Lack of robust incident reporting and
feedback which could result in learning
opportunities lost
Much work has been undertaken over the last few years to
support learning and organisation feedback from incidents.
This includes;
Development of multimodal cascade system for sharing
lessons learnt from incident and errors
SUI: At a Glance” and “Lesson of the Month” cascade
processes (including Nurse induction programmes and
junior doctors’ “Risky Business” Forums)
Targeted sharing of incidents (for examples re: inpatient
diabetes care in “Diabetes June”)
Development of Patient Safety boards on a number of
wards and also in the education centre.
Learning lessons survey (April 2015) to evaluate learning
lessons initiatives and identify gaps
- Collaboration with Warwick University on research into
what factor most strongly affects the efficacy of
implemented learning initiatives at HEFT using the safety
board concept
More recently: Phase 1 of project to reduce IR1 backlog
underway. This will include ward by ward visits to all staff
and high level feedback on incident trends
1) Further communications will be sent out to Directorates and
Departments reinforcing the importance of incident reporting and
learning from incidents
2)
A report summarising the previous 12 months trends in incident
reporting will be sent to all wards and departments to support learning
3) Implementation of Phase 1 of the project to reduce IR1 backlog . This
will include ward by ward visits to all staff and high level feedback on
incident trends will be undertaken.
4)
Implementation of be-spoke training to areas of percieved high risk or
where additional training has been requested, will be implemented.
5) Review of Datix System Capacilities to improve userbility at ward level
and enable greater feedback to reporters.
6) Implementation of Phase 2 of the IR1 Project focusing on
departmental training and awareness.
7) Incident Reporting Policy will be revised and raified with roll out to
ward areas.
8) Continue work with Director of Education & Clinical Tutor to provide
feedback to junior doctors who report incidents
9) A new Datix front page will be developed to incorporate more
information on how to get feedback and also link to organisational
feedback in the form of “SUI:At a Glance” and “Lesson of the Month”
Clinical Holding (Restraint) Policy.
Safegaurding Policy
Quarterly Audit cycles.
1) An MCA and DOLS Task and Finish Group will be implemented
reviewing and implementing best practice processes across the
organisation
2) Clinical Holding (restraint) Policy will be revised and include reference
to the use of mittens
3)
Following ratification the new policy will be implemented and rolled out
within the organisation.
4) A review of the Safegaurding Audit Programme will be undertaken to
include more regular review of restraint.
November update: Clinical holding policy has been revised, approved and the policy launched.Launch has
been led by Beverly Chew which has included site walkarounds, stands, roadshows etc. In depth audits to
take place in Jan/Feb 2016. MCA DOLs and task finish group to be established in Feburary. Quality Reviews
to test DOLs awareness and the appropriate use of clinicial restraint.
Lorraine Longstaff
The hospital must improve the information
available to departments to ensure that
these are monitored and action taken to
improve services through audit, trending
and learning.
Implementation of Performance Management Framework.
November update: The PMF process has been established. Unfortunately the first round of meetings were
cancelled due to finance pressures. The framework is in place but requires exec suport to implement and
embed
Diane Povey
MUST DO
An external audit of hand hygiene practice has been
carried out in clinical departments throughout the Trust.
The hospital must take steps to improve
Hand hygiene education and re-enforcement of
adherence to infection control processes to compliance with six step technique and WHO five
ensure the safety of patients. This includes moments carried out in identified clinical areas e.g
the monitoring of hand
outbreak ward.
washing practices and the bare below
elbows policies.
This includes hand hygiene roadshows on wards,
implementation of “Chain Reaction” and teaching of
medics in surgery and AE.
1) Staff from the audited areas to attend hand hygiene forum, support
will be given to cascade the learning to their departments. A re-audit of
hand hygiene practice will be carried out in the same clinical departments
at the end of 2015.
2) Hand hygiene road shows will be carried out across all three hospital
sites during summer 2015. This will be supported by GOJO supplier of
hand hygiene products.
3) Further programme of actions will be developed as part of the planned
activity on the IPCT away day on 16.06.2015.
4) Increased hand hygiene education will be delivered as part of the
doctors induction programme in August 2015.
5) Hand hygiene audit of medical staff in August and October 2015 in
order to demonstrate sustained compliance.
6) There will be a Re-launch of “Major Handwash” twitter feed and
communications campaign to reinforce hand hygiene messages.
External audit of hand hygiene practice carried out in selected clinical departments at three hospital sites
during October 2015. Slight improvement in hand hygiene compliance was noted in some but not all areas
although all staff were observed to be bare below the elbow. The main area of non compliance was failure
to decontaminate hands following contact with patient environment. Pocket reminder cards for staff are
currently in development which include a reminder relating to hand hygiene practice. Infection control
sessions are now included in the new nurse induction programme and a trainign video has been developed
relating to MRSA screening.
MUST DO
The trust must address the ambivalence
held by staff about reporting incidents as
they may be under reporting and trust
could miss important trends.
MUST DO
The trust must ensure all patients requiring
items of restraint such as hand control
padded mittens are supported with a
mental capacity assessment, a DoLS and
are regularly reviewed by the MDT which is
recorded in the patient’s notes and mittens
are replaced when soiled. A consistent
practice must be adopted across the trust.
MUST DO
All patients treated at the Trust have a designated
The trust must ensure patients are not
consultant who is responsible for their care and clinical
labelled with a condition unless a diagnosis management. Other members of the multidisciplinary
has been confirmed by a medic.
team, including nurses, therapists and other clinical
support staff will contribute to the diagnostic process
Regulation 17 (2(b)(f)):
Good Governance
Regulation 13(4)(b) (5) :
Safeguarding
service users from abuse
and improper treatment
MUST DO
Safeguarding processes were not in place
for people
wearing mittens within the trust.
Adult
Updates on progress
Since the start of this project the pre-April backlog has reduced from just over three and a half thousand to
just under a thousand
The total number of incidents awaiting review has decreased from just under five thousand to just over
three and a half thousand (two and half thousand of which are over a month old)
The remaining pre-april incidents will be devolved to head nurse and triumvirate leads as well as the
current backlog (all incidents a month old) which has recently started to increase
Agreement of revised incident reporting process and responsibilities will be agreed with chief nurse and
triumvirate leads with appropriate supportive resources rolled out
Revised process and performance monitoring framework to be embedded in January.
Exec
Monitored by
Lead
Evidence Req
Timescale
RAG
Quality Committee
Project TOR/Outline
Project updates/Data Analysis
Evidence of ward visits /teaching
Jan-16
A/G
SF
Adult Safegaurding
Committee
Revised Policy
Minutes from Adult Safegaurding
Committee
Minutes from Tak and Finish
Group and Action Plan
Audits
Education packs/programmes schedule of visits.
Feb-16
A/G
JB
EMB / CEO meetings
PMF Framework and schedule of
dates
Feb-16
A
Gill Abbott
SF
Infection Control
Committee
Evidence of Audit Teaching
packs/sessions IPC Committee
papers evidencing active learning
and review
Dec-15
A/G
See above. Enforcement notice for Regulation 17
Lisa Pim/Louise
Rudd
SF
Project TOR/Outline
Phase 2 IR1
IIP Programme Board Project updates/Data Analysis
Project December
2015
A/G
See above. Enforcement notice for Regulation 13
Lorraine Longstaff
SF
Adult Safegaurding
Committee
Feb-16
A/G
Clive Ryder
CR
Exceptions to the
Trust quality forums
Apr-16
A
Monitoing of complaints, incidents and patient / carer feedback will
identify areas where tis is not being delivered
Lisa Pim/Louise
Rudd
SF
Audits to be carried out.
Minutes of quality forums and
Board reports
MUST DO
MUST DO
The trust must ensure that staff are clear
about clinical responsibility for patient’s
awaiting handover by Ambulance services.
1) An AHO will be funded to support ambulance handovers.
2) An SOP will be written to support standardised practice in the Rapid
Assessment Area.
3) The SOP will be rolled out.
4) Practice will be audited to ensure compliance.
November update BHH Site only: Head nurses receiving daily reports on the patients waiting over 15
minutes in recovery
Theatre matron and associate head nurse are working together to minimise delays as there are
improvements to be made on both sides.
It is discussed regularly with the surgical SWSs
Bleeps have been ordered for each ward to have, once received and programmed an automatic bleep will
be sent to the appropriate ward informing them that their patient has arrived in recovery therefore giving
them approx 1/2 hour advance notice of the patient being ready to return.
An escalation process has been developed for recovery to follow should they encounter barriers to
returning the patient(s).
There are some situations where the delays will not be easily prevented - for example when a patient is
sent to theatre with no clearly identified receiving ward/when the patient has different surgery to that
planned which requires a different exit location (eg planned for DSU or HDU, but due to a change in
procedure requires a ward bed).
November update for GHH site only – head Nurse receiving daily updates regarding delays for Patients
waiting over 15 minutes in Recovery . AHN , Matrons and Ward Mangers for Surgery / T/O working closely
together to monitor , minimise delays and make improvements .
0800 – Surgical / TO meeting held on ward 17 daily with SWS , Matrons and Surgical Bed Coordinator to
discuss daily Theatre list / Trauma List and Bed Capacity issues .
Surgical Coordinator aware of who is the point of Contact for each ward and who in Recovery is Charge so
there is a single point of contact between areas .
Initiative to be started at Bed Meetings is to highlight any delays in Recovery ,
There are situations where delays as BHH describes which not easily be prevented .
Recovery delays are discussed at 1-1 s with Matron by AHN for planned care .
Patients waiting over 30 minutes in
recovery
MUST DO
The trust must review the operation of
rapid assessment of patients to improve its
consistency and effectiveness.
MUST DO
The trust must take effective action to
achieve consistent staff compliance of
infection control procedures
MUST DO (GHH&BHH)
The trust must take effective action to
address the crowding in the majors area of
Estate rationalisation Project Workstream
the ED department and ensure that staff
Major/Minors Re-design
on duty can see and treat patients in a
timely way.
SHOULD DO
The trust should ensure staff are given
training how to report poor staffing levels
via incident reporting software.
The trust should ensure that patient’s with
complex needs such as mental ill health,
dementia or learning disability are
SHOULD DO (GHH&BHH)
appropriately supported through their
experience of emergency department
services.
AHO is funded to support ambulance handover
ED team have written operational policy for Rapid Assessment area (RAT) which clarifies responsibility
ED redesign porject should help to support effective and timely handover
Urgent Care Improvement Programme - Workstream 1
See above. Line 6
The theme of overcrowding with patient handover and timely
assessments will be adressed by ensuring capacity and flow through the
department, ensuring safe and efficient care delivery . The actions have
therefore been forcused on improving the capacity through the
department to achieve the outcomes required;
1) The works to move minors to an alternative environment will be
completed.
2) The upgrade and expansion of Majors will be completed.
3) A working establishment will be devised (incorperating medical and
nursing and support service models)
4) Safer placement of patients review will be undertaken to improve
efficiencies and engagement with process.
5) Re-launch process re Safer Placement of Patients Process
6) Commence Escalation Card Process.
The current ED expansion project at BHH is on schedule. New Minors Dept opened several weeks ago,
Majors B (old minors) has been refurbished, Majors A has been refurbished. The resus area is currently
closed so that the floor can be replaced. Resus cubicles have been re-provided in the Majors A area.
Therefore all of the planned ED redesign and improvement work will be complete, additional Majors
cubicles will be functioning
• Safer Patient Placement is in place, site continues to embed this
• Discharge Lounge , numbers increasing gradually and planning to open earlier to support SPP. Pilot
planned to commence 2nd Nov with Pharmacy to evaluate the impact of putting Pharmacy resource into
DL to prevent delays in transfer to DL from wards due to TTO issues
• Site Safety Huddle at 0800am in Site office commenced – daily overview and briefing of priorities for the
day
• Site is continuing to support AHO in order to manage timely ambulance handovers
See above. Regulation 17
1) Appropriate Assessment Areas will be provided for patients requiring
this specialist intervention
2) Cohesive working will be evidenced working with the MH Trust/RAID
to share best practice and improve patient care.
New MH assessment room provided in New Minors area – fully compliant with MH requirements
Engagement with MH trust and commissioners regarding additional support for winter period
Increased engagement and collaboration with RAID services
Elderly In reach to ED provided by Elderly Care team (Sally Jones & Niall Fergusson)
Nov-15
A
Dec-15
A
Dec-15
R
Evidence of Audit Teaching
packs/sessions IPC Committee
papers evidencing active learning
and review
Dec-15
A
Pending meeting with CQC
Action Plan Lead
Nov-15
A
Ben Richards
SF/AC
IIP Board
BHH site- Louise
Everett
GHH site - Emma
Harthill
SF
Ben Richards
SF/AC
IIP Board
Gill Abbott
SF
Infection Control
Committee
Ben Richards
SF/AC
IIP Board
Lisa Pim/Louise
Rudd
SF
Project TOR/Outline
Phase 2 IR1
IIP Programme Board Project updates/Data Analysis
Project December
2015
A/G
Ben Richards
SF
IIP Programme Board
A/G
Weekly breach
position to be
Evidence of pilot study and Audit
monitored on devliery Results
unit dashboard
SHOULD DO
The trust should take steps to address staff
Complaints procedure
understanding of the value of learning from
patient’s complaints and better promoting the engagement groups
public engagement methods already in place.
Patient
1) Commence monthly complaints review process with Divisional Heads
of Nursing - reviewing live complaints and handling.
2) Add patient experience data to the current Nurse Quality Dashboard.
This will include complaints data - improving data visibility and enabling
ward managers to review at a glance specific data fields.
3) Ensure that Patient User Groups have the appropriate direction and
governance arrangements in place to support their work.
4) Peer Review to be undrtaken to review trust processes in respect to
patient complaints and handling - where possibel generating
improvement in efficiencies and practice.
5) Following the review an action plan will be generated. This will be
monitored through Quality and Risk Committee to ensure completion.
6) A business case will be develped to support devolved patient
complaint handling - ensuring better ownership at local levele and
improving engagement in the process.
7) To implement performance reporting to Quality and Risk Committee to
ensure overarching review and monitoring.
November update:
Framework for patient engagement with governance and term of reference for newly configured patient
panels. Peer Review Complaints process and subsequent action plan. Business case development to
support devolved complaints handling. Web based computer handling database comissioned. Assurance
performiance framework implemented reporting to Quality and Risk.
HoPS involvement in Quality Champion programme. Use of EBD methodology to highlight messages
contained in Patient Experience information/feedback to front line staff.
Updated Complaints policy is drafted, in preparation for circulation to the Trust and other stakeholders for
comment.
Business case requirement for the department going forward have been firmed up in readiness for
discussion with finance and formal request for consideration of business case.
ToRs for Patient Panels are finalised and launched
Patient Experience Advisory Group Committee to be established, draft ToRs circulated (sub group of
Quality Committee)
Datix implementation action plan underway, for completion end of December 15
Jamie Emery
SF
Quality committee.
Weekly Complaints
Review. Monthly HON
Complaints Review.
Weekly and Monthly
Complaints. Quality and Risk
Reports. Peer Review. Business
Case.
Jan-16
A/G
BHH Division
Regulated
Activity/Must
Do/Should Do
Regulation 17
(2(b)(f)): Good
Governance
SHOULD DO
SHOULD DO
CQC Finding
Management of patient handover,
overcrowding and timely
assessments undertaken in ED
The hospital should consider
improving the information available
on delays for patients and consider
what actions are taken to alleviate
these to ensure a responsive service
that meet the needs of patients.
The trust should improve the
connectivity with the iPads in use
within anaesthetics.
Estate rationalisation Project
Workstream
Major/Minors Re-design
All patients have a predicted date of
discharge (PDD) within 48 hours of
admission and this is monitored via
the daily Jonah board rounds
The theme of overcrowing with patient
handover and timely assessments will be
adressed by ensuring capacity and flow
through the department, ensuring safe and
efficient care delivery . The actions have
therefore been forcused on improving the
capacity through the department to achieve
the outcomes required;
1) The works to move minors to an alternative
environment will be completed.
2) The upgrade and expansion of Majors will
be completed.
3) A working establishment will be devised
(incorperating medical and nursing and
support service models)
4) Safer placement of patients review will be
undertaken to improve efficiencies and
engagement with process.
5) Re-launch process re Safer Placement of
Patients Process
6) Commence Escalation Card Process.
1) Communication with patients regarding
discharge arrangements will be improved.
2) A patient leaflet will be devised informing
patients of their discharge
arrangements/requirements.
ICT Director prioritising all requests for front
line improvements.
Updates on progress
Staffing Plan has been completed this incorperates both nursing and medical
workforce models. Ongoing recruitment plan in place - escalation plan in place to
cascade staff from other areas should ED staffing be insufficient to ensure that all
cubicles are open at all times. Escelation cards ahve been signed off and circulated
and are in active use by management - site wide email remainded to go out from GR
in early Jan 15
• The current ED expansion project at BHH is now complete - all capacity opened,
there are now additional majors and high dependency cubicles in place. The site has
also agreen a handover process with WMAS where patients are cohorted ans there is
a designated individual in place (usually 1st POD) who is designated to provide
nursing cover to the corridor should surge occur
• Safer Patient Placement is in place, site continues to embed this
• Discharge Lounge , numbers increasing gradually and planning to open earlier to
support SPP. Pilot commenced 2nd Nov with Pharmacy to evaluate the impact of
putting Pharmacy resource into DL to prevent delays in transfer to DL from wards due
to TTO issues
• Site Safety Huddle at 0800am in Site office commenced – daily overview and
briefing of priorities for the day
• Site is continuing to support AHO in order to manage timely ambulance handovers
A Patient leaflet wasdrafted to go to every patient outlining the process and
expectations of their stay and how they can plan their discharge with their families,
however as the new Bed Utilisation policy has been implemented the leaflet has been
replaced with a series of letters to patients which are consistent through the patient
journey. The process was lauched across the BHH site at the Clinical Engagement
Meeting on 29th October 2015 and therefore is currently becoming embedded and
will be reviewed and monitored
Awaiting final update/assurance from Leads
November 2015
Operational Lead
Ben Richards
Ragu
Sally Caren
RG/CH/SQ- Stuart Dale
Exec Lead Monitored by Evidence Req
Timescale
RAG
Dec-15
A/G
Ward Metrics and
spot audits of
Carl Holland availablilty. In Letter process in place,
Sarah
future when
improved patient feedback on
Quinton
available, will be discharge arrangement s
monitored by
JONAH
Nov-15
A/G
RG/CH/SQ
Stuart Dale General
manager for
Critical care
and
Anaesthetics
Nov-15
SF/AC
IIP Board
Project Plan
Staffing establishments/plan
Safer Placement Review
Escalation cards
Pending Meeting
Pending Meeting with CQC
with CQC Action
Action Lead
Lead
GHH Division
Regulated
Activity/Must
Do/Should Do
MUST DO
SHOULD DO
SHOULD DO
CQC Finding
Current Measures in PlaceFurther action identified
Improve the environment of the
transfer corridor used to transport
patients and dispose of refuse
appropriately.
The trust address the ambivalence held
by staff about the impact reporting
incidents has on learning and improving
the quality and safety of the service.
The trust should ensure that staff
working in the ED department are
For further detail: see Urgent Care
made aware of a vision and strategy for
programme IIP workstream 6
the service and their contribution to
achieving it.
Updates on progress
1) Maintaining the decluttering of corridors
2) Safety Survey of the corridor will be undertaken for transferring patients (mainly children)access to telephones, cables, electrics.
3) Re-decoration of the corridor will take place to make it child friendly and less intimidating
(Painting of floors/walls)
4) Contact will be made with "speight of the art" to provide further artwork.
5) Spot Audit checks will be undertaken to review the environment regularly.
6) To investigate the addition of medical equipment and telephones in the corridors
November Update: Decluttering and cleaning of the corridors completed
and being maintained. Schools are working on the themes identified by
staff. Speight agreed to take on project will commence as soon as some
funding has been agreed.
Byron Batten
Fire and Safety issues escalated to Dave Smith- Estates GHH- costing
Julie Taylor
obtained from estates and project lead. Update will be presented at
Mona Cambell
November STEER Co.
See Trust wide action: Regulation 17
The Trust will ensure that engagement events are held with staff working within
A&E on changes to the department and strategy going forward.
Operationa
l Lead
October Update - There have been several away days and
engagement events for all ED staff across three sites to discuss and
debate the vision for Emergency Care at HeFT. The first on 6.7.15
and subsequent internal events for the wider ED team. On
14.07.15 – the vision was presented by the CD to the wider Trust
at clinical engagement session.
Work is in now in progress to work through the finer detail of the
future plans , before meeting with key stakeholders to develop a
health economy wide emergency strategy to align with the wider
Urgent Care strategies.
November update: Service plans for Emergency Medicine is
currently under develpoment, along with a workforce strategy,
first draft to be presented to BHH site team in Jan 16
November 2015
Exec
Lead
Monitored
Evidence Req
by
Timescale RAG
AR/JT/CS
Divisional
Committee
Meeting
Spot Audits of environment.
Formal environmental audits
Safety Survey STEER Committee
Minutes
Feb-16
A/G
Lisa Pim/Louise
Rudd
SF
IIP
Project TOR/Outline
Project updates/Data Analysis
Phase 2 IR1
Project
December
2015
A
Ola Efi,
Raghu
Urgent care
Group
Mar-16
A
Agreed Strategy document and
roll out plan
Solihull Division
Regulated
Activity/Must
Do/Should Do
SHOULD DO
SHOULD DO
CQC Finding
The trust should consider using
assessment rooms fit for purpose at
the AMU ground floor service and
not admin offices or bereavement
rooms.
Exec
Lead
AMU – Currently site is trying to manage
flow through the department to reduce
congestion in the department and reduce
the length of time patients spend in the
department. This facilitates use of
designated triage cubicle
Quality Review undertaken on the 26/08/15.
Action Plan put in place - Divisional Clinical
Governance Forum for review and monitoring on
the 13/08/15. Action plan includes requirement to
address issues relating to RAID Room so is fit for
patient contacts. This includes removal of clutter
Options paper
AMU - There is a potential opportunity to
and ensure appropriate equipment in place.
Quality Review Undertaken Short Term Actions
review AMU physical location and layout in the Commenced early phase of ambulatory care
AEC Performance Data
31/10/2015 Long
context of the Urgent Care Review proposals. which is facilitating identification of patients who General Manager for
Options to Solihull Site
VW/AC/VS
produced weekly.
These need to be explored by the site team
can be assessed in alternative clinical areas.
Transformation
Board
Term Actions June
Ambulatory Care Model and Trust to establish whether there are
November update: RAID assessment room has
2016
Process and Pathways.
viable alternative options (See abov
improved but still isn't totally free from clutter.
Audit Spot Checks
To be discussed with Ward Manager
December update: Assoc Head Nurse to
implement check and challenge process
immediately which includes weekly review of the
AMU assessment rooms to ensure they are fit for
purpose.
A
A Quality Review was undertaken of AMU in
August 2015 which has highlighted a lot of the
AMU - There is a potential opportunity to
detailed issues the dept needs to address.
review AMU physical location and layout in the Delivery of the Quality Review recommendations /
context of the Urgent Care Review proposals. requirements will be monitored through the sites
These need to be explored by the site team
Clinical Governance forum - Matron and CD for
and Trust to establish whether there are
Medicine are identified leads. Night walk around
viable alternative options (See above)
conducted by Corporate Senior Nurses on the
Wards (ward 17, 18 & 20B templates)– Work 15/09/15. Management of flow and capcity to
to be undertaken with wards to establish
reduce volume of patients in the department
‘LEAN’ processes for storage requirements;
during the overnight period reducing noise levels.
Work to reduce occupied bed days to
Substantiating additional ward (20B) and EJONAH
continue, with a view to providing opportunity Programme of work to suuport wards with
to reduce number of beds per ward and
reducing lengths of stay.
create opportunities for improved storage
November update: FFT score for noise level at
solutions
night has not improved. Work ongoing to
improve this. December update: Assoc Head
Discussion has taken place with infection
Nurse to carry out observations in AMU as
Prevention who have recently provided LEAN previous work has not improved the situation. A
training to site Housekeepers - request has
robust action plan will be implemented to reduce
been made for a 2nd session focusing on SWS. noise/confidential information being overhead.
Work to improve the flow through out the
hospital is ongoing.
A
AMU: currently site is trying to manage
flow through the department to reduce
The trust should ensure reducing the
congestion in the department and reduce
noise level and improve
the length of time patients spend in the
communicating (verbal) confidential
department
information at the AMU ground floor
service.
Wards (ward 17, 18 & 20b templates)
Updates on progress
Operational
Lead
November 2015
Monitored by
AMU: Options to Site
Board
VW/AC/RS
VW/AC/VS
Wards: Site walk
arounds
Evidence Req
Quality Review paper
including recommendations
and Action plan
Evidence of walk arounds
Daily SBARs which refelct
numbers of patients in AMU
Site LOS Information.
Timeline
RAG
Solihull Division
SHOULD DO
The trust should ensure that
identified risks and shortfalls in
compliance relating to Solihull
Hospital ED are specifically
addressed in action plans for
improvements.
Urgent Care Improvement Programme Workstream 1
December update: Risk presented by Governance
lead to risk forum on 11th December. 1. Safe
sustainability of the MIU service at Solihull
Hospital – score 15 -ENP anxiety has reduced
slightly with only limited and manageable
vacancies present with current staff having
benefited from official MIU
status/advertisement.GP cover 5 days with
phased 7/7 working from 2016. Review of
incidents planed for January with an improved
picture anticipated. Lead /Group agreed to
review risk score once the review of incidents has
been completed and UCC development is clarified.
2. Compromise to care of Critically Ill Children at
Solihull A&E – score 12 - Further comms exercise
to parents in January advising . Incident audit due
in January. Refresher training in paediatric
advanced life support for staff providing the GP
service is being provided by Trusts advanced life
support trainers. As a new quality ans safety
initiative , resuscitation and anaesthetic staff at
SOH carry bleeps to advise them immediately of
any sick child that may require their specialist
support / medical input to stablise prior to
transfer. This is also transmitted to the on call
ED/MIU consultant who will attend in and out of
hours , when required. New concerns are around
the Paediatric ENP who is leaving in Feb and the
challenges to recruitment . UCC " on hold" .
Agreement with WMAS to ensure appropriate 999
transfers is currently working well and operating
as planned.
November 2015
Ben Richards
RG/CH/SQ
IIP Board
Action Plan
Under review - to
be clarified when
further information
is known re UCC at
SH
A
Solihull Division
SHOULD DO
The trust should ensure that locum
doctors in the ED have the expertise Urgent Care Improvement Programme Workstream 1
that they need at hand at all times
including overnight, to manage any Doctor Rotas - ED
patient condition that may present.
1) The Trust will review its rota trustwide consider the adoption of further night cover
being undertaken by current substantive
Locum doctors.
2) The Trust will undertake a workstream
reviewing a "blended front door approach",
increasing the support of specialty doctors
within busy ED's to give patients timely and
appropriate access to specialty doctors
promoting better decision making, movement
of patients to appropriate specialty areas and
discharge where appropriate.
3) As aprt of the workstream specialties will
submit plans of how they will support the ED
Directorate.
November update: GP now in place 7 days per
week thereby restricting locum usage to OOH
periods allowing use of more experienced locum
drs. A business case for the use of this service as a
substantive basis has been submitted by the
Directorate and approved. Discussions ongoing
surrounding management of the service.
December update: 1. Expansion of the GP in MIU
service has enabled a small core group of locum
doctors to provide consistent rota cover during
the night time shifts. This has reduced the
requirement for ad hoc and unknown locums ,
improving quality and safety in the department.
Rotas are developed 8 weeks in advance , gaps are
identified and ample opportunity is given to
requesting bank/ internal locums to fill the gaps,
On occasions where the shift cannot be filled with
a known locum ( usually short notice absence)
the locum CV is reviewed by the CD or on call
Consultant to ensure that the Doctor has the
necessary qualifications, skils and capabilities to
work in the MIU, before they are booked.
2. Ongoing development of the AEC to include
speciality input to patients attending MIU ,will
include pathways by which MIU can refer directly
to AEC.
3. Please refer to developments outlined above
with reference to sick children.
November 2015
Ben Richards
Ragu
RG/CH/SQ
IIP Board
Rota in place
Work stream evidence
Specialty plans
Dec-15
A/G
Maternity
Regulated
Activity/Must
Do/Should Do
Regulation 17
(2(b)(f)): Good
Governance
Regulation
15(1)(f):Premises
and
equipment
Regulation
18(1)(2)(a)
:Staffing
CQC Finding
Lack of robust incident reporting and
feedback which could result in learning
opportunities lost
Operational
Lead
Current Measures in place
Updates on progress
• Lessons are fed back in a variety of forums
including:
- Labour Ward Forum
- Women’s Health Governance Committee
- Women’s Risk and audit committee
- Perinatal Mortality Meetings
Safety Briefs at handovers
- Women’s and Children’s Quality and Safety
Committee
- HoM Meeting
- Consultant meetings
- Band 7 meetings
- Obstetric training day
- 8B Lead Midwife for Governance in place and
also a lead Obstetrician with a governance
team in place supporting her.
- Team Stepps supporting the directorate in
safety improvement projects
- Circulation of Newsletter Matty chat
- SUI at a glance
1) A Quality Safety Review will be undertaken at
Birmingham Heartlands Hospital - an element of
this will be focused on incident reporting /learning
2) Evidence of Safety Briefs is to be captured
across BHH and GHH
3) The Maternity Newletter will be revised to
make the content more safety focused capturing
lessons learnt
4) The Structure of the Womens Governance
Team will be revaluated including the reevaluation of job roles and responsibilities
strengthening local governance systems.
5) Unit Meetings will be set up on each site. A
structured aganda incorperating learning from
incidents will be implemented.
6) Training sessions will be delivered around DOC
and learning from incidents.
TOR devised for safety review BHH. Safety
Reviews Commenced - Timescale for
completion to be determined.
Safety Briefs underway and evidenced.
Newsletter has got evidence of learning
currently but is under review - New
newsletter anticipated deadline of December.
Katherine Barber
Unit Meetings in place - Governance lead to
Clinical Director
review if minutes are being recorded.
Joy Payne HoM
Presentation prepared - sessions underway
Shalini Patni
(4/6 seesions already delievered)
Lead Obstetrician for
Governance
November update: Actions above all
Janet Pollard Lead
underway and are ongoing. Systems and
Midwife Governance
processes in place. Two new consultant
and Quality
midwives recently in post to embed
Liz Howland Lead
processes.
Obstetrician GHH Site
Equipment Folders in place - however these
Lack of equipment and faulty equipment were not accessible to clinical staff and
not being replaced in a timely fashion.
knowledge of these folders by clinical staff
were poor.
Nursing staffing was insufficient in places
having a direct
Risk identified on the risk register.
impact on patients. For instance not
Business cases previously submitted for
being able to staff
increased staffing requirements.
the second obstetrics theatre in
maternity.
1) Equipment logs will be maintained by ward
managers/ matrons in each designated area
2) A review of compliance with locally held ward
equipment logs will be undertaken by the
Associate Head of Nursing for Midwifery and
Childrens Services.
3) Accountability in relation to equipment will be
discussed at the away days, band 7 meetings and
unit meeting.
4) Accountability for equipment will also be
included in the monthly newsletter for September.
5) Spot checks of compliancee with expected
standards will be undertaken by the Matrons.
6) Spot checks of equipmeny in clinical areas will
be undertaken by the matrons.
7) Quarterly report of equipment compliance will
be presented at the Womens Health Committee.
1) Staffing requirements will be rescoped in
conjunction with Dr E Walker Consultant
Anaesthetist.
2) Risk assessment to be reviewed on risk register
3) A Gap Anaylsis paperwill be undertaken to
outline the risks and identify the gap between
current staffing levels and recommended staffing
levels with and the shortfall will form the basis of
a businss case for additional staffing
4) The trust will review and approve the required
funding and resource.
5) Training and competency based assessment will
be provided to midwives and maternity support
workers on scrub technique and circulating
practitioner duties.
Exec
Lead
Meetings in place
monthly so on
going in practice
SF
Folders in place.
Spot checks to ensure folders accessible and
up to date are in place.
Spot checks of equipment are to be instigated
and evidenced. Quarterly reports continue to
be embedded as common practice by all
sites.
November update: spot checks underway,
quarterly reports ongoing, list of equipment
needed collected and this will be used to
compile a priority list of equipment to be
purchased. Problems with CERC under
discussion. Maternity investigating own store
of equipment. New BP machines being
delivered by 20/11/15. Equipment folders in
place and in use.
Joy Payne/Tracey
Nash
A business case has been developed and
been taken to Executive Management Board.
The risk assessments for both sites have
been updated and the risk score of 16 agreed
at the Divisional Quality and Safety Group.
Katherine Barber
The risk has been presented at the Trust Risk Clinical Director AND
Joy Payne Head of
Forum. Pending approval on the business
Midwifery
case.
Programme of training has commenced. it is
Janet Pollard
anticipated that this will be an elongated
Lead Midwife
process due to the requirement to backfill
Governance and Quality
staff in order to enable training.
November update: Business case is going
through the trust processes, currently at
executive level. CSS division are supporting
the staffing standards. Programme of
training midwives is ongoing in the
meantime.
November 2015
Katy Hogan
Monitored by Evidence Req
SF
Safety Briefs
Matrons via
governance July
2015
Women's Health
Governance
Committee
Meeting
Minutes
Agendas
Example of revised
news letter.
Evidence of Quality
safety Review
Evidence of
Governance Team
Review, Evidence of
training sessions.
Safety Briefs and
sign in sheets.TOR
for Safety Review
Random Spot check
by Operational
Deputy
Tracey Nash and
Matrons
Minutes of WHG
Committee
Spot Audit
Documentation and
Action Plans
Timescale
RAG
Nov-15
A/G.
Nov-15
A/G.
Dependent on
Business Case
approval
A
Women’s Health
Governance
committee
SF
Women’s and
Children’s Quality
and Safety
Committee
Women’s and
Children’s Divisional
Board
Scoping Exercise Risk
Assessment
Committee and Board
papers Business Case
TNA
Training and
competency package.
Maternity
Katherine Barber
Clinical Director AND
Joy Payne Head of
Midwifery
MUST DO
The trust must provide sufficient staff to
operate the second obstetrics theatre at
night, and prevent delays occurring.
Janet Pollard
Lead Midwife
Governance and Quality
See above line 5
Women’s Health
Governance
committee
SF
Women’s and
Children’s Quality
and Safety
Committee
Scoping Exercise Risk
Assessment
Committee and Board
papers Business Case
Dependent on
Business Case
A
Nov-15
A/G.
Dec-15
A
Women’s and
Children’s Divisional
Katy Hogan
Maternity: Site
Matrons
Maggie Coleman
Lorna Foster
MUST DO
The trust must replace or repair essential
equipment in a timely manner.
The trust should review the number of
SHOULD DO (BHH)syringe drivers and blood pressure cuffs to
meet the needs of women in maternity.
See above line 4
Maternity: Ward managers and Matrons should
ensure equipment logs are maintained and
monitored in each ward delivery suite or
community team.
Equipment should be purchased on an annual
rolling programme or as required.
Equipment library in use
The Associate Head of Nursing and Midwifery,
Women's Services is in the process of actioning
compliance with that there are equipment logs in
each clinical area.
Compliance will be monitored through the
Women's Health Governance Committee
Meeting
Accountability in relation to equipment is
discussed at the away days, band 7 meetings and
1) Please review actions accordingly in respect to
unit meeting. In addition, this will be included in
management of equipment (Regulation
the September Maternity Newsletter
15(1)(f):Premises and
November update: spot checks underway,
equipment)
quarterly reports ongoing, list of equipment
2) Priority list of equipment purchases will be compiled needed collected and this will be used to compile
3) Equipment will be purchased
a priority list of equipment to be purchased.
Problems with CERC under discussion. Maternity
investigating own store of equipment. New BP
machines being delivered by 20/11/15.
Equipment folders in place and in use.
November 2015
Joy Payne/Tracey Nash
SF
JP/PL
SF
Women's Health
Random Spot check
Governance
by Operational Deputy
Committee Meeting
Tracey Nash
Minutes of WHG
Committee Spot
Audit Documentation
and Action Plans
Womans Health
Governance
Committee
Audits Annual
equipment logs
Clinical Support Services
Regulated
Activity/Must
Do/Should Do
Regulation 17
(2(b)(f)): Good
Governance
CQC Finding
Patients waiting over 30
minutes in recovery
Operational
Lead
Exec
Lead
Monitored
by
Evidence Req
November update: BHH Site: head nurses receiving daily reports on the patients waiting over 15 minutes in recovery
Theatre matron and associate head nurse are working together to minimise delays as there are improvements to be
made on both sides.
It is discussed regularly with the surgical SWSs
Bleeps have been ordered for each ward to have, once received and programmed an automatic bleep will be sent to
the appropriate ward informing them that their patient has arrived in recovery therefore giving them approx 1/2 hour
advance notice of the patient being ready to return.
An escalation process has been developed for recovery to follow should they encounter barriers to returning the
patient(s).
Safer patient placement to be There are some situations where the delays will not be easily prevented - for example when a patient is sent to theatre
BHH site- Louise
extended to surgery.
with no clearly identified receiving ward/when the patient has different surgery to that planned which requires a
Everett
Louise Everitt Associate Head different exit location (eg planned for DSU or HDU, but due to a change in procedure requires a ward bed).
GHH site - Emma
Nurse BHH and Debra Jones
Harthill
Theatre Matron to lead.
November update for GHH site: head Nurse receiving daily updates regarding delays for Patients waiting over 15
minutes in Recovery . AHN , Matrons and Ward Mangers for Surgery / T/O working closely together to monitor ,
minimise delays and make improvements .
0800 – Surgical / TO meeting held on ward 17 daily with SWS , Matrons and Surgical Bed Coordinator to discuss daily
Theatre list / Trauma List and Bed Capacity issues .
Surgical Coordinator aware of who is the point of Contact for each ward and who in Recovery is Charge so there is a
single point of contact between areas .
Initiative to be started at Bed Meetings is to highlight any delays in Recovery ,
There are situations where delays as BHH describes which not easily be prevented .
Recovery delays are discussed at 1-1 s with Matron by AHN for planned care .
AC/SF
See updates
section
Recovery breach data
in TMIS
Updates on progress
November 2015
Timescale RAG
Ongoing
A/G
Title: Finance Report to 30 November 2015
Attachments:
From: Interim Director of Finance
To: Board of Directors (6 Jan 2016)
Decision N
Discussion
Y
Assurance Y
Endorsement N
The Board is being asked to:
Receive the Finance Report for the period ending 30 November 2015.
Key points/Summary:




The Trust has reported an I&E deficit of (£5.4m) in Month 8 leading to a year to date
deficit of (£45.9m) which is (£38.5m) above plan.
The current forecast year end deficit is between (£53.0m) and (£64.0m) dependent
upon the delivery of recovery actions and other upside / downside movements.
The cash balance is £50.3m at 30 November 2015.
The Financial Sustainability Risk Rating has fallen to 1.
Recommendation(s):


Receive the contents of this report.
Note the range anticipated for the reforecast year end trajectories for 2015/16.
Y
Y
Resource/Assurance
Y
Disclosure
N/A
N
N/A
None
0
BOARD OF DIRECTORS
FINANCE REPORT FOR THE PERIOD ENDING 30 NOVEMBER 2015
PRESENTED BY THE INTERIM DIRECTOR OF FINANCE
1. Introduction
This report covers the first eight months of the 2015/16 financial year (1 April
2015 to 30 November 2015). The report summarises the Trust’s year to date
financial performance and includes information on healthcare activity,
expenditure variances and Cost Improvement Programme (CIP) delivery.
During the planning for the 2015/16 financial year, using the information
available at the time, it was anticipated that the underlying financial position
would be a (£9.9m) deficit and this was submitted to Monitor on 31 March
2015, in line with the national timetable.
In June 2015 (backdated to the start of the financial year), the CCG
commissioners imposed a change from the Jointly Managed Risk Agreement
(JMRA) to Payment by Results (PbR) on the Trust. No change to the Monitor
plan was anticipated or submitted as a result of this change whilst it did
introduce additional risk including marginal rates for a number of areas of
growth. The impact of this change to PbR is currently being reassessed.
Year to date, the Trust is reporting a deficit of (£45.9m), an adverse variance
of (£38.5m) against the plan at this point in the year. The adverse variance is
partially driven by Medical staffing (£10.0m) and Nursing staffing (£7.7m) with
a number of different reasons behind the expenditure including Quality
Initiatives, growth in activity/capacity constraints and premium rate cover.
Other key drivers of the adverse variance are the use of the Private Sector
(£3.2m) and slippage against CIP delivery (£19.1m) which includes both
current and prior year targets.
The process of recovery has started to deliver small improvements in the
monthly financial position but further work is required to identify robust and
recurrent plans which will reduce the deficit further. Currently the year end
forecast is expected to be within the range of (£53.0m) deficit as a best case
and (£64.0m) deficit as a worst case.
2. Income & Expenditure
Year to Date Summary
The Trust’s year to date income and expenditure position as at the end
of November is a (£45.9m) deficit against a plan of (£7.4m), an adverse
variance of (£38.5m).
Table 1 below details the actual income and expenditure deficit
compared to the planned trajectory produced at the start of the year.
Table 1: I&E - Actual vs Plan
2015/16 I&E - Actual vs Plan
0.0
(5.0)
(10.0)
(15.0)
(20.0)
£m's
2.1
(25.0)
(30.0)
(35.0)
(40.0)
(45.0)
(50.0)
Apr
May
Jun
Jul
Aug
Sep
Cumulative Planned Trajectory
Oct
Nov
Dec
Jan
Feb
Cumulative Actual
Table 2 below summarises the Trust’s income and expenditure position
at the end of November with analysis of expenditure in section 2.3 and
operating revenue in section 2.6 below.
Mar
Table 2: YTD Income and Expenditure Plan vs Actual
YTD Plan YTD Actual Variance
Nov
Nov
£m
£m
£m
424.6
433.2
8.5
(415.7)
(463.4)
(47.7)
8.9
(30.3)
(39.1)
(11.5)
(11.4)
0.1
0.2
0.1
(0.0)
(0.2)
(0.2)
0.0
(4.6)
(4.0)
0.5
(0.0)
0.0
0.0
(7.2)
(45.7)
(38.5)
(0.2)
(0.1)
0.0
Operating Revenue
Operating Expenses
EBITDA
Depreciation
Interest Receivable
Interest Payable
PDC Dividend
Other Finance Costs
Surplus/(Deficit)
Gain/(Loss) on Asset Disposal
Total Surplus/(Deficit)
(45.9)
(38.5)
Monthly Run Rate
The monthly deficit from the start of the financial year is demonstrated
in table 3 below.
Table 3: Deficit by Month Compared to Plan
I&E Deficit versus Monitor Plan
1,000,000
0
(1,000,000)
(2,000,000)
£'s
2.2
(7.4)
(3,000,000)
(4,000,000)
(5,000,000)
(6,000,000)
(7,000,000)
(8,000,000)
Apr-15
May-15
Jun-15
Jul-15
Aug-15
I&E Actual Deficit
Sep-15
Oct-15
Nov-15
Dec-15
Jan-16
Feb-16
Mar-16
Monitor Plan
The Trust has been delivered an average monthly deficit of (£5.7m) for
the year to date against a planned average monthly deficit of (£0.9m).
Although there has been an improvement since the recovery
programme commenced in September, the deficit during November
was (£0.9m) above the prior month due primarily to lower NHS clinical
income in the period.
2.2.1 Ernst & Young Recovery Support
As part of the recovery process, EY has been commissioned to provide
two 6 week programmes. The first was to support the Trust in
developing and implementing a short term recovery plan.
This process has aided in the identification of recovery actions totalling
a best case delivery of £20.4m in the 2015/16 financial year broadly
split as follows:





Nursing Medics Income schemes Reduction of Private Sector Usage Other Non-Pay Other Pay -
£5.4m
£2.4m
£4.4m
£1.1m
£5.7m
£1.4m
Table 4 below details the anticipated trajectory with the delivery and
implementation of rectification and recovery plans.
Table 4: Improvement Trajectory
Forecast Trajectories as at End of October 2015
(40.0)
(45.0)
(50.0)
£m's
(55.0)
(60.0)
(65.0)
(70.0)
(75.0)
Oct-15
Cumulative Do Nothing Forecast
Nov-15
Dec-15
Cumulative Worst Case Forecast
Jan-16
Feb-16
Cumulative Likely Case Forecast
Mar-16
Cumulative Best Case Forecast
The second 6 week programme, currently in progress and due to run
until early Jan 2016, involves quantifying the underlying recurrent
baseline deficit position (following these recovery actions) moving into
2016/17 financial year, improving financial controls and starting to look
at longer term productivity and efficiency opportunities.
2.3
Expenditure Analysis
The adverse expenditure variance of (£47.1m) against plan can be
broken down as detailed in table 5 below.
Table 5: Breakdown of Variance Against Plan
YTD Plan
Nov
£m
PAY
Medical Staff
Nursing
Scientific & Technical
Other
Total Pay
NON PAY
Drugs
Clinical Supplies & Services
Unidentified CIP
Private Sector Usage
Other
Total Non Pay
GRAND TOTAL
YTD Actual Variance
Nov
£m
£m
75.1
106.9
38.3
55.3
275.6
85.1
114.6
39.4
54.6
293.7
(10.0)
(7.7)
(1.1)
0.7
(18.0)
45.6
42.6
(19.1)
4.2
83.1
156.3
432.0
44.4
46.0
0.0
7.4
87.5
185.4
479.0
1.2
(3.4)
(19.1)
(3.2)
(4.5)
(29.0)
(47.1)
The main areas of pay and non-pay variance are explored further in
sections 2.4 and 2.5 below.
2.4
Pay Analysis
The drivers behind the pay variance are predominantly Medical and
Nursing staffing.
2.4.1 Medical Staffing
Table 6 below details the average monthly expenditure in the first
seven months of the year compared to the month 8 period expenditure.
Table 6: Change in Average Medical Expenditure
Consultant
Consultant Total
Non Consultant
Agency
Locum
Substantive
Agency
Locum
Substantive
Non Consultant Total
WLI's
WLI's
WLI's Total
Grand Total
Average Monthly
Expenditure
Expenditure in Change
Months 1-7
Month 8
£000's
£000's
£000's
541.2
498.3
42.9
291.7
204.8
87.0
4,765.0
4,874.0 (108.9)
5,597.9
5,577.0
21.0
744.4
655.7
88.7
384.2
395.0
(10.9)
3,541.8
3,727.2 (185.4)
4,670.4
4,777.9 (107.5)
370.1
257.1
113.0
370.1
257.1
113.0
10,638.4
10,612.0
26.4
It is clear that the recovery plans for medical expenditure are taking
some time to gain traction. However, the following actions should
result in improvements in future months:



The phased removal of a number of unfunded posts between
October and December.
Introduction of Confirm and Challenge meetings where the use
of locum cover is evaluated on a shift by shift basis starting in
early December.
A change in the authorisation process for use of external
locums.
Review of medical efficiency and productivity prioritising areas of
concerns.
2.4.2 Nursing
Table 7 below details the average monthly expenditure on nursing
compared to the month 8 period expenditure.
Table 7: Change in Average Nursing Expenditure
Qualified
Qualified Total
Unqualified
Agency
Bank
Substantive
Agency
Bank
Substantive
Unqualified Total
Grand Total
Average Monthly
Expenditure
Expenditure in
Months 1-7
Month 8
£000's
£000's
850.1
1,044.0
1,080.6
711.1
9,783.4
9,856.3
11,714.2
11,611.5
55.9
9.1
436.3
326.7
2,142.2
2,194.4
2,634.5
2,530.2
14,348.6
14,141.7
Change
£000's
(193.9)
369.5
(72.9)
102.7
46.8
109.7
(52.2)
104.3
207.0
The nursing position is showing some improvement, despite additional
unfunded beds being opened, as a result of the following initiatives
being implemented in the latter part of the year:






2.5
Substantive recruitment to posts previously covered by
temporary staff.
Weekly Confirm and Challenge meetings.
Reconfiguration of wards at GHH to allow the cohorting of
patients suitable for discharge.
Introduction of dementia and delirium outreach team at Solihull.
Removal of enhanced bank rates.
Removal of use of off-framework agencies eg. Thornbury.
Some take up of frontline shifts by CNS and Faculty nurses.
Non Pay Expenditure
2.5.1 CIP Delivery
Table 8 below details the breakdown of the undelivered CIP target.
Table 8: Breakdown of Unidentified CIP
Unachieved CIP 2015/16
Cash Releasing Run Rate Reductions 2015/16
Unachieved CIP Prior Years
Grand Total
Mth 8 In Month
£m
0.8
(0.3)
(1.4)
(0.8)
Mth 8 YTD
£m
(5.0)
(2.8)
(11.3)
(19.1)
The month 8 position shows an over-recovery of £0.8m against target
for the 2015/16 programme largely as a result of back-dated income
over-performance. However the prior year targets are contributing a
(£1.4m) deficit per month to the position.
The CIP delivery and year end forecast will be analysed further in
section 3 below.
2.5.2 Clinical Supplies and Services
The deficit on clinical supplies is largely driven by increased activity
levels.
2.5.3 Private Sector Usage
The early part of the financial year has seen the use of the private
sector in order to support the Trust’s performance against Referral to
Treatment Targets.
The Trust is now ahead of trajectory to achieve 18 weeks by March
2016 and so the use of the private sector has largely stopped. The
referrals to the private sector have been reducing on a weekly basis
and now average around 5 cases per week.
This should deliver an improved financial position in future months
whilst monitoring continues to ensure the reduction in usage does not
adversely affect the waiting lists.
2.6
Income Analysis
2.6.1 Total Operating Income
Total operating income is £8.5m above plan at the end of November as
shown in table 9 below.
Table 9 – Income against Plan
Clinical - NHS
Clinical - Non NHS
Other
TOTAL
YTD Plan
Nov
£m
(381.1)
(6.8)
(36.7)
(424.6)
YTD Actual YTD Variance
Nov
£m
£m
(391.3)
10.3
(6.7)
(0.2)
(35.1)
(1.6)
(433.2)
8.5
NHS Clinical Income currently indicates over-performance of £10.3m
year to date, however, it should be noted that contract payment
challenges have been received from commissioners totalling circa
£10.5m to the end of September. Although the Trust disputes the
majority of these a bad debt provision has been made where
appropriate.
The over-performance on other income is predominantly from the NHS
Lease Car Scheme and Sale of Goods and Services.
2.6.2 NHS Clinical Income/Activity - Inpatients
Table 10.1 below details the monthly admitted patient care (APC)
spells against target to the end of November.
Table 10.1: Trust Inpatient Activity
Admitted Patient Care 2015/16 - Actual vs Target (PbR)
8,000
7,500
Spells
7,000
6,500
6,000
5,500
5,000
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Month
Emergency Spells - Actual
Emergency Spells - Target
Daycase & Elective Spells - Actual
Daycase & Elective Spells - Target
The in-month activity position reflects an increased level of demand for
Emergency pathways. There was an increase in the number of
patients being seen in A&E of 4.0% compared to plan which has
converted into a 3.9% increase in emergency inpatients and an 11.3%
increase in assessment activity.
Year to Date A&E activity is 0.2% above plan, contributing to a 0.5%
increase in emergency inpatient but a (3.4%) reduction in assessment
activity against plan.
The in-month planned inpatient activity was 11.6% above plan and
2.4% above the year to date plan.
2.6.3 NHS Clinical Income/Activity – Outpatients
Table 10.2 below details the monthly outpatient attendances compared
to target to the end of November.
Table 10.2: Trust Outpatient Activity
Outpatients 2015/16 - Actual vs Target
78,000
76,000
74,000
Attendances
72,000
70,000
68,000
66,000
64,000
62,000
60,000
58,000
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Month
Outpatient Attendances - Actual
Outpatient Attendances - Target
The Outpatient activity in month is 7.3% above plan which brings the
year to date performance to 0.3% above plan.
The main areas of over-performance in Outpatients in month are
Paediatrics (691 attendances, 38.6%), Respiratory Medicine (477
attendances, 27.4%) and ENT (681 attendances, 25.4%).
Main areas of over-performance year to date against plan are
Endoscopy (2,344 attendances, 13.2%), ENT (2,470 attendances,
10.9%) and Respiratory Medicine (1,541 attendances, 10.5%).
2.6.4 2016/17 Commissioning Intentions
The LDP process for 2016/17 has begun with the Trust submitting a
letter highlighting proposed counting and coding changes. An initial
response has been received from commissioners and the detailed
negotiations will commence in January.
3. Cost Improvement Programmes
The Trust’s 2015/16 financial plan includes a total efficiency savings target of
£24.0m. Against an equal 12ths year to date target of £16m, the Trust has
delivered £11.0m (68.7%). Of this year to date delivery (£3.6m) is nonrecurrent for which recurrent alternatives need to be identified going into
2016/17.
Mar
The delivery in the period of November shows over-performance against
target of £0.8m predominantly due to some back-dated activity overperformance. The current year end forecast delivery is expected to be
£19.1m, 79.8% of the target.
The delivery by Division is detailed in table 11 below.
Table 11: CIP Delivery by Division
Division
Heartlands Hospital
Corporate Directorate
Clinical Support Services
Trustwide Education Services
Facilities
Good Hope Hospital
Solihull Hospital
Womens & Childrens
GRAND TOTAL
November - In Month
Year to Date
Target
Actual Actual Non Variance Target
Actual Actual Non
£000's Recurrent Recurrent £000's £000's Recurrent Recurrent
£000's
£000's
£000's
£000's
623.8
249.7
91.4 (282.7) 4,990.0
1,793.3
1,521.4
117.3
54.8
0.0
(62.5) 938.0
463.0
0.0
436.5
465.7
1,112.4 1,141.7 3,491.7
1,248.3
1,498.1
7.8
7.8
0.0
0.0
62.0
62.0
0.0
116.7
118.9
2.1
4.3
933.3
897.1
16.7
183.3
117.2
0.0
(66.1) 1,466.7
678.5
5.9
289.8
238.4
62.2
10.8 2,318.3
1,654.3
446.6
225.0
288.7
28.1
91.8 1,800.0
580.3
125.9
2,000.0
1,541.2
1,296.2
837.4 16,000.0
7,376.8
3,614.5
Year End Forecast
Variance
Annual
Forecast Variance
£000's Target £000's Actual
£000's
£000's
(1,675.3)
7,485.0
5,030.0 (2,455.0)
(475.0)
1,407.0
735.8 (671.2)
(745.3)
5,237.5
5,906.9
669.4
0.0
93.0
93.0
0.0
(19.6)
1,400.0
1,397.8
(2.2)
(782.4)
2,200.0
1,542.1 (657.9)
(217.4)
3,477.5
3,394.8
(82.7)
(1,093.8)
2,700.0
1,044.6 (1,655.4)
(5,008.8)
24,000.0
19,145.0 (4,855.0)
Quality Impact Assessments have been completed, and signed off by
Divisional Associate Medical Directors and Head Nurses, for 360 schemes
with 97 currently overdue.
Corporate QIA’s have been reviewed and are now with Execs for final sign off.
This is expected by the end of December. The overall percentage of QIA’s
complete has reduced from previous months following the addition of new
schemes.
4. Statement of Financial Position
The Statement of Financial Position (Balance Sheet) shows the value of the
Trust’s assets and liabilities. The upper part of the statement shows the net
assets after deducting short and long term liabilities with the lower part
identifying sources of finance. Table 12 below summarises the Trust’s
Statement of Financial Position as at 30 November 2015.
Table 12: Statement of Financial Position
Audited
Mar-15
£m
Non Current Assets:
Property, Plant and Equipment
Intangible Assets
Trade and Other Receivables
Other Assets
Total Non Current Assets
Current Assets:
Inventories
Other Financial Assets
Other Current Assets
Cash
Total Current Assets
Current Liabilities:
Trade and Other Payables
Borrowings
Provisions
Tax Payable
Other Liabilities
Total Current Liabilities
Non Current Liabilities:
Borrowings
Provisions
Other Liabilities
Total Non Current Liabilities
TOTAL ASSETS EMPLOYED
Financed by:
Public Dividend Capital
Income and Expenditure Reserve
Donated Asset Reserve
Revaluation Reserve
Merger Reserve
TOTAL TAXPAYERS EQUITY
Actual
Nov-15
£m
Plan
Nov-15
£m
Annual Plan
Mar-16
£m
245.3
3.6
1.1
4.2
254.2
248.0
3.7
1.4
4.1
257.3
239.7
11.8
1.1
4.0
256.6
266.4
12.9
1.1
4.0
284.4
8.5
23.5
0.0
8.5
87.7
128.2
10.6
30.0
0.0
16.6
50.3
107.6
8.5
19.9
0.0
8.5
71.9
108.8
8.5
21.9
0.0
8.5
49.1
88.0
(73.7)
(0.5)
(8.7)
0.0
(6.5)
(89.4)
(102.2)
(0.5)
(7.6)
0.0
(7.8)
(118.1)
(67.6)
(0.5)
(7.7)
0.0
(7.6)
(83.3)
(79.1)
(0.5)
(7.0)
0.0
(6.5)
(93.1)
(4.0)
(6.7)
0.0
(10.7)
282.3
(3.8)
(6.5)
0.0
(10.3)
236.4
(3.7)
(6.7)
0.0
(10.4)
271.6
(3.5)
(6.7)
0.0
(10.3)
269.1
215.3
19.4
(0.2)
47.7
0.0
282.3
215.3
(25.3)
(0.2)
46.6
0.0
236.4
215.3
13.2
(0.2)
43.3
0.0
271.6
215.3
11.8
(0.2)
42.1
0.0
269.1
5. Capital Expenditure (Non-Current Assets)
The approved capital plan for the 2015/16 year is £50.4m which includes
£20.4m of schemes brought forwards from 2014/15.
The expenditure in November 2015 was £0.8m, to take it to £14.0m year to
date which is underspent against plan by £3.0m but is on track against
forecast. The variance is explained by a £2.5m underspend on ICT schemes
and a £0.6m underspend on site strategy schemes.
The capital forecast was revised at the October Capital Planning Group to
£21.4m and subsequently to £19.5m on 9 November.
6. Current Assets
The Trust’s total current assets (excluding cash and inventories) amount to
£46.7m at 30 November 2015, (£18.2m) higher than plan.
Table 13: Analysis of Current Assets (excluding Inventories and Cash)
YTD Actual
YTD Forecast
November 2015 November 2015
£m
£m
39.1
26.0
(11.2)
(8.4)
2.1
2.4
30.0
19.9
3.4
2.5
3.4
2.5
13.2
6.0
13.2
6.0
Trade Receivables
Bad Debt Provision
Other Receivables
Accrued Income
Other Financial Assets
Prepayments
Other Current Assets
TOTAL
46.7
28.4
Analysis of the age profile of Trade Receivables (unpaid invoices issued by
the Trust) is summarised in table 14 below.
Table 14: Aged Debt Analysis
Aged Trade and Other Receivables for Nov 2015
40%
35%
% of Debt
30%
25%
20%
15%
10%
5%
0%
0-30
30-60
60-365
1 Year+
Of the over 30 day debt, there are 3 debts in the region or in excess of £1m:

Burton Hospitals Foundation Trust (£1.7m > 30 days, £2.0m total) –
this has increased by £0.1m as new maternity pathway invoices was
issued. There have been no payments since July. There is still £1.5m


outstanding in respect of maternity pathways debt, including £0.9m in
respect of 2013/14 activity, for which Burton refuse to pay.
Sandwell and West Birmingham Trust (£0.9m > 30 days, £1.2m total) –
this has increased by £0.1m in month. The majority of this debt
(£1.1m) is for maternity pathways which have been escalated
alongside other maternity debt. Other recharges for £0.1m are being
chased by the debtor’s team and additional information has been
provided so payment is expected to be made by mid-January.
University Hospitals Birmingham (£1.1m > 30 days, £1.1m total) – the
majority (£0.8m) is due to maxillofacial services with a further (£0.2m)
being for ministry of defence HIV services. These accounts are under
review with an expectation that the queries can be resolved within the
next month.
The Trust transactions team is working with Ernst and Young to implement
new debtors chasing policies which include the following;




Chasing actions to make sure debt is paid on its due date (this has
already been in place for mandate payments for 12 Months)
Chasing all debts over a set value that are over 30 days
Sending letter from the FD to all larger debts
Employing additional credit controllers for a short period of time to
chase outstanding debt.
7. Cash Flow
7.1
Current Position
The cash balance at the end of November 2015 was £50.3m, an
increase of £3.7m in month. The variance to plan is (£21.6m) which is a
£3.3m improvement on the October variance of (£24.9m). This
improvement against plan variance is due to the working capital
measures that have been put in place including the following;



Only paying creditors when they have chased and not before the
payment date.
An improved collection rate on debtors.
Weekly production of a rolling cashflow forecast based on known
factors.
As a result of the rate of payment to suppliers being slowed,
performance against the Better Payment Practice Code target of 90%
will not be hit in 2015/16, with October and November’s performance
being 64% and 61.9% respectively.
It is important to note that whilst working capital measures have been
taken to improve the cash position in the short term, the ongoing
reduction in cash will only slow if the recovery/rectification plans take
effect and the income and expenditure deficit reduces.
7.2
Forecast Year End Cash Balance
The graph below shows the impact on cash over the rest of the
financial year of delivering the best, likely and worst case forecasts as
at 7 December 2015 with a capital forecast of £19.5m.
Table 15: Cashflow Forecast
Month End Cash Flow Forecast
60.0
50.3
50.0
50.3
£m's
40.0
37.0
36.8
30.8
34.7
33.5
30.0
26.3
23.0
20.0
15.1
10.0
0.0
End Nov 15
27 Nov Rolling Forecast
End Dec 15
End Jan 16
Best Case Forecast
End Feb 16
Likely Case Forecast
End Mar 16
Worst Case Forecast
8. Monitor Financial Sustainability Risk Rating
Monitor has replaced the previous Continuity of Services Risk Rating with a
new Financial Sustainability Risk Rating (FSRR) from August 2015. The four
criteria evaluated, the weighting placed on each of them and the scoring
rationale is detailed in table 16 below.
Table 16: Scoring Mechanism for FSRR
FSRR
Metric
Capital Service Cover
Liquidity
I&E Margin
I&E Margin Variance
Weight
25%
25%
25%
25%
4
2.50
0.0
1%
0%
3
1.75
(7.0)
0%
(1%)
2
1.25
(14.0)
(1%)
(2%)
1
<1.25
<(14.0)
<(1%)
<(2%)
The Trust planned to achieve an FSRR of 2 as at both month 8 and the year
end. However due to the large income and expenditure deficit, three of the
four criteria are rated as 1 bringing the actual FSRR at month 8 down to a
weighted average of 1.
The fourth criteria Liquidity is now rated as a 2, down from 3 in September,
with the continued deterioration in the Trust’s net current liability position.
9. Conclusion
The Trust is declaring an overall deficit of (£45.9m) for the first eight months
(April – November) of the 2015/16 financial year, representing a (£38.5m)
adverse variance against the Monitor plan of (£7.4m) deficit.
The Trust’s cash balance as at 30 November 2015 is £50.3m which is
(£21.6m) below the planned cash balance at this point in the year.
Work on rectification plans continues with the yearend forecast income and
expenditure position expected to be between (£53.0m) deficit as best case
and (£64.0m) as worst case. As plans become more robust it is anticipated
that this range can be reduced.
10. Recommendations

Receive the contents of this report.

Note the range anticipated for the reforecast year end trajectories for
2015/16.
Julian Miller
Interim Director of Finance
21 December 2015
Title: Board Structures
From: Chair and Company Secretary
Decision Y
Discussion
Y
Attachments:
To: Board
Assurance
N
Endorsement
N
Consider and, if thought appropriate, approve changes to Board structures, including
disestablishment of certain assurance committees and revising the membership of
remaining committees.
Key points/Summary:


The interim Chair and interim Chief Executive have reviewed the Trust’s Board
structures and believe that they should be streamlined to improve efficiency.
The authority to make the changes contemplated rests with the Board.
Recommendation(s):
The Board is recommended to approve the proposed changes.
N
N
Resource/Assurance
N
Disclosure
N/A
N
N/A
Which other Committees has this paper been to? (e.g. F&PC, QRC, etc.)
None
2
BOARD OF DIRECTORS
BOARD STRUCTURES
1. BACKGROUND
The interim Chair and interim Chief Executive have reviewed the Trust’s Board
structures and believe that they should be streamlined to improve efficiency and
accountability. This is supported by and subject to the simultaneous review of
operational structures that is also being brought to the Board.
Given concerns about performance and governance, it is appropriate at this time
to maintain direct sight of key operational and performance issues at Board level
and to reserve to the Board the issues currently contained within the terms of
reference for the related committees.
The expectation is that the new operational structures will deliver a clearer and
more robust accountability framework that will enable the Directors to receive
assurance at Board meetings in relation to the majority of operational matters.
It is therefore recommended that the following Board committees are
disestablished with immediate effect:




Finance & Performance Committee
Information Management & Technology Committee
Research Committee
Workforce Committee
The Chair will review the annual cycle of Board business to ensure that statutory
responsibilities are fulfilled and key issues and decisions are appropriately
brought to the Board and bring the Board Business Plan 2016/17 to the Board for
approval in March 2016.
The role of the Quality Committee will be re-focussed, so that, rather than the
Board delegating its responsibility for clinical quality to that Committee, the role of
the Committee becomes one of supporting and providing continuity for the Board
in relation to its responsibility for ensuring that the care provided by the Trust is of
an appropriate quality. It is intended that this Committee will meet on a bimonthly basis. The members of this Committee will be all of the Non-Executive
Directors, including the Chair, the Chief Executive, the Medical Director, the Chief
Nurse and the Director of Operations. Other officers of the Trust, including other
members of the Executive Team, may be invited to attend the Committee as and
when required.
It is further recommended that the Appointments Committee is amalgamated into
the Nominations Committee, the membership of which will be all of the NonExecutive Directors, including the Chair, and the Chief Executive (save when the
matters before the Committee concern the Chief Executive). The revised terms
of reference are attached and recommended for approval.
There are no immediate plans to disestablish the following Board Committees:



Audit Committee
Donated Funds Committee
The membership of these committees is proposed to be revised as per the
attached schedule with immediate effect.
The Board will undertake a review of these new arrangements in six months.
The authority to make the changes contemplated rests with the Board.
2. RECOMMENDATION
The Board is recommended to approve the proposed changes as described
above.
Rt Hon Jacqui Smith
Chair
Kevin Smith
Company Secretary
Board Committees – Membership proposal – January 2016
Audit Committee
Chair
Alison Lord
Donated Funds Committee
Chair
Paul Hensel
NEDs
Andy Edwards
Jon Glasby
Karen Kneller
David Lock
Jammi Rao
ED & Senior Mgr support
Andrew Catto/ Clive Ryder
Sam Foster/ Alison Fuller
Julian Miller/ Angeline Jones
NEDs
Angeline Jones
Jacqui Smith
Kevin Smith
Governor
Albert Fletcher
Chair
NEDs
Jacqui Smith
Nominations Committee
Chair
Jacqui Smith
Quality Committee
Chair
Jacqui Smith
Remuneration Committee
Chair
Jacqui Smith
David Lock
Alison Lord
Jammi Rao
EDs (and Senior Mgr
support)
Sam Foster/ Alison Fuller
Julian Miller
Julie Moore
NEDs
Andy Edwards
Jon Glasby
Karen Kneller
David Lock
Alison Lord
Jammi Rao
EDs
Julie Moore
NEDs
Andy Edwards
Jon Glasby
Karen Kneller
David Lock
Alison Lord
Jammi Rao
EDs
Jonathan Brotherton
Andrew Catto
Sam Foster
Julie Moore
NEDs
Andy Edwards
Jon Glasby
Karen Kneller
David Lock
Alison Lord
Jammi Rao
ED support
Hazel Gunter
Julie Moore
NOMINATIONS COMMITTEE
TERMS OF REFERENCE
(Approved by the Board on 3 6 January 20126)
All powers and authorities exercisable by the Board, together with any delegation of
such powers or authorities to any committee or individual, are subject to any
limitations imposed by the Constitution or by Monitor or by the National Health
Service Act 2006. Due regard will also be had to any Code of Governance issued
from time to time by Monitor.
Any reference to “Director” shall be to formally appointed directors of the Trust
Board and, unless otherwise specified, not to personnel who carry the word
“Director” as part of their title.
1.
2.
MEMBERSHIP
1.1
Members of the Committee shall be appointed by the Board and shall be
made up of at least three members. At least one third of the membership
shall be independentcomprise all of the Non-Executive Director(s), including
the Chair, together with the Chief Executive, except that the Chief Executive
shall not participate in any matters relating to her/ his own role.
1.2
The Chairman of the Board and the Chief Executive shall be members of the
Committee. An independent non-executive director shall be the third member.
1.32
Only members of the Committee have the right to attend Committee
meetings. However, other individuals, including external advisers, may be
invited to attend for all or part of any meeting, as and when appropriate.
1.43
The Board shall appoint the Committee Chairman who should be either the
Chairman of the Board or an independent Non-Executive Director. In the
absence of the Committee Chairman or a deputy nominated by the Chairman
and appointed by the Board (who shall also be an independent Non Executive
Director), the remaining members present shall elect one of their number to
chair the meeting. The Chairman of the Board shall not chair the Committee
when it is dealing with the matter of succession to the chairmanship.
SECRETARY
2.1
The Company Secretary shall be Secretary to the Committee and shall attend
all meetings and provide appropriate support to the Chairman and Committee
members.
2.2
The Secretary's duties will include:
2.2.1 agreement of the agenda with the Chairman, collation and circulation
of papers;
2.2.2 minuting the proceedings and resolutions of all meetings of the
Committee including recording the names of those present and in
attendance. Minutes shall be circulated promptly to all members of
the Committee;
2.2.3 keeping a record of matters arising and issues to be carried forward;
and
2.2.4
3.
QUORUM
3.1
4.
6.
The Committee shall meet at least twice a year and at such other times as
the Chairman of the Committee shall require.
NOTICE OF MEETINGS
5.1
Meetings of the Committee shall be summoned by the Secretary of the
Committee at the request of the Chairman of the Committee.
5.2
Unless otherwise agreed, notice of each meeting confirming the venue, time
and date together with an agenda of items to be discussed, shall be
forwarded to each member of the Committee and any other person required
to attend no later than 5 working days before the date of the meeting.
Supporting papers shall be sent to Committee members and to other
attendees as appropriate, at the same time.
ANNUAL GENERAL MEETING
6.1
7.
The quorum necessary for the transaction of business shall be three, onetwo
of whom must be an independent Non-Executive Directors. A duly convened
meeting of the Committee at which a quorum is present shall be competent to
exercise all or any of the authorities, powers and discretions vested in or
exercisable by the Committee.
FREQUENCY OF MEETINGS
4.1
5.
advising the Committee on pertinent areas.
The Chairman of the Committee shall attend the Annual General Meeting
prepared to respond to any questions on the Committee's activities.
DUTIES
7.1
The Committee shall:
7.1.1 regularly review the structure, size and composition (including the
skills, knowledge and experience) required of the Board compared to
its current position and make recommendations with regard to any
changes;
7.1.2 give full consideration to succession planning for Directors, taking into
account the challenges and opportunities facing the Trust, and what
skills and expertise are needed on the Board in the future;
7.1.3 keep under review the leadership needs of the organisation, both
executive and non-executive, with a view to ensuring the continued
ability of the Trust to compete effectively in the marketplace; and
7.1.4 keep up to date and fully informed about strategic issues and
commercial changes affecting the Trust and the market in which it
operates;
7.2
The Committee shall also be responsible to a Committee of the Board
comprising the Chairman, the Chief Executive and all Non-Executive
Directors for:
7.3
7.2.1
identifying, shortlisting, interviewing and recommending for approval
candidates to fill Executive Director (whether voting or non -voting)
vacancies as and when they arise;
7.2.2
recommending for approval the reappointment of any Executive
Director who becomes subject to the periodic reappointment cycle
having due regard to their performance and ability to continue to
contribute to the Board in the light of knowledge, skills and experience
required; and
7.2.3
any matters relating to the continuation in office of any Executive
Director at any time including the suspension or termination of service
of an Executive Director as an employee of the Trust subject to the
provision of the law and their service contract.
The Committee shall also make recommendations to the Council of
Governors concerning:
7.3.1 formulating plans for succession for Non-Executive Directors;
7.3.2 the appointment of any Non-Executive Director;
7.3.3 the re-appointment of any Non-Executive Director at the conclusion of
their specified term of office having given due regard to their
performance and ability to continue to contribute to the Board in the
light of the knowledge, skills and experience required; and
7.3.4 any matters relating to the continuation in office of any Non-Executive
Director at any time including the suspension or termination of any
Non-Executive Director.
7.4
8.
9.
REPORTING RESPONSIBILITIES
8.1
The Committee Chairman shall report formally to the Board on its
proceedings after each meeting on all matters within its duties and
responsibilities.
8.2
The Committee shall make whatever recommendations it deems appropriate
on any area within its remit where action or improvement is needed.
8.3
The Committee shall make a statement in the Annual Report about its
activities.
OTHER MATTERS
9.1
10.
The Committee shall also make recommendations to the Board concerning
membership of the Audit and Remuneration Committees, in consultation with
the Chair of those Committees.
The Committee shall, at least once a year, review its own performance and
Terms of Reference to ensure it is operating at maximum effectiveness and
recommend any changes it considers necessary to the Board for approval.
AUTHORITY
10.1
The Committee is authorised to seek any information it requires from any
employee of the Trust in order to perform its duties.
10.2
The Committee is authorised to obtain, at the Trust's expense, outside legal
or other professional advice on any matters within its Terms of Reference.
Attachments:
Title: BOARD ASSURANCE FRAMEWORK
From: Sam Foster
Assurance Y
Decision N
Discussion
Y
Endorsement Y
1
Review the revised BAF and identify any gaps in controls and assurance.
Key points/Summary:





The existing BAF has been revised by the relevant leads and is attached
Risks have been mapped to the relevant strategic priority
The BAF continues to be work in progress and further work is underway to ensure
that the corporate risk register is integrated further to ensure that operational risks
are recorded on the strategic risk register, where appropriate specifically for the
risks that have been raised by the CEO/Chair to both Board members and Monitor.
Once this revised process is fully established, it will also be cross checked with the
performance report to ensure that all risks are captured on the relevant Executive
risk register
There are currently 3 red risks, 5 Amber risks and 1 Yellow (8) risk
Recommendation(s):
Review the revised BAF and identify any gaps in controls and assurance.
Y
Resource/Assurance
N
N
Disclosure
N
None
DRAFT
Heart of England NHS Foundation Trust
Board Assurance Framework 2015/16
Dec-15
Safe, Caring & Compassionate, Empowering and Effective
DRAFT
Heart of England NHS Foundation Trust - Board Assurance Framework - Summary (Q3-2015/16)
QUALITY - Setting out our future clinical strategy through clinical leadership in partnership with whole
system working to achieve continuous improvement in the quality of patient care that we provide
Current
Assurance
Level
Failure to have in place a sustainable governance infrastructure for all divisions, set against the Trust's quality and
safety strategy and assurance frameworks.
12
Failure to deliver access standards owing to rising volume of routine secondary care work, delayed TOC, rising
ED attendances, gaps in community provision, lack of impact from better care fund and rapidly rising two week
wait
16
Breach of terms of Monitor Provide Licence /Material non-compliance with external regulators -with particular
reference to capacity, finance and CQC inspection follow up action plan.
16
WORKFORCE - We will be a great place to work with a highly-engaged, motivated and skilled workforce
who are supported to deliver high-quality care
Current
Assurance
Level
Failure to have in place the leadership skills and capacity at all levels to deliver new ways of working and
appropriate ways of leading
12
Failure to maintain staff engagement
8
Inability to recruit sufficient numbers of appropriately skilled,trained and competent staff due to reduced workforce
availability.
9
INTEGRATION - We aim to provide care as close to home as possible and patients will see a
coordinated seamless approach to their care
Current
Assurance
Level
Failure to deliver an agreed vision within the Birmingham economy to deliver a fully integrated health and social
care service
12
Inability to deliver the infrastructure metrics, workforce, information system, financial modelling and payment
methods are not in place or sufficiently well-understood to deliver the programme of change
12
AFFORDABILITY - We will make the best use of every pound, developing services for the long term.
Quality will be the key driver to affordability
Significant deterioration in the Trust's underlying financial position resulting in the inability to deliver the Financial
Recovery Plan against insufficient income.
Current
Assurance
Level
20
DRAFT
Note: for Q2 as this is the first report in the new format a trajectory has not been included
This assurance framework assesses the most important risks that the Trust faces and which have the highest potential
for external impact. These risks differ in magnitude and complexity to operational (day-to-day) risks and typically require
comprehensive risk mitigation plans which span a longer time than most operational risks. The Trust defines strategic
risk as a strategic control issue that could close down a service(s):1. Seriously prejudice or threaten the achievement of one or more of our strategic objectives.
2. Threaten the safety of service users.
3. Threaten the reputation of the Trust / the NHS.
4. Lead to significant financial imbalance and / or the need to seek additional funding to achieve resolution and / or
result in significant diversion of resources.
Strategic risk will be reviewed as part of the Trust’s annual business planning cycle and, if required, as identified during
the year. The risks are managed to minimise the potential impact and / or likelihood of the risk occurring. The purpose
of the BAF is to provide assurance to the Board of Directors that strategic risks are being fully and effectively identified,
managed, mitigated and reported with clear ownership and accountability within the organisation.
A risk score is attributed to each risk based on scores for impact (the effect the risk occurring would have on the
organisation) and likelihood (of the risk occurring). Successful mitigating actions should lead to a reduction in one or
both of these scores. The Trust uses the following matrix for scoring its risks.
DRAFT
Quarter 3 Board Assurance Framework Report
Objective
What is the Trust's objective?
1. CLINICAL QUALITY
Setting out our future clinical strategy through
clinical leadership in partnership with whole
system working to achieve continuous
improvement in the quality of patient care that
we provide
Risk
Principal Risk
ID
Risk Describe the risk which threatens the
Ref achievement of the objective
1.1
Failure to have in place a sustainable
governance infrastructure for all divisions, set
against the Trust's quality and safety strategy
and assurance frameworks.
Risk Owner Key Controls
Individual What existing controls and processes that are in place to manage
ultimately the risk
accountable
for managing
the risk
CN
Good Governance Institute Review
Key roles & responsibilities at Divisional and Directorate level
triumvirates
Divisional Committee structure
Monthly Performance Framework reporting through to divisional
review
Trust Board reporting
Sources of Assurance
Where can we gain evidence that
our controls/systems on which we
are placing reliance are effective
CQC Action Plan
Board reports
Minutes of Groups and Committees
aligned to Divisions and corporate
accountability
Current Assurance
Level
RAG
Rating
Target Score Gaps in Assurance/Control
Target RAG Where we are failing to pull
Rating post
controls/systems in place. Where we are
mitigation plan failing in making them effective
Current governance systems not fully
mature within Directorates and Divisions
to ensure the delivery robust clinical
governance.
12
6
No clear route of escalation for risk from
ward to Board
Demand and capacity group involving all divisions and corporate
services.
DoP
Trust Board Report.
Performance against national target
and waiting list size through
Forecast activity for 2015/16.
performance reports to divisional
meetings, exec meeting and Board of
Identified bed and theatre requirements overseen by business case Directors
review group.
16
9
16
9
No transformational programme in place
that is aligned to strategic objectives /
projected activity in terms of efficiency /
productivity / redesign
Activity, income and performance reviews
2. WORKFORCE
We will be a great place to work with a highlyengaged, motivated and skilled workforce who
are supported to deliver high-quality care
Breach of terms of Monitor Provide
Licence /Material non-compliance with
1.3
external regulators -with particular
4.1
reference to capacity, finance and CQC
inspection follow up action plan.
CoSec
Failure to have in place the leadership
2.1 skills and capacity at all levels to deliver
the organisational objectives
DoW
2.2 Failure to maintain staff engagement
2.3
Inability to recruit sufficient numbers of
appropriately skilled,trained and
competent staff due to reduced workforce
availability.
IIP and other regulatory frameworks. Monitor update
Timescale
What further action (if any) is necessary to address the
gap? Dates/notes on slippage or controls assurance
failing
Work force review of corporate governance services to
wrap round Directorates and strengthen the resilience and
capacity of the local governance arrangements.
To implement Executive-led risk group to ensure ward to
Board accountability
Divisional restructure
Feb-16
Sustained clinical engagement
Available information flow and analysis for
monitoring
Capacity demand modelling undertaken to right size capacity.
Winter plan
Failure to deliver access standards owing
to rising volume of routine secondary care
work, delayed TOC, rising ED
1.2
attendances, gaps in community provision,
lack of impact from better care fund and
rapidly rising two week wait referrals.
Actions/Planned Updates
EMB, Trust Board and PMO - CQC
action plan
Mature governance systems and
processes
Divisions working to implement the capacity
requirements as identified via BCRG.
Alternative / collaborative (community) models of care for
ward based capacity
Divisional activity monitoring through range of forums.
Aligned to Quarterly reviews of activity and growth. All
plans presented to Exec Team.
Activity and capacity plan for 2016/17 to be presented
early February as year 1 of 5 sustainable plan (all as
16/17 Monitor planning guidance)
Transformation plan will be derived from this in response
to the capacity / financial requirement
On-going
Review of governance framework as described in 1.1 and
4.1
On-going
Trajectory to reduce datix backlog
DoW
Managed through the new executive team meetings currently and
Weekly Execs
Trust Board. Structures including accountability currently being
worked on and will be implemented early 2016. Good Governance
Minutes of and reports to Trust Board
Institute commenced work with the Board.
Quarterly engagement scores.
National staff survey results.
Communications with staff via range of communications from Chief
Executive
Extensive recruitment activity has resulted in circa 160 nurses
joining the Trust in October and December 2015. Pastoral support
is in place to support and improve attraction and retention
DoW
12
6
Leadership programmes for senior leaders
Discussions to be held with the new CEO aligned to the
in the organisation have not been
financial envelope.
identified.
8
6
Sustained defined Staff Engagement
programme
9
6
Sustaining an affordable integrated quality
To continue to evaluate the current workforce position set
workforce within the current financial
against the Trust corporate objectives.
envelope set against clinical activity
12
6
Fully agreed vision at Executive level with
reference to short-term winter plan and
medium-term priorities
Jan-16
Staff Engagement Steering
Committee
Reports to Trust Board
Teambrief events have been set across each main site
plus the Chest Clinic, Lyndon Place and a number of
community locations, delivered by the CEO. These will be
held each month from January 2016
Jan-16
Weekly and monthly monitoring of
recruitment trajectories.
Weekly monitoring via Finance
Medical Efficiency Programme incorporating medical vacancies and
Recovery Board
job planning
Dec-15
Trust Board
Discussions taking place between HEFT and partners including the
GP Federations, East and North Birmingham
3. INTEGRATION
We aim to provide care as close to home as
possible and patients will see a coordinated
seamless approach to their care
Failure to deliver an agreed vision within
3.1 the Birmingham economy to deliver a fully
integrated health and social care service
DOP
Service model discussions with UHB and City and Sandwell
The clinical model discussed and clarification sought with
Birmingham Community Healthcare using a shared approach to
post-acute care
Integrated Care and Social Services
(ICASS)Programme management
structure
Trust Board
EMB
Systems Resilience Group
To monitor discussions through existing Governance
arrangements
Direct discussion with CEOs
Jan-16
DRAFT
Inability to deliver the infrastructure
metrics, workforce, information system,
3.2 financial modelling and payment methods
4.1 are not in place or sufficiently wellunderstood to deliver the programme of
change
Solihull Vanguard Project to address the issues relating to the
infrastructure
Gaining full assurance that BCF is fit for
purpose
Trust Board
DOP
Plans to roll this model out into Birmingham economy once
recognised
12
6
ICASS Systems Resilience Group
Sustained collaborative working with the
CCGs
To continue to strengthen the programme and change
management capacity within the financial envelope and
work collaboratively with key stakeholders
Jan-16
Additional resource provided to support the programme
Trustwide rapid cost reduction programme
Controls reviewed and updated
4. AFFORDABILITY
We will make the best use of every pound,
developing services for the long term. Quality will
be the key driver to affordability.
Expenditure across the Trust has
significantly exceeded the income received
leading to a rapid deterioration in the
Trusts cash position. Despite the financial
4.1 recovery plan there is likely to be a
requirement for ongoing central financial
support in early 2016/17. This may reduce
the Trusts ability to determine its own use
of resources
Financial Recovery Programme established
Availability and transparency of financial
information
Directorate accountability through
divisional monitoring
Unidentified savings within 2015/16 cost
improvement programme
Financial Recovery Tracking
Framework
Financial Recovery Framework agreed and issued internally
DoF
External support with plan (Ernst&Young) now in place
Short term Financial Recovery Plan agreed by the Board of
Directors and Monitor
Longer term Financial Recovery Plan to be developed and
submitted by 11 April 2016
Financial Recovery Programme
Board
20
12
Widespread communications strategy
Fully-implemented job planning (Demand
& Capacity)
Divisional recovery meetings
Clarification of staff terms and conditions
Weekly Ernst&Young report
Maximise transition to PBR (getting paid
for the activities performed)
Monthly finance report to the Board
of Directors
Understanding of financial baseline /
robustness of financial plan for 2015/16
Support from Ernst Young
Cash and capital expenditure review
Trustwide finance communications plan
Endoscopy 7-day working consultation
Nursing efficiency programme
Medical efficiency programme (focus on locums & job planning)
Workforce redesign
Trustwide activity and income entitlement project
(counting and coding)
SLR programme being tested and rolled out
Ongoing
Title: Annual Safeguarding Report
Attachments: 2
From: Sam Foster Chief Nurse
To: Trust Board
Decision N
Discussion
Y
Assurance Y
Endorsement Y
Note the activity of the Children’s’ Safeguarding Boards across Birmingham, Solihull and
Staffordshire – and be assured that The Trust is satisfied that it has the internal and
partnership processes in place to monitor the effectiveness of safeguarding arrangements
within the organisation and can identify areas of strength and areas for further
development during 2015-16.
Key points/Summary:
 Heart of England NHS Trust sees and treats over 132, 000 UNDER 16’s.
 The Trust has an established Specialist Safeguarding Team reporting to the
Executive Lead for Safeguarding (Chief Nurse) and internal governance processes
to oversee the effectiveness of safeguarding arrangements within the Trust.
 The Trust reviews the compliance with CQC safeguarding regulations and Section
11 quarterly
 There is external scrutiny of the safeguarding arrangements within the Trust
through the CCGs, LSCBs, the CQC and monitor.
 The Trust has completed a capacity review of Specialist Safeguarding Resource in
view of growing demands and new ways of working (including Multi-agency
Safeguarding Hubs).
Recommendation(s):
For the Board to receive the Annual report and to receive assurances on current position
and proposed activity of the safeguarding team.
N
Y
Resource/Assurance
N
Disclosure
nil
N
n/a
Which Committees has this paper been to? (E.g. F&PC, QC, etc.)External
safeguarding boards, Internal safeguarding committees,
Partner Agency Annual Safeguarding Report 2014/15
To the Local Safeguarding Children’s Board
To provide assurance and to contribute to the LSCB Annual Report Evaluating the
Effectiveness of Safeguarding arrangements in Birmingham, Solihull and
Staffordshire.
Partner Agency: Heart of England NHS Foundation Trust
Report Author: Maria Kilcoyne
1
Executive Summary
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Effectiveness of safeguarding arrangements in your organisation with evidence
The Trust has an established Specialist Safeguarding Team reporting to the Executive Lead
for Safeguarding (Chief Nurse) and internal governance processes to oversee the
effectiveness of safeguarding arrangements within the Trust.
The Trust reviews the compliance with CQC safeguarding regulations and Section 11
quarterly
There is external scrutiny of the safeguarding arrangements within the Trust through the
CCGs, LSCBs, the CQC and monitor.
The Trust has completed a capacity review of Specialist Safeguarding Resource in view of
growing demands and new ways of working (including Multi-agency Safeguarding Hubs).
Progress made in improving safeguarding practice and outcomes for C&YP in
2014/15 in your organisation
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During 2014-15 the Trust has:
Expanded the scope of supervision to include the large group community midwives and
increased the amount an frequency of supervision to the health visitors
Increased compliance with the safeguarding learning and development strategy
Responded to the latest requirements in relation to Child Sexual Exploitation and developed
and commenced delivery of in house Child Sexual Exploitation (CSE) Training; a
communication strategy to promote awareness of CSE and how it may present to health
staff; arrangements to capture use of the CSE screening tool
Introduced the new multi-agency referral forms from Birmingham and Solihull and maintained
a focus on the quality of information transferred at referral
Implemented a number of audits to track the effectiveness of information sharing at points of
transition
Sought the views of families following safeguarding referrals and gained an understanding of
how they experienced this process
Tracked both good practice and learning through implementation of the ‘patient story’
template using this to highlight both good practice and areas for improvement. This has in
many cases illustrated the contribution of HEFT staff in achieving safety for children through
application of assessment and multi-agency processes.
Increased CAF initiation in maternity and health visiting services
Emerging themes and areas for improvement for your organisation in 2015/16
The Trust has identified the following areas for further improvement:
Sharing of information – particularly at transition points is an area that will feature in audit
activity in 2015-16 to ensure that the Trust can be satisfied that information sharing is reliable
and ensures that children can be safeguarded. This includes a continued and relentless
focus on the quality of information shared in multi-agency referral forms (MARFs) with further
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improvement required
The Trust will commence rotation into the Multi-agency Safeguarding Hub in 2015-16
and will aim to improve the interface between acute care and the MASH. Recruitment is
underway.
Supervision – the Trust plans to maintain compliance with supervision targets whilst
expanding provision in the Emergency
Ensuring that user experience continues to inform practice
Consistency of application of safeguarding knowledge and processes -Ensuring the
consistent application of safeguarding assessments with 16-18 year olds and for adults
presenting with problems with substances, mental health issues or domestic abuse
Early Help -The Trust will be seeking to increase use of the appropriate assessment to help
families access early help in health visiting, maternity, neonates and clinical nurse
specialisms in paediatrics
Challenges to be addressed in 2015/16 by your organisation
Completion of a capacity review and consideration of a Business Case for Safeguarding
Specialist Resource in quarter 1 2015-16
Full implementation of recommendations following the Lampard and Marsden report into the
NHS following the Investigations into Jimmy Saville
Illustrating improved consistency in the safeguarding assessment for 16-18 year old and
adult presentations suggesting parenting capacity could be compromised
Establishing a consistent and skilled response to young people at risk of child sexual
exploitation wherever they present in the organisation.
Enhancing the communication skills of practitioners when they are raising safeguarding
concerns
Maintaining momentum in the assessment of families for early help
Maintaining compliance and expanding the remit of specialist child safeguarding supervision
Expanding the voice of the child and service user in the safeguarding arena
Refreshing the understanding of key staff in relation to Right Service Right Time and
thresholds.
2
Introduction
Heart of England NHS Foundation Trust is large provider of a wide variety of child and family’s
services for residents of Birmingham, Solihull, Staffordshire and other neighbouring areas. The
Trust provides the following services to patients: Emergency Care, Maternity and Neonatal
Services, Acute Services for Adults and Children, Community Services within Solihull.
The Trust, annually, sees and treats 1.2 million people and has 250,000 attendances to the
Emergency Departments. The Trust employs approximately 10,000 staff.
Due to the geographical area covered by the Trust there are relationships with three Local
Authorities and three Safeguarding Children Boards (Birmingham, Solihull and Staffordshire).
Although it should be noted that the Trust does not sit as a formal member of the Staffordshire
Board currently.
Birmingham City Council has also been continuing its improvement journey in relation to
safeguarding children and the BSCB published it plan ‘Getting to Great’ in 2014 which highlights
3 priority areas:
•
The voice of the child
•
Early Help
•
Safe systems
Birmingham Local Authority has during 2014-15 altered arrangements at its ‘front door’ to ensure
that there is multi-agency screening of referrals, prior to decision making. This new arrangement
is part of the safe systems work stream and is known as MASH (multi-agency safeguarding hub)
and these arrangements have been replicated elsewhere in the West Midland and will be
implemented in Solihull in quarter 2 of 2015-16. The Trust will be required to commit
safeguarding specialists to both MASH arrangements and is working to increase capacity within
the Team to facilitate this.
The national agenda and media coverage in relation to child safeguarding within the NHS has
been dominated by two main issues during 2014-15: Themes from the investigations into Jimmy
Saville within the NHS and high profile exposés of system wide, inadequate responses to child
sexual exploitation. The Trust has developed responses to both issues and will continue a focus
on implementation in these areas into 2015-16.
3
Effectiveness of Safeguarding Arrangements

Section 11 ‘Duty to safeguard’
o Outcomes for your agency from BSCB S11 Peer Challenge event
The Trust has self-assessed against section 11 during 2014-15 and participated in a peer
challenge event. The Trust judged itself to be overall 85% compliant with the requirements.
In 2014-15 the main areas for HEFT development were:
 Expansion of specialist safeguarding supervision
 Increasing service user involvement and feedback in relation to safeguarding.
 Reviewing restraint
 Increasing access to information on how to stay safe for children and young people using
our services
 Increasing use of the Common Assessment Framework
The Trust is in the process of undertaking a review of Section 11 compliance with the new BSCB
tool and anticipates that this will be completed by the end of May 2015.
o
Progress on implementing actions from 2014 audit.
The table below highlights progress on implementation from the audit completed in 2014-15.
Element of the S11
audit
Expansion of specialist
safeguarding
supervision
Progress
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Increasing service user
involvement and
feedback in relation to
safeguarding
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Increasing children’s
awareness of how to
stay safe
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Reviewing recruitment
of volunteers
Early help – delivery
enhanced through use
of the CAF
Restraint
Business case completed to allow community
midwives to participate in safeguarding
supervision
Increased the frequency of provision for health
visitors from 2015-16
Evaluation of supervision undertaken in
Community Services
Patient Experience Team encouraged to get
involved with families at the point of referral
Small scale telephone survey completed with
families who have experienced safeguarding
processes
Patient stories completed
Digital patient stories incorporated into training
of frontline staff
Links between the safeguarding team/ patient
experience and complaints reviewed
Trust internal and external websites developed
with key messages for children and young
people.
Packs developed for in patients adolescents
exhibiting mental health problems or risky
behaviours
Key display areas promote how to stay safe and
the Child Line number is promoted within the
Trust
The Trust Safeguarding Team tweet and have
links to the wider Trust circulation – this allows
contact with parents regarding e-safety and the
‘Underwear Rule’.
Status
Community
midwives receive
supervision
All completed
Completed
This was reviewed and decision made for enhanced
checks on all volunteers
CAF initiation increased in Maternity and Health Visiting
Completed
Training reports received in relation to the any service
offering physical restraint. Awareness raising completed
in relation to the policy
Completed
Completed
.
o Internal assurance of our safeguarding effectiveness?
•
There is a Safeguarding Children Committee which meets bi-monthly to review progress
against all statutory and regulatory requirements
•
This group reports to the Governance and Risk Committee (a formal sub group of the
Trust Board)
•
The Trust has an annual safeguarding audit programme which tests out the effectiveness
of safeguarding arrangements in response to reviews/ incidents and this programme is
particularly focussed on information sharing at transition points in a child’s life.
•
The Trust has a robust Safeguarding Learning and Development Strategy (updated in
2014) and monitors progress in relation to compliance with the strategy on a quarterly basis.
•
Safeguarding supervision is available to staff in line with the policy and again compliance
with the framework is monitored quarterly.
•
The Trust works closely with partners in police, social care, other health organisations
and with the LSCBs and CCGs to continuously strive for best practice in relation to safeguarding.
•
The Trust monitors safeguarding children activity and quality of information shared on
referrals to Children’s Social Care
The Trust implementing recommendations from the Children’s Looked After and Safeguarding
Inspections carried out by the CQC.

Safeguarding Performance
NB: Please note that Education and Development is covered under section 6 – workforce
development
Safeguarding Children Referral Activity
The Trust has seen a year on year increase in the numbers of children referred each quarter
since 2010 as illustrated in the table below.
Average Referral rates per quarter year on year for children are:
2010-11
2011-12
2012-13
2013-14
2015-16
150
445
446
601
653
The graph below illustrates the referrals completed each quarter during 2014-15
Quality of referrals is continuously monitored with feedback provided to staff. Level 3
Safeguarding Children Training focuses on the quality of information shared at the point of
training.
Quality issues are identified most frequently with ED referrals and additional targeted training is
being delivered within that Department, commencing in May 2015.
The introduction of new referral forms by Local Authority partners has been welcomed as having
potential to improve information shared at the point of referral.
However whilst the Solihull web based tool has been easily implemented the trust has
experienced difficulties with the Birmingham MARF and is unable to send referrals electronically
due to lack of secure email in many areas. This has been raised as a risk within the organisation.
The form is not liked by ED staff who find it difficult to fill in and report issues with the ‘drop down’
sections and access to computers. However, as more referrals are being typed this has
improved legibility.
Referrals due to concerns regarding adult behaviours are monitored quarterly.
The table below reports the numbers of referrals citing adult concerns.
Acute
Services
Community
Services
Domestic Abuse
608
Substance Misuse
366
Mental Health Problems
692
24
13
19
Whilst the information in the table above demonstrates that professionals ‘think family’ and
provides some assurance of this the Trust has also conducted audits which demonstrate that
consideration of safeguarding of children is not consistent when adults present with problems.
This is an area for further development.
Referrals per Local Authority: The graph below illustrates the percentage of referrals to Local
Authorities. Overall percentage rates of referrals to Local Authorities fluctuated slightly during
2014-15 with referral rates to Birmingham Local Authority at 70 % compared to 77% in the
previous year and referrals to Solihull increasing to 24% from 17%.
Feedback from referrals
This remains a problematic area with feedback not being received in particular from Birmingham
Local Authority who have asked that we do not request it and that they will send to the individual
referring practitioners. We remain in discussion with them as individual practitioners often will not
be able to marry the outcome up with the child’s records due to their work patterns/ nature of
work and also few of our staff have secure emails to send this information to. We are continuing
discussions as we are keen that this information is sent to a central point (Safeguarding Team)
for internal dispersal and to ensure that records can be updated.
Outcome unknown increased during quarter 4 to the highest ever level as previously this has
consistently been between 20 and 30%
See table below in relation to feedback from referrals during quarter 4 2014-15.
Already
open –
passed
to SW
Section
47 &
Strategy
Meeting
Social Work
Single
Assessment
Family
Support
Signposted
for CAF
Signposted
other
Outcome
Unknown
No
further
Action
15%
5%
13%
5%
0.4%
4%
38.5%
19%
Child Sexual Exploitation
During 2014-15 the Trust commenced monitoring of the numbers of referrals made by staff due
to concerns regarding CSE.
This monitoring commenced in quarter 2 and the table below illustrates the relevant referral
activity. It should be noted that the Trust has started to deliver targeted CSE Training to key staff
groups and this commenced in Quarter 4.
Quarter
Quarter 2
Number of Referrals
related to CSE
2
CSE screening tool at the
time of the referral
0
Quarter 3
8
3
Quarter 4
17
5
Referring Department
1xCAMHS
1x Sexual Health
2 x ED
1x Maternity
1 x other
3 x Sexual Health
1 x CAMHS
3 x ED
1x HV
3 x Maternity
1 x Paediatrics
9 x Sexual Health
CAF
The Trust has also seen an increase in use of CAF to drive early help with both Maternity and
Health Visiting increasing their use of CAF during 2014-15 (maternity produced 68 CAFs and
Health Visiting 64). Staff report that they have found this work beneficial and the Trust will
continue to monitor use of CAF in these areas during 2015-16.
Supervision
The Trust has supervision in place for the highest risk areas including:
 Paediatrics
 Health Visitors
 School Nurses
 Specialist and Community Midwives
The Trust has struggled to achieve and maintain the 90% target set in relation to compliance with
the supervision policy. This is due to capacity within the specialist safeguarding workforce and
was exacerbated by some sickness.
The Trust continues to work with consultant paediatricians to tweak the format for their ‘peer
review’ to meet their needs.
For acute services the average compliance with supervision policy was 82% during 2014-15
For Community Services the average compliance with supervision policy was 86%.
The Trust has been asked to develop supervision within the ED during 2015-16.
All Named Professionals receive supervision and for Acute services 93.75% compliance was
achieved. For community services this was 87.5%
The Trust provided supervision to two groups of staff during 2014-15 that have transferred out of
the Trust for 2015-16 . These include high risk areas of sexual health services and CAMHS.
 Quality of safeguarding practice
Audit Activity in the Trust is driven by the Inspection and review processes (completed as part of
the Serious Case review Process or the Domestic Abuse Process).
Key areas of focus are ‘Think Family’, Transition and Information Sharing. The table below
provides a brief flavour of areas looked at that the results
Area of Audit
Findings
Further Action
Maternity Liaison Audit –
Some delays, found, good Introduction of electronic
transfer of information from compliance with
transfer and recording of
maternity to Health Visitor
completion of paperwork
transfer of information.
by midwives but lack of
Area for further audit in
evidence of how they were 2015-16
sent
Maternity Due Date Audit
Poor compliance (60%)
On-going live audit in place
with transfer of
with remedial action if nondocumentation relating to
compliance found.
safeguarding issues to the Workshops for new
child’s record at birth and
midwives.
to the transfer of alert to
the child’s electronic
record
Domestic Abuse routine
Improved compliance with Subject to on-going
inquiry
routine inquiry x 3
monitoring
Genogram audit in
Compliance with
Communicated to staff and
paediatrics and community genograms variable (better for further review
services
in acute than community
records).
Self-Harm Audit to look at
0-16 year olds presenting
16-18 year old assessment
safeguarding response.
with self-harm all had
paperwork updated and
Audit of 0-16 years and 16- consideration of their
18 years completed
safeguarding needs, multiagency discussion and
admission for support in
relation to self-harm
behaviours.
‘Invisible Child’ Audit
Quality of referrals
16-18 years olds often had
limited assessment of
safeguarding needs
Variable response to the
assessment of child
safeguarding needs when
adults present with mental
health problems
Variable quality, many
referrals not explicit
enough about nature of
concern.
Paediatric Audit of
stepping down in
safeguarding concern
Highlighted that there was
infrequent discussion
between ED and Paed
doctors
Audit of checks with other
hospital when children are
investigated for nonaccidental injury
100% compliance not
achieved
safeguarding assessment
enhanced.
Training planned for the
adult ED workforce who
assess 16-18 year olds
Further training and
support for staff indicated
and underway.
Messages sent to all staff.
Training in place,
mechanisms in place to
provide additional
information when required.
Improvements noted in
paediatrics and
maternity
Process changed in view
of the findings to ensure
discussion between ED
and Paediatric Consultants
when a case is stepped
down
Supervision used to
oversee this requirement.
Patient Stories
During 2014-15 the Trust has completed a number of patient stories, many highlighting good
practice including staff that had appropriately identified safeguarding issues, contributed to the
multi-agency processes and effectively ensured a safe outcome for children.
Areas for development that have arisen in relation to some patient stories are:
 Ensuring that the history of complex cases is fully explored by health visitors following the
transfer in of cases from out of area.
 Promoting the escalation process to staff when they are unhappy with threshold decisions
 Ensuring staff are confident with thresholds for intervention
 Ensuring that staff are active in pursuing information that they need shared from other
agencies.
 Reminding staff about referral responsibilities.
The patient stories have enabled us to capture and ‘celebrate’ good practice with our
staff who in many instances have been at the forefront of the identification and
articulation of concerns.
Learning from complaints and compliments
Learning from complaints and compliments during 2014-15 has consistently highlighted one
main finding and that is that communication at the time that safeguarding concerns emerge,
during and post the referral process is critical.


One family drew attention to a nurse who was identified by name who the family had said
was a ‘caring and empathic nurse who explained the safeguarding process and pathway
clearly and effectively’. The family contrasted this nurse with other professionals involved in
the process who they felt had been abrupt, uncommunicative and in some instances had
appeared judgemental.
Another family likened the fact that they had been notified of a safeguarding concern, in what
they felt was unnecessarily blunt terms, before the full assessment had been completed to
being told ‘you had cancer before all the diagnostic tests had been carried out’.
Communication was the dominant theme from safeguarding complaints and discussions are
underway about to ensure that this finding is most effectively relayed to staff (via digital patient
stories) and how staff skill in this area can be enhanced. A digital patient story is used in Level 3
training currently.
Summary of work to engage with and listen to children and young people and the learning
from this.
 The Trust commenced work this year in the form of a telephone survey to understand some
of their views of the child protection process. This work has highlighted the importance of
very clear communication throughout the process. It has really captured the views of parents
and carers rather than young people.
 The views of young people on the care they receive whilst inpatients is captured using ‘Fabio
the Frog’ and the Trust has links with school groups which enable consultation with young
people on the development of services.
 Young people make a clear contribution to the decisions made about their clinical care when
they are assessed to have capacity. Their views are also taken into account during multiagency meetings. Where adolescents have expressed strong desires about where they wish
to reside or be discharged to there are examples of where staff have advocated for them to
ensure their views are taken into account.
Number of serious incidents involving children and young people and outcomes from
reviewing them
 The Trust has reported a total of 5 significant Incidents: 2 obstetric, 2 paediatric and one
paediatric prevented never event
 Serious Incidents during to 2014-14 have led to an increased focus within the trust on the
SUDIC process as a number of SIs highlighted poor compliance with the process. This has
been refreshed with key staff in paeds/ neonates and ITU.
Findings from Internal Reviews and action taken
Internal reviews have highlighted the following learning:
 During 2014-15 the Trust has been in the process of implementing learning from a SCR
which highlighted the need for increasing staff awareness in relation to substance
misuse, domestic abuse and other risk factors, enhancing assessment tools and
documentation in the health visiting service, reviewing supervision processes for health
visitors and exploring the liaison between maternity and health visiting services.
 The Trust has completed a number reviews as part of the domestic homicide process this
year that highlighted the need for staff to adhere to self-harm pathways, the domestic
abuse policy, to ensure that adults presenting with ‘Toxic Trio’ type presentations have
consistent consideration of the safeguarding needs of any children in the family.
 All training provided during 2014-15 has been updated to ensure that relevant messages
are embedded. The audit programme reflects these key areas for further exploration.
Findings from External Inspections and Reviews and action taken
The Trust has been subject to a CLAS inspection as part of the health economy in Birmingham
during 2014-15 and has learning to implement around:
 Ensuring the safeguarding assessment of 16-18 years olds is consistent
 Consistent application of ‘Think Family’ principles
 Ensuring compliance with the assessment of safeguarding risks in paediatric Emergency
Department
 Ensuring assessment in maternity reflects social factors and routine inquiry
 Review of ED discharge information
Summary analysis of the effectiveness of safeguarding arrangements
o Strengths
 The Trust has an established specialist safeguarding team and clear arrangements in
place for governance in relation to safeguarding.
 The Trust has a workforce that are identifying children with safeguarding concerns and
can evidence they follow safeguarding processes.
 The Trust has improved the CAF initiation rates amongst midwives and health visitors
during 2014-15 and will continue to work on this in 2015-16 to drive early help to families
as soon as needs emerge.
 See section 6 below on workforce development – the Trust has a robust Education and
Development plan in place and staff report feeling confident in identifying and referring
concerns and knowing who to contact for help.
 The Trust has an audit programme annually for safeguarding which is driving some key
improvements and identifying areas for further work and audit.
Areas for improvement
 The safeguarding assessment of 16-18 year olds particularly in relation to CSE
 The consistency of assessment of safeguarding needs of children related to adults with
toxic trio type presentations
 The span of safeguarding supervision to include the ED
 The quality of referral information – particularly from the ED
 The transfer mechanism for referrals to Birmingham
 Increase and consistency in the use of the of the CSE screening tool
 Increase in the use of CAF and the initiation of early help in key services
 Documentation in the ED in relation to safeguarding assessment and whether
safeguarding alerts exist
 Communication at the point of referral and following referral is an area for development
 User involvement requires further development
Summary of lessons learnt, actions taken and impact on practice / multi-agency working /
outcomes for C&YP.
 The escalation process is being highlighted to all staff in response to learning from patient
stories and reviews. There is evidence that staff are using this with confidence to
advocate for children and young people.
 Safeguarding Supervision opportunities have been increased for health visitor, school
nurses and community midwives and effective monitoring is in place to ensure that all
staff receive this on a quarterly basis from 2015-16. This increases opportunities for
reflection and oversight of cases.
 Peer review is in place for medical staff working in paediatrics and is continuously being
reviewed to meet the needs of the doctors.
 Across the organisation there have been improvements to the information shared at
points of transition and this is focus of all audit activity to maintain an emphasis on this.
 The quality of information on referrals remains a high priority for 2015-16.
4
Responding to emerging issues
How our organisation is developing its agency contribution to early help and monitoring
the quality of input into fCAF/Integrated Support plans and Child in Need plans
I.
The Trust has incorporated the Right Service Right Time guidance into all safeguarding
training in the Trust with a particular emphasis on this in Level 3. This is in the process of
being ‘refreshed’ in line with the latest training materials from the BSCB and a delivery
plan has been developed to ensure that all relevant staff receive a face to face update in
relation to RSRT.
II.
The Trust Safeguarding Policy was amended in 2013 to reflect the requirement for staff to
support access to early help for families
III.
IV.
V.
VI.
VII.
The threshold guidance “Right Service, Right Time” – Delivering effective support for
children and families in Birmingham has been disseminated throughout the relevant
areas of the organisation.
The Trust has identified the key staff groups who will participate in fCAF, ISPs and Child
in Need Plans. The Trust has refreshed training for staff in health visiting and midwifery
services in 2014-15 and maintains monitoring processes in relation to CAF training other
key groups of staff including school nurses, neonatal, paediatric and specialist nurses.
The Trust has participated in a CQIN with the CCG during 2014-15 to encourage use of
CAF. Although the target was not achieved the health visiting and maternity services
achieved over 60% of the required CAF implementation. This is a significant shift in
maternity practice in particular.
Monitoring will continue in 2015-16.
There will be an audit of the health visiting records / intervention for a cohort of CIN cases
during 2015-16
How our agency is monitoring the quality of and outcomes from referrals to MASH
I.
The Trust Safeguarding Team review all safeguarding children referrals sent through to
partners
II.
Where additional information is required this is done as soon as possible directly to
MASH
III.
There is a mechanism to provide feedback in relation to the quality of referrals to staff.
IV.
There is core training at level 3 internally on how to complete good quality referrals ,
additional training is being targeted at specific areas identified as needing additional
support (this includes the Emergency Departments)
V.
The RSRT developed materials in relation to quality of referrals is used and disseminated
widely to support practitioners with this aspect of their work
VI.
Data is captured in relation to the quality of information shared including whether
demographic details are correct and concerns adequately explained. The Trust is looking
at aligning the quality judgement with the ones used in MASH. A report on the quality of
referrals is captured quarterly within the Safeguarding Referral Report which goes to
Safeguarding Committee
VII.
Data is captured in relation to outcomes received centrally however this continues to be a
problematic area with outcomes to a third of referrals remaining unknown.
How our organisation is embedding “Strengthening Families and the West Midlands Child
Protection Protocol” into your organisational practice
I.
Key staff have been identified and received training in relation to Strengthening Families
II.
Report templates have been made available to staff
III.
Internally supervision documentation reflects a strengthening families approach to identify
risk and protective factors.
How our agency is improving attendance at Initial child Protection case conferences, core
groups and review conferences
I.
Attendance at Case Conferences and Core Groups is a high priority for staff and
managers within the Children’s Workforce at HEFT
II.
Solihull LA share information with the Trust in relation to requests to attend so that staff
can be supported and any non –attendance in Solihull is reported so that is can be
investigated and remedied.
III.
In some instances nonattendance is linked to late invitations or poor communication and
so we are working with local authorities to improve these processes.
IV.
Birmingham is more problematic as we do not yet receive information per individual
provider but this has been requested.
5
Partnership Working




The Trust continues to work with the LSCBs and maintains over 80% attendance at LSCBS
and sub groups. The Trust contributes to a number of sub groups responsible for developing
joint working (Policy and Procedures, Education and Development, CSE Strategic Groups
and CMOGs). The Trust makes a considerable contribution in manpower to the Solihull
Training Pool.
The Trust participates in a wide variety of multi-agency reviews including reviews undertaken
as part of the serious Case review Process
The Trust staff regularly attend Strategy Meetings carried out as part of Child Protection
Investigations, MACE meetings carried out in relation to CSE and a variety of other case
specific multi-agency meetings.
The Trust is currently recruiting staff to ensure that they can participate in MASH in Solihull
and Birmingham.
6. Workforce Development

A summary of your involvement in multi-agency safeguarding training / learning and
development activity
The Trust makes a considerable contribution in manpower to the Solihull Training Pool and has a
Training Matrix clarifying the staff groups who are required to attend multi-agency training
 Single agency safeguarding training / learning and development activity
During 2014-15 the Trust updated its Learning and Development Strategy for Safeguarding and
it is compliant with both Working Together 2013 and the RCPCH competences for health care
staff issued in 2014.
Current training Figures are illustrated in the table below:
Level of Safeguarding
Total Number of Staff
Total percentage of the
Training
required to be trained at workforce trained at this
this level
level
Level 1
9736
98.55%
Level 2
6467
88.42% (93.2% of
community staff)
Level 3
1358
83.5%
PREVENT Health
9736
42.38%
Training

Level 1 safeguarding training includes identification and referral and is delivered through
a video and updated via annual leaflets and communications.
 Level 2 is delivered through face to face training and updated through a moodle package.
Level 2 training is delivered to all clinical staff at induction.
 Level 3 training is delivered via face to face sessions in house and multi-agency. Inhouse level 3 focuses on enhanced recognition and response to safeguarding and
includes multi-agency processes.
 Staff from key groups are encouraged to access multi-agency training from the selection
provided by the LSCBs. Solihull LSCBs share this information with us so that it can be
logged on our internal safeguarding training database.
 Bespoke CSE Training has been developed within the Trust and delivery commenced in
January 2015.
Training evaluations are positive in terms of the impact on the learning. See details below:
Level 2 safeguarding Children and Adults
 Total number of sessions = 151
 Total number of attendees = 2355
 Completed evaluation forms = 2094 (89%)
Responses from evaluation forms 2014-15
1400
1200
1000
800
yes
600
yes
400
part
200
No
N/A
0
what
Categories of Know how to Understanding Know what to Know what to Did you find
constitutes
abuse for
seek advice of information do - about
do - adult
the session
child and adult children and and support
sharing
child abuse
abuse
useful?
abuse
adults
Attendees are asked to record in a free text box information received that has enhanced their
understanding of safeguarding and what they will take back to the work place.
Responses are categorised in the table below
Level 3 Safeguarding Children
 Total number of sessions = 28
 Total number of attendees = 387
 Total number of completed forms = 269 (69.5%)
Responses from evaluation forms
During 2014-15 there have been 2 ‘survey monkey’ surveys and a moodle learning questionnaire
developed. Both were designed to see how confident and knowledgeable staff have felt in
relation to safeguarding.
Survey activity was small (particularly in relation to level 3) and will be repeated with larger
cohorts in 2015-16
Level 2 staff indicated some inconsistency in the understanding of ‘Think Family’ messages in
relation to identifying the needs of children where there are parental concerns and this has been
identified in other audits during the year.
The level 3 workforce results highlighted staff know where to get help within the organisation,
had confidence in speaking to families about concerns, all could make referrals and knew how to
do this although some found the process difficult and complicated and stated that they were
required to re-refer in some instances to MASH.
Safer recruitment requirements and referrals to the LADO



The Trust has a DBS and Safe recruitment Policy in place and is fully compliant with all
legislation in relation to regulated activity. DBS checks are carried out on all volunteers
working within the Trust.
The Trust carried out 4250 DBS checks on staff within the Trust between April and the
end of March 2015 as part of the 3 yearly review of DBS status. This is an on-going
process managed by HR.
Where positive DBS results are returned the Trust has a process to ensure that they are
reviewed and risk assessed by senior staff with consideration given to the implications for
their role and to the need for onward referral to professional bodies and the barring
authority.
Referrals to LADO from HEFT during 2014-15 were 9 (1 from Community Services and 8 from
Acute services)
Conclusion
The Trust is satisfied that it has the internal and partnership processes in place to monitor the
effectiveness of safeguarding arrangements within the organisation and can identify areas of
strength and areas for further development during 2015-16.
Executive Summary
Annual Report
2014 –15
Foreword
I am happy to present this Executive
Summary of the Birmingham Safeguarding
Children Board Annual Report (2014-15)
for publication. The full report which
is available on www.lscbbirmingham.
org.uk gives a full description and
robust analysis of the activity of the
Board collectively over that year.
people, their families and for the staff
working with them. The new model for
establishing how staff should respond to
need, (‘Right Services, Right Time’), and the
In April 2014 Safeguarding
we publishedHub
this (MASH)
three year Strategic Plan
Multi-Agency
Williams
Serious
Case
Review,
the Local Governmen
are both excellent examples of the changes
safeguarding
arrangements
Government
we are making as is our much enhanced Review led by Ju
Ofsted Inspection
in March
2014. It work.
meant the previous pla
performance
and quality
assurance
to a three
Strategic
Planstill
andtoan
There
is of year
course
much more
do.annual Business an
Plan
for
2014/15
included
the
action
being
We are ambitious for the city’s children. taken in respons
They deserve the best and we are central
This
revised
was
agreed
Birmingham
Safegua
to
helping
theplan
city’s
services
beby
thethe
best
in
after a review of the previous year’s performance and
the country rather than some of the worst.
commitment to driving forward a strong plan for achieving th
We need to build on the progress in 2014improvement over the next two years of the plan up to 31s
15, increase pace, and taking action that
some firm foundations and ensured that the basic requirem
is,
if necessary,
The
place.
It is now radical
time to and
buildinnovative.
on this foundation
over years tw
challenges ahead undoubtedly remain very
great.
In particular
weretain
need to
We have
agreed to
oursupport
three priorities as a Boar
the
great work
to coordinate,
elements
to theunderway
“safer systems”
priority. We will obsess co
extend
and
develop
early
help
in
the everything else – far
do. That does not mean we stop doing
City,
rapidly
improve
our
responses
more on what life is like for a single to
vulnerable child living in
Child
Exploitation
and address the
every Sexual
child’s life
for the better.
issues for children who are missing from
home,
school,
caretoand
those children
not that all professio
We must
continue
unequivocally
ensure
receiving
or accessing
and with families
knownormal
when universal
to act to safeguard the vulne
city andeducation
what to do
they are
worried about a possib
health,
or when
early years
services.
they
walk inwe
theneed
shoes
of a much
child, simpler
and see the world throug
In
addition
to find
something
might
affect the
a child for the better. W
ways
to do that
things,
different
wayslife
toofbecome
the
children
and
young
people
they
serve,
more effective on less money, to share our and for the su
child’s needs.
Wemore
musttogether
support, rather
supervise
resources
and do
than and train those
but
excellently,
based
on
what
works
and
what the evidenc
separately. Most importantly we need to not
everyone
to
account
for
how
they
do
it.
As
only build the confidence of children, younga Board, we mu
also hightheir
challenge
for our children. We wa
people,
familiesand
and aim
theirhigh
communities
support,
great
training
and
great
challenge.
that we can make them safer, we need to
ensure that those children, young people,
In two years’ time I want us all to hear children tell us tha
families and communities shape what
have made their lives better. It is our responsibility as a Bo
we do, and challenge us to do better.
how we will get to that point
Introduction
As Chair of the Board from October 2011
the report covers my fourth year in the role,
setting out the effectiveness of the Board
itself and the effectiveness of the work of
Board partners in safeguarding children
and promoting their welfare in the City.
The Report presents a positive picture of
progress over that year in most aspects of
the Board’s work. There is clear evidence
that as a result of the hard work put in by
the local authority, and all other partners
to the Board, especially the NHS (in all its
organisational forms) and West Midlands
Police, children are safer in Birmingham,
and the most vulnerable are getting a better
response. In addition there is a lot of good
work happening across the city, undertaken
by front line professionals from every
agency who are quietly ‘getting on with the
job’ and doing above and beyond what
is necessary to meet individual children’s
needs which should be recognised and
celebrated. This is imperative if the
children and young people of the city are
to get the services they deserve, achieve
their potential, remain safe and become
fully rounded and responsible adults. I
also continue to believe we owe it to the
children of the city and their families and
communities to be as open, honest and
transparent as possible about our progress,
our effectiveness and our inadequacies.
The Executive Summary covers the first
year of “Getting to Great”, the Board’s new
Strategic Plan 2014-17. We have made
steady progress across all three of our
priorities and we can see the differences
we are making for children and young
JaneHeld
Held
Jane
Independent
Chair
Independent Chair
Birmingham
Safeguarding
Children
Birmingham
Safeguarding
Children
Board Board
23rd June 2015
2015
••••
2
Introduction
This Executive Summary provides
an overview of the full Birmingham
Safeguarding Children Board Annual
Report 2014–15. The full report
is available on the Birmingham
Safeguarding Children Board (BSCB)
website ( www.lscbbirmingham.org.uk )
as are the 16 appendices that accompany
the report. This summary includes all
the key information in a shorter and
more accessible form, which allows the
people of Birmingham to easily read
about the improvements that have
taken place over the year. In addition
a two page summary for children and
young people is being developed and
will be available by the end of 2015.
Working Together (2015) requires each Local
Safeguarding Children Board to produce
and publish an Annual Report evaluating the
effectiveness of safeguarding in the local
area. The guidance states that the Annual
Report ‘should provide a rigorous and
transparent assessment of the performance
and effectiveness of local services. It should
identify areas of weakness, the causes of
those weaknesses and the action being
taken to address them as well as other
proposals for action’. The Report should:
•Recognise achievements and progress
made as well as identifying challenges
•Demonstrate the extent to which
the functions of the LSCB are
being effectively discharged
The Executive Summary focusses on the key
priorities the Board set itself in 2014, and
on the statutory objectives and functions of
the BSCB as set out in Working Together
to Safeguard Children 2015. The BSCB
is a statutory body established under the
Children Act 2004. It is independently
chaired (as required by statute) and
consists of senior representatives of all the
principle stakeholders working together
to safeguard children and young people
in the City. Its statutory objectives are to:
•Include an account of progress
made in implementing actions
from Serious Case Reviews
•Provide robust challenge to the
work of the Children’s Trust Board
This Executive Summary summarises the
progress made by Birmingham LSCB in
2014-15 through and with its partners
and analyses the effectiveness of:
• Safeguarding arrangements in the city
•Co-ordinate local work to safeguard
and promote the welfare of
children and young people
•The LSCB itself in supporting
and coordinating safeguarding
arrangements and in monitoring and
challenging those who provide them.
• To ensure the effectiveness of that work
••••
3
Context and key facts about Birmingham
Birmingham, is the largest unitary authority in Europe
with a population of 1,085,400 is one of the youngest,
with approximately 280,000 0-17 year olds (312,000
0-19). It is one of the most diverse cities in the UK
with almost 50% of the population from a Black and
Minority Ethnic (BME) community. As a major regional
city it has areas of considerable wealth and areas of
great deprivation. 47.7% of the population is under
30 (nationally this averages at 36.8%) and 32.4%
of children in the city are children living in poverty
(nationally 20.1%). The annual Birmingham child
wellbeing survey indicates that there are declining
rates of physical health in children in the city and
ongoing high levels of significant behaviour problems
and emotional ill health. About 82% of children and
young people report feeling safe at home, about
50% feel safe at school and about 45% feel safe in
their neighbourhoods. The Birmingham Child Poverty
Commission is working to understand how best to
change the pattern and the impact of poverty in the
city and is due to report in 2016
1,976 children in care and 1,251 children the subject
of a child protection plan. 93.8% of care leavers were
in suitable accommodation at the end of February
2015 and 67 out of 157 care leavers were NEET.
In terms of complexity of services in December 2014
there were:
Commissioned and funded by Birmingham City
Council, The Birmingham Commission for Children
was run by The Children’s Society. The Commission
examined what life should be like for children and
young people in Birmingham in ten years’ time and
how the city council and other organisations might
go about making their vision for Birmingham’s young
people a reality. It’s Report, “It takes a City to raise a
child” found that children and young people said
that:
The BSCB commissioned a full analysis of what life is
like for most children in the city from the Department
of Public Health in the council (“Understanding the
needs of children and young people in Birmingham”)
which provides a rich source of information about
need in the City.
In 2014-15, ethnicity, faith and diversity became a
more dominant element of the work of the Board
and of all its partners. Two major issues, one of which
(Trojan Horse as it is known) sparked significant
national and governmental attention, created
concerns about how well children and young people
from the wide and diverse range of communities in
the city were safeguarded and getting their needs
met and their wellbeing promoted.
•441 schools in the city, comprising a mix of
academies, free schools, and maintained schools.
•Of the total school population 34,088 have special
educational needs.
•There are 73 children’s centres (of three different
types)
•20 youth settings, based in areas of high levels of
multiple indices of deprivation.
•Relationships are the most important thing in the
lives of children and young people, especially
relationships with their families.
•12,618 different young people aged 11-25
received a youth service and 64% of them were
from BME backgrounds.
•Children and young people from every group,
and from every part of Birmingham, want to feel
safer in the city. They feel they lack safe, affordable
spaces and activities that allow them to be with
friends and family.
•The Youth Offending Service provided more than
8,833 programmes during the year.
•There are 3 Clinical Commissioning Groups (CCGs)
in the city with 268 GP practices, with 1,096 GPs.
•Children and young people want to have a say
in the issues that matter to them, they want their
voices to be heard and acted upon.
•There are five child development centres five
Accident and Emergency Units and nine NHS trust
hospitals.
•Children were positive about school and valued
the opportunities that education gave them.
• There are 10 BCC children’s homes in the city.
•The Board estimates that the total workforce in
daily contact with children and young people just
in the statutory sector is above 85,000.
•Young people wanted knowledge and skills that
were useful for getting a job and being a good
citizen. They valued their community and their
sense of place.
As a consequence outcomes for children and
young people are very mixed. By the end of March
2015, 2,614 16-19 year olds were not in education,
employment or training (NEET) (6.9%), there were
•Children and young people wanted a positive
story to be told about Birmingham and young
people’s achievements.
••••
4
Partnerships
The Board agreed and implemented a new three year
Strategic Plan, “Getting to Great 2014-17” in 2014.
The Board’s priorities reflected the three key issues
highlighted in previous years as most needing to be
improved. This Plan is underpinned by a strong focus
on business excellence.
The previous partnership infrastructure in relation to
Children’s Services was dismantled at the beginning
of 2014-15 and a new structure was not put back
in place to replace it. Instead of the Children’s
Trust partnership the Council led a series of multiagency topic based “think tanks” over the year. This
increased the risk of, and at times real experience
of BSCB continuing to act as a “proxy” for service
design, delivery and operational detail. That said, two
effective and focused council led programme boards,
the MASH Board and the Early Help Board, included a
range of partners and BSCB was represented on both.
In addition the multi-agency outcomes from these two
boards were reported to and signed off by BSCB in
the absence of any other “full system” body. It did,
however, lead to confusion at times.
The BSCB Strategic Priorities
•The voice of the child – central to everything
we do
• We provide early help –when problems first arise
•We run safe systems – to ensure children are
properly safeguarded
The Strategic Plan also highlights the underpinning
behaviours expected of anyone who works with
children, young people, their families and their
communities.
However, as the year progressed, Lord Warner’s views,
plus strong debate at BSCB, partially stimulated by
the Governance Review, as well as challenges from
individual partners led, by March 2015 to a clear
recognition by the Council as the lead agency, of
the need to address the problem of partnership
and governance confusion, and to develop a new
partnership landscape and architecture for the city in
relation to children and young people. This coincided
with the City Council’s decision to review all its
partnership arrangements, but by the end of March
2015 exactly how those two strands of work fitted
together was still not clear.
The Birmingham Basics
• The child comes first
• Do simple things better
• Never do nothing
• Do with, not to, others
• Have conversations, build relationships
Plans and Improvement Programmes
Partners were asked to build the Birmingham basics
into their own strategic plans and expectations. In
addition the Council drew up and implemented
two key strategic plans for improving services for
children and young people. The first, in response to
Government directions was overseen by Lord Warner
(the appointed Children’s Commissioner) and was fully
implemented by March 2015. The BSCB priorities
contributed to key elements of this improvement
plan. Following the “Trojan Horse” events, a second
External Commissioner, Sir Mike Tomlinson, was
appointed. An Education Improvement Plan was
developed and agreed and is progressing under the
External Education Commissioner’s leadership. A
third Commissioner, Bob Kerslake, reviewed and the
whole Council’s performance and a third improvement
plan, the ”Future Birmingham” has been put in
place. Finally a multi-agency Early Help Strategy
was developed and agreed by March 2014 which
will underpin the work of all partners in designing
and developing appropriate integrated early help
services. This will ensure children and young people
get support and help “early in the life of a problem”
rather than wait until they need statutory child
protection interventions.
Partnership relationships with the Community Safety
Partnership and Adult Safeguarding Board remained
informal, built on the shared agreements made in
2012-13 about which partnership body should lead
on which cross cutting issue and informed by the
increasingly close working drive through the MASH
initiative.
In 2015 the challenge for the lead agency,
Birmingham City Council, with every partner will be to
design and implement a new partnership framework
for multi-agency co-operation, co-ordination,
and commissioning of services to meet children’s
needs. This will need to also feed into the “Future
Birmingham” process.
The challenge for the Board will be to fully cease to
act as a proxy for partnership working and to create
meaningful relationships with the new models for
partnership, including the new Birmingham Education
Partnership (BEP), to inform and influence their work
and hold them to account.
••••
5
Organisational change across partnership
As well as the impact of the improvement
programmes and agendas the Council did not have a
stable permanent senior leadership team for children’s
services throughout the year. However, the impact of
this was minimised through the presence of strong
interim leaders. In addition, the City Council was not
the only organisation where there was significant
change and organisational churn. Change also
occurred to:
The whole of 2014-15 was (as was 2013-14)
characterised by substantial change, in many of
the statutory partner agencies, with the resultant
churn in staff, services and stability of practice,
and the challenges arising from such churn. Much
of what happened during the first half of the year
was imposed from outside Birmingham itself, with
significant Central Government and Inspectorate
activity taking place, often all at once. This meant
that it was extremely difficult for partners to steer a
steady course and build on the areas for improvement
identified by the council and BSCB in 2013-14, and
the additional and new requirements identified by
Ofsted in their report.
• The Probation Service and West Midlands Police.
• Heart of England NHS Foundation Trust
• Birmingham and Solihull Mental Health NHS Trust
• NHS England underwent
All of these changes had an immediate impact on the
BSCB Board in terms of changing membership. The
Board was appraised of the changes appropriately
and the impact was less challenging than it would
have been, as the governance review facilitated good
discussion about the safeguarding functions and
accountabilities of organisations through a period of
change. Organisation change and its impact remained
on the BSCB Risk Register over the whole year and
action taken to adjust the mitigation each time the
Risk Register was reviewed.
By the end of 2014-15 the City Council and its
partners were dealing with the requirements set
by Lord Warner, as the External Commissioner
for Children’s Services Improvement, Sir Mike
Tomlinson Education Commissioner, and his Deputy
Commissioner, Colin Diamond, all commissioned
by the Department For Education, and those set for
the whole of the City Council by Sir Robert Kerslake,
commissioned by the Department for Communities
and Local Government.
The effectiveness of safeguarding arrangements in Birmingham
Engagement with Children and Young People
in some limited cases had a strong impact on service
provision.
The Board’s collective work with partners in terms of
listening to, engaging with and responding to children
and young people’s views, wishes, and experiences
in 2014-15 continued to be limited. Despite this
we became increasingly aware of the range, depth
and breadth of work that was being done by
different agencies across the city. In November 2014
work commenced to map agencies methods of
engagement with children and young people. Once
this work is completed in 2015-16, it will provide
the Board with a fuller picture of the excellent work
undertaken by the city to engage children and young
people whilst providing the Board with a platform to
engage children and young people in its work.
All participant partners (all of whom are members of
BSCB as well) agreed to sign up to seven principles
for engagement with and providing services to
children, young people, and their families:
•We need to design services which respond to the
public (as opposed to public services)
•Do nothing without us (design and deliver nothing
without involving children and young people)
• Always act (never do nothing)
•Engage in an ongoing relationship (every contact
counts and every contact is an opportunity)
• Embrace technology and new methodologies
In March 2015 the City Council, working with
INLOGOV held the last of its series of “Think Tank”
events and focussed on the voice of the child, the
report of the Birmingham Commission and work
across the city. The event addressed the question
of “What is our commitment to listening to, hearing
and acting on the voices of children and young
people. Overall it was clear that during 2014-15 the
collective amount of energy going into involving
children and young people was significant, and it has
• Listen, listen, listen!
•Recognise the opportunity of the experience for
young participants (“giving back”, “belonging”
and “it’s your city”)
It would be fair to say however that the Board did not
progress its first key priority as far as it wished. The
work is continuing into 2015-16.
••••
6
The key challenge is to find ways of harnessing the
energy and activity across the city in involving children
and young people and build on that to inform,
influence and set direction for the Board, as well as to
find ways to directly engage with children and young
people in the work of the Board.
CCG and South Central CCG). Unlike Ofsted, CQC
do not provide an overall grade or judgement in
these inspections. Nor do they arrive at a general
conclusion. Good practice was observed in the
provider services and the safeguarding leadership
of the Clinical Commissioning Groups was praised.
GPs were identified as making a strong contribution
to safeguarding in the city. 42 recommendations
were made, and the report overall demonstrated that
serious consideration was given to ensuring effective
safeguarding practice by NHS Organisations across
the city.
A challenge for the City Council through the Place
Directorate is to work with children, young people,
communities and partner agencies to significantly
reduce the expressed sense of being unsafe in public
spaces articulated so strongly by the children and
young people of the city.
An aggregate report on six inspections focused on
protecting children was published by Her Majesty’s
Inspector of Probation in August 2014. The then
Staffordshire and West Midlands Probation Trust was
not inspected and the findings and recommendations
now need to be seen in the context of the
Transforming Rehabilitation (TR) agenda cumulating in
the formation of two district operations which made
up the former Probation Trust. Staffordshire West
Midlands Community Rehabilitation Company (SWM
CRC) is the provider responsible for the supervision
of low/medium risk of harm offenders, while the
National Probation Service (NPS) has responsibility
for high risk of harm offenders, MAPPA arrangements
and providing advice to Courts. The NPS and CRC
have provided assurance that the report’s four
recommendations will be taken forward within
Birmingham by providers of Probation Services.
External Inspections and Reviews
As well as implementing and addressing the
requirements of the Ofsted Single Inspection and
Review of the LSCB (http://www.ofsted.gov.uk/
inspection-reports/find-inspection-report ) published
in May 2014, we began to receive Inspection Reports
relating to all our partner agencies and monitor the
implementation of relevant recommendations by
each agency in 2014-15. This has provided a more
comprehensive understanding of practice across the
whole system and supported the identification of key
common themes and challenges.
Ofsted undertook a review of the Birmingham
Multi-Agency Safeguarding Hub (MASH). This was a
helpful review, which provided valuable advice about
areas for development and improvement (including
timeliness, delay, and the approach to domestic
violence contacts) but also praise for the strong front
door and multi-agency nature of the MASH.
West Midlands Police were subject to a safeguarding
Inspection between 2 and 13 June 2014 as part of
their new National Child Protection Inspections. The
conclusion of the Inspection Report was that “West
Midlands Police has demonstrated a commitment
to improving child protection services. The move to
build increased capability and capacity is testament
to this as is the focus on child protection within the
force’s strategic change programme. However, at the
time of the inspection, not all children at risk of harm
were sufficiently protected by West Midlands Police
and it is too soon to judge whether the changes
underway will deliver the level of improvement
required.
Ofsted also undertook a significant number of
inspections of early years providers and schools in
2014-15, particularly following the initial phase of
the period after the publication of the Trojan Horse
material, and subsequent inquiries.
The Care Quality Commission (CQC) also undertook
a range of inspections in the city in 2014-15. The
full inspection reports are available to download
at the Care Quality Commission website; http://
www.cqc.org.uk/. This included a full review of
health services for Children Looked After and
Safeguarding in Birmingham undertaken in
September and October 2014. This review included
key provider services (Heart of England NHS
Foundation Trust; Birmingham Children’s Hospital
NHS Foundation Trust; Birmingham Community
Healthcare NHS Trust; Birmingham Women’s NHS
Foundation Trust, Birmingham and Solihull Mental
Health NHS Foundation Trust; University Hospitals
Birmingham NHS Foundation Trust; Sandwell and
West Birmingham Hospitals Trust) and two of the
three CCGs in the city (Birmingham Cross City
The report covered all seven local authority areas but
much reflected the experience in Birmingham. This
report included 20 recommendations and WMP have
been proactive and energetic in addressing them. By
the end of 2014-15 the transformation programme
was beginning to show dividends although it became
very clear over the year that as the police addressed
the issues identified, and the MASH in Birmingham
began to have a major impact, the allocation of
resources to the Birmingham Safeguarding Service
was still inadequate to meet need.
••••
7
Birmingham Youth Offending Service were
informed by and involved in a thematic inspection
of resettlement led by Her Majesty’s Inspector of
Probation in July 2014 and an Ofsted Inspection of
Community Safety and Public Protection Incidents.
We have during 2014-15 been able to gain a much
better understanding of the collective views of external
regulators across the city about the strengths, areas for
development and competence of all partners in relation
to their safeguarding practice, and the way their work
improves the welfare of children and young people.
•Each agency should regularly review and monitor
progress on the implementation of the audit
action plan
•The audit findings and action plans should be
disseminated and progress monitored through
existing agency management structures that have
responsibility for safeguarding
•Agencies should ensure that all relevant
documents providing evidence of their judged
compliance with each level should be uploaded to
the online audit and management system
Partner Compliance
The learning points for BSCB are that:
Each year all the Board’s statutory partners undertake
a self-assessment of their effectiveness in terms of
how well they are safeguarding children and young
people and promoting their welfare. Known as the
Section 11 audit it is part of their responsibilities
under Section 11 of the Children Act 2004. In
Birmingham the Board asks for a copy of every
statutory partner’s audit in order to analyse the
overarching strategic, operational, practice and
workforce themes and achieve a sound understanding
of the current quality of what is happening as
well as the emerging issues for the city. The aim
of a Section 11 audit is to provide the board with
reassurance that organisations have good structures
and processes in place to safeguard children and
to provide a benchmark of current performance to
enable organisations to monitor progress and quantify
improvement in safeguarding practice for children and
young people over time.
•The learning points around action plans are the
same as the last 2 years which is a concern to the
board in that the section 11 process is not being
embedded into agencies safeguarding standards.
•BSCB needs to be assured that agencies are
completing their Section 11 Audits and are
following up on their action plans to implement
the actions they have identified to improve their
compliance with safeguarding standards
•The BSCB need to ensure that agencies have
access to the appropriate training for domestic
violence and child sexual exploitation.
In summary, whilst there has been some improvement
in the response from partner agencies on last year’s
audit, we still need to be assured that, for all partners
which have identified areas for development from the
audit have an action plan in place to resolve the areas
of concern. We also need to ensure partners provide
better evidence of progress and facilitate the sharing
of good practice identified thorough the audit process
and through the peer review.
One agency has not completed the section 11 audit
and a further three agencies have not completed
action plans this year. The action plan is key to
improving the safeguarding in agencies and as
such all agencies should have an action plan that
is being regularly reviewed and updated. The local
authority have completed four separate section 11
audits rather than of one for the whole of the local
authority. The West Midlands Ambulance Service
complete a standard section 11 for the whole of the
West Midlands and is not specific for the Birmingham.
A well received peer review event was held in
November 2014 where partners reviewed each other’s
section 11s against other agencies. This helped
agencies gain an understanding of how to apply the
grades in their agency. Further independent validating
of the section 11 audit is still required.
In addition to the Section 11 audits, Board asked
formally for each statutory partner to submit an annual
report to the Board accompanied by an assurance
letter from the Chief Executive or Chair of the
organisation for the first time in 2013-14. The quality,
consistency and depth of the returns in 2013-14
was very variable. As a consequence partners were
given a framework within which to report. This asked
organisations to report as follows:
• Executive Summary of progress over the year
• Introduction to the service
•Their evaluation of the effectiveness of their
safeguarding arrangements
Analysing the Section 11 returns overall there are a
number of key learning points to inform our work in
2015-16. The learning points for agencies include:
•Their organisational governance and arrangements
for evaluating their effectiveness
•Each agency needs to be required to submit
a detailed Action Plan to evidence how audit
findings will be taken forward
•Their safeguarding performance and arrangements
for quality assurance, audit and learning from
practice
••••
8
•A summary of the work undertaken to engage with
and listen to children and young people, and the
learning from this
The challenge for the Board in 2015 is to improve the
span of agencies driving the priorities forward, and
the consistency of their focus and “ownership” of the
issues, and to share the work across partner agencies
more effectively, reducing “silo” working.
•The number of serious incidents they had had and
the learning from them
Joint Commissioning
•The findings from internal reviews and the action
taken
Another area where the absence of clarity about
roles, responsibilities, functions and accountabilities
across partnership arrangements was important
related to joint commissioning activity and priorities
(0-25 service; drugs and alcohol services; school
nursing). Whilst an LSCB has no direct responsibility
for joint commissioning activity, a good LSCB can
influence what happens, what is a priority, and what
should change through its regular performance
reports and quality assurance activity. In 2014-15 recommissioning of relevant children’s services was led
by the joint commissioning Sub-Group of the Health
and Wellbeing Board (HWB)
•The findings from external inspections and reviews
and the action taken
•A summary analysis of the effectiveness of their
arrangements in terms of strengths, areas for
improvement, and the impact of lessons learnt on
practice
•The organisation’s response to emerging
issues and Board priorities (early help, fCAF,
integrated support plans and child in need plans;
MASH, attendance at Initial Child Protection
case conferences, core groups and reviews,
strengthening families protocol and west midlands
child protection protocol
In Birmingham for the third year running the Board
had limited direct influence and was not consulted
sufficiently well in identifying priorities or developing
new commissioning programmes. The risks were to a
degree mitigated by all the other scrutiny, challenge,
review and quality assurance activity taking place, and
by the fact that the BSCB Vice Chair was Chair of the
Children’s Joint Commissioning Sub-Group.
• Partnership working
•Training and workforce development (single and
multi-agency)
This framework broadly covered the Board’s
priorities and business plan in 2014-15. Returns were
significantly better this year with greatly improved
consistency and focus. This has allowed for a far
greater understanding of exactly what the common
themes are, where there are challenges, and how
well learning is being demonstrably used to improve
practice. In addition more returns were received with
only two who did not respond.
However, the work of the Joint Commissioning
group was in fact extremely positive over the year.
The Children’s Joint Commissioning Board oversaw
a significant amount of work on behalf of the key
partners during 2014-15. Progress was made in:
1. Early Help:
2.Services to Vulnerable Young People – especially
the 0-25 mental health service
Overall it is important to recognise that the reports
collectively provided sound evidence that in 2014-15
the Board’s priorities were recognised and were
informing individual agency practice, that key areas
of work are genuinely rolling out from the board
to the front line, that learning is being applied to
practice and compliance with requirements improving.
None of this in itself improves the safeguarding
experience in an individual case but it is clear there
is an increasingly shared understanding of what is
required, to what standard and how we can use what
we do to improve practice. The majority of reports
were analytical, open and evidenced. The returns
demonstrate significant forward progress, particularly
on compliance, process and delivering the Board
priorities. The impact of this is demonstrable through
the data in the annual performance report. It is a
positive sign of real progress and improvement.
3. Looked After Children
Joint Commissioning Priorities during 2015-16
include:
1.Early Help – implement the recommendations
contained within the Early Help strategy.
2.Safeguarding/MASH – build on the work to date
and deliver a fully functioning MASH including
ensuring CSE is part of the new arrangements and
that the HUBS are operating effectively.
3.SEND – Continue to deliver on the requirements
of the guidance in this area including the
development of a more coordinated funding
arrangement as contained within the Sect 75
agreement
••••
9
4.0 – 25 – mobilise the new service and implement
the evaluation process as planned and work
closely with other stakeholders including schools
to deliver on recent guidance to create a whole
system approach to emotional wellbeing
would make them feel safer. However, although the
findings are captured from a relatively small target
audience, they clearly reinforce the key themes
identified in the Child Wellbeing Survey 2013-14 and
forms part of the information collated to capture the
‘voice of the child’. In addition, as part of the quality
assurance process established by the Board through
the Performance and Quality Assurance Sub-Group all
audits now include at least a question or a section on
the voice of the child.
5.Work to engage the schools through the
Birmingham Education Partnership and initially
through the Ladywood Pathfinder project.
6.Children in care – reduce the numbers of children
in care and increase the proportion placed with
families in order to promote better outcomes and
deliver improved value.
How well have we done it?
The audit work on Initial child Protection conferences
(ICPC) in October identified as its main concern
that the Voice of the Child is not being heard.
Recommendations were made in the report to include
more work on the Voice of the Child in BSCB training.
All of these will assist in improving the whole
safeguarding and wider welfare system positively
The Annual Performance Report
Evaluating the child’s journey through the
safeguarding system. The Board agreed a new and
comprehensive Performance and Quality Assurance
Framework “Improving Safeguarding Standards
and Assuring the Quality of our Service Delivery in
Birmingham” in March 2014. This was refreshed in
February 2015 and updated to reflect a wider range
of datasets.
The audit identified in four out of the five cases that
the Voice of the Child was not clearly present and
that opportunities for partners other than social
workers to talk to young people were not always
taken. Another area of concern was the identification
of cultural background /ethnicity of the child and
family on the CareFirst forms including the A1
form which is the initial point at which a referral
is recorded on the system. The lack of ethnicity
here was perpetuated through other forms within
CareFirst. Consequently issues around honour based
violence, forced marriage, FGM could be missed.
The recommendations from the ICPC audit will be
followed up later in 2015, to assess progress against
the recommendations.
The Board was able to report against all three Board
priorities at each Board and Executive Meeting over
the year, although there were some changes over that
period to the key data sets and overall dashboard as
the Performance and Quality Assurance Sub-Group
improved the range contribution and depth of its
work. As a consequence the Board was able to take
a full Annual Performance Report for the first time in
four years. The annual performance report examined
each BSCB Priority in terms of our three dimensions:
‘how much are we doing?’; ‘how well are we doing
it?’; and ‘what did we learn and change as a result?’
The audits of re-referrals and child protection for
2015 also include a question/section on the voice
of the child. Currently 97% of Looked After Children
participate in their reviews.
Priority 1 – Voice of the Child
What did we learn and change as a result?
How much have we done?
The audit work on ICPC has already been
incorporated into the training provided to child
protection chairs and further work is ongoing with
them to ensure the Voice of The Child is clear in
the conference.
The Early Help Brokerage Support Team on 7 October
2014 held a youth conference called ‘Protect Yourself’.
In line with the theme of the conference the following
questions were posed: a) what makes you feel unsafe
when you’re outside in your neighbourhood or at
school, and b) What could be done to make you feel
safer. Out of the 13 key issues identified in relation
to what makes young people feel unsafe; groups
were highlighted as the highest concern (22%) with
strangers and inadequate street lighting being cited
as the next main concern (13%). In respect of what
would make young people feel safer; 33% identified
that there should be an increased Police Officer
presence on the streets before and after school, with
17% of the young people stating that more CCTV
Priority 2 – Early Help
How much have we done?
A priority action for the Board last year was to
develop a definition for Early Help and to develop an
early help strategy. The definition was approved at
the Board meeting on 13 May 2014 and the strategy
was approved on 31 March 2015. As part of the work
on early help it was agreed in the performance and
quality assurance sub-group to use the fCAf (family
••••
10
Common Assessment Framework), family support
plans and health visitor active interventions as a proxy
measure for early help. Figure 1 below shows a clear
increase in the early support work being carried out
by all agencies with fCAF and health visitors’ active
interventions. The increase in health visitor active
interventions may be as a result of the increase in the
number of health visitors which is seen in the staffing
data later this has resulted in an overall drop in
caseload for health visitors.
Figure 1
Rate of Early Help Assessments initiated
35
100
20
80
Health Visitor – active
intervention – rate of
cases opened in last
quarter per 10,000
population per month
Family support plan
rate per 10,000
population per
quarter
2014/15 Q4
2014/15 Q3
2014/15 Q2
2014/15 Q1
0
2013/14 Q4
0
2013/14 Q3
20
2013/14 Q2
5
2013/14 Q1
40
2012/13 Q4
10
2012/13 Q3
60
2012/13 Q2
15
CAF rate per 10,000
population per
quarter
Family Support Plan rate
120
2012/13 Q1
CAF and Health Visitor Active Interventionn rate
Rate of Early Help Assessments initiated
30
How well have we done it?
Birmingham has now come to the end of phase 1
of the Think Family Programme. Despite extremely
strong performance over the final year, delays at the
beginning of the programme meant that the final
target for families where outcomes have
been achieved was missed by a narrow margin (figure
2). Nevertheless entry into the expanded Troubled
Families phase 2 has been secured and DCLG is
extremely satisfied with the progress that has been
made in the city.
Figure 2
Key Targets
Actual
Target
Identified Think Family cases
7,449 families
4,180 families
Families worked with
6,200 families
4,180 families
Families where outcomes have been achieved
(families “turned around”)
3,984 families
4,180 families
Over the last three years the programme has
achieved:
A major long term national evaluation exercise is
under way covering both phases of the programme
and for which Birmingham has already supplied a
large amount of data, although findings from this
will not be available for some time. Locally there are
indications of the effectiveness of the whole family
approach, although this is an area which would
definitely benefit from further analysis. It is intended
to carry this out once more analytical capacity is
created within the Think Family Team.
– 424 families where adults have found sustained
employment
– 2,320 families where children have improved
school attendance
– 752 families where youth offending has ceased
or significantly reduced
– 844 families where anti-social behaviour has
ceased
(note families may have achieved more than one
outcome).
••••
11
Priority 3 – Safe Systems
a degree of early assurance that changes to early
help, better identification of concerns and earlier
intervention are having an impact.
Despite significant efforts to address and deal with
substance abuse in the under 18 population we are
not yet seeing a significant downturn in presentations
to hospital. This however does not mean that every
young person presenting has significant problems.
The system for identifying and supporting children
and young people who present more than once
is improving as awareness of the issues of risk and
sexual exploitation improves.
How much we do? How well do we do it?
As part of Safe systems Performance and Quality
Assurance have reviewed data from all agencies
Health Organisations and Police provided data to
assist in identifying areas of concern.
It is clear that, in line with national trends, there is
an increasing level of self- harm in the under 18
population. The changes to the 0-25 mental health
service should impact on these figures in 2015-16
onwards. However the mental health of children and
young people is an increasing concern, particularly in
our schools.
Overall the levels of crime against children has stayed
reasonably stable over the year. 60% are for child
cruelty/neglect which would suggest the majority of
offences are committed by a parent or someone in
care and control of the child. Sexual offences then
account for the vast majority of the remainder.
It is clear that there has been some reduction in
the numbers of children presenting at hospital with
unexplained or non accidental injuries which provides
Volume of CSE Reports for the West Midlands
Figure 3
200
178
280
250
142
240
142
141
125
118
120
103
95
100
84
70
200
50
10
4
20
0
17
6
13
1
24
16
16
10
23
23
9
9
19
8
12
6
6
104
90
84
71
63
56
48
40
92
62
62
42
12
7
21
10
21
11
21
15
3
4 14
5
4
4
5
5
14 -14 Y-14 -14 -14 -14 -14 T-14
13 R-13 -13 -13
-1 -13 -13 -13 -13
-1
V-1 C-1 N-1 B-1 AR-1
RR
N UL UG EP
A
A JUN JUL AUG SEP OCT NOV DEC JAN FEB
J
JU
S
FE
OC NO DE
JA
A
M
MA AP M
M
R-
AP
Volume of CSE Reports for the West Midlands
Missing Children
•The orange line in figure 3 shows the total number
of referrals with a CSE “Special Interest Marker”
force wide – the blue line shows the number for
the Birmingham LPUs.
Figure 4
Misper Age Range 01/01/2015 – 30/04/2015
95 56
•The data is over two years to show the substantial
increase in the number of referrals from May 2014
onwards when the new tools for identification and
assessment of risk of CSE were introduced.
U 12
758
1136
12-18 YRS
18-60
•Figure 4 shows a four month snapshot of missing
persons data by age and local policing unit area.
During this period 386 children under the age of
18 years were reported missing.
Over 60
Related to CSE is the issue of missing children Police
data (figure 4) shows that the majority of children and
young people reported to them as missing from home
or care in 2014-15 were between 12 and 18 years old.
A significant number were however over 18, which
is a relevant issue for adult safeguarding practice.
All these areas of concern indicate areas for increased
focus and the targeting of expertise and resources in
2015-16. More about what we were doing to address
these areas of concern are set out below.
••••
12
Identification; referral and assessment of need:
Multi-Agency Safeguarding Hub
in fewer single assessments being initiated. Whilst
performance has dipped slightly (appropriate)
reduced demand will result in improved timescales
and more importantly improved quality in working
with the family.
During 2014-15 the Birmingham Multi-Agency
Safeguarding Hub (MASH) began operating on 28
July 2014. MASH is a fully integrated and co-located
multi-agency team based in the centre of Birmingham.
The team focuses on receiving referrals for children
believed to be at risk of significant harm, including
domestic violence. MASH was agreed as the strategic
multi-agency response to reaching and meeting high
levels of unidentified risk as articulated by Ofsted, Le
Grand, Kerslake and Lord Warner.
All single assessments should be completed within
45 days. Those over 45 days are out of time, as at 31
March 2015, 223 single assessments were out of time,
this has dropped from 517 as at 4 March 2015.
A task and finish group was established in June 2014
to audit referrals into the “Front door” of children’s
social care. The audit has identified that the quality
of the referrals being made over the latter part of the
year has shown generally a consistent improvement.
The audits have been spread across a number of
agencies and further work is intended next year
to identify the quality of referrals from particular
agencies. Next year’s audit will review re-referrals.
Each agency within the MASH has access to their own
systems and shares information as appropriate with key
partners. This enables partners to gain a much more
timely and comprehensive understanding of the current
situation, together with any relevant historical information.
The team jointly discusses and assesses the risk and
needs of the child and agrees what action needs to be
taken. MASH works because the partners are sitting
together, sharing information and taking joint action.
Child Protection Processes
At the end of March 2013 there were 1,149 children
who were the subject of a child protection plan.
At the end of March 2014, there were 844 children
with a child protection plan. Reaching a low of 806
in December 2013 but rising to 1301 by 31st March
2015. These numbers indicated that Birmingham was
significantly below the national average during 2013
and raised concerns that too many children may have
been at risk of harm without appropriate protection
plans in place. However, a significant number of
these led to no further action (NFA) which became
a major concern for the Board by March 2014. The
number of section 47s NFA was 160 in March 2014
and by September 2014 this had dropped to 31
and by March 2015 it was 29. Part of the problem
was identified as a lack of coding in CareFirst
and consequently a number of staff were using it
inappropriately, new coding was introduced. At the
beginning of 2015 it was identified there were 930
S47 cases open.
MASH is embedded within the Birmingham ‘Right
Service, Right Time’ model. The key determination
within Right Service, Right Time is that MASH
responds to all children with additional needs and
complex/significant needs.
Following the introduction of MASH there was
a significant increase in the number of contacts,
however, this not only coincides with the start of
MASH on 28 July 2015 but also 1 August was the
point at which police started sending in information
regarding domestic violence, which accounts for an
additional 1,100 contacts approximately per month.
These contacts do not usually become referrals as the
majority are referred to other agencies. Hence the
conversion from contact to referral rate appears to
have dropped over this period.
At the start of last year the Board identified an issue
with the number of single assessments not allocated
to a social worker. At 31 March 2014 there were 457
unallocated single assessments, during the year this
went up to 763 on 1 July 2015. Areas of children’s
social care developed a triage system for managing
the unallocated single assessments. The directorate
carried out some focused work in the south of the
city which had the biggest number of unallocated
single assessments. As at 31 March 2015 there were
68 unallocated single assessments. From 1 April
the directorate established teams in all three areas
to manage referrals that are rated “amber” in the
MASH which are then referred to the area. The area
then decides whether an assessment is required
and the nature of the assessment. This has resulted
In March 2014 a new child protection conference
process was introduced known as “Strengthening
Families”. This new approach involves the chair being
sent reports from agencies prior to the conference to
provide the chair with an overview of the case before
hand. The chair then facilitates the meeting between
professionals, families and young people identifying:
•
•
•
•
•
•
•
Danger/risk factors
Child and Family history
Grey Areas/Complicating Factors
Child’s Views
Parental Views
Family strengths/protective factors
Safeguarding statement
••••
13
An improvement in performance in relation to the
number of children and young people appropriately
made the subject of a child protection plan took place
as a consequence.
The results of the referral audits were fed into the
development of the new multi-agency referral form
which was rolled out to agencies in March 2015.
Further work is still required to improve referrals
from some agencies.
The Board was concerned about poor attendance
by partners at Initial Child Protection Conference
with no agency achieving a 100% attendance to
the conferences they have been invited to. The
data identifies a significant improvement in police
attendance over the last 12 months primarily as
a result of the police establishing a small team
of officers who are responsible for attending
conferences.
There remain some significant challenges. We have,
for example, still not improved the case conference
system processes enough to facilitate a strong
understanding of multi-agency attendance at child
protection case conferences. However, it is clear
that there has been sufficient improvement for us to
focus far more on the quality of what is being done to
safeguard children and promote their welfare rather
than on the processes being used.
Timeliness of ICPCs was also inconsistent over the last
year. At the end of quarter 3 there was a significant
problem in the Child Protection Review Service in that
a significant number of chairs where either on leave
or off sick, resulting in a large number of conferences
being cancelled. This resulted in a backlog. At the
same time a lack of suitable conference venues was
identified to resolve these issues two additional chairs
have been temporarily employed and temporary
additional conference space identified in the
city centre.
The key challenge in 2015-16 is for the Board in
monitoring effectiveness is to develop robust ways of
assuring quality of practice, and to create a learning
culture across agencies to allow our understanding of
quality to improve practice and make a measurable
difference to children’s lives.
Right Service, Right Time
National guidance ‘Working Together to Safeguard
Children’ published in March 2013 requires LSCBs to
publish threshold guidance setting out the process
for early help, criteria to determine levels of need
and when cases should be referred to social care
for assessment and statutory intervention. It further
stipulates that the guidance must be understood and
consistently applied by all professionals and ultimately
lead to services that deliver the right help at the right
time.
Unfortunately during this period the service received
a high volume of late ICPC requests. These late
notifications delayed the booking of conferences
within the 15 working day statutory requirement.
Improvements in conference timescales were seen
in by March 2015 rising to 45% compared to 8% in
January 2015.
Staffing levels in both social care and health visiting
were a major concern over the last year. The number
of health visitors has increased significantly following a
national drive to increase the numbers in the last three
years. In line with this the average caseloads of health
visitors has dropped significantly from 696 in 2012-13
quarter 1 to 368 in quarter 3 2014-15. Social care at
March 2015 still had significant permanent vacancies
with over 35% of full time posts filled by agency staff.
We do not currently have the police data for staffing.
Social work caseloads are hovering around the
average of 24.
The Ofsted Inspection in 2012 highlighted fragility
and inconsistency in professional understanding
and application of thresholds of need across the
city. In response the BSCB published Right Service,
Right Time (RSRT) threshold guidance in May 2013
and carried out a six month evaluation of progress
the findings of which were presented to the Board
in January 2014. Disappointingly the finding from
an employee survey found that only 53% of frontline staff across organisations in Birmingham were
aware of RSRT. During the same period the quality of
fCAF and referrals to children’s social care remained
problematical. The Ofsted inspection in 2014 rightly
highlighted concerns about how widely it was
understood and applied.
As a result of the concerns surrounding the
Unallocated Single Assessments the process for
dealing with amber rated referrals at MASH has been
amended. Amber rated referrals are now assigned
straight to an area team who assess the referral and
decided whether an assessment should be carried
out. Consequently there has been a significant
reduction in the number of unallocated assessments.
In 2014-15 the Board’s most significant programme
of work was the redevelopment and dissemination
of the “Right Service, Right Time Threshold model”
(RSRT) in response to these concerns. The refresh was
led by a multi-agency task and finish group, working
closely with the MASH Programme Board and the
••••
14
Early Help Programme Board on its development. The
key principles are that every child needs and receives
universal services, and that at times they may also
need more input, varying in its types and intensity,
depending on the type of need, its complexity and
potential to cause harm. It allows for movement
between categories without any implication of a
progression “upwards” towards the most serious
intervention. It expects professionals to intervene
early in the life of a problem or expressed need and
to seek to meet that need with and through the family
or carers of the child. It is predicated on agencies
being prepared to accept and work with a degree
of risk, and to ensure families are as far as possible
supported to find their own solutions and ways to
meet their own needs.
The successful introduction of RSRT and MASH have
restored confidence but resulted in a huge amount of
work being escalated to social care, when it could be
better dealt with in other ways. The development of
early help is a key to achieving this change in 201516, as is greater clarity about when family support
under s17 is an appropriate response and when it
is appropriate to move to a s47 investigation. RSRT
provides a strong platform to support that drive.
Early Help
At the beginning of the 2014-15 year early help
was not sufficiently well developed, co-ordinated or
understood within the council and across the partner
agencies. The BSCB Board developed and consulted
on a “definition” of what we mean by early help in
Birmingham (which was congruent with the RSRT
refresh). This was to ensure that being assessed as
“child in need” (under S17 of the Children Act 1989)
and provided with social care services was not seen
by partners as the only way in which children receive
“early help”. It was also designed to underpin and
support the BSCB Neglect project and campaign
being led by the Board with partners and the NSPCC.
As part of the Warner led Year 1 Improvement plan in
the Local Authority the Early Help Programme Board
was established to develop the multi-agency early
help strategy. This strategy was supported by the
BSCB Board, widely consulted on and debated across
a range of services. The strategy outlines the vision,
principles and approach for Early Help and identified
seven strategic priorities.
The revised model was launched with an extensive
programme of awareness raising events and a
comprehensive single and multi-agency training
programme, utilising training for the trainers and an
implementation pack for each partner agency. Early
adoption of the refreshed model means that the
MASH referral pathways and the whole early help
strategy are based on the application of the model.
The impact of the revised model will be evaluated
in the autumn of 2015-16. However it is clear from a
range of data sources that the model has provided a
common conceptual framework for all partners, and a
shared language to use when considering, assessing
and meeting need.
1. Leadership Partnership Working and Governance
2.Strengthen and clarify the Early Help and
Safeguarding front door pathway
3. Assessment and Interventions
4. Information Sharing
5. Localities and Pathways
6.Workforce
7.Commissioning
The Early Help Programme Board has now (2015-16)
become integrated into the Birmingham Early Help
and Safeguarding Partnership Board (BEHSP). The
BEHSP is accountable to the new Strategic Leaders
Forum and will report on Early Help performance to
the BSCB.
The Board have agreed clear ‘success criteria’ for
the refreshed model, which will inform the overall
evaluation and impact assessment that will be
presented to the Board on 15 December 2015.
What is also clear is that the RSRT threshold
model has not yet had sufficient impact on cultural
behaviours across the system. The degree to which
the child protection system was failing in 2009 to
2014 undermined confidence in practitioners and
drove a culture of pushing things up to social care
repeatedly when they had real and genuine concerns.
Children in care and young people leaving care
Children and young people in care, young people and
care leavers continue to be recognised as a vulnerable
group in society, despite the attention over recent
years paid towards improving outcomes for them. This
••••
15
was not a priority for the Board in 2014-15. However
the Board was aware that there were significant issues
with the volume, quality and approach to care in the
city. As part of the year 1 Improvement Plan a major
programme of work took place. This culminated in
a new strategy for Corporate Parenting, agreed and
published in March 2015 and subsequently scrutinised
by the BSCB Board.
A comprehensive programme of training has
been developed for schools building on the work
commissioned by BCSB during 2014. These sessions
are aimed at all schools regardless of designation
and currently are attended by 65% of schools across
the City. Work for 2015-16 has identified the need to
widen further the access to these events for
all schools.
Private fostering
The cascade of Right Services, Right Time has been
coordinated through the Education plan as part of the
work of schools relating to the MASH. In conjunction
with the BSCB a set of training and cascade tools
have been produced and an audit and impact process
identified to measure how schools brief all their staff
on the threshold model. To date 60% of schools
have received this training with three additional
sessions booked for September 2015. In addition
a programme has been put into place to ensure
schools are aware of their responsibilities under the
new Prevent Duty and Equalities legislation. Prevent
training continues to be delivered into schools, with
take up now at 71%, and the LA supports the delivery
of two theatre in education programmes around
Prevent aimed at key stage 2 and 3, both of which
evaluate extremely well.
The Children Act 1989 defines a privately fostered
child as: “A child under the age of 16, or 18 if the
child is disabled, who is cared for (or will be cared
for) and provided with accommodation by someone
who is not a parent, a close relative or someone
who has no parental responsibility for the child for a
continuous period of 28 days or more. If the period
of care is less than 28 days but there is an intention
that it will exceed 28 days it is considered to be
private fostering.
There is a duty placed on anyone involved in a private
fostering arrangement to notify the local authority.
Local authorities do not formally approve or register
private foster carers
On 3 April 2015 there were 28 private fostering
arrangements known to the council. This was a
reduction of four from 32 at 31 March 2013. The
database has been revised to show 26 children are
currently living in private fostering arrangements.
Given the size of Birmingham this is under reported
and is an area of risk which requires some focus over
the next 12 months.
The UNICEF Rights Respecting Schools Award is
being promoted as a way of engaging the children’s
rights agenda within the curriculum with 71 schools
registered within the first 3 cohorts. A key element
of work that is being progressed within the plan
is engaging with faith and supplementary settings
with a safeguarding tool kit that these organisations
can sign up to too ensure good practice and a safe
environment for the children. This work was initially
led by the LADO service and commissioned from
Faith Associates.
Safeguarding in schools
At the beginning of the 2014-15 year, the BSCB
in partnership with the newly formed Birmingham
Education Partnership (BEP) funded a 6 month
secondment to look at how best to improve
safeguarding practice and improve the focus of
schools on promoting welfare as well as safeguarding
children. This work was also supported by the local
authority. The decision at the end of the secondment
was that there needed to be increased capacity within
the system to support schools with these expectations
and requirements. The local authority funded two
posts on an interim basis – the Schools Safeguarding
Advisor and the Schools Resilience Advisor. At
the same time Sir Michael Tomlinson, the External
Commissioner for Education in Birmingham reported
on what needed to be done to improve education
overall, including to improve safeguarding practice.
This led to the development of an Education Plan
(a companion to the Early Years and Safeguarding
Improvement Plan).
Finally work is being undertaken to identify and
support schools which need additional support with
safeguarding practice. Completion of the Section
175 self-assessment has been monitored through
the plan and schools which have not completed or
only partially completed will be supported in the next
academic year. A programme of safeguarding reviews
have been established with a supporting monitoring
tool for safeguarding and one for the single central
register to ensure that good practice is identified
and support offered where required. Data around
safeguarding will be provided to the Education
Dashboard and is seen as a key element in the cross
cutting reviews of schools around whom concerns
are expressed.
Every school is expected to undertake a selfassessment of their safeguarding practice annually,
report it to their governing body and act on the
••••
16
findings. This is referred to as the Section 175 report.
The Safeguarding in Education audit (Section 175)
has been carried out in the city for the last three years
and there has been steady improvement in return
rates and compliance. In 2012-13 63% completed;
2013-14 97% completed; Compliance with submitting
the audit on 10 July 2015 was 97.6%. At the deadline
for submission of 31 May 2015 89% of schools had
started the audit (54/489 schools not including
Children Centres and Further Education colleges).
The largest groups not completing the audit were
Independent schools (46%), All Through Schools
(43%), Secondary Schools without 6th forms (29%),
12% of outstanding schools and 23% of Edgbaston
schools (this district has the most Independent
schools at 21%).
c) E-safety support and training for parents – Only
75% of schools responded to say they gave
training or support to parents on e-safety. There
were 70 schools who did not respond to this
question. Independent schools did worst in this
area with only 29% of them providing e-safety
support and training to parents. 83% of Selly
Oak schools supported parents in this way but
only 46% of schools in Lady Wood and 29% of
Independent schools did.
Each school is expected to have an action plan in
place to address areas for improvement. A separate
analysis of the training elements within the audit
has been completed to support the strategic
development of a safeguarding in education training
plan for the city. There are some key learning points
arising from this analysis. For the Board there is still
significant work to do to ensure schools are complying
with the expectations laid on them, particularly in the
independent sector.
Key factors from the 2014-15 audit are that there has
been an increased response rate across all schools
even with an increase in the number of schools
contacted to submit. But within this Independent
schools have a significant lack of engagement.
For the Local Authority the learning from the audits
includes the need to develop:
The key areas which schools are responsible for within
safeguarding have high response rates that they
comply with requirements i.e. 95% of schools report
that they have robust governance arrangements in
place, 97% report that they follow statutory guidance,
99% complete risk assessments for offsite activities,
100% of schools responding report that they have
systems of reporting safeguarding concerns, they
respect and value their students, that DSLs make staff
aware of policies and procedures, schools have made
appropriate action when students are persistently
absent, keep records of low level concerns, have a
person designated to attend CP meetings and have a
regularly maintained SCR.
a)A strategic plan to address the training needs
identified in the attached training report
b)A clear information and tracking system to
capture safeguarding concerns and information
from schools i.e. which young people are missing
from education, what are the contact details in
each school of their DSL and LAC teacher, which
schools have high levels of non-compliance
and need additional support in line with the
draft strategy currently being developed by the
CSE Strategic Sub-Group and the Child Sexual
Exploitation and Missing (CMOG) operational
group.
c)Develop a clear “In Birmingham” message about
expectations on all schools and how schools
can fulfil those expectations focused on low
compliance areas.
Areas which had low rates of responding that the
school had areas in place were:
a) Action Plans – 57% of schools who responded
reviewed and submitted safeguarding action plans
to Governors although 73% of schools responded
that they had completed a safeguarding action
plan. Of the schools responding to say that they
did not review 14% were schools whose Ofsted
result was Requires Improvement (RI) whereas
Outstanding schools only had 4% who did not
review their action plans.
For schools the learning from the audits includes the
need to:
a) Ensure ongoing compliance to reporting to the
BSCB
b) Make appropriate information returns to the local
authority
c) Ensure governors/responsible bodies have
the correct information and understanding of
safeguarding practice within their schools in order
to be able to fulfil their statutory duties
b) Anti-bullying – 22% of schools reported not
reviewing their anti-bullying policy with children
and young people, 24% of schools did not
complete an anti-bullying survey. 92% of Sutton
Coldfield schools completed an annual survey,
compared to only 60% of Edgbaston, Erdington
and Hall Green schools. Only 33% of Independent
schools complete an annual bullying survey.
d) Put in place a ‘Safeguarding in Education’ Action
Plan to monitor progress on addressing the areas
for development identified in the Audit which is
annually reviewed with Governors.
••••
17
The Local Authority Designated Officer (LADO
Service)
•Including WRAP as the Learning and Development
offer accessed through a central point
•Developing trainer capacity across the council to
meet need.
•Safeguarding support and co-delivery of services
with Birmingham Education Partnership
This service fulfils the Local Authority Statutory Duties
under Working Together to Safeguard Children (2015)
and sections 10 to 11 of the Children Act 2004.Local
authorities should have a Local Authority Designated
Officer (LADO) to be involved in the management
and oversight of individual cases. The LADO should
provide advice and guidance to employers and
voluntary organisations, liaising with the Police and
other agencies and monitoring of cases to ensure that
they are dealt with as quickly as possible, consistent
with thorough and fair processes.
Key vulnerable groups in the City
Child Sexual Exploitation (CSE) has been a major
focus in 2014-15. We know that there are a significant
number of children and young people who have
been exploited or are at risk of exploitation in the
city. The Birmingham Local Authority Problem Profile
in October 20141 and the Education and Vulnerable
Children Overview and Scrutiny Report in December
2014 both make it clear that the evidence base about
CSE in the city is not good enough. There is still a
significant lack of information about the numbers of
children and young people who are at risk of CSE and
underreporting of those who are victims of CSE. There
is also a lack of information that allows us to identify
the root causes.
In 2014-15 there were 1,076 referrals to the
Birmingham LADO this year as compared to 864
last year, which represents an increase of 24.5%. Of
these referrals 211 were taken forward to managing
allegations meetings. This compares to 219 meetings
held last year. A large number of referrals will
be closed as advice only. Of the total number of
referrals during 2014/2015 the number that were
closed as advice only was 839 cases as compared
to 606 last year which suggests that on balance the
same proportion of referrals are dealt with at source
commensurate to the overall number of referrals. This
may well indicate significantly heightened awareness
of safeguarding issues within the workforce across
most organisations.
Earlier in the year the BSCB CSE Sub-Group
contributed to the regional assessment of the nature
and scale of child sexual exploitation across the West
Midlands for the period January till June 2014. The
findings ‘Tackling Child Sexual Exploitation’ were
published in March 2015 and provided a valuable
overview of risk at that time and helped inform the
development of our CSE strategy.
The largest number of referrals were received from
education and this continuous a year on year trend.
The figures for this year are 331 as compared to 270
last year. A significant number of these referrals were
received as parental complaints from Ofsted. The
referrals from education are now broader and will
not just involve staff members but may also include
referral about education transport and possibly
voluntary agencies that may be using the school site.
This reflects a greater understanding about the role
of the LADO and schools’ willingness to refer anyone
of concern that has any connection with the school.
The issue of allegations in relation to physical restraint
within schools and residential homes continues to
feature in the referral base and the police are involved
in a great many of these cases.
We (at 16 March 2015) also know that:
•There were 340 Children and young people
identified as at risk of Child Sexual Exploitation in
the City.
•177 were assessed as Children in Need, and have
a child in need plan in place
•75 were high risk and the subject of Child
Protection Plans and
• 88 were in Care of the Local Authority.
•Since February 2014 to date there have been
284 referrals with CSE as presenting issue and
423 Single Assessments (incl. S47) have been
undertaken with CSE as a contributing factor.
The second largest numbers of referrals are received
from Early Years partners with referrals about
residential children’s services featuring as significant
as well. There has been an increase of over 100% in
the referrals received from Early Years partners this
year 136 as compared to 65 captured last year.
•There have been 67 (MASE) meetings held in last
4 months (Nov 2014-Feb 2015).
•80% of referrals to MASE are initiated from
Children in Care, Safeguarding and Family
Support Teams; the other 20% is via MASH and
other Agencies. Including Youth Service and third
Sector Aquarius
Key challenges for 2015-16
•Workforce development and the mandatory
inclusion of the Prevent Duty in training
1
“We Need to Get it Right – A Health Check into the Council’s Role in Tackling Child Sexual Exploitation – Birmingham City Council Dec 2014
••••
18
•There have been 18 C(M)OG meetings (Nov 2014Feb 2015). A total of 98 Victim discussions and
106 Perpetrator discussions have been held within
CMOG during the reporting period. These include
reviews of progress and agreeing action pending
completion.
than through a proper needs analysis.
Our current position is that Birmingham is doing
some important and bold things as part of our shared
approach to tackle CSE. Despite the failure of partners
to contribute to and drive the way in which CSE was
being responded to in the City progress is being
made. There is a strong commitment by all partners
and a lot of energy going into it. We are building
the necessary structures, processes, and services to
identify children and young people at risk of CSE,
ensure there are the right interventions and services to
support them and their families and to protect then,
and to pursue perpetrators.
This snapshot of the current situation represents a
significant increase in the numbers of children and
young people identified at risk of CSE since last
reported in November 2014. This is very positive and
a direct consequence of the more effective structures
put in place over the last year and greater awareness
across the partnership. However it is probable that it
is still an underestimate about the actual extend of
CSE and the risk of CSE in the city.
However, we are only a few steps along the road to
dealing with it comprehensively and are still learning
how much we have got to do ahead of us. We know
that the scale of CSE in the West Midlands is greater
than initially identified, that CSE is a regional and
national issue and that victims of CSE come from all
parts of the city and all walks of life. We now need
to better understand prevalence, ethnicity, age and
gender issues for offenders and victims, and the
patterns of risk and offending across the city, the key
areas for strategic focus, the scale of the investment
needed and the impact and effectiveness of what we
have done. We also need to start to involve children
and young people, especially victims, in the design
and development of our services.
The BSCB approved a new CSE Strategy in January
2014, following the establishment of a CSE Strategic
Sub-Group in 2013. However the complexities
and pressures of a range of external reviews of
Birmingham, organisational change for the West
Midlands Police, the impact of setting up a MultiAgency Safeguarding Hub in Birmingham have all had
an impact on the delivery of this strategy.
There was a considerable focus on CSE over the 201415 year which has ensured awareness of CSE has risen
across the whole City. Some very good and innovative
work has taken place over the year, but much has
been despite rather than because of a coherent local
strategic approach. This has largely been due to the
lack of effective work by the BSCB Strategic SubGroup, which lacked the drive, capacity, coherence,
contribution from and commitment of partners with a
number of changes of chair leading to an absence of
continuity. This is made more obvious by contrast with
the MASH Programme Board, Early Help Programme
Board and Troubled Families Partnership Board
despite the importance of the issue. CSE has been
everybody’s problem and
none in many ways.
As a consequence of the lack of strategic drive to
develop and improve CSE services the Board agreed
a new Strategy in March 2015. This included a set of
key principles to govern what we do collectively and
individually, as practitioners, managers and senior
staff in each agency, as partners and as the BSCB in
responding to CSE.
Two major achievements have had an impact over the
year. Firstly the local authority successfully applied to
the court for a civil remedy to disrupt the perpetrators
of CSE in a specific case. Secondly an innovative new
DVD, BAIT, was commissioned, led by young people
and distributed to secondary schools across the City
for use with students.
Whilst this has been less important over the year as
services develop and the whole system becomes
increasingly complex a bottom up approach ceases to
be either effective or safe. A number of complexities
have made achieving strategic coherence difficult.
The Regional Preventing Violence against Vulnerable
People Programme has driven much of the work
that has been done, and it has at times been difficult
adapting the regional approach to fit the Birmingham
context. Capacity to respond to CSE has been
increased by the local authority, and significantly
increased by West Midlands Police, but in the
absence of a strong strategic set of drivers additional
multi-agency capacity has not been scoped, or
commissioned. The size of the dedicated CSE team
has grown incrementally and opportunistically rather
In addition work is now underway to better integrate
CSE into “business as usual” in order to equip
practitioners in every aspect of multi-agency children’s
services to recognise and respond to the risk of or
actual CSE as part of their case work rather than
transfer it to a small centralised specialist team. This
is driven by both the principles in the strategy and by
the work underway to rebalance the system to ensure
the majority of work takes place at as low a level as
possible, and in the areas, and local communities
children and young people live in.
••••
19
In 2015 there is however a major challenge to the
strategic leaders’ forum, early help and safeguarding
partnership and BSCB to assertively and decisively
strengthen the work of the CSE Strategic Sub-Group,
agree a programme delivery plan behind it and
deliver the new CSE Strategy. In addition there is
a corporate challenge for the local authority as a
whole to get a better collective “grip” on how CSE
and other safeguarding issues across the whole
council are appropriately led and co-ordinated across
departments and partnership bodies.
By July 2014 and the start of MASH there had
been a significant increase in the number of police
incident reports moving from a previous average of
11,000 children per year to 13,500 in 2013/2014.
The increase was influenced by police service redesign and proactive training in respect of domestic
abuse with police frontline colleagues. The resulting
increase in volume was not matched by resource and
as a result a significant backlog of cases accumulated
during the 12 months. Ofsted cited this as a major
risk for the city in their 2014 inspection and the
January improvement visit. It has subsequently
been dealt with.
Missing Children is another area which saw very
significant slippage in 2014-15. The challenge for
2015 is for the multi-agency partnership, through
the MOG, to develop an integrated approach to
identifying responding to and intervening with
children missing from home, care, school and from
view. This should include the development of a
shared database, some simple accessible systems and
processes and the ability to ensure appropriate early
help or statutory interventions are put in place with
each individual child.
Early in 2014 the BSCB Board convened a meeting
of the Community Safety Partnership, WMP, NHS
representatives and the Adult Safeguarding Board
and BSCB to discuss how best to respond to the
increasing concerns about the need to better address
the issue of Female Genital Mutilation (FGM).
The meeting agreed FGM should be led by the
BSCB rather than the other Boards. It also agreed
to ask BAFGM to become part of the partnership
governance structure of BSCB. BAFGM is now an
affiliated group to the Board, which has also agreed to
underwrite some of its budget. The Board signed off
the action plan, and takes reports from BAFGM every
six months.
Domestic Violence has a significant impact on
children’s lives and as such is part of the Board’s
work, although it is clearly led by the Community
Safety Partnership. The Birmingham multi-agency
screening process of child risk in domestic violence
has been in place in the city since 2009. In addition
the newly defined criteria which includes the 16-18
year old age group has further emphasised the role
that safeguarding plays in trying to improve the future
safety and wellbeing of children and young people
under 18 years of age. For the past 18 months the
BSCB has required 6 six monthly reports on the
progress of the joint screening teams and the learning
for the city in respect of the trends and outcomes of
the screening process.
Significant progress was made over the year, largely
due to the efforts of BAFGM and its inspirational chair,
the Police Sentinel Programme, the commitment of
the NHS providers and the support of the Regional
PVVP. This was helped by new government legislation
and guidance.
The model provides a clear opportunity for BSCB
with the Community Safety Partnership and the Adult
Safeguarding Board to support similar arrangements
for other emerging issues and concerns, where
community and practitioner led initiatives can be
much more effective that statutory arrangements.
With the advent of the Multi Agency Safeguarding
Hub (MASH) the joint screening process now is part
of the integrated arrangements in MASH. The first
anniversary of MASH in July 2015 has seen the historic
backlog of cases removed, resources improved and
the use of MASH staff flexibly to meet demand.
Processes for responding to high risk have changed
and now any incident where the police deem the
adult to be at high risk is screened within 24 hours.
All high and medium adult risk cases are therefore
screened within a working day. There is now assurance
for MARAC that the screening of child risk will inform
their discussions. A database tracks the numbers
of cases screened daily and a weekly report allows
managers constant oversight of the volumes and
outcomes of screening. MASH audit programmes will
encompass domestic abuse outcomes.
Another emerging issue over the year was the
impact of radicalisation both nationally and locally in
Birmingham. The Board took a presentation from the
Counter Terrorism Unit on radicalisation and its impact
on children and young people at the beginning
of the year. It took an update report on the joint
radicalisation and prevent hub at the end of the year.
Prevent is led by the Community Safety Partnership
rather than by BSCB and has little impact until
relatively recently on the work of the Board. It has
latterly highlighted some significant gaps between the
two Boards in terms of a common understanding of
each other’s responsibilities, priorities and strategies,
agreements about shared initiatives and shared
••••
20
priorities. It is clear that there is a major gap in relation
to the BSCB’s relationships with the very wide range
of faith communities across the City, and its ability to
communicate with them, set expectations, support
them to develop safeguarding systems and to
better respond to risks including those as a result
of radicalisation.
Partnership’s areas of concern. This relates too to
the need for a corporate council led approach to the
whole safeguarding agenda, and has implications
for the “Future Birmingham” programme in terms
of the partnership landscape for safeguarding in the
future. The challenge in 2015-16 is for the Community
Safety Partnership, the Adult Safeguarding Board, the
Health and Wellbeing Board and the BSCB Board to
agree a protocol governing the relationship between
them, address the issue of who leads on what, agree
shared priorities and a shared work-streams within the
context of the Future Birmingham Programme.
Other emerging issues that the Board has not yet
addressed but needs to consider are modern day
slavery, trafficking, honour based violence and forced
marriage. These also fall with the Community Safety
The effectiveness of the Birmingham Safeguarding Children Board
This part of the report deals with how effective the
BSCB Board, Executive and Sub-Groups have been
in fulfilling their statutory objectives and functions.
It covers the delivery of the Board priorities, the
governance of the Board, its business arrangements,
budget and major programmes of work.
The Board complies with the requirements of
‘Working Together to Safeguard Children 2015’,
with its independence built upon individual and
collective responsibility for holding organisations
to account, by evaluating how effectively they work
together to safeguard children. The Chief Executive
of Birmingham City Council is responsible for the
appointment and removal of the Independent LSCB
Chair with the agreement of statutory partner Chief
Executives and lay members. Membership of the
Board comprises of 42 members, of whom there
are 27 statutory board partners, 2 lay members, 2
participant observers, with Sub-Group chairs and
professional advisors making up the remaining 11
representatives. The diversity of the city is reflected
by the make-up of membership of the Board,
with a gender ratio of 56% female and 46% male
representatives from different faiths, cultures
and communities.
The key focus of the BSCB is to provide independent
strategic oversight of partnership working to
safeguard and promote the welfare of children in
Birmingham. The BSCB is responsible for collectively
leading, co-ordinating, developing, challenging
and monitoring the delivery across the city of
effective safeguarding practice by all local agencies.
It is not responsible or accountable as a Board for
actually delivering safeguarding services. That is the
responsibility of each of the local agencies separately
and collectively.
Figure 5
Our structure in 2015
Birmingham Safeguarding Children Board Structure
Birmingham
Safeguarding Adult
Board
Education and
Vulnerable Children
Overview and
Scrutiny Committee
Chief Executive
BSCB
Strategic Board
Birmingham
Community Safety
Partnership
Health and Wellbeing
Board
BSCB
Executive Group
FGM Sub
Group
Safeguarding
Learning &
in Education
Development
Sub Group
Strategic
Child
Sexual
Exploitation
Child Sexual
Exploitation
Operational
Group
Practice
Standards &
Procedures
Missing
Children
Operational
Group
••••
21
Performance
& Quality
Assurance
Serious
Case
Child
Death
Overview
Panel
Comms &
Public
Engagement
During 2014-15 the Board met on five occasions,
supported by the Executive Group schedule bimonthly meetings. The geographical boundary of the
Board’s strategic responsibility is coterminous with
that of Birmingham City Council and includes all those
statutory agencies that operate within this area. The
Board’s span of influence and collaboration extends
to both a regional and national level, focused on
utilising finite resources to maximum effect on tackling
safeguarding issues that have no boundaries, such
as Child Exploitation, Trafficking and Female
Genital Mutilation.
All the Terms of Reference (for each body)
were redrafted, along with new membership
role descriptions, statements of responsibility,
appointment terms, membership contracts and
individual objectives for agreement at the November
2014 Board. Each statutory partner was asked to sign
up to a statement of accountability and commitment
to the Board and its requirements. The previous
Executive oversaw the changes, negotiated new
appointments and commissioned a piece of work
to provide the required governance material. At the
same time the executive put out to tender a Board
Development programme to support the first year of
operation. The Executive Group managed the smooth
transition to the new Governance arrangements and
the establishment of the new Sub-Group structure
in place for the new financial year. The Board have
commissioned the Executive Group to monitor
implementation of the new governance arrangement
in 2015.
The Independent Chair utilises a Practitioners
Forum to consult front-line professionals across a
range of agencies to test, challenge and develop
new safeguarding initiatives and seek feedback on
the embedding on practice. This network has 80
members with approximately half attending the five
consultation events chaired by the Independent Chair,
Jane Held. The feedback from frontline professionals
contributed significantly to the board’s work over the
year. For example, the final version of Right Service,
Right Time, with members also volunteering to be
involved in multi-agency case file audits during
the year.
The Board discharges its statutory functions through
an Executive Group and six established Sub-Groups.
During 2015 implementation of the governance
review findings saw the creation of two new SubGroups, Safeguarding in Education and Practice
Standards and Procedures. The Board also provides
strategic oversight and direction for the Birmingham
against Female Genital Mutilation Group.
Governance Review
In January 2014 the Independent Chair commissioned
a review of its governance arrangements to improve
the Board’s ability to deliver on the aims and
objectives set out in the three year strategy ‘Getting
to Great’ 2014-2017 and the Business Improvement
Plan 2014-15. The review took account of the findings
of Ofsted Inspections and the Independent Chair’s
Reports to the Parliamentary Under Secretary of State.
It also ensured compliance with statutory guidance set
out in Working Together to Safeguard Children. The
review was also cognisant of the emerging direction
of travel of Lord Warner’s intervention to improve
safeguarding of children in Birmingham.
Implementation of the Business and Improvement
Plan 2014/2015 is predominantly delivered through
the Sub-Group structure and approved Work
Programmes. The role of Sub-Group Chairs is crucial
to the successful delivery of safeguarding priorities.
The Independent Chair, Vice Chair and Board’s
Business Manager ratify the appointment of SubGroup Chairs and Vice Chairs and there is an effective
succession planning process in place. In 2015 the
Board Induction Programme was revamped focusing
on core roles, functions and expectations of Chairs
and new members.
In order to improve, radical changes were needed to
the Board membership arrangements, governance
mechanisms and arrangements, organisational
accountabilities, business and administrative
arrangements.
The chairing arrangements appropriately reflect the
requisite expertise, seniority from a range of key
stakeholders:
1.Practice Standards and Procedures Sub-Group
– West Midlands Police
The report makes 50 recommendations which were
all accepted. The Board, the Executive and the SubGroups were all dissolved on 31 December 2014
and reconstituted the following day (1 January 2015)
under the new arrangements, with new membership
of the Board, the Executive and all Sub-Groups, as
well as newly appointed Sub-Group chairs and vice
chairs. In addition the new meeting cycle began in
from 1 January 2015.
2.Child Death Overview Panel – Public Health
3.Strategic Child Sexual Exploitation – Birmingham
City Council
4.Serious Case Review Sub-Group – Birmingham
South Central CCG
5.Learning and Development Sub-Group
– Birmingham City Council
••••
22
6.Communications and Public Engagement SubGroup – NHS Communications and Engagement
Service
support delivery on safeguarding priorities set out
in the agreed work programme which is subject to
regularly monitoring by the Board. Each of the SubGroup completes a concise annual report identifying
progress, improvements practice and outcomes;
emerging themes and areas for improvement and a
record membership, representation and attendance.
7.Performance and Quality Assurance – Birmingham
City Council
The Independent Chair and Business Manager
meet on a bi-monthly basis with Sub-Group Chairs
and Programme Managers to monitor progress on
Sub-Group agreed work programmes and to resolve
issues that impact on the implementation of the BSCB
Business and Improvement Plan. Some agencies
attendance at Sub-Groups has continued to fail to
meet the Board’s high expectations. Sub-Group Chairs
are provided with an analysis of attendance data by
agency to enable non-attendance to challenge and
escalated when required.
Board Attendance, Representation and
Engagement
Attendance and representation at Board (figure 6) and
Executive Level is good, during 2014-15 all statutory
agencies achieved attendance targets. Within that
overall picture however some agencies with 100%
attendance had a significant churn in membership
itself, particularly the Local Authority with changes in
year to the Strategic Director and to the professional
advisers. This necessarily impacted heavily on
that Agency’s ability to contribute effectively and
consistently to the Board.
Each Sub-Group has a clearly defined function,
dedicated programme management support to
Figure 6
BSCB Attendance May 2014 - March 2015 - 5 meetings + development session
100%
80%
70%
60%
50%
40%
30%
20%
10%
Organisation
Represented
Non Attendance
No Identified Member
••••
23
Membership Ceased
Lay Member
Lay Member
Third Sector Assembley
Cabinet Member, People’s
Directorate
Designated Nurse
Chair of Child Death Overview
Panel
Chair of Communications and
Public Engagement
Chair of Learning and
Development Sub Group
Chair of Child Sexual
Exploitation Steering group
Chair of Performance and
Quality Assurance
Chair of Policy and Procedures
Sub Group
Chair of Serious Case Reviews
Sub Group
BSCB, Business Manager
NHS England
Designated Doctor
Cross City CCG
Heart of Englands NHS
Foundation Trust
Birmingham & Solihull Mental
Health Foundation Trust
Birmingham Children’s Hospital/
CAMHS
Birmingham Community Health
Care Trust
Birmingham South and Central
CCG
West Midlands Police
Youth Offending Service
National Probation Service
Rep: Nursaries
Sandwell and West Birmingham
CCG
Staffordshire and West Midlands
CRG
Rep: Special Schools
Rep: Primary Head Teachers
Attended
Rep: Secondary Head Teachers
Rep: Adults and Communities
BSCB Independent Chair
0%
People’s Directorate, Strategic
Director
Safeguarding and Development,
Peoples Directorate
Education and Commissioning.
Strategic Director
Place Directorate
Attendance Percentage
90%
Figure 7
- Agency Attendance by Sub-Group between April 2014 – March 2015
Green: The named member attended 80% or more of the meetings
Blue: The named or nominated members attend 80% or more of the meetings
Red: The named or nominated members attended less than 80% of the meetings
Pink: The organisation joined the Sub-Group
Yellow: The organisation’s membership at the Sub-Group ceased
Board
Comms
CDOP
CSE
L&D
P&QA
SCR
People Directorate
Place Directorate
Legal Directorate
BSCB
Primary Schools
Secondary Schools
Special Schools
Nurseries
West Mids Police
Probation
CRC
Vol / Third Sector
Youth Offending
Public Health
SC CCG
CC CCG
SWB CCG
BCH / CAMHS
BCHC
BSMHFT
BWH
HEFT
ROH
WMA
WMF
A dedicated Business Support Unit supports the
work of the Board and is currently hosted by the
City Council, but funded by key statutory partners.
In April 2014 the Board appointed three dedicated
programme managers and an additional administrator
to reflect the expansion of the safeguarding structure
and address concerns in relation to capacity and
management resilience within the Unit. The changes
have made a significant impact in driving forward the
Board’s Business and Improvement Plan and the SubGroup work programmes.
The Business Support Unit is directly managed by
the Independent Chair, increasing its independence.
The Business Manager provides the Independent
Chair with regular performance updates on the
efficiency administrative systems that impact on the
effectiveness of the Sub-Group Structure.
••••
24
Business Plan
performance must be included in the routine work of
the BSCB.
The Birmingham Safeguarding Children Board
Business Plan 2014-15 reinforced the continued focus
on four key business priorities from the previous year.
Key business tasks for 2014-15 were:
These four areas remain a priority and have been
integrated into the Business and Improvement Plan
from 2015-16. The Board remains concerned that
despite effective delivery of much of the plan it still
needs further reassurance of the impact on frontline
practice. Against the performance measures we set
for 2015 we delivered as follows:
•Ensuring that multi-agency frontline practice
focuses on the experiences and life of children
•Understanding and assuring the quality and
consistency of front line practice through strong
data and multi-agency audit
By March 2015, we will know that:
1.The number or re-referrals and children made
subject to a protection plan for the second time
are both reducing year on year. We have the
data to demonstrate activity. Re-referrals are now
within the national norm. However we cannot
demonstrate the total target we set ourselves.
•Using quality assurance information, review
of child deaths, SCRs complaints and other
activity to inform a comprehensive learning and
development strategy
•Creating a multi-agency workforce development
programme which supports excellent practice
through practical tools and learning opportunities
2.Children and families are assessed and receive
services within statutory timescales. We are not
yet fully achieving timescales across the Board
but have made significant progress. What is more
important now timescales are reasonable and
most cases allocated quickly is the quality of the
assessments, plans and outcomes achieved.
•Influencing and supporting multi-agency
strategic planning, integrated commissioning and
integrated service delivery
•Creating the capacity as a Board Business Support
Unit to effectively support the system
3.Where children are the subject of a protection
plan the family can tells us they know what has to
happen why and by when, and what will happen if
this isn’t achieved. There is still some distance to
go to deliver fully on this measure.
It identified 96 specific actions. Throughout the year
the Board closely monitored implementation of these
themes and tasks and actively intervened to address
under performance where necessary and ensured
the completion of work within the agreed timescales.
At the end of the year 53% (51) of actions were
completed and 22% (21) of actions were progressing,
but not finalised. The outstanding actions were
reviewed as part of the Board’s formal end of year
review of progress and effectiveness 21% (20) of
actions had been deferred until 2015-16. There was
significant slippage in the below areas:
4.All our statutory agencies are able to demonstrate
how well their safeguarding systems are
functioning, what needs to be improved and what
action they are taking to achieve this. This has
been achieved.
Risk Register
As part of the strategic planning framework, the Board
periodically undertakes environmental scanning to
identify risks and focus partnership intervention to
mitigate the potential impact. The Board’s Executive
Group is working in partnership with Birmingham
South Central Clinical Commissioning Group to
further refine and develop the management of risk
utilising good practice from the NHS.
•Work with, and utilise, existing opportunities for
children and young people to help develop a
programme of engagement in the Board’s work.
We are building on young people’s feedback from
the seminar in October 2014.
•Agree with the scrutiny committee the theme we
will undertake a joint scrutiny exercise on in 201415 and then undertake it
The key risks and mitigation action focused on:
•Implement a full annual Quality Assurance
Programme, implement and utilise the outcomes
to inform learning and development
•Children’s safeguarding arrangements in
Birmingham continue to fail to keep children safe
•Children continue to be invisible to practitioners,
managers, senior managers, strategic planners
and system governors
•Work with partners to develop good quality
collection and collation of data on missing children
so that partners have a full understanding of
the risks to these children and can identify what
actions they need to take to minimise these risks.
Scrutiny of challenge to this data and related
•Lack of tangible evidence of trajectory on
improvement journey
•The impact of publication of Serious Case Reviews
in undermining public confidence
••••
25
• Impact of MASH and Early Help developments
A Zero Based Budget exercise recommended an
increase agency contributions, which resulted in a
total BSCB budget for the financial year 2014/2015
amounted to £834,615. The below chart (figure 8)
provides a breakdown of the components of the
budget detailing individual agencies contributions
(£659,267), income generation (£7,830) and a carry
from the 2013-14 budget (£167,518). Figure 9
provides details of expenditure during 2014-2015
which concentrated on five core business areas.
•Lack of clarity about Early Help model delivery and
coordination of multi-agency services for Universal,
Universal Plus and Additional Needs
•Lack of assurance of the effectiveness partnership
intervention to combat child sexual exploitation
•Impact on safeguarding capacity and delivery
during a period of austerity
The future development of the Board’s risk
assessment model will be incorporated with its
strategic and business planning process from 2016
Figure 8
Breakdown of BSCB budget and agency contributions 2014-15
£167,518
20%
£7,830
1%
Birmingham City Council
£550
0%
Health
£15,176
2%
Staffordshire & West Midlands Probation
CAFCASS
Income Generation
£39,837
5%
Carry Forward from 2013/14
£447,964
54%
£155,740
18%
Figure 9
Breakdown of BSCB Expenditure 2014-15
40%
Safeguarding Business Support Unit Infrastructure
Supplies & Services
Professional Fees relating to Serious Case Reviews
Independent Chair Arrangements
Delivery of Multi-Agency/Campaigns/Projects
28%
10%
5%
4%
Birmingham City Council also continues to make a
significant contribution in kind, by the provision of
office accommodation, IT, Legal, Financial and HR
support for the BSCB Business Support Unit.
••••
26
Performance Management and Quality Assurance
Sub-Group (P&QA)
children and young people. The Assistant Director
Education and Skills has been appointed to chair
the new Safeguarding in Education Sub-Group
which commenced in June 2015 following the
recommendations of the Governance Review. The
Group provide a conduit between the 445 education
establishments and the LSCB.
This Sub-Group moved forward significantly during
2014-15. All statutory partners completed the annual
Section 11 safeguarding audit return. Since June
2014 a Front Door Reference Group has been running
as a small Sub-Group of the P&QA. This group had
audited 66 referrals by the end of March 2015. The
data has been regularly reported to the group, the
MASH Board and the BSCB, the information to date
indicates that there has been some improvement in
the quality of the referrals since last June.
In 2015 the Sub-Group will concentrate on supporting
the development and co-production of a safeguarding
assurance, improvement and development ‘offer’ for
education establishments in order to:
•Improve the welfare and safety of children
and young people (through the delivery of
support, training, audit processes and education
improvement offer.)
The PQMA Sub-Group completed four audits of Initial
Child Protection Conferences (ICPCs) in October
2014. The findings have been acted upon to enhance
training of child protection chairs and the ICPC
process. These audits identified that the Voice of the
Child is still missing in the child protection conference
process with only one case identified as good. The
BSCB will seek further assurance of improvement in
the conference process during 2015-16.
•Provide assurance for establishments and the
LSCB of the effectiveness of safeguarding
arrangements and practice (through the Section
175) audit process, support visits, external
inspections and reviews.
We are starting to see positive outcomes on the
stronger relationship, which is evidenced by the 97%
completion rate for the Safeguarding in Education
Audit 2014. Head Teachers and Designated
Safeguarding Leads have contributed to the design
and rolled out programme of new on-line Section
175 Audit process. The new Chair of Safeguarding in
Education Sub-Group is a participant member of the
Board alongside Head Teacher representation form
Secondary, Primary, Special and Early Years settings
on behalf of the relevant schools forum.
Towards the end of the year a multi-agency audit pool
was developed, with professionals from a range of
organisation being trained to undertake joint child
protection audits. The audits are due to be completed
by the end of June and a final report produced on the
outcome of the audits in July.
Practice Standards and Procedures Sub-Group
The Board tendered for a supplier to undertake
the detailed work of procedures and Tri-Ex was
appointed. They worked on a total revision of
procedures which were launched in September
2014. The Practice Standards and Procedures SubGroup is a newly established Sub-Group as part
of the Governance Review, and is chaired by a
Superintendent from West Midlands Police. The SubGroup is focusing on the continued development and
dissemination of multi-agency practice standards,
protocols and practice requirements. The Sub-Group
is also overseeing the development and maintenance
of the Tri-Ex on-line procedures that provide the
children’s workforce with instant access to current
national, regional and local guidance. Work is being
undertaken at regional level to develop local multiagency protocols, standards, and service pathways for
the West Midlands region.
Communication and Public Engagement Sub-Group
During the last year good progress has been made on
establishing a foundation for good communications
and focused work on:
•The Voice of the Child – working with and utilising
existing opportunities for children and young
people to develop a programme of engagement:
Whilst it is acknowledged that progress on this key
objective has been restricted an initial mapping
exercise was undertaken in November 2014 to
scope and map who is leading on participation
within the city. This objective will be carried
forward into the 2015-16 work programme.
•A re-fresh of Right Services, Right Time
information campaign was delivered right across
all agencies in Birmingham to help professionals
understand how to access right support at the
right time and to improve quality of referrals (Right
Services, Right Time) – this included delivering
nine briefing sessions for 1,492 professionals to
raise awareness of the threshold guidance model.
Safeguarding in Education Sub-Group
During the last year the Board has worked closely
with the Local Authority, Schools and Birmingham
Education Partnership to ensure processes are in
place to support schools to own and fully engage
with statutory responsibilities for safeguarding
••••
27
•Launch of new way of working in Birmingham –
2014 saw substantial support for the launch of a
new Multi-Agency Safeguarding Hub (MASH) in
August 2014 – this included delivering 15 briefing
sessions for over 2,750 professionals to raise
awareness around forthcoming changes.
the 5,915 delegates who attended training during the
2013-14 year, this was due to a reduction in capacity
to commission training, with 19 less courses than the
previous year.
The L&D Sub-Group have been fully committed to the
delivery and implementation of the Sub-Group Work
Programme 2014-2015 and key achievements include:
• Awareness raising campaigns – this year saw:
•Delivery of a full multi-agency campaign in
partnership with the NSPCC for raising awareness
around neglect and monitoring public and
professional response – this included supporting
the delivery of a multi-agency conference for 200
professionals.
•All commissioned training material reflects, ’The
Voice of The Child’
• Standard Induction Programme developed.
•Attendance and satisfaction with training deliver
remains high, with low levels of non-attendance
and cancellation.
•Commencement of a safer sleeping campaign to
raise awareness of the importance, perception and
social views on sleeping arrangements with roll out
and implementation expected in 2015-16.
•Development of ‘Right Service, Right Time’
training materials/trainer’s pack produced to
support a programme of train the trainer events.
•Public Information – the newly designed BSCB
website has continued to be maintained as a key
gateway with up to date information. However,
there are limited metrics available about the usage
of the BSCB website. This will be remedied in
2015-16.
•Commissioned a programme of training and
briefing during 2014-15.
Training courses remain full, with representation from
different agencies enhancing the learning experience.
Fewer courses were cancelled due to non-attendance
and the importance of attending training has been
reinforced through charges for non-attendance.
•Agreeing communications protocols and joint
working between agencies for media and
campaigns so an effective multi-agency response
is managed.
The Sub-Group now has in place a Learning and
Development Strategy, Learning and Improvement
Framework and Training Plan. Work will continue
to implement the Learning and Improvement
Framework, to ensure that we build learning from
serious case reviews and learning lesson reviews into
future commissioned training activities. The SubGroup is actively working in partnership with Research
in Practice on a number of initiatives including
developing an evaluation framework.
Learning and Development Sub-Group
There are approximately 75,000 front line staff in the
city who work with children or with adults who also
have children. This creates a significant challenge in
ensuring the Board effectively commissions multiagency safeguarding training and targets its finite
resources at those professionals who can make the
maximum impact on safeguarding children and
young people across the city. The Board’s Training
Offer compliment and builds upon each agencies
safeguarding training, however there are particular
issues in every agency in delivering with sufficiency in
terms of skilled practitioners, recruitment and, more
importantly, retention.
The training module for RSRT was recognised as
good practice and will act as an exemplar for the
development of future training courses in relation to
Early Help, FGM, CSE and Strengthening Families
Framework. The Sub-Group assisted in developing
briefing sessions to prepare and inform the workforce
of the practical application of the assessment of needs
model in March 2015.
During 2014-15 the Learning and Development SubGroup commissioned and delivered multi-agency
safeguarding training to 2,524 delegates across the
children’s workforce. This is significantly fewer that
Further achievements include:
Figure 10
Number of Training Courses/Conferences
•Four year procurement framework established
to secure delivery of multi-agency training
programme.
140
120
100
•Course utilisation has decreased by 1% from 93%
during 2013-14 to 92% during 2014-15.
80
123
60
40
69
20
87
104
59
0
2010/11
2011/12
2012/13
2013/14
2014/15
••••
28
•The number of training courses excluding
conferences has remained stable during
2014-15 at 124, an increase of one course
on the previous year.
•Develop specific training activities around
Early Help.
•To continue to support, commission and quality
assure RSRT training.
•Implementation and usage of charging policy
to maximise attendance and therefore justify
expenditure.
•Review, revise and evaluate existing training
courses and use intelligence to inform future,
commissioning intentions.
•Delivery of key components within the 2014-15
L&D Work Programme.
•Commission bespoke and multi-agency training
specific to target groups.
•A number of new training courses are currently
under development and will be delivered during
the forthcoming year, including learning from SCR,
FGM and CSE.
•Explore the application of e-learning for target
group 1 and 2.
•Review, revise, evaluate and develop training
around Strengthening Families Framework.
•A review of training courses has taken place,
leading to a number of courses being revised
and updated.
•Develop and implement a multi-agency evaluation
framework.
•Develop a ‘core offer’ of training activities that is
fundamental to what we do.
The training courses delivered have increased the
knowledge, skills, confidence and understanding
of the children’s workforce as outlined by course
evaluation sheets; however we recognise the need
to further develop an Evaluation Framework that
will demonstrate the impact that learning and
development activities are having at different levels
throughout the organisation.
•Develop a robust process for the commissioning,
delivery and evaluation of training activities.
•Clearly identify and establish the meaning of multiagency training.
Work is ongoing to develop courses as a direct result
of lessons learnt from SCR, DHR and DV’s as well as
other sources including section 175 and section 11
audits.
Work will be undertaken in the forthcoming year to
revise and update the Cancellation and Charging
Policy; however, course take up rates from the
Voluntary/Private and Independent sector have
improved, showing a significant reduction in nonattendance and cancellation. Course utilisation
remains above 90% even though there has been a
reduction in the number of courses commissioned.
During the coming year work will be undertaken to
review and revise the existing course booking process.
Strategic Child Sexual Exploitation Sub-Group
Earlier in the year the Sub-Group contributed to the
regional assessment of the nature and scale of child
sexual exploitation across the West Midlands for the
period January till June 2014. The findings ‘Tackling
Child Sexual Exploitation’ were published in March
2015 and provided a valuable overview of risk at that
time and helped inform the development of our CSE
strategy.
During 2014/2015, 57 courses were delivered with
1,385 training places available and 1,350 training
places were actually achieved which equates to
97.47% places filled. Overall delegates satisfaction
with the content of the courses was 98.31% and
98.23% rated as very good and good the delivery of
the training. Training has been updated throughout
the year to reflect changing structures in Birmingham,
in particular the introduction of MASH in July 2014
and new ‘Working Together’ guidance 2015.
The Board are ensuring the continued development
of services takes account learning from the Rotherham
Review, Birmingham City Council review ‘We need
to get it Right’ and the emerging regional approach
being driven by the Home Office supported initiative
‘Preventing Violence against Vulnerable People’. In
August 2014 the Sub-Group on behalf of the Board
contributed to Office of the Children’s Commissioner
national review of ‘Gangs or Groups’.
The 2015-16 L&D Work Programme will further
develop and embed the key themes contained within
the Strategic Plan around; the voice of the child, early
help and safe systems. Therefore our key priorities for
the forthcoming year are:
The Sub-Group have also contributed to the
development of a protocol for hotels; this approach
is to become the ‘Gold Standard’ for the hospitality
industry in Birmingham.
•To ensure safeguarding child protection training at
levels 1-3 are delivered via the sub-group.
••••
29
The Sub-Group commissioned a training needs
analysis specifically focused on equipping participants
within the new CSE framework as well as the broader
children’s workforce. Interim findings were presented
to the group in May 2015 and this will be a key
feature of the work programme for 2015-16. We have
participated in a regional awareness raising campaign
to help parents, young people and communities
to spot signs of abuse http://www.seeme-hearme.
org.uk. In partnership with Birmingham Community
Safety Partnership, Birmingham City Council and
Birmingham Community Healthcare NHS Trust we
have produced a resource pack to help support
delivery of the PHSE curriculum in Secondary
Schools and Further Education Colleges to enhance
14-17 year olds’ awareness and understanding
of the dangers of CSE. The BAIT Resource pack
which included a DVD, Work Book and posters was
launched on 10 March 2015 with a screening of the
film at Cineworld on Broad Street, Birmingham. The
resource pack has been sent to every secondary
school and Further Education College in the city.
The resource pack is receiving recognition as good
practice at both regional and national level.
•Deliver a programme of CSE training that
enhances staff skills, knowledge, professional
competence and confidence to address CSE.
Engagement in National and Regional Networks
to share good practice.
•To lead and continue to participate in a regional
and local awareness raising campaign to help
parents, young people and communities to spot
signs of abuse.
•Work with the Performance and Quality Assurance
Sub-Group to develop the CSE dataset to meet
local priorities and facilitate regional comparison
of performance.
•Evaluate the impact on young people of the BAIT
educational recourse pack to be undertaken in
December 2015. The findings to be shared with
Headteachers, School Governors, Governing
bodies and the Safeguarding in Education
Sub-Group.
The Child Death Overview Panel (CDOP)
The Birmingham Safeguarding Children Board has a
statutory duty to review and enquire into the deaths
of all children under the age of eighteen. The Child
Death Overview Panel (CDOP) oversaw the review of
the 165 deaths that occurred between 1 April 2014
and 31 March 2015. The responsibility for determining
the cause of death rests with the coroner or the
doctor who signs the medical certificate of the cause
of death and is not therefore the responsibility of
the Child Death Overview Panel. The Panel’s role,
under a chair that is independent of service provision
responsibilities, is to:
In March 2015 the Board ratified the revised Child
Sexual Exploitation Strategy 2015-17 to tackle Child
Sexual Exploitation. The strategy is built around four
key strands, prevention, protection, disruption and
prosecution. Successful implementation will be
closely monitored by the Board and is embedded
within ‘Getting to Great’ the Board’s three year
Strategic Plan.
Emerging Themes & Areas for Improvement
2015-16
•Classify the cause of death according to a national
categorisation scheme;
The Strategic CSE Sub-Group will concentrate on
ensuring the effective implementation of the priorities
set out in first year of the two year CSE Strategy
ratified by the Board in March 2015. The Chair will
closely monitor performance and provide regular
progress reports to the Board. The main focus in year
one will be:
•Identify factors in the pathway of death, service/
environmental/behavioural, which if modified
would be likely to prevent further such deaths
occurring; then
•Consider recommendations on these factors for
action to the Safeguarding Children Board, who
then arrange to ensure any appropriate actions
agreed with partners.
•Explore the feasibility of co-locating the dedicated
CSE Team within the Multi-Agency Safeguarding
Hub based at Lancaster House.
Figure 11 below provides a comparison of the
number of child deaths and serious case reviews
commissioned between 1 April 2007 and 31
March 2015. Each year the Board publishes
statistical analysis of the causes of child deaths
and emerging learning.
•Establish and embed the Missing Operational
Group to improve our data collection systems to
better identify the most vulnerable children so we
can intervene earlier to make a difference.
•Strengthen the pathways between CSE Operation
Group and the Multi-Agency Safeguarding Hub to
secure the requisite expertise earlier in identified
cases of CSE.
••••
30
Figure 11
Comparison of Child Deaths to SCR’s in Birmingham between 2007 - 2015
Number of Deaths
Number of Deaths
200
190
180
170
160
150
140
130
120
110
100
90
80
70
60
50
40
30
20
10
0
Number of SCRs
184
175
171
160
171
165
157
144
4
2007/2008
5
2008/2009
3
2009/2010
4
2
2010/2011
2011/2012
1
2012/2013
2
2013/2014
2
2014/2015
Year
A separate detailed analysis of the learning from the
review process is commissioned and overseen by
the Board through the Child Death Overview Panel
(CDOP). A separate annual report analysing why
children die is published by the Board. The report
provides a detailed overview of the work of CDOP
and the associated work of the Sudden Unexpected
Death in Childhood (SUDIC) Team.
a systematic bias in recording ethnicity. However the
proportion of deaths is higher for Asian Pakistanis
children than British White children. This can be
attributed to the proportionately higher number of
births to Asian Pakistani women.
Serious Case Reviews and Learning Lessons
Reviews
The Sub-Group oversees the commissioning of the
independent reviews process when a child dies or is
serious injured and child abuse is suspected of being
a contributing factor. The Sub-Group also monitors
and ensures that the learning and action plans have
been fully implemented.
The findings from the CDOP Annual Report are
referred to the Director for Public Health and the
Health and Wellbeing Board in order to inform their
work particularly in terms of the on-going issues
relating to higher incidents in certain populations
in the city.
During the year two Serious Case Reviews were
commissioned. The first Serious Case Review relates
to a family of nine children who suffered sexual
abuse at the hands of family members. The other is
in relation to a Looked After Child who was sexually
abused after absconding from a residential unit.
In past reports we have been concerned about the
influence of premature births upon the pattern of
deaths, particularly the perinatal category. There
were 100 neonatal deaths in 2014-15, 31 of these
were born at less than 22 weeks of pregnancy. The
mortality rate in this group is 100%, despite all
the technological expertise available. The reviews
undertaken by the panel, using our current resources
and processes, cannot demonstrate any missed
opportunities to prevent these births. The impact of
these very premature and inevitable fatal births on
families and service providers is, however, significant.
Also during this reporting period six Learning Lessons
Reviews were commissioned. The first of the Learning
Lessons Reviews is in relation to a child who survived
a house fire; the child’s mother was suffering from
mental health issues and died suddenly after the
fire. The second was in relation to a family who
previously lived in Birmingham and moved to another
Local Authority, court proceedings were taking
place and the Judge requested that BSCB look into
the circumstances of why the children were placed
with the parents after Birmingham Social Care had
previously had involvement. The third case was into
a Looked After Child, and it was felt that his care was
not managed appropriately. The fourth case was a
young person who committed suicide, it was not felt
In view of Birmingham’s cultural diversity it is
important to understand any demonstrable
differences in the patterns of deaths in different ethnic
groups. The recording of the ethnic group of children
overall is not complete (25%) but slightly better
than in previous reports, particularly in the neonatal
and infancy groups. The children whose ethnicity is
unrecorded are spread proportionately across all the
age groups which suggests that there has not been
••••
31
Published Serious Case Reviews
that this case me the criteria for a SCR but it was felt
that there would be learning that could be established
from a Learning Lessons Review. The fifth case is of
a baby whose arm was fractured by her father. She
was only four weeks old at the time of the incident.
This review only involves two agencies. The sixth case
involves a baby who died suddenly and was remitted
from the Child Death Overview Panel due to both
parents being deaf and information that mother had
not been provided with safer sleeping advice.
The Board completed and published the findings
from one serious case review, the tragic death of
Harli Delves Reid who died at the hands of her
father who pleaded guilty to causing the death and
was subsequently convicted of manslaughter on 4
November 2013. He was sentenced to three years
and nine months imprisonment. The full report is
publically available through BSCB website at www.
lscbbirmingham.gov.uk (BSCB 2010-11/2).
Serious Case Review Sub-Group were notified of
serious injuries to two children, this case was referred
on to the Domestic Homicide Review Steering Group
as the mother had been murdered by the father who
subsequently went on to try to murder the children.
Serious Case Review Sub-Group reviewed the
Terms of Reference to ensure that the safeguarding
arrangements for the children were included.
Homicide Investigation Report
The SCR Sub-Group has been involved in reviewing
the death of Christina Edkins who was killed
during an unprovoked attack by a stranger who
was convicted of manslaughter on the grounds of
diminished responsibility in October 2013. He was
detained without a time limit in a secure psychiatric
hospital. Birmingham and Solihull Mental Health
NHS Foundation Trust were required to investigate
the circumstances of Christina’s death and did so in
conjunction with their lead commissioner, Birmingham
Cross City Clinical Commissioning Group. Early on
in the course of the review it was identified that
a number of partner agencies external to health
organisations had been involved and a collaborative
approach was taken to maximise learning. BSCB
agreed that this review fulfilled the requirements of
safeguarding legislation. The full report is available
through www.bhamcrosscityccg.nhs.uk.
Work has taken place with the NSPCC and Sequeli
to produce a Serious Case Review manual for
practitioners, which will assist them in the completion
of reports and chronologies, provide guidance on the
differing types of review that can be undertaken, set
out the expectations of BSCB board and SCR subgroup members and be a resource for independent
reviewers and report authors. This piece of work will
be finalised in the forthcoming year.
During the year, BSCB also commissioned
Birmingham University to undertake a thematic
review of Serious Case Reviews and Learning
Lessons Reviews over the previous five years; this
was not completed by the year end and will be
carried forward.
Key learning points from the published SCRs
and Homicide Reviews
The key learning identified through the review
processes inform policy development, training
delivery, communication and public engagement and
audit activity to evidence learning has been effectively
implemented.
The Disclosure policy has been developed by
SCR Sub-Group and ratified and disseminated.
The scoping document, sent to agencies requesting
preliminary information about cases, was not always
submitted in a format which allowed considered
decisions to be made by the Sub-Group. It has,
therefore, been revised to ensure that the Sub-Group
has more accurate and complete evidence on which
to make decisions.
The key messages are:
•Lack of focus on the children in frontline and
management practice.
•Domestic violence, mental health and substance
misuse all featured which is a recurring theme in
national reviews.
•Lack of in depth assessment and insufficient
support, guidance and explanation of how to
safely care for a baby.
There has been a significant amount of work
performed by BSCB to ensure that SCRs that are
nearing completion are quality assured and reflect
the guidance in Working Together 2013, and looking
ahead will need to reflect the 2015 revision. This
has resulted in a revision of timescales to reflect the
new requirements.
•Insufficient attention given to emotional impact of
event upon the parents.
•Lack of information sharing between health
professionals.
••••
32
•Organisations failed to listen to and respond to
carers and significant others consistently and
adequately.
to these reviews. This has been particularly noticeable
in recent very complex cases where organisations
have to gather and analyse high volumes of material
whilst continuing to deliver services which are already
under scrutiny within Birmingham.
•The accessing and sharing of information between
key agencies was ineffective.
•Organisations’ information recording and
storage were not robust enough to allow good
management and care.
In some circumstances a statutory review may not be
required but does raise issues about safeguarding in
its widest sense. This is particularly the case where
children are seriously injured, perhaps as the result
of an accident, where supervision is of concern but
there does not appear to be overt neglect or abuse
or concern about the way in which agencies have
worked together. These cases lead to substantial
debate amongst Sub-Group members. This also
requires consideration of the relationship between
the SCR Sub-Group with that of the Child Death
Overview Panel and Public Health. An example would
be serious injuries of children due to falls from open
windows which would not result in a CDOP review
and do not require an SCR or LLR. Clearly, there are
important safety messages that need dissemination
and it will be important to develop better links to
ensure this happens.
•Services need to be more proactive in making it
easier for a person with mental health issues to
engage with them.
Ensuring lessons are learnt
The Birmingham Safeguarding Children Board closely
monitors timely implementation and compliance
with the key learning from Serious Case Review.
Each agency provides regular reports detailing how
learning has been embedded into front-line practice.
Six other SCRs are still in the process of being
finalised: on completion they will be submitted to the
Department for Education and the findings published.
A detailed performance overview is presented to the
BSCB on a quarterly basis and an executive summary
is provided.
Themes that are emerging are the increasing number
of cases involving families who have moved to the UK
from mainland Europe and may have unrecognised or
unmet needs. The Sub-Group have also considered
how lessons from SCRs and LLRs are disseminated
and will be taking this work forward, with the Learning
and Development Sub-Group, to ensure that frontline
staff can access learning in the most effective way
recognising that this may be through use of a variety
of formats.
Reflection of the work of the Sub-Group
For each case that is discussed at the Sub-Group
there can be considerable debate about the type of
review that should be conducted. There has been
substantial deliberation about the reviews that may
be required and their proportionality in ensuring
important lessons are identified whilst balancing this
with the capacity within organisations to commit
significant resources in order to contribute effectively
Summary, conclusions and whole system analysis
This Executive Report sets out the work of the
Birmingham Safeguarding Children Board in 201415. It addresses both the effectiveness of what is
done in the city by partners to safeguard children,
and the effectiveness of the Board itself in delivering
its statutory objectives and 14 functions. The report
shows that there has been significant progress by
the BSCB Board through and with partners across
the whole of the Board’s functions and objectives,
delivering on much of the Business Plan for the
year, and on the Ofsted requirements whilst adapting
to changing policies and expectations nationally
and locally.
and service improvements that have been underway
during the year. It has been drafted in line with
national guidance on what a good report should
contain. However this Executive Report fundamentally
addresses six key questions. It assesses the Board’s
work objectively against the evidence and against the
guidance provided by guidance as to what a Board
must do. It evaluates the quality of what we are doing
against the criteria for what constitutes a “good”
Board, and against the evidence we have of the
impact of our work.
The conclusions are short, and framed in the context
of what the work of 2014-15 tells us about what we
need to be doing next, the priorities for 2015-16 and
the challenges we are setting.
The full Report is long, largely because of the need
to provide strong evidence of that progress, and to
set out the range of activities, projects, programmes
••••
33
What is it like to be a child growing up in
Birmingham?
We have a high performing youth offending service,
an excellent “Think Family Programme” and some
strong NHS services in place. West Midlands Police
have reorganised services specifically to build their
capacity to respond to children at risk of harm and
abuse. New approaches to key services, in particular
the 0-25 Mental Health Service and the planning for
an early start service (involving early years services
and health visiting) will contribute to that process.
We also have good evidence of the increased
ownership of and responses to their safeguarding
responsibilities from the majority of partners on the
Board, with more investment in services as well as
specialist safeguarding staff, and a much stronger
approach to dissemination of material, development
of learning and practice compliance. The rapidly
improving engagement by and with schools, and
the demonstrable areas of improvement in the way
safeguarding is being built into school improvement
work is another positive indicator of progress.
We now have much better information about what
life is like growing up in Birmingham. The Children’s
Commission Report, ‘It takes a City to raise a Child’
has provided an in-depth analysis, and demonstrates
that the Board’s preoccupations are not necessarily
those of the children and young people living in the
City. We also now have in-depth and sophisticated
data available to us about the extent and depth of
need in the City, both met and unmet. There has
been a demonstrable increase in engagement and
participation work with the children and young people
using services across the partnership which we now
need to capitalise on and use to inform our own
Board work.
In 2015-16 the BSCB Board will monitor progress
generally by the Council and its partners against
the recommendations of the Children’s Commission
Report, “It takes a City to Raise a Child” as well as
against our formal performance data set and other
scrutiny activity. However it is clear that children
and young people most want to feel safe in open
spaces and on public transport. Clearly the City
Council through the Place Directorate needs to lead
work with children, young people, communities and
partner agencies to significantly reduce the expressed
sense of being unsafe in public spaces articulated so
strongly by the children and young people of the City.
However that is just the start of the long process
of creating a city where children grow up happy,
safe, and well, with good futures ahead of them.
Paradoxically, although focussing on the children
who are most unsafe has acted as a spur it has taken
attention away from services to support families to
keep children safe themselves, from the cooperation
and coordination needed across the partnership in
creating effective early help services, and from multi
agency ownership of the need to respond early to
emerging problems rather than pass the problems on
to someone else.
Challenge 1: Improving the safety of children’s
lived experiences in their communities presents
a significant challenge to the Council and its
partners. Are children safer in the City?
The much used “safeguarding is everybody’s
responsibility” mantra is still a long way from being
realised. Indeed the creation of strong centralised
multi-agency safeguarding activity, whilst both very
welcome and very necessary at the “front door” into
statutory interventions is acting as a draw, rather
than a filter, pulling everything up into a level of
response higher than may realistically be needed.
Partners have not yet fully developed cohorts of
strong confident multi-agency staff in every service,
school or setting, who can respond to need quickly
and effectively, and who have the support, training
and capacity to do it well. Neither is there a welldeveloped range of service “offers” they can draw
on to create the right support packages. However
partners are engaging strongly and willingly with the
new Early Help Strategy.
Overall the data and other evidence combine to
demonstrate that by the end of 2014-15 children
and young people were demonstrably safer. This
does not of course mean they are safe, and indeed
we can never guarantee the safety of every single
child. In addition we have made significant progress
in understanding the degree of need there is for
services to support vulnerable children in the city.
We know those most at risk are now getting a
speedier and more consistent response to their
needs, and professionals are clearer about what
to do when they are concerned about a child or
young person through the new Right Services, Right
Time Threshold Model. The significant increase in
contacts and referrals to the MASH, the numbers of
children and young people getting assessments from
social care, the number who are the subject of child
protection plans, court proceedings and in care have
all increased, and timescales diminished in terms
of drift.
Over 2015-16 onwards there needs to be a multiagency focus on to how best to appropriately and
safely reduce the amount of work going through
the MASH when it can be better dealt with at Right
Service, Right Time (RSRT) Additional Needs and
Universal Plus needs levels. This needs to be done
••••
34
without undermining agency confidence or the
momentum gained by the successful development
of the MASH. In addition the rebalancing of the
relationships between the highly centralised City
wide service (MASH) and the three local area service
delivery model agreed with Lord Warner will be
a challenge. This needs to be achieved within the
context of reducing capacity across the partnership
so needs to demonstratbly realign resources as a
consequence of success.
through providing data and intelligence, high
support and high challenge. There is a long way to
go however.
Across all agencies service redesign has taken place
without early engagement with partners. This affects
multi-agency working.
Challenge 4: There is a major challenge ahead for
the new partnership bodies established to lead
children’s services across the city, in establishing
new ways of working, developing real cooperation
across the system, rather than cooperation on
specific issues, and to ensure the most effective
ways of delivering services as resources reduce,
capacity shrinks, and demand increases.
Challenge 2: The major challenge for partners is
to retain the confidence brought into the system
through the work done in 2014-15, whilst ‘rebalancing’ resources, investment, staff capability
and capacity so early help takes precedence over
child protection for the majority of children and
young people needing support.
This applies equally to the overall partnership
framework across the City, and to the simplification
and rationalisation of the multiplicity of boards
with overlapping responsibilities, and increasingly
shared priorities. The BSCB Board has made limited
progress in 2014-15 in terms of developing clearer
and more effective strategic relationships with the
Health and Wellbeing Board, Community Safety
Partnership and Adult Safeguarding Board although
some discussions have taken place about this with
the Adult Safeguarding Board and, to a lesser extent
the Health and Wellbeing Board. The LSCB Board has
also not yet addressed the relationship that needs
to be developed between the Board and the BEP.
Whilst there are understandable reasons for this it is
time to sort it out.
Are we making sufficient progress with our
strategic objectives?
Overall the Board has made some significant
progress in demonstrating it is more explicitly
working with partners to co-ordinate local work
to safeguard and promote the welfare of children
and young people. By the end of the year it was
also appropriately and positively withdrawing from
over-engagement in co-ordinating activity that was
more properly the responsibility of others. Significant
challenges remain, partially reflecting the internal
incoherence in Working Together in relation to our
statutory functions as opposed to our statutory
objectives. CSE for example is currently being led by
the local authority, by West Midlands Police, by the
PVVP and by the LSCB leading to a significant degree
of overlaps, contradictions confusions for front line
staff, middle managers and service providers. It is
possible that there are far better ways of delivering
some of the BSCB statutory functions than through
the LSCB.
Challenge 5: The Board’s challenge in 2014-15 of
developing stronger, clearer and more mutually
robust and accountable relationships with all key
partnership bodies remains a challenge in 2015-16.
Challenge 6: The Board welcomes the focus of
the Council’s Future Council Programme on the
quality of partnership working across the city. The
Board hopes that this work, led by the Director
of Public Health will assist the Community Safety
Partnership, the Adult Safeguarding Board, the
Health and Wellbeing Board and the BSCB Board
and others to agree protocols governing the
relationship between them, address the issue of
who leads on what, agree shared priorities flowing
from a common vision and shared work-streams.
Challenge 3: This is of course a national as well as
local debate. However, there is no reason why the
BSCB should not build on its experiences of the
last few years by challenging itself to think radically
together as partners in terms of examining what
functions should be led by whom, how and where
in order to be far more effective in contributing
to and supporting the co-ordination of what is
done collectively.
Challenge 7: This work combined with the
continued partnership work by InLoGov in
Children’s Services has given the Board the space
to stop acting as a proxy for partnership working,
and create meaningful relationships with the new
models for partnership, in order better to inform
and influence their work and hold them to account.
This new role will test the Board in the coming year.
As confidence grew about the MASH Board’s
programme of work across the partnership, the Early
Help Programme Board engaged in extensive multiagency consultation, and discussions began about
a new partnership landscape, the Board has been
able to redefine its role to better support service
planning, service design, and service commissioning
••••
35
There have also been new challenges in terms
of the dynamics between national departmental
policy, regional work and local partnerships
thrown up by the work of the Preventing Violence
against Vulnerable People, which have helped to
highlight the issues locally. Whilst strong leadership
of the children’s agenda has assisted in making
progress the multiplicity of national policy agendas
and Departments involved, plus complexities
locally have meant that at times there has been
duplication, overlapping work streams and confused
accountabilities as well as gaps in activity. This has
been particularly the case in relation to emerging
issues and the role of the community safety
partnership. There is no central shared safeguarding
group or collaborative arrangement within the
council to address common council wide issue.
and the revised fCAF material and MASH tools. This
work will now be taken forward by one of the new
partnership’s work streams.
In terms of our ability to monitor the effectiveness of
what is done to safeguard children and promote their
welfare we have made significant progress. Increased
capacity to support this work within the Board’s
Business Unit coupled with a strong Sub-Group chair
in the performance and quality assurance Sub-Group,
and a clear willingness by partners to focus on this
work have all paid dividends.
Do we have sufficient assurance about the practice
of all statutory partners?
In addition to the challenges identified in the BSCB
2014-15 Annual Report, the Ofsted Inspection of the
LSCB identified a number of areas for improvement.
Progress has been made on the majority of them. In
terms of an expectation that each partner agency
urgently develops and can demonstrate stronger and
more effective accountability within its organisation
for their roles and responsibilities in safeguarding
children and young people in Birmingham particularly
at middle and frontline manager level we made
significant progress over the year in our assurance
and challenge systems. Evidence includes the Section
11 Peer challenge event, the development of multiagency audit, and the independent chair’s audits,
as well as the analysis of Section 11 audits (and
follow up visits) and the requirements of the Annual
Assurance Letter and Annual Report. In addition we
are evaluating and testing the effectiveness of
“roll outs” of major policies.
This impacts on the City Council’s relationships
and leadership of the overall safeguarding agenda
with partners. Improvement is dependent on the
Council’s progress in developing new frameworks
for partnership working, within the context of the
Future Birmingham Programme as well as on partner
organisations committing to the new frameworks as
part of their own strategic and operational planning.
Challenge 8: The challenge for the lead agency,
Birmingham City Council with every partner will
be to design and implement a new whole council
partnership framework for multi-agency cooperation, co-ordination, and commissioning of
services to meet children’s needs. This will need to
also feed into the “Future Birmingham” process.
Ofsted expected us to ensure that partners urgently
agree a definition of early help and drive the
implementation of the Early Help Strategy so that
partners are fully engaged in the work to achieve
and deliver this. The definition is agreed and in use
through is still not fully embedded and used by
individual agencies in their own agency early help
work. A strong multi-agency strategy was developed
over the year and agreed by the beginning of 201516. Assurance and Annual Reports demonstrate a
variable engagement in early help although every
agency is now involved in developing services. The
BSCB Early Help Working Group undertook three key
pieces of work over the year; an audit and analysis
of the range of assessment tools currently in use
in the city) (over 300); an examination of national
evidence about interventions and what works; and
the development of a proposed outcomes evaluation
tool to use in the city. In addition it agreed an
ideal model for a coherent system of integrated
common pathways, processes, and tools to use for
all forms of early help within the RSRT model. We
also contributed to the development of the strategy
We were required by Ofsted to ensure that single
and multi-agency audits are undertaken, analysed
and evaluated and that findings are used to help to
improve standards of practice in all agencies. We
developed new frameworks, systems and process
for this over the year and it was underway by the
year end. Significant progress has been made. The
Assurance and Annual Reports demonstrate this
and provide evidence to support the evidence from
the P&QA Sub-Group. A multi-agency audit pool
is in place and auditing, the Front Door Reference
Group is working well and having a direct impact and
themed multi-agency audits were undertaken over
the year. There is good evidence of the outcomes
being applied to changes in practice, action plans
being implemented and learning applied. However
now systems are in place we need to focus on
developing the quality of practice rather than just our
compliance with statutory requirements.
The City Council as lead agency has been under
intensive supervision with Lord Warner as
Commissioner for the improvement plan. Although
••••
36
Challenge 9: The challenge to the Board and its
partners in 2015-16 is to improve the span of
agencies driving the priorities forward, and the
consistency of their focus and “ownership” of
the issues, and to share the work across partner
agencies more effectively, reducing “silo” working.
only one year through the plan, the council has
made significant investment into services and Lord
Warner has overseen the Council’s re-engagement
with partners. Its programme with inLoGov has
been a constructive approach to helping agencies
consider how they work with others rather than just
decide how to structure working arrangements. This
challenge and review mechanism will start to be
tested over the next year and this will be important
for the development of further partnerships.
The BSCB was also expected to ensure that a range
of mechanisms, platforms and processes are in place
to support schools to own and fully engage with their
statutory responsibilities for safeguarding children
and young people. This has been achieved with good
evidence to support positive comments on progress.
The Section 175 audit provides rich evidence as to
where compliance is still an issue, and a focus on
those settings follows. Termly briefings, the School
Noticeboard, the re-established education SubGroup, and locality based DSL networks are all now
in place.
The development of the local authority “quartet”
model of improvement has ensured a really
strong grip on the local authority’s improvement
programmes across social care, early help and
education. It has at times meant partners have felt
excluded or uninvolved but without it the progress
would have been less effective.
The BSCB was also required to work with partners
urgently to develop and implement systems and
processes to ensure that they fully comply with
safeguarding audit requirements. The Annual
Assurance process and Annual Report demonstrate
the variable degrees to which this has been achieved,
but it is now underway and the BSCB has presented
some important challenges to agencies at a practice
level over the year. The Section 11 Audit indicates
there is still much to do in some agencies to properly
embed the Section 11 cycle of audit, action plan,
change, compliance, assurance that is required
although increase in number of agencies delivering
better on compliance expectations. In address we are
monitoring agency progress towards compliance,
with a requirement to complete regular audits which
are routinely tested and reported regularly to BSCB.
We have had a series of reports from key services
such as the Child Protection Service over the year
as a result.
Alongside this the BSCB was required to provide
robust challenge and scrutiny to ensure that the
arrangements between schools and their partners,
especially the local authority, are secure and progress
on these arrangements should be reported routinely
to the safeguarding board. This has been achieved
to a degree but at times deflected by the internal
improvement agenda over the year. There have been
some issues about multiple scrutiny for schools.
Reports should now coming to the Board via the
Education Sub-Group. Senior ownership of this issue
still developing but is quickly being established in
2015-16. There is a potential risk of the BEP transfer
deflecting attention from this and the BEP will report
to the BSCB to mitigate against the risk.
The Board and the lead partners have completely
failed to deliver a programme of work with partners
to develop good quality collection and collation of
data on missing children so that partners have a full
understanding of the risks to these children and can
identify what actions they need to take to minimise
these risks. Over the year there were various
attempts to address it but inconsistent leadership
grasp and a focus on getting CSE sorted deflected
attention too often. This is a high priority and a
challenge for 2015-16.
The BSCB were asked to improve the degree
to which partners at the Board use their role to
properly influence their own strategic and corporate
governance, and to ensure the Board’s work is
integrated into their own strategic, operational
and business as well as workforce development.
Progress has been made with majority of agencies
as demonstrated in the Annual Assurance Letters
and Reports. This is more challenging for regional
organisations working on a regional basis that are
accountable to a number of LSCBs. This has also
been a significant challenge for the City Council who
have not yet shown that it can address assurance
across all its range of functions outside of social care
and schools which has not yet been addressed.
Clearly scrutiny of challenge to this data and related
performance must be included in the routine work of
the BSCB. This was not done over 2014-15.
Challenge 10: The challenge for 2015 is for the
multi-agency partnership, through the Missing
Operational Group, to develop an integrated
approach to identifying responding to and intervening
with children missing from home, care, school and
from view. This should include the development of a
••••
37
shared data base, some simple accessible systems
and processes and the ability to ensure appropriate
early help or statutory interventions are put in place
with each individual child.
Work on improving the attendance of partners at SubGroups and ensuring that Sub-Groups are resourced
appropriately to undertake the tasks and actions
that are required, and that they maximise learning
from their work is underway although it has taken a
lot longer than planned. Governance arrangements
between the local authority and its partners to achieve
effective and coherent strategic relationships has
only really begun in the latter part of the year but is
now developing well and discussions are beginning
about redefining accountabilities and responsibilities
to ensure the Board has the resilience and flexibility
to relate to new service design and delivery models
agreed between the LA and partners.
What impact is the Board having?
This report demonstrates that the Board is
increasingly effective and has had a direct impact on
most aspects of Children’s Services across the whole
system over the year. However this has not yet had
a big enough impact on the strength, depth and
quality of front line practice.
Challenge 11: The Board needs to build on the
impact the Board has made in 2014-15 and
increase the degree to which to Board supports
the improvements underway in the City in terms of
safeguarding children and promoting their welfare.
The Governance Review has successfully addressed
the need to improve the attendance of partners
at Sub-Groups and assure that Sub-Groups are
resourced appropriately to undertake the tasks and
actions that are required and that they maximise
learning from their work. This has been strengthened
by the bi-monthly Sub-Group chairs meetings. SubGroup performance is still however far too variable. A
lot depends on the leadership of each group and the
capacity and authority of Chairs to drive performance,
as well as on the understanding, capacity and
willingness as well as ability of members to do the
required work.
What progress is the Board making in improving its
own effectiveness?
Getting to the point when we became an effective
Board was a major priority in the 2014-15 Business
and Improvement Plan, as part of year one
of delivering “Getting to Great”. This Report
demonstrates that progress has been made on all of
these challenges. Good progress has been made in
terms of the Board’s own governance, membership,
systems and processes. Participation by statutory
partners is more variable. Limited engagement with
three NHS Trusts continues but the safeguarding
teams within those Trusts are now engaged with the
Board’s work.
We also need to ensure that learning from serious
case reviews is used effectively to inform practice
and that audit work is beginning to demonstrate that
learning is having an impact on improving practice
across partner agencies. Similarly we need to find far
better ways to use audits and other quality assurance
information, learning lessons reviews, serious
incidents, complaints, and Serious Case Reviews
as well as reviews of good practice to improve our
practice. It would be fair to say that a learning culture
has not been developed and embedded across the
partnership or in the Board. We are still too focussed
on process and who is responsible for what rather how
we will learn grow and develop.
The 2013-14 Report also set the BSCB Partnership a
series of challenges. The key and primary challenge
was to ensure that the Board works collectively and
collaboratively, holds the whole system to account
and delivers on its statutory requirements, both
as a Board and as individual partners. There is
substantial evidence that good progress has been
made in this respect. In addition there is also good
evidence that each partner agency has developed
and can demonstrate stronger and more effective
accountability within its organisation for their roles
and responsibilities in safeguarding children and
young people in Birmingham, particularly at middle
and frontline manager levels.
Our Learning and Improvement Framework is
relatively limited and we are prone to defensive
or blaming behaviours at times. Although we talk
about providing high support and high challenge we
have not yet consistently modelled the behaviours
associated with such an approach. We have a
huge amount still to do. We have some good
examples of application and impact in some of the
individual Agency Assurance Annual Reports and in
our relatively new audit activity. When monitoring
effectiveness the Board needs to develop robust ways
of assuring quality of practice, and to create a learning
culture across agencies to allow our understanding of
Whilst the Board has not been successful in
strengthening governance arrangements between
the BSCB and other Boards, it has however improved
the degree to which partners at the Board use their
role to properly influence their own strategic and
corporate governance, and to ensure the Board’s work
is integrated into their own strategic, operational and
business plans as well as their workforce development.
••••
38
quality to improve practice and make a measurable
difference to children’s lives.
strategy was not completed until after year end. This,
like much of what has been so impressive in 201415 is due to highly committed individuals working
together. The PVVP leadership has supported and
to a large extent driven this although at times it
has created tensions, confusions and complexities.
Increased investment by the LA has also had a
significant impact. The OCS Report provided another
impulse to focus on delivery.
Ofsted also expected us to develop and implement
a comprehensive programme of multi-agency child
protection training (levels 1, 2 and 3) with clear
arrangements for evaluation of impact to inform future
training needs. Unfortunately this was not delivered
in 2014-15. The matter was the subject of debate
throughout year at the Learning and Development
Sub and an early presentation of options made to
the Board. However debate has stimulated better
discussions within agencies and the project will be
delivered by the end of 2015-16.
Challenge 12: In 2015 there is also a major
challenge for the strategic leaders forum, local
authority and BSCB who together need to
assertively and decisively strengthen the work of
the CSE Strategic Sub-Group, agree a programme
delivery plan behind it and deliver the new CSE
Strategy, as well as continue to improve and
develop services to support children and young
people at risk of CSE and to disrupt and pursue the
perpetrators.
Summary
Overall the Board has achieved a significant part of
last years’ priorities and Ofsted’s requirements and
the impact is evidenced. In addition it is clear that
overall progress in improving the effectiveness of
safeguarding children is occurring across the city
on a multi-agency and a single agency basis.
Work with schools has been intensive, multi-faceted
and important over the year despite the complexities
and the majority of schools now appropriately look
to the BSCB for advice. They also understand their
responsibilities better, are engaging more and better
understand the system.
There is no doubt that the MASH has had a
transformational impact on this and the over
performance of MASH by the year end testifies to how
effective it has become (and therefore highlighted the
emerging challenge of much more rapidly developing
and providing effective early help across every
agency and collectively at universal plus level as well
as at additional needs). Lord Warner’s challenge to
the NHS was uncomfortable but ultimately helpful
and the Police have invested heavily in the MASH.
Lord Warner himself saw MASH as having been a
touchstone moment in changing the way the city’s
partner agencies work together.
Priorities for the 2015-16 work programme are to:
•Continue to focus on and improve the delivery of
effective practice in relation to the voice of child,
early help and safe systems (adding children in
care to child protection and court processes)
•Clarify the governance arrangements for and
deliver a more coherent strategic approach to
CSE ,support the development of an effective
operating model and implement the strategy
The Board’s work on systems and processes has
underpinned this and the refresh and re-launch of
RSRT has also been very important, creating a fully
agreed, accepted and disseminated framework for
people to use in judging how best to respond to
identified need. Work on the West Midlands Protocol
and Strengthening Families was also important in
underpinning and providing consistency to child
protection work in the MASH as well as at ICPC’s and
through the CP system. The material on how to make
good referrals and the focus of the FDRG has assisted
in improving referral practice and creating a better
understanding about when to seek advice and make
contact with MASH and when to make a referral. By
year end there was good evidence of better localised
partnership working through the Safeguarding Hubs.
•Address the gap in relation to missing children
•Strengthen still more our challenge and scrutiny
functions and the use of our intelligence to inform
partner and single agency priorities for service
delivery, practice improvement
•
Intensify and extend our multi-agency audit work
•Deliver even stronger accountability and
challenge relationships with each agency and use
that to inform collective strategic activity
•Facilitate the development of a much better
learning culture and reduce unnecessary
processes in relation to LLR’s and SCR’s
•Support and challenge the development of a
new partnership landscape between partners and
Children’s Services and corporately
We have also made significant progress in tackling
CSE, to a degree despite rather than because of
coherent multi agency leadership locally as the
Strategic CSE Sub-Group struggled and the new
•Address the question of what a “new” approach
to scrutiny, challenge, coordination, performance
••••
39
and quality assurance, learning from practice and
from what good practice looks like in order to
agree how best to approach these requirements
across the system by April 2016
•A rigorous and transparent assessment of our
performance and effectiveness, as a board and
across local services
The fact remains we will remain inadequate as a Board
if we cannot demonstrate that we understand the
experiences of children and young people or fail to
identify where service improvements can be made.
Whilst we have made significant progress in both
these areas it is not yet secure, embedded or wide
reaching enough.
Conclusions and sufficiency statement:
In terms of the five dimensions of a Board’s
responsibilities set out by Ofsted, we are now meeting
our statutory responsibilities, with varying degrees of
effectiveness with the exception of missing children.
We are able to provide substantial evidence as to how
we have worked to support and co-ordinate the work
of statutory partners in helping, protecting and caring
for children, and we are able to demonstrate how we
monitor effectiveness.
It is appropriate to say that overall the Board’s
arrangements are increasingly sufficient to meet our
basic responsibilities and to ensure children are safer
in the City. The biggest challenge of all is to explore
whether there are better ways to achieve the same
ends within an overarching statutory framework.
Children are getting a better service, but it could
be much better if we allow ourselves to think more
radically about how we work together and as a Board.
We are not yet however monitoring multi-agency
training for its effectiveness and evaluating its’ impact
on practice. In fact although we have continued to
provide significant amounts of training we have not
yet created a learning and workforce development
approach to multi-agency workforce training and
learning. We do check that policies and procedures
and thresholds for intervention are applied properly
through our audit programme and the work of the
Front Door Reference Group. Whilst partners can be
quite challenging of each other in meetings they do
not consistently demonstrate how they challenge
practice and audit casework in their own agency and
across the partnership.
Challenges in 2015-16
The challenges we are setting for 2015-16 are:
To the Board:
The Board needs to find the best ways to engage with
and involve children and young people, their families
and their communities in the work of the Board and in
providing high support and high challenge as critical
friends of what we do.
We cannot as yet demonstrate that we meet the
criteria for a good LSCB. In fact we are still quite
a long way from that, and we certainly require
improvement to be able to get to good. However
we can demonstrate progress against the criteria in
terms of:
The BSCB should build on its experiences of the
last few years by challenging itself to think radically
together as partners in terms of examining what
functions should be led by whom, how and where
in order to be far more effective in contributing to
and supporting the co-ordination of what is done
collectively.
•The priority given to safeguarding by statutory
LSCB Members and how that is demonstrated
both through Section 11 assessments, sound
financial contributions (although how sound
varies) and contributions to the audit and scrutiny
activity of our Section 11
The Board’s challenge in 2014-15 of developing
stronger, clearer and more mutually robust and
accountable relationships with all key partnership
bodies remains a challenge in 2015-16.
•Our policies and procedures, and the way we
review these.
In addition the Board needs to stop acting as a
proxy for partnership working, and create meaningful
relationships with the new models for partnership, in
order better to inform and influence their work and
hold them to account.
•Case file audits and the use of data and audit
evidence to determine priorities for the board,
the challenge we put into the system and the
assurances we seek.
•Our contribution to and influence in informing
senior leaders, and supporting planning and
commissioning activity
The Board needs to ensure that the Community Safety
Partnership, the Adult Safeguarding Board, the Health
and Wellbeing Board and the BSCB Board can agree
a protocol governing the relationship between them,
address the issue of who leads on what, agree shared
priorities and shared work-streams.
•The provision of a high level of high quality
training
••••
40
The Board needs to improve the span of agencies
driving the priorities forward, and the consistency
of their focus and “ownership” of the issues, and
to share the work across partner agencies more
effectively, reducing “silo” working.
In 2015 there is also a major challenge for the
strategic leaders forum, local authority and BSCB who
together need to assertively and decisively strengthen
the work of the CSE Strategic Sub-Group, agree a
programme delivery plan behind it and deliver the
new CSE Strategy, as well as continue to improve
and develop services to support children and young
people at risk of CSE and to disrupt and pursue
the perpetrators.
The Board needs to build on the impact the Board has
made in 2014-15 and increase the degree to which
to Board supports the improvements underway in the
City in terms of safeguarding children and promoting
their welfare.
To the Council with its’ partners:
Improving the safety of children’s lived experiences in
their communities presents a significant challenge to
the Council and its partners.
The challenge for the lead agency, Birmingham
City Council with every partner will be to design
and implement a new whole council partnership
framework for multi-agency co-operation, coordination, and commissioning of services to meet
children’s needs. This will need to also feed into the
“Future Birmingham” process.
To the Strategic Leaders Forum and Early Help and
Safeguarding Partnership:
The major challenge for partners is to retain the
confidence brought into the system through the
work done in 2014-15, whilst ‘re-balancing’ resources,
investment, staff capability and capacity so early
help takes precedence over child protection for
the majority of children and young people
needing support.
There is a major challenge ahead for the new
partnership bodies established to lead children’s
services across the city, in establishing new ways of
working, developing real cooperation across the
system, rather than cooperation on specific issues
and to ensure the most effective ways of delivering
services as resources reduce, capacity shrinks, and
demand increases.
The challenge for 2015 is for the multi-agency
partnership, through the Missing Operational Group,
to develop an integrated approach to identifying
responding to and intervening with children missing
from home, care, school and from view. This should
include the development of a shared data base,
some simple accessible systems and processes
and the ability to ensure appropriate early help or
statutory interventions are put in place with each
individual child.
••••
41
Birmingham Safeguarding Children Board
Room B54
Council House Extension
Margaret Street
Birmingham
B3 3BU
Tel: 0121 464 2612
Fax: 0121 303 8427
Web: www.lscbbirmingham.gov.uk
Solihull Local Safeguarding Children Board
Statutory Annual Report
1st April 2014 until 31st March 2015
The effectiveness of partners’ work to
safeguard and promote the welfare of
children in Solihull.
1
About this report
Every year, the LSCB (Local Safeguarding Children Board) publishes a report accounting for
our work. This is our account for 2014-2015.
In this report we aim to provide a rigorous and transparent assessment of performance and
effectiveness of local services to safeguarding children. We aim to describe the challenges we
have identified and their causes. We set out what we are doing about them and what we have
learned from our reviews of practice across all our participating agencies.
The report begins by analysing our progress in relation to the priorities set by the LSCB in
2013/2014. This led directly to our work in 2014/2015. These priorities were to safeguard
children at risk of sexual exploitation and those living with neglect.
An analysis of key child protection performance indicators for the year 2014 - 2015 is then
provided, followed by our overall analysis of the current LSCB effectiveness and future
challenges.
At the date of publication of this report i.e. this year, (2015-2016) partners are continuing to
account to their colleagues on the Board, led by our Independent LSCB Chair. Partners are
working on performance measured against their current organisational arrangements in relation
to their safeguarding duties. This ongoing analysis informs our current priorities for 2015/2016.
The business plan for 2015/2016 is at the end of the report along with the budget for 2015/2016.
Contents
1 FORWARD By Independent Chair ........................................................................................... 3
2 About Solihull ........................................................................................................................... 4
3 LSCB Effectiveness; Progress on priorities set for 2013/2014 ................................................. 6
4 LSCB Effectiveness; priorities set for 2013/2014 ................................................................... 10
5 Performance analysis; The data on Child Protection ............................................................. 12
6 Regulation 5 ........................................................................................................................... 21
7 Statutory partners safeguarding responsibilities .................................................................... 28
8 Solihull LSCB: A summary of our strengths and weaknesses 2014/2015 .............................. 41
9 The business plan 2015-2016 ................................................................................................ 42
10 LSCB Budget and Spending 2014/2015 ............................................................................... 48
11 LSCB Attendance at Board Meetings 2014/15...................................................................... 49
2
FORWARD from our Independent Chair
I am delighted to introduce the Annual Report of Solihull Local Children Safeguarding Board
covering our period of activity from April 2014 to March 2015 and commenting on our plans for
our future work in 2015.
This has been a busy year for the Board. We have focused on addressing those priorities we
know will support children and families best.
Amongst other priorities, we have listened to your feedback and we have refocused our training
offer. We have also been working in partnership to continue to improve the way we listen to
children and young people and children’s services practitioners.
Building on what we have learnt this year we will continue to improve our work in the future, not
only by working on our priorities but by engaging with our community more.
We hope that this report will be useful to you and that you will take it back into your
organisations to inform your work.
If you have any comments or questions about this report, I shall be pleased to hear from you.
I would be particularly pleased to hear how we could improve future annual reports so that they
could be more helpful.
If you have any comments please write to me at [email protected]
I am grateful to all our partners and supporters who have contributed to the work of the Board
during the year. I am particularly grateful to the LSCB Board staff who work so hard behind the
scenes to ensure that our programme works efficiently.
I look forward to working with you again next year.
Edwina Grant OBE
3
2. Facts about Solihull
2.1
Solihull is a broadly affluent borough characterised by above-average levels of income
and home ownership. A high proportion of residents (50%) are classified as belonging to
the Prosperous Suburbs socio-demographic classification. 22 of the Borough’s 133
Lower Super Output Areas (LSOAs) are in the most 20% deprived areas in the country
and just 2 are in the bottom 5%.
2.2
Solihull has significant geographic and infrastructure advantages, lying at the heart of the
West Midlands motorway network, with excellent public transport connections with the
Birmingham city conurbation and linked to European and global markets by Birmingham
International Airport. Economically, this supports a strong service sector economy with a
thriving Solihull town centre and key regional strategic assets, for example the NEC
complex, Land Rover and the Birmingham & Blythe Valley Business Parks.
2.3
Solihull is challenged by a prosperity gap, with performance indicators in the
Regeneration Area, framed by the wards of Chelmsley Wood, Kingshurst & Fordbridge
and Smith’s Wood to north of Birmingham International Airport, significantly lagging the
rest of the Borough. The Regeneration Area contains the 20 most deprived LSOA
neighbourhoods in Solihull, with 24 of the areas 29 LSOAs in the bottom 25% nationally.
The impacts of this are felt across a broad range of outcomes including educational
attainment, employment, crime and health. We therefore take care in the Board to
understand the postcode variations. Solihull is in the midst of dynamic and rapid sociodemographic change. The Black and Asian Minority Ethnic (BAME) population has more
than doubled since the 2001 Census and now represents nearly 11% of the total
population. Yet the Borough is less diverse than England as a whole and significantly
less so than neighbouring Birmingham, but with BAME groups representing a relatively
higher proportion of young people in Solihull (over 15% of those aged 15 and under) this
representation is set to increase.
2.4
Whilst Solihull’s population is ageing, the age profile of the North Solihull regeneration
wards is significantly younger than the rest of the Borough. 29% of the population in
north Solihull are aged 19 years and under and 20% aged 20-34 years, compared to
23% and 15% respectively in the rest of the Borough. At the other end of the spectrum
4
just 14% of the North Solihull population is aged 65 and over and 1.4% is aged 85+,
compared to 20% and 3% in the South.
2.5
This difference in age profile is important in our deliberations about the development of
services. Particularly as they relate to the development of early help support to families.
5
3. LSCB Effectiveness; evaluation of progress on priorities set for 2013/2014
Safeguarding children from sexual exploitation (CSE)
3.1
A collective, concerted ambition has made a difference to children in Solihull on this
priority. We know this because the community at large, children and young people and
their families and the professional community as well as local politicians are telling us
that they are now more aware of CSE. We have taken care to create a web of support
and enable early identification and a swift, timely and robust response to concerns.
Solihull has led the west midlands region in identifying and helping children at risk of
sexual exploitation. In March 2015, 34 children had been helped by the local
arrangements with demonstrable reduction in risks to them seen during the course of our
work with them. These results arise as a result of the following elements;
3.2
Leadership comes from the highest level. Solihull’s Chief Executive (CEO) provides
the CEO lead and Solihull’s Director of Children’s Services (DCS) provides the DCS lead
on CSE across the West Midlands region. This involvement and leadership ensures
sound local direction and accountability. The Council’s portfolio holder for Children’s
services is an active member of the CSE steering group and has led in ensuring that
ward members can be informed of general progress and issues specific to their ward.
3.3
A clear governance structure, (see diagram below) enables development through
strategic, tactical and operational levels.
3.4
Multi-agency Sexual Exploitation (MASE) meetings are a part of our routine response
to children at risk. Their effectiveness is seen through the reduction of risks to individual
children, some moving from level 3 to level one as a result of partnership effort and
specialist support.
3.5
The CSE and Missing Operation Group (CMOG) is a multi-agency task group which
meets to direct medium and long term actions to safeguard, disrupt and reduce
opportunity for children to be harmed through sexual exploitation and missing episodes.
We track this work closely and can see that it has had effect for individuals.
3.6
The CSE steering group , a sub group of the LSCB is chaired by the Detective Chief
Inspector for Coventry and Solihull, who is the Child Abuse Lead in the Police Public
Protection Unit. This group ensures sound governance and links with regional
developments and provides overall strategic direction to the work. It has delivered on a
comprehensive action plan for 2014/2015. The recently developed “Problem profile”
shares local intelligence and is used by the CMOG group to target preventative
interventions. The Police have identified a range of civil and criminal avenues to disrupt
potentially offending behaviours.
3.7
The Local Authority is re-structuring its teams to enable a better offer for early help.
3.8
The police have re-structured the public protection unit, creating additional posts to
respond to CSE.
3.9
Awareness-raising involves dissolving the myths as well as clarifying the facts;
• The majority of our schools have “safe and healthy relationships” as part of the PHSE
curriculum and training for governors regularly features in schools safeguarding
programmes.
6
•
The police have visited over 141 establishments in order to raise awareness and
encourage a response to concerns.
•
Politicians have also received briefings on CSE, including a full Council meeting. We
will continue to brief ward members in the future to support their representational role
because they are so close to their communities.
•
CSE training has been successful, and at the time of writing , a total of 698
professionals from a wide variety of agencies, including the voluntary sector, are
receiving high quality awareness-raising and skills acquisition training. The police
public protection unit have re-structured to provide additional officers to deliver on
CSE.
•
Taxi-drivers will be targeted to ensure that CSE training is a condition of license
renewal.
•
For CSE awareness day in March 2015, Solihull Youth Service had displays and
awareness raising activities in most venues including:
•
•
In Chelmsley Wood Adventure Playground healthy relationships bite-sized
programme of work was started with the first session looking at consent and
the grooming line.
•
In “Safe Time Out” a group for young people with learning difficulties started a
targeted 8 week programme about healthy & safe relationships delivered in
partnership with the NHS.
•
Kingshurst Youth Centre carried out a session based around the NWG helping
hands campaign.
•
Evolution and Outdoor Ed alternative education provision ran awareness
raising sessions as part of their PSHE on-going programmes.
A small group of young people from Solihull, including representation from the Youth
Council and Children in Care Council were supported to attend the West Midlands
CSE conference organised by West Midlands Police and Birmingham Youth Service.
These young people then informed the ideas and development of a future
conference.
A sound operational core;
3.10 Solihull has established a CSE Team, liaising closely with the Public Protection unit of
the police and the Youth Offending Team.
3.11 It provides information, advice and guidance to workers and teams on CSE and a robust
data set is maintained to inform service planning. Specialist training is delivered and
creative ways to engage families designed.
3.12 In addition, the team has two case-workers who offer direct specialist long-term support
to young people at risk of CSE. The CSE team operate within the CSE governance
structure and attend all MASE meetings, the CMOG and the LSCB CSE steering group.
7
3.13 The team regularly revises QA arrangements, refining KPI’s to ensure high quality
engagement with professional staff and with a focus on outcomes for children and young
people.
3.14 We know that all these activities require good coordination across agencies. We also
know that good prevention of CSE requires us to work across our geographical
boundaries which is why we have decided to be so active in supporting the work of the
West Midlands region.
3.15 We keep in mind at all times that accountabilities need to be clear and we have set out
the accountability structure for our partnerships on the next page.
8
Safeguarding
Adults Board
Health and
Wellbeing Board
Regional CSE Group
LSCB
Strategic overview
LSCB Executive sub group (Chairs)
Performance Activity
LSCB CSE Steering Group
CSE Team
Delivering LSCB CSE Strategy
Whole borough training,
communications and intelligence
gathering.
CMOG
(CSE and Missing Operational
group). Overview, support and
challenge on a number of cases
MASE
Multi agency sexual
9
exploitation
meetings (case
specific)
Community Safety
Partnership
CSE next steps
3.16 We shall work to further combine intelligence to ensure sound analysis of children who
go missing from home or from care. Soon this will lead to an even deeper understanding
of their views and experiences. This will then help the CSE steering group to more proactively plan and to inform services working directly with the young people and develop
even better educational and awareness raising programmes.
3.17 The CSE strategy for 2015/2016 has been revised following the government response to
the Rotherham report and our local and national experience, including the experience of
our young people. A very simple but relevant set of measurable objectives for 2015/2016
has been devised. The police experience in using civil as well as criminal interventions
has been included in our performance measures.
3.18 Young people at risk of CSE maturing into adulthood will be prioritised by the group in
2015/2016.
3.19 A new multi-agency case audit tool will assess the quality of interventions to children at
risk of CSE.
3.20 A training review highlighted the high quality of CSE training provision. This has been
improved and will be continually reviewed by the CSE steering group to ensure sound
multi-agency workforce development in this area. This will be informed by a practitioner
led safeguarding learning faculty described below.
4. LSCB Effectiveness; evaluation of progress on priorities set for 2013/2014
Neglect
4.1
A serious case review, while as yet unpublished at the time of writing, generated
awareness of a range of activities to be worked on by the LSCB as a group. There were
also lessons learned for their own agencies built on individually by board partners to
deliver better practice. We have already introduced some changes building upon lessons
learned.
4.2
Linked to the learning ,a new neglect strategy was developed in consultation with a range
of practitioners and managers. The use of the graded profile was approved by partners in
the LSCB. Training on neglect was provided and continues to feature strongly in the
current 2 day course. A series of seminars provided practitioners and managers with
information on lessons learned from this SCR and included learning from national
experience. The LSCB carried out a whole systems review of training. While evaluations
show that training continues to be of a high quality, consultation with over 400
practitioners, showed a demand for re-modelling training around the skills needed to
identify non-and false compliance in families and to recognise and act on drift and delay.
This has led to a radical new model of training, with new competencies based on
partnership communications and negotiation skills. This model also includes the use of
the graded care profile. After a gap for recruitment, a new training officer has now been
appointed to deliver this programme.
4.3
Case audits carried out in this period were designed to address the early lessons from
the serious case review and to test out practice around the following; child focus,
thresholds, assessment and planning, core group work, information sharing and
10
management oversight. This informed the Board that work was yet to be done to embed
the threshold document in practice. Recently a leaflet setting out what needs to be
considered to be important was produced and widely disseminated via board members to
all practitioners. The leaflet is also actively promoted in training. This has provoked
discussion and challenge throughout the partnership system in relation to the Early Help
initiative. Further testing of practitioners’ use of the threshold document will be carried out
via our improved case audit tool. The audits also demonstrate recent improvements in
positive practice around assessments, including actively engaging the child. Partners
engage more effectively at key points in decision making. We know that there remain
pockets where engagement of practitioners working with adults needs improving and we
are actively engaged in working to achieve this.
4.4
Working with our colleagues in the Adult’s Safeguarding Board, we recognised that there
was a need for the safeguarding training review to incorporate adults’ services’
safeguarding training needs. The new training strategy provides for a modular approach
with a curriculum which aligns the common safeguarding training needs of adults and
children’s practitioners. Core group working continues to need improvement, in terms of
timeliness and recording. Progress on this will be assessed by future case audits. We
have learnt that assessing the quality of management oversight and supervision has
been challenging due to the diverse cultures across agencies. In response to this, simple
common standards are, at the time of writing, being developed by the newly focussed
case audit group to provide a basic measurement tool and more realistic expectations.
4.5
Overall, recent multi-agency case audits have showed positive practice in multi-agency
working and communications with a continued need to improve the use of practical tools,
such as chronologies and the need to improve understanding of the various available
assessment tools, such as the graded care profile and the DA assessment tools. The use
of these tools has been included in the training strategy and the practice and procedures
group will continue work on this in 2015 to provide clarity and consistency.
4.6
An audit of agencies’ compliance with domestic abuse standards was also initiated and
was reported to the LSCB at its meeting in July 2015.
4.7
This audit work will culminate in a rigorous Section 11 audit due to be completed in the
Autumn of 2015, combining the learning from the above and including key messages
from case audits to inform further work. This will include further assurance on partner
member’s progress on their SCR action plans.
4.8
On analysis, the LSCB has created new priorities around neglect for 2015/2016
recognising the intrinsic relationship with domestic violence, substance misuse and
parental mental health problems. Also the importance of understanding the experience
of the child living with one or all of these features as an aspect of family life. We are
aware that the need to continue on this work will be brought into focus by the publication
of our first Serious Case review in Solihull expected in the Autumn. As a result the Board
has prioritised children living with any or all of these features for attention in 2015/2016.
Our set of objectives with key performance indicators alongside them will measure
progress.
11
5. Performance analysis; the data on Child Protection
5.1
This section of the annual report accounts for child protection performance, the core of
the LSCB business. Data has been selected from the Local Authority quality assurance
data set and independently analysed. This data is regularly used to inform the LSCB
overall performance analysis and the LSCB performance dashboard. This performance
analysis involves strategic review of trends and, for this report, where relevant, the last 5
years performance is used as a comparison to help understand trends and explain
performance trajectories. Each performance indicator is taken in turn; some are
combined to help understand trend analysis. Overall performance is summarised at the
end. The data selected corresponds to the referral pathway, the child’s journey.
Referral rates per 10,000
Year
SN
10/11
500.20
11/12
508.30
12/13
421.80
13/14
472.10
14/15
England
556.80
533.50
520.70
573
Solihull
728.81
634.58
527.21
492.7
400
Referral rates per 10,000
1000
800
600
400
200
0
10/11
SN
5.2
England
11/12
Solihull
12/13
13/14
14/15
Year
Referral rates appear to have come down in comparison to previous years. However, in
that time there have been several changes in definitions and so this would impact on the
results. In previous years, all contacts to social care were counted. This year, only those
that are considered to meet the relevant threshold of need (level 4 of the threshold
procedures) are now counted resulting in these figures. Historically, there was a lack of
clarity around threshold definitions and therefore a lack of application of thresholds in
practice. Recent communications with all agencies and the reissuing of the thresholds
guidance has led to widespread debate and engagement in the early help agenda. Local
demographics in Solihull suggest a resilience to societal economic fluctuations and an
associated expectation of increased family resilience overall. This would explain the
referral rates being lower than statistical neighbours. Widespread communication,
awareness raising and campaigning by the LSCB on issues around lessons learned from
serious case reviews, neglect and the toxic trio are likely to result in an increase in
contacts and referral rates. This will almost certainly result in increased activity in
demand for early help services, which are at the time of writing being reconfigured and
improved.
12
Percentage of referrals that are repeat referrals within 12 months
SN
27.4%
27.5%
25.3%
23.5%
10/11
11/12
12/13
13/14
14/15
England
25.6%
26.1%
24.9%
23.4%
Solihull
27.3%
22.6%
22.1%
12.6%
14.3%
Percentage of referrals that are repeat referrals within 12 months
40%
35%
30%
25%
20%
15%
10%
5%
0%
10/11
11/12
SN
5.3
12/13
Year
England
13/14
Solihull
Fewer referrals are repeat referrals than was the case 2 or 3 years ago. The rate is
currently lower that the England and statistical neighbour average but has increased
slightly in 14/15. There will always be a cohort of children who need referral for a second
time. A low rate of repeat referrals may indicate that more children are being directed to
other services, preventing the need for formal statutory intervention. Our multi agency
reviews will test this assumption.
13
NI 68 (Proportion) proceeding to assessment or S47
Year
SN
England
10/11
66.5%
71.5%
11/12
69.2%
74.6%
12/13
75.9%
74.4%
13/14
75.9
74.4
14/15
Not published Not published
Solihull
54.3%
75.5%
74.8%
89.6%
83.6%
Source: CPPID
N168 (Proportion) proceeding to assessment or S47
100%
80%
60%
40%
20%
0%
10/11
11/12
12/13
13/14
14/15
Year
SN
5.4
England
Solihull
The proportion of referrals proceeding to initial assessments or S 47 has increased.
When combined with a low referral rate and low repeat referral rate, this reflects a high
degree of assessment activity by social care acting as a single agency filter. This was
brought to our attention by an external peer review as well as from our own observations.
Work to address this has already begun and this rate is predicted to reduce to statistical
neighbour rates early in the financial year 2015/2016.
5.5
Increasing application of the thresholds guidance will reduce this figure to SN and
England average or lower, as cases will be diverted to improved early help services
without the need for a formal social work assessment.
5.6
In addition, the Local Authority has made significant investment in early help,
restructuring to ensure more effective delivery. These plans combine to ensure
sustainable delivery of effective filtration and so improvement in performance.
14
No of children subject to s47 enquiry initiated year to date per 10,000 population under
18
SN
England
Solihull
10/11
77.1
101.1
59.77
11/12
97.1
109.9
98.26
12/13
96.7
111.5
83.70
13/14
112.9
124.1
131
14/15
Not published
Not published
125.7
Source: CPPID
No of children subject to s47 enquiry initiated year to date per 10,000 population under 18
140
120
100
80
60
40
20
0
10/11
11/12
SN
12/13
Year
England
13/14
14/15
Solihull
5.7
This figure is in line with the England average and above the average rate for statistical
neighbours and has been increasing year on year.
5.8
When accompanied by a low rate of referral, low re-referral rate and a high proportion
proceeding to assessment, the identified need for checking that we have effective
communications becomes clear.
5.9
We conclude that the right numbers of children are getting s47 investigations but getting
to this point involves using scarce social work resources to filter cases through. This is a
process that would be more efficiently delivered through multi-agency triage. In 2015 we
shall continue to work on the opportunity for a MASH and to improve interagency debate
about this issue.
15
NI 64 Child Protection Plans lasting 2 years or more
10/11
11/12
12/13
13/14
14/15
SN
England
Solihull
7%
8.3%
4.5%
5.4%
Not published
6%
5.6%
5.2%
4.5%
Not
published
1.3% (2/154 plans)
9% (18/200 plans)
3.7% (8/214 plans)
10.4% (27/260)
7.4% (21/284)
Source: CPPID
NI 64 Child Protection Plans lasting 2 years or more
20%
15%
10%
5%
0%
10/11
11/12
12/13
13/14
14/15
Year
SN
England
Solihull
5.10 National and local experience shows the importance of monitoring drift and delay. This
indicator is a high level Key performance indicator for the LSCB in relation to monitoring
practice around neglect. This is with particular reference to children living with domestic
abuse, parental mental health problems and or parental substance misuse.
5.11 There will always be a cohort of children whose needs indicate that they need the formal
child protection system longer than most. If this figure is too low, it means there is a risk
that child protection plans cease too soon. This eventually leads to a higher figure for
children with repeat child protection plans. If the number is too high, it can indicate that
there is drift and delay in supporting the children.
5.12 Reflecting on this in the LSCB, action has been taken to prevent any drift and delay. This
has included the use of senior level reviews with reference to the recently reissued
threshold guidance. More work will be ongoing in the autumn of 2015 to test the
thresholds are effective.
5.13 Children in Need cases are reviewed at the 9 month stage and children with child
protection plans at 15 months.
5.14 We conclude that the evidence is that this supportive challenge is already beginning to
address drift and delay. So whilst this indicator has seen swinging changes in the last 5
years, it is now stabilising. The outcome is that it has reduced from 10.2% to 7.3% in the
last year (2014/2015) indicating a steady and sustainable change with a positive
trajectory for 2015/2016.
16
5.15 This is an early indication that the LSCB is delivering on lessons learned around SCR’s
both locally and nationally.
5.16 We will monitor this key performance indicator closely to ensure the trajectory is
sustained.
17
NOS of Children with child protection plans per 10,000
SN
England
Solihull
(source: (source:
(source: CPPID)
LAIT)
LAIT)
10/11
30.9
38.7
43.78
11/12
35.7
37.8
48.89
12/13
34.5
37.9
48
13/14
39.5
42.1
46
14/15
48.43
Not
Not
published published
NOS of Children with child protection plans per 10,000
60
50
40
30
20
10
0
10/11
11/12
12/13
Year
Solihull
13/14
14/15
5.17 The rates of children with child protection plans is in line national and statistical
neighbour averages.
5.18 In 2015/2016 we shall continue to monitor this indicator and to look for outliers e.g. very
young children with child protection plans and their time on plan. Also those in families
that move across our geographical boundaries.
18
NI65 Children becoming the subject of CP Plan for second or subsequent time
SN
England
Solihull
10/11
11/12
12/13
13/14
14/15
Source: CPPID/DFE
15.2%
14.0%
13.3%
14.0%
15.1%
14.9%
16.3%
15.8%
Not published Not published
9.9%
5.9%
9.4%
16.3%
21.03%
NI 65 Children becoming the subject of CP plan for second or subsequent time in their lifetime.
5.19 This has increased since 13/14.
5.20 This is an issue that we will keep in focus. However, the challenge relating to the validity
of assessing performance in relation to this key performance indicator has been
evaluated by local authorities’ safeguarding leads at regional level. In areas with low
population denominators, such as Solihull, the value of this indicator in assessing
performance is reduced as small fluctuations in family size can sometimes artificially
inflate the numbers.
5.21 Evaluation is also distorted by the possible 18 year timeframe. For example, a child born
and provided with a child protection plan, and having a repeat plan at 16 years is
included in this indicator. This reduces the effectiveness of this KPI in evaluating overall
performance. Regionally safeguarding leads have agreed that measuring the proportion
of these children who have a repeat plan within 2 years of ceasing their original plan is a
more effective evaluation of the validity and effectiveness of the original plan and so of
overall effectiveness of safeguarding arrangements. Solihull’s performance is good on
this measure as the percentage of repeat plans which occur within 2 years is low in
comparison to available benchmarking data.
19
NI65A Proportion of children becoming subject of a CP plan for the second time within 2 years
of the original plan.
WM average
England
Solihull
13/14
14/15
10.3%
14.9
Not published Not
published
Source: CPPID
7.8%
9%
5.22 Regional benchmarking and local targeting show a positive trajectory. In Solihull 9% of
children with CPP for a second time have a CPP within 2 years of their original plan.
The remaining 12.3% of those with repeat plans in their lifetimes can be attributed in part
to one or two large families and also in part to historical inheritance of unclear thresholds
and poor filtration which we have begun to address (see earlier comments).
CCP x 2 and 2 year analysis
5.23 These two indicators, when analysed together can help evaluate the pace and quality of
decision making within the child protection system. If too many children have child
protection plans for too long, this informs us that decision making is slow and that there is
delay. If at the same time the rate of children with repeat child protection plans is lower
than our expectation, this tells us that overall and retrospectively, children are in the
system for too long and there is too much drift and delay.
Conversely, if very few children have child protection plans for 2 years or more and there
are excessive numbers have repeat plans, this tells us that there is a pattern of ceasing
plans too early. These two indicators, therefore, have to be analysed together to aid our
understanding of practice around the timeliness and quality of decision-making.
5.24 Our analysis over the last five years shows that these indicators have been volatile, with
swinging changes until the last 2 years where performance has begun to settle down.
Recent work on re-publishing thresholds should ensure that a positive trajectory is
sustained with appropriate balance between these two performance indicators. These
will be regularly monitored by the LSCB and the social care quality assurance
programme.
% of Children on Child Protection Plan by Category
70.0%
60.0%
Em otional
50.0%
Neg lect
40.0%
Mult i
30.0%
20.0%
Sexual
Abuse
10.0%
Physical
20
May-15
Apr-15
Mar-15
Jan-15
Feb-15
Dec-14
Oct-14
Nov-14
Sep-14
Aug-14
Jun-14
Jul-14
May-14
0.0%
5.25 Local Authority audit findings in autumn 2014, reported to the LSCB, show that use of the
Emotional Abuse category in child protection procedures is effectively linked with
understanding of emotional impact upon children where domestic abuse is present in the
household. This was discussed at a meeting of Child Protection Conference Chairs to
provide an opportunity for them to reflect on and adjust their practice. This was to ensure
that the category of Child Protection Plan (CPP) is focused on and reflective of the
primary issue of significant concern. The picture regarding the distribution of CP Plans in
terms of category is now, in Solihull, increasingly comparable to the national picture, with
neglect being predicted to overtake the emotional abuse category towards the end of the
year. This evidences progress as a result of the focus of the learning and analysis from
the serious case review and ensuing work by the LSCB on clarifying neglect, as
explained above.
Conclusions
5.26 Overall the pattern of year on year swinging data changes in Solihull seen up to 3 years
ago is settling down. Our analysis suggests that there is a need to improve filtration to
ensure children get the services they need and that social workers concentrate on
safeguarding those children who need it. We are aiming for them not to be distracted by
inappropriate referrals.
5.27 Work to hone in on performance around children with CPP for 2 years in their lifetime and
those with CPP for 2 years or more is proving to have a positive impact. Performance is
improving and has stabilised in the last 2 years and there has been considerable
improvement in this year.
Next steps
5.28 We know that performance in 2014/2015 has improved on previous years. We know that
we need to do more. The key area of weakness in performance identified in more recent
analysis is around the need to deliver on effective filtration. The Local Authority has taken
the lead in working with partners on plans to deliver a multi-agency safeguarding hub
(MASH) and an aligned efficient triage for police notifications of domestic violence
incidents. At the time of writing this work is ongoing.
Significant investment in re-structuring to align local authority and partners services to
deliver early help is well developed at the time of writing. An early help performance
framework has been created to monitor impact with particular reference to impact on
workflow. The LSCB has agreed that Early Help is a priority for 2015-2016 and will aim to
use a high level performance monitoring process to assess progress.
6. Regulation 5 and the LSCB Functions
6.1
Regulation 5 of the Local Safeguarding Children Boards regulations 2006 sets out the
functions of the LSCB in relation to its objectives under Section 14 of the Children Act
2004. This is an account of those functions.
Policy development; (Regulation 5 1(a))
6.2
The following procedures were updated during 2014/15:• Multi-agency guidance on threshold criteria to help support, Children, Young
People and their Families in Solihull
• Information Sharing and Confidentiality Protocol
21
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Referrals
Social Work Assessments
The Child Protection Plan – Including Lead Social Worker and core Group
Responsibilities
Safeguarding children and Young People from Child sexual Exploitation: West
Midlands Metropolitan Area Child Sexual Exploitation Procedures
West Midlands Metropolitan Area Child Sexual Exploitation Disruption Toolkit
Domestic Violence and Abuse procedures
Fabricated or induced illness
Forced Marriages and Honour based violence
Neglect Toolkit
Serious Case Review Guidance
Local Protocol for Children’s Assessments
Joint procedures for the Assessment of Housing and support needs of homeless
16 and 17 year olds
Solihull Community Housing and Children’s Social Work Services Joint protocol
for the Assessment of Accommodation and Support Needs of homeless 16/17
Year Olds
Joint Assessment of Accommodation and support needs of homeless 16/17 year
olds flowchart
West Midlands Metropolitan Area child Sexual Exploitation Framework
(incorporating the See Me, Hear Me Framework)
Thresholds; (Regulation 5 1(a) (i))
6.3
A revised threshold document was agreed by the Board and promoted through the
dissemination of a leaflet summarising the levels of need. It is available on the LSCB
website. The document is also embedded in training programme. Communications on
raising awareness of the document will continue into the autumn period (2015). Case
audits will seek to identify the degree of professionals understanding of the application of
the thresholds locally.
Training (Regulation 5 1(a) (ii))
6.4
A comprehensive training review was carried out February to March 2015 in order to
assess the quality of current provision, governance and commissioning arrangements.
6.5
This review involved over 400 practitioners and also took views from local Children
“Looked After”. At that time, a joint training sub-committee managed the training
developments of both the LSCB and the Safeguarding Adults Board (SAB). The review
recognised that whilst the current training was high quality with very positive evaluations,
it also recommended alternative means to ensure training was effectively evaluated and
delivered.
6.6
The joint committee was replaced by a Safeguarding Learning faculty, an open forum of
practitioners and managers from adults and children’s services, working together on
curriculum design and content. In addition a new set of core multi-professional
competencies was produced based on the experience of the recent serious case review
and national research on homicide reviews. These competencies are based on the skills
needed to deliver effective and safe practice in safeguarding children in a multi-agency
environment.
22
6.7
The outcome of this work is therefore an improved training offer with increased emphasis
on how a professional navigates thresholds and negotiates with partners on the
appropriate services a child needs.
6.8
Focussed competencies are now established for the range of practitioners and
managers, including those working in the newly developed Early Help arrangements. The
programme also includes the competencies of senior managers supporting staff with, for
example, escalation procedures, challenge and arbitration.
6.9
The aim of these improvements is to promote these skills across the workforce overall,
enabling sound judgement and decision making among partners at practice, tactical and
strategic levels in the infra-structure. After a gap for recruitment, the LSCB has appointed
a full time trainer to ensure delivery of high quality multi-agency training. We now need
to focus on evaluating the impact of this change and to make further revisions based on
what partners tell us.
23
Attendance at LSCB training courses in Q1- 4 2014/15 (1 April 2014 - 31 March 2015)
SMBC Other Staff
Youth Offending Service,
Youth Services & Solihull
Specialist Careers Service
HoEFT Community
Services
HoEFT Acute Services
Solihull NHS Clinical
Commissioning Group
Birmingham and Solihull
Mental Health NHS
Foundation Trust
WM Police
Community Rehabilitation
Company
National Probation Service
Solihull Community Housing
Schools and Colleges
Early Years
CAFCASS
UK Visas & Immigration
Voluntary/Third Sector
Other (e.g. Private
business/ out-of-borough
organisations)
Grand Total
PROBATION
Adult Social Care
HEALTH
Childrens Social Care
SMBC
LEVEL 2 Working Together to Safeguard Children
and Young People (2 days) [11 courses]
24
1
25
7
20
0
0
2
8
1
1
7
59
32
0
0
41
12
240
LEVEL 2 Refresher (half-day) [2 courses]
1
0
0
5
2
0
0
0
0
0
0
0
16
7
0
0
2
3
36
LEVEL 3 Child Sexual Exploitation Awareness (halfday) [3 courses]
9
0
0
8
10
0
0
1
0
0
0
0
8
1
0
0
3
5
45
LEVEL 3 Understanding & Responding to Child
Sexual Exploitation (1 day) [1 course]
6
0
3
0
2
0
0
0
3
0
0
0
1
0
0
0
1
0
16
LEVEL 3 Skills for Working With Vulnerable
Young People (1-day) [1 course]
5
0
0
3
5
0
0
3
0
0
0
0
1
0
0
0
1
0
18
LEVEL 3 Skills in Recognising & Responding to
Signs of Physical Abuse (half-day) [2 courses]
8
1
0
2
6
0
0
4
0
0
0
0
5
2
3
0
2
1
34
LEVEL 3 Working with Highly Resistant Families (1
day) [1 course]
0
1
0
0
7
0
0
0
0
1
0
0
5
0
0
0
3
0
17
LEVEL 3 Working With Neglect (1 day) [3
courses]
2
0
4
0
25
0
0
0
0
1
0
0
7
1
0
0
9
0
49
LEVEL 3 Practitioner Forum (half-day) [1 course]
3
0
5
2
13
0
0
0
0
0
3
2
1
0
0
0
6
1
36
LEVEL 3 Domestic Abuse (1 day) [2 courses]
8
0
3
1
16
1
0
1
1
0
0
2
5
0
3
0
5
2
48
LEVEL 3 Female Genital Mutilation (half-day) [1
course]
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
2
LEVEL 4 - Learning from Serious Case Reviews
(half-day) [4 courses]
31
1
9
4
8
0
0
0
0
3
0
7
31
0
0
0
1
2
97
LEVEL 4 Managing Allegations Against Staff (halfday) [2 courses]
2
0
5
0
2
0
0
1
0
0
0
0
9
20
0
0
2
1
42
LEVEL 4 Managing Allegations Against Staff (halfday) (Early Years Only) [1 course]
0
0
0
0
0
0
0
0
0
0
0
0
0
18
0
0
0
0
18
Total
99
4
54
32
116
1
0
12
12
6
4
18
148
81
6
0
78
27
698
24
Local Authority Designated Officer (LADO) report (Regulation 5 1(a) (iii) and (IV))
6.10 Since February 2014, the LADO has been supported by officers of the Child Protection
and Review Unit to manage referrals, chairing of Position of Trust (POT) meetings, and,
provision of advice. The details of the changes to the LADO were circulated widely and
this was supported by the LSCB. The LADO annual report on the period January 2014January 2015 was provided to the LSCB in May 2015.
6.11 The report provided detailed analysis of the numbers of allegations in that period, (43)
and a profile of agencies with the concern, the majority being from the Local Authority
and the Education provider sectors. The report noted that there were no referrals from
health and enquiries were made into the reasons why and referrals have been
encouraged and monitored. As a result of this the Board was assured that health
agencies have tested awareness in-house, having used LADO’s in neighbouring areas
and that there was no deficit in training or processes. The LADO provided 3 training
sessions to 72 attendees on managing allegations.
Private fostering (Regulation 5 1(a) (v))
6.12
At the time of writing, there are seven children known to the local authority currently in
private fostering arrangements in Solihull. All of them received a visit within 7 days of the
LA being informed. Private fostering is managed through one of senior social workers in
the fostering service.
6.13 Publicity materials on private fostering are on the Council website and promoted to
schools via Designated Members of Staff (DMS) training .Most recently at the time of
writing in November 2014 for DMS in schools and for GPs in July 2014. Training was
also offered to the wider community via foster carers (newsletter July 2015). Briefings
have been delivered to Social Work teams to make sure they are aware.
The LSCB communications function (Regulation 5 1(b)
6.14 The LSCB’s role is to communicate to persons and bodies in the area of the authority the
need to safeguard and promote the welfare of children, raising their awareness of how
this can best be done and encouraging them to do so.
6.15
Key highlights for work carried out in 2014/2015 are as set out below;
6.16 The threshold leaflet has been designed and delivered to practitioners through their
member agency representative on the Board. It has also been a key focus for training
and is included in the LSCB website.
6.17 Seminars for practitioners were held to raise awareness about lessons learned from
national and local experience of case reviews.
6.18 As part of the training review; over 400 practitioners engaged in a survey to express their
views about training resulting in a new training strategy.
6.19 The community, schools, politicians and the workforce received awareness raising on
CSE as described above.
25
Communications; Next steps
6.20 A revised whole systems communication strategy will be delivered in the autumn of 2015.
Using a new LSCB website, a range of communications will deliver messages more
effectively to the frontline. This will include a conference to be held in November to bring
key stakeholders together to consolidate lessons learned from serious case reviews,
early help provision and the neglect strategy as well as raising awareness on private
fostering.
6.21
Communications on the new training strategy and programme will promote the training.
6.22
CSE communications will also include messages for parents.
The LSCB is a learning organisation (Regulation 5, 1 (c))
6.23 A new Learning and Improvement framework has been created in order to reflect the
learning experience of the Board in this period. We aimed to provide a clear
understanding of how the LSCB improves practice from learning. This provides the
rationale for members’ decisions and priority setting. A new quality assurance framework
has been created, linking the Boards’ priorities directly to key performance indicators and
including data shared from partner agencies.
6.24 This helps Board members focus and analyse progress in relation to outcomes for
children and young people and represents a shift in emphasis from the Board’s
processes to productivity in terms of impact. The Local Authority continues to provide the
raw data on child protection, and this is analysed above.
6.25 This data, and data from partners is used to inform performance on overall priorities and
objectives. The aim of this new arrangement was to de-clutter the process to allow
increased visibility and transparency and therefore enable ownership of the progress
made. Data is analysed by the LSCB executive group and items for further analysis are
examined by the full Strategic LSCB and sometimes entered on the risk log so providing
opportunities for challenge and improvement.
Source
We learned in 2014/2015
Serious case review Intrinsic relationship between
neglect and the toxic trio. We will
prioritise children living with any
or all of these features.
We need to improve LSCB
communications.
Training review
(and practitioners
views)
Case audit
Therefore in 2015/2016 we will;
Deliver the neglect strategy
Promote the graded care profile
Use simpler performance tools to
measure progress.
Focus on outcomes, not process
Devise new training competencies.
Devise new communications strategy
and LSCB website.
We need to shift the emphasis to Provide clear training strategy outlining
partnership skills development.
partnership competencies.
Enable practitioners to identify
Ensure training on graded care profile.
and respond to drift and delay,
Relentless focus on outcomes for the
and providing healthy challenge
child, not processes.
and to use escalation procedures. Engage practitioners in training design.
Need to improve core group
Improve case audit methodology.
working, audit supervision and
Re-audit core group working,
management oversight,
supervision and auditing children living
repeatedly disseminate
with domestic abuse, neglect and the
thresholds leaflet, and improve
toxic trio, those at risk of CSE and
26
case audit methodology,
challenge drift and delay.
CDOP
Co-sleeping awareness
campaign
Risk assessment of mothers with
High BMI
those receiving early help services.
E-enable communications to reach a
wider audience faster.
Monitor children with child protection
plans for 2 years or more as part of QA
framework.
Ensure all lessons are in training.
Continuing awareness campaigns in
health agencies.
Information includes risk assessment
included in “Red Book”.
6.26 A learning log is maintained by the LSCB business unit to ensure lessons learned are
captured and used in the LSCB’s various initiatives. Below are examples from the
learning log which provides key highlights of how we learn from experience;
LSCB participating in planning of services for children; (Regulation 5 (d))
6.27 During the year we began to explore further the way we work with other partnerships and
Boards to better effect. Work to align our training priorities took place with the Adult
Safeguarding Board. We have developed protocols for our work with other Boards and
are currently exploring how we can improve these further with specific tasks to be
identified to improve outcomes.
Serious case reviews (Regulation 5,1(e))
6.28 A serious case review was commissioned in March 2013. There has been a delay in
publication due to legal reasons outside the control of the LSCB. Work on engaging the
family and the completion of the report was suspended for these legal reasons. Partner
agencies therefore proceeded to deliver on their action plans to ensure that lessons were
learned quickly and the LSCB action plan has been completed. Initial learning from the
SCR, though not published or complete, influenced training and priority setting for the
LSCB. This work is likely to be completed in the autumn of 2015, generating the high
level communications strategy described above.
Child Death Overview Panel (CDOP) ;( Regulation 5, (2)
6.29 13 deaths were notified and 12 reviewed between April 2014 and March 2015. 5 were
neonatal deaths, 5 were sudden and unexpected deaths and 3 were expected deaths
from limiting conditions. 8 had identifiable modifiable factors and 4 had non-modifiable
factors.
Age
5
0
3
2
3
6.30
Aged 0-28 days
29-364 days
1-4 years
5-9 years
10-17 years*
Gender
7 Male,
6 Female
Ethnicity
7 White English
4 Asian
2 “Other”
Key Highlights:
•
Following the review of an 11 year old who died prematurely from Cystic Fibrosis,
CDOP referred the case to the LSCB chair to consider whether the case meets the
27
criteria for serious case review. It was agreed that it did. CDOP suggested that
parental neglect was a contributory factor in the child’s death.
•
Following the review of a neonatal death where there was a perceived delay in the
ambulance attending to transfer the patient to a Level 3 hospital, CDOP wrote to
West Midlands Ambulance Service to ascertain how the service was to sustain its
attendance targets with increased demands being placed on the service. In this
particular case the target time was found to be met and CDOP was reassured by the
response received, i.e. the plans in place to recruit 400 paramedic students over the
following year, ordering additional vehicles and introducing additional shifts to provide
more flexibility during peak demands.
•
A high maternal BMI was found to be a contributory factor in 2 neonatal deaths
reviewed. This is more significant when grouped with Coventry and Warwickshire
CDOPs as we work as a sub-region; i.e. a high maternal BMI was found to be a
contributory factor in 4 neonatal deaths reviewed at Coventry CDOP and 3 neonatal
deaths reviewed at Warwickshire CDOP, taking the total to 9. A raised BMI has
featured as a contributory factor in previous years. CDOP sought reassurance that
expectant mothers with a high BMI were being referred to the Maternal and Early
Years Obesity Pathway. It was ascertained that this referral service stopped in 2014
and it is a commissioning decision whether to reinstate. CDOP sought to learn more
about ‘Lighten Up’, a Birmingham service weight loss programme
•
Solihull CDOP reviewed a further SIDS death during 2014-2015 where modifiable
factors were identified. Parent(s) not following safe sleeping advice is a recurring
theme. Together with Coventry and Warwickshire, Solihull Health Visiting Service has
agreed to utilise a risk assessment model to identify any factors which increase the
risk of SIDS. This will be undertaken at the primary (home) visit. The proposal is to
have the risk assessment bound into the Personal Child Health Record (red book)
and a draft has been forwarded for printing which will then be circulated for
consultation with Midwifery and Health Visiting services.
Children Missing Education
6.31 Schools rigorously monitor children who are not regularly in school with particular
reference to the child’s safety. This includes children who are persistently absent,
children whose attendance has dropped below the national average figures and
continues to slip, and children who are not attending but have not been removed from
school roll. Schools are also supported to use a Behaviour and Attendance tool
(https://extranet.solgrid.org.uk/schoolissues/BehaviourAttendance/Shared%20Document
s/Forms/AllItems.aspx) to promote good attendance. This applies to all vulnerable
groups, including those in need of safeguarding, at risk of CSE or in need of early help. A
specialist Children Missing Education Team supports schools in working to ensure
children missing education are safe and that procedures are followed. School
Improvement Advisors discuss and challenge attendance/persistent absence termly and
during their annual safeguarding visit.
7. Statutory partners safeguarding responsibilities
7.1
Each partner member of the LSCB is accountable to all members for their safeguarding
responsibilities. This section provides a summary of statutory partners account in
2014/2015.
28
7.2
West Midlands Police (WMP) force has made significant strides forward in the
understanding of the threat relating to CSE across the Force and this is a key area that
has advanced over the last period. Police now have a force CSE perpetrator team who
look to target the most risky groups around CSE and, at the time of writing, there are a
number of live operations running across the force area.
7.3
In Solihull, the force has reduced the number of victims from over 70 to around 40 with
few high risk victims. These have all been managed and reviewed through CMOG and sit
with the LA, CSE team and the WMP CSE co-ordinator. There have been some
significant interventions and partnership work around all of the victims based on their
level of risk.
7.4
WMP has set up a local CSE team led by a Detective, (DS) who manages the CSE coordination and utilises local police resources where necessary. Front line training has
been implemented around the use of civil interventions (Child Abduction Warning
Notices) and disruption tactics. A CSE tasking group is led by a DCI to ensure aspects
are gripped around victim, offenders and locations. Return interviews are conducted and
a robust intelligence sharing process has been developed. The force are receiving a lot
of ‘bite size chunks’ from partners through this system helping to fill intelligence gaps.
7.5
A missing and absent pilot, (Coventry and Solihull PPU) began on 1st July which will
ensure absent children are entered into the police software, allowing an automatic
referral to Local Authority colleagues to ensure no victims slip through the net.
7.6
The force continues to support the Early Help process and attend Domestic Abuse (DA)
screening meetings whilst managing the MARAC process via a DI. Also the force is
currently looking to finalise the recruitment for MARAC support through the LA. Through
the voice of a child work, the force is also dip sampling our Domestic Abuse (DA) crimes
to ensure the children are being seen and checked 100% for DA incidents and that the
relevant referrals are submitted.
7.7
WMP are committed to the anticipated delivery of a Solihull MASH unit and are working
with partners around the foundation of early help which is vital to the implementation of a
child MASH and to ensure we can manage the demands. This discussion is on-going
through the MASH governance structures.
7.8
Future developments are looking around digital capability around CSE and child
investigations through a specialist trained officer. This is embedded within the team.
WMP are progressing the training and awareness raising through the CSE sub group and
trying to tackle the adolescent issue where a child becomes 18 years of age and so may
fall through the gaps during this transition.
NHS Solihull Clinical Commissioning Group (NHS CCG)
Achievements
7.9
We are active members and work closely with Solihull Safeguarding Adults & Children’s
Boards, Safer Solihull, Birmingham Community Safety Partnership, Solihull Health &
Wellbeing Board, Solihull Special Needs & Disabilities Board, Solihull Youth Offending
29
Board, West Midlands Police, Solihull Multi-agency Public Protection Arrangements (for
example, via MAPPA Panels level 2 & 3), Solihull Domestic Abuse Priority Group and
Solihull Prevent Forum.
7.10 Solihull CCG (SCCG) appointed on behalf of NHS England a 0.8 week time equivalent
Named Professional for Primary Care during the autumn of 2014. The post holder
commenced in December 2014. During January to March 2015 the Named Professional
for Primary Care completed practice based audits in respect of: implementation of the
domestic homicide reviews and serious case review recommendations, as well as the
wider test for compliance in regards to: implementing safeguarding policies and
procedures; information sharing guidance; and application of the threshold documents
(LSCB and SSAB).
7.11 NHS CCG continue to support practices through the establishment of the Practice
Safeguarding Leads Network Meetings and giving planned opportunities for practice
members to attend Solihull CCG safeguarding workshops and multi-agency training.
Where we can, we combine partnership resources and opportunities to enable multiagency learning events for example, the Protecting Young People and Vulnerable Adults
at Risk: Domestic Abuse allied to vulnerabilities conference held on 2nd October 2014 at
The National Motorcycle Museum.
Child Protection Conferences
7.12 Piloting telephone conferences in respect of child protection conferences was in progress
during March & April 2015. Findings, analysis and recommendations are being built on
and evidence shows that this has improved input to these meetings.
7.13 During 2014/15 we have reviewed the vetting & barring requirements and our entire
workforce continue to meet the criteria.
There have been no referrals to the Disclosure & Barring Service. In respect of
safeguarding adults & children’s learning and development we have reviewed
compliance with all courses taking account of the Care Act 2014, Children and Families
Act 2014, Safeguarding Children and Young People: roles and responsibilities for health
care staff (2014), Solihull Domestic Abuse Workforce Strategy (updated February 2015),
Solihull Joint SSAB & LSCB Learning and Development Strategy 2013-15 and the
respective professional learning and development competency frameworks (e.g. NHS
England Prevent competency framework). Benchmarking against current 2015 standards
and competency level as mentioned above, during 2014/15 we have achieved an uptake
of:
•
89% compliance for Governing Body (16 out of 18 members have received executive
learning & development for safeguarding adults, children, and domestic abuse
awareness).
•
64.7% compliance (80% on 7/7/2014) for Safeguarding children, level 1 (equivalent
to SSAB/LSCB Foundation Level (33 out of 51).
•
100% compliance for levels 2 safeguarding adults and/or children (equivalent to
SSAB/LSCB Level 1).
•
100% compliance for higher levels including level 3, 4 & 5 for Safeguarding Adults &
Children.
•
81.8% compliance for Prevent/ WRAP training (45 out of 55 paid staff).
30
•
During May 2015 SCCG Senior Management Team is revisiting the mandatory
requirement for inductions and documentation for annual appraisals.
Assurance- summary
7.14 Within the past year we have continued to strengthened assurances from health
providers and from local authority that commission and/or deliver services on our behalf.
The CCG continues to use contractual mechanisms to reinforce or raise queries with our
providers. Key specifications continue to be included in the NHS Commissioning Board
2015/16 NHS Standard Contract – Service particulars and any care placements it
commissions are safe, with mitigating action against potential concerns when they arise.
All of our contracts, including third sector contracts reference our safeguarding policies,
which are linked to the multi-agency agreed standards and procedures. For 2015/16 we
have issued, via our SCCG contracts and performance team, a comprehensive learning
and development dashboard to all providers we contract with. The purpose is to obtain a
current stock check mapped against the existing polices, standards, new legislation and
competency frameworks.
7.15 During 2014/15, we have had two Commissioning for Quality & Innovations (CQUINs) in
place in relation to experiences of staff and service users via capturing safeguarding
stories (safeguarding adults and children) and improving the common assessment
framework compliance for health professionals.
7.16
Future challenges for safeguarding and actions:
•
Getting better at protecting people from harm to include: early and/or preventive help
for those at risk of abuse, including the local priorities given to child sexual
exploitation, domestic abuse’ & neglect.
•
Giving every child the best start in life, this includes children with disabilities, looked
after children, children & families meeting the local authority thresholds of
intervention and those subject to child protection plans .
•
Embedding and implementing the Children & Families Act 2014, Working Together to
Safeguard Children (March 2015), Promoting the Health and Well-Being of Looked
after Children (March 2015), Care Act 2014, and the Mental Capacity Act 2005.
•
Continue to ensure the programme of action to transform care is in place. This will
ensure that people no longer live or remain in hospital inappropriately, but are cared
for in line with best practice, in ways which place their individual needs and families
views at the heart of support and planning.
•
To continue to support and strengthen system wide safeguarding quality assurance,
including monitoring visits; assisting with evidencing best practice and improvements
are making a difference to improving the safety and welfare of our most vulnerable
residents. Partner Agency: Heart of England NHS Foundation Trust.
Heart of England Foundation Trust
7.17 The Trust has an established Specialist Safeguarding Team reporting to the Executive
Lead for Safeguarding (Chief Nurse) and internal governance processes to oversee the
31
effectiveness of safeguarding arrangements within the Trust. Compliance with CQC
safeguarding regulations and Section 11 duties is carried out quarterly.
7.18 There is external scrutiny of the safeguarding arrangements within the Trust through the
CCGs, LSCBs, and the CQC. The Trust has completed a capacity review of Specialist
Safeguarding Resource in view of growing demands and new ways of working (including
Multi-agency Safeguarding Hubs).
7.19
7.20
During 2014-15 the Trust has:
•
Expanded the scope of supervision to include the large group community midwives
and increased the amount and frequency of supervision to health visitors.
•
Increased compliance with the safeguarding learning and development strategy.
•
Commenced delivery of in house Child Sexual Exploitation (CSE) training and a
communication strategy to promote awareness of CSE and how it may present to
health staff and arrangements to capture use of the CSE screening tool
•
Introduced the new multi-agency referral forms maintaining a focus on the quality of
information transferred at referral.
•
Implemented a number of audits to track the effectiveness of information sharing at
points of transition.
•
Sought the views of families following safeguarding referrals and gained an
understanding of how they experienced this process.
•
Tracked both good practice and learning through implementation of the ‘patient story’
template using this to highlight both good practice and areas for improvement.
•
Increased Common Assessment Framework (CAF) initiation in maternity and health
visiting services
Key areas of improvement for the Trust in 2015/16
•
Sharing of information – particularly at transition points is an area that will feature in
audit activity in 2015-16. This includes the use of multi-agency referral forms
(MARFs) with a view to continuing practice improvement.
•
The Trust will commence rotation into the Multi-agency Safeguarding Hub in 2015-16
and will aim to improve the interface between acute care and the MASH. Recruitment
is underway.
•
Supervision – the Trust plans to maintain compliance with supervision targets whilst
expanding provision in the Emergency Department.
•
Expanding the voice of the child and service user in the safeguarding arena.
•
Ensuring the consistent application of safeguarding assessments with 16-18 year
olds and for adults presenting with problems with substances, mental health issues or
domestic abuse.
32
•
Early Help -The Trust will be seeking to increase use of the appropriate assessment
to help families’ access early help in health visiting, maternity, neonates and clinical
nurse specialisms in paediatrics.
•
Completion of a capacity review and consideration of a Business Case for
Safeguarding Specialist Resource in quarter 1 2015-16
•
Full implementation of recommendations following the Lampard and Marsden report
into the NHS following the Investigations into Jimmy Savile.
•
Establishing a consistent and skilled response to young people at risk of child sexual
exploitation wherever they present in the organisation.
•
Maintaining compliance and expanding the remit of specialist child safeguarding
supervision.
•
Refreshing the understanding of key staff in relation to Right Service Right Time and
thresholds.
Birmingham and Solihull Mental Health NHS Foundation Trust
Summary:
7.21 In 2014, Birmingham and Solihull Mental Health Foundation Trust’s Executive Director for
safeguarding commissioned an external review of the safeguarding team in order to
discern how improvements could be made to service delivery. The review suggested
that the safeguarding team needed additional staffing capacity and an improved
governance structure. The Trust appointed a new Head of Safeguarding and agreed to
increase the number of staff to improve the capacity of the safeguarding team. During
this financial year the Trust responded to an unprecedented number of investigations,
such as serious case reviews and domestic homicide reviews. Changes related to
commissioning, a revision of children’s safeguarding arrangements and the introduction
of the Care Act have all impacted upon the workload of the safeguarding team, as has
the political landscape of austerity on public service provision.
7.22 As a result of the above 2014/15 was a challenging year, however the safeguarding team
are now settling into new ways of working. They are not as yet fully staffed, but now
have a full time trainer and two safeguarding facilitators, one for adults and one for
children. The named nurse provision had increased from 2 nurses to 3.
Training:
7.23 In 2014 it was identified that training provision was hampered by a lack of staff capacity.
From November 2014 we have employed a full time trainer and have reviewed and
rewritten our training package to comply with Intercollegiate (2014) requirements and
Working Together 2015.
7.24 We deliver safeguarding training at level 1, 2 and 3 (level 3 training was introduced in
January 2015). At level 3 we offer 45 places per month to external candidates, most of
which come from early help services. The purpose of this was to comply with
intercollegiate guidance and to improve BSMHFT staff understanding of early help and
partnership working.
33
7.25 Training includes “Think Family” SCIE 30 Guidance and aims to incorporate “the voice of
the child”. This meets our section 11 peer challenge to improve training provision. The
Safeguarding Team have recently commissioned a training needs analysis to determine
specific areas for targeted training above and beyond statutory requirements. An
evaluation exercise is due to be conducted in July. Evaluations to date are very positive.
However, we are aiming to assess the impact of training on staff competency this year.
7.26
Training Compliance at end of Quarter 4 2014/15
Safeguarding Children
Level 1
Level 2
Level 3
Training %
94.0%
70.5%
Σ62.5%
Audit:
7.27 We have conducted an audit in Solihull to ascertain how staff identify children with young
carer responsibilities and who may be in need of support due to limited parenting
capacity.
7.28
Planned improvements for 2015/16 are:
•
Improving our understanding of the safeguarding experience of children and
service users. We have engaged with patients within Trust youth services to
produce a safeguarding leaflet. We have offered to make this available in other
languages (there has been no demand for this to date). Our new training package
has more emphasis on “the child’s voice”. A 2015 priority is to develop this
aspect of service delivery.
•
Implementing a new supervision policy. In 2014/15 we offered supervision in the
form of Action Learning Sets to targeted areas with a high proportion of young
service users or where there were significant numbers of children on Child Protection
Plans. However, the Trust has undergone some service changes and therefore a
new approach needs to be introduced. The Trust’s external review has
recommended that all appropriate staff are trained in NSPCC supervision – this is
planned for 2015/16.
•
Domestic Abuse. We will be recruiting a Domestic Abuse Named Nurse and
implementing a domestic abuse strategy.
•
Improving data collection and retrieval. The system used in 2013/14 was
reviewed and was not fit for purpose. Currently we are able to flag children known to
be on child protection plans on our alert system. We are able to record numbers of
referrals via our incident reporting system. We are not able to accurately measure
families with child in need or early help plans. We aim to review our data retrieval
systems within the next eighteen months.
Schools and education providers
7.29 The LSCB now incorporates the safeguarding in education group as a sub-group. The
chair of that group is also a member of the LSCB executive and the full LSCB board.
Schools have made a significant contribution to the board’s priority on Child Sexual
34
Exploitation with the majority of schools attending training for governors and staff on CSE
and e-safety is incorporated into the PHSE curriculum of all schools, with many schools
also raising awareness for parents and the local community.
7.30 The revised Safeguarding children in Education guidance (Keeping Children Safe in
Education, 2015) has been disseminated via regular forums for safeguarding children
developments, including a head teacher “Breakfast” meeting, Solihull Schools Strategic
Accountability Board, school collaborative groups and training for Designated Members
of Staff. Regular information on national and local safeguarding issues, including serious
case reviews is disseminated widely through this sub-group and using these forums.
7.31 Solihull schools have a clear referral process for PREVENT to refer any concerns about
radicalisation and violent extremism. Three workshops to raise awareness of PREVENT
have been delivered to PREVENT leads. 43 education providers have been trained and
24 school governors have attended governor sessions.
7.32 All schools and education providers receive an annual visit from the education
improvement advisors to establish their compliance with Section 175 or 157 of the
Education Act 2002. As a result of this work, the LSCB is assured that schools now have
a clear oversight of pupils at risk of harm and are responding appropriately to need and
engaging key partners in line with statutory duties.
This results in continual improvement across the schools sector. This year a vulnerability
profile was produced indicating the numbers of children in schools who had additional
vulnerabilities around child protection or looked after or with other additional needs. This
profile was shared with the LSCB executive group and aligns with the demographic
profile of the borough described in section 2 of this report. There are more children with
additional needs in the north of the borough, with a concentration on the B36 and B37
postcode, than in the south. This will help schools to work with the Early Help initiative on
workforce and capacity planning and informs schools concerns to prioritise the
improvement of mental health services to children and young people.
7.33 Bullying has been identified as a specific safeguarding priority by schools; the following
are key highlights of findings from the Health Related Behaviour Questionnaire (2014) to
schools. This explains its priority .
•
89% of schools that responded to the questionnaire identified bullying, including
cyberbullying, as a top-five priority.
•
32% of these identified bullying as their number one priority.
•
Three quarters of pupils surveyed (Years 4 and 6) report that their school takes
bullying seriously
•
Specific gender issues are apparent and begin in Year 2
•
Pupils are over three times more likely to have been picked on or bullied for their size
or weight if they would like to lose weight than if they are happy with their weight as it
is.
•
When responding to “If you had a problem with bullying, with whom would you share
it first?”, respondents are more likely to keep it to themselves
35
•
5% of pupils, Years 4 and 6 (just over 200) report having been bullied through their
mobile phone, whilst 7% (286 pupils) have received nasty or threatening emails or
online messages.
Ongoing progress on addressing this will be reported to the LSCB in 2015 as set out
below..
7.34 The managing allegations policy has been revised, and managing allegations training is
regularly provided to all school leads by the LADO and HR. A new safer recruitment
training package has been developed and training is currently being rolled out to all
education providers. Work is underway to sustain child protection foundation level 1
training in schools through organisational change.
7.35 Priority setting for this sub-group therefore involves borough wide concern to address
mental health issues, and to support anti-bullying work in schools including cyberbullying. It also includes taking the lead on the LSCB priority around neglect and
delivering on CSE and toxic trio objectives. In addition this group will deliver on the core
business of safeguarding children in education settings, and align working with any
MASH and Early Help developments.
Solihull Community Rehabilitation Company (CRC)
7.36 On 9th May 2013, the government announced its aim to “transform the way we manage
offenders in the community to achieve a reduction in the rate of re-offending whilst
continuing to protect the public”. This means that in the near future, the majority of
offender services will be delivered by a range of contracted private and voluntary
organisations.
7.37 Staffordshire and West Midlands Probation Trust came to an end on the 31st of May,
with staff transferring to either the new public sector National Probation Service (NPS)
cluster of Warwickshire, Coventry and Solihull, or the new Staffordshire & West Midlands
Community Rehabilitation Company (CRC) cluster of Coventry and Solihull. The SWM
CRC remains under contract to the National Offender Management Service until share
sale is completed (anticipated to be 1st February 2015).
7.38
The key aspects of the Coalition’s Transforming Rehabilitation reforms are:
•
•
•
•
•
•
A new public sector National Probation Service has been created.
Every offender released from custody will, in due course, receive statutory
supervision and rehabilitation in the community.
Legislation will extend this statutory supervision and rehabilitation to all 50,000 of the
most prolific group of offenders – those sentenced to less than 12 months in custody.
Currently, these offenders have no statutory involvement with the probation service.
A nationwide ‘through the prison gate’ resettlement service will be put in place,
meaning most offenders are given continuous support by one provider from custody
into the community. The prison service is to re-organise the prison system so that
most offenders are held in a prison designated to their area for at least three months
before release (a resettlement prison).
The market will be opened up to a diverse range of rehabilitation providers in the
voluntary and private sectors, at the local as well as national level.
New payment incentives for market providers will be introduced, giving providers
freedom from bureaucracy and flexibility to do what works, but only paying them in
full for significant reductions in reoffending.
36
The Community Rehabilitation Company
7.39 The Coventry and Solihull Probation cluster of the SWM Community Rehabilitation
Company (CRC) is led by Kobina Hall.
7.40
The Community Rehabilitation Company is responsible for:
•
•
•
•
•
the supervision of all cases assessed to present a low risk of harm or medium risk of
harm
delivery of Community Payback
delivery of accredited programmes (group work with offenders except for sex
offenders)
delivery of other interventions e.g. Employment training and Education support and
services; non-accredited group work programmes; and a range of interventions
addressing issues such as finance, accommodation and substance misuse issues
Integrated Offender Management (IOM)
7.41 In October 2014, The Reducing Reoffending Partnership was announced as the
preferred bidder for the Staffordshire and West Midlands CRC. This partnership between
Ingeus, St Giles Trust and Crime Reduction Initiatives was also successful in securing
preferred bidder status for the Derbyshire, Leicestershire, Nottinghamshire and Rutland
CRC.
7.42 Ingeus UK is a leading provider of employment and training, including the government’s
Work Programme amongst other employability services. The company works alongside
one hundred partner organisations from the public, private and voluntary sectors.
7.43 St Giles Trust is a registered charity that aims to break the cycle of prison, crime and
disadvantage and create safer communities by supporting people to change their lives.
Their services put offenders at the heart of the solution by training them to put their skills
and experience to use in providing peer support and mentoring. Interestingly about a
third of St Giles Trust’s staff are ex-offenders who now support others towards living
independent lives, according to the following needs: Somewhere to live; “Something to
live for”; Support from someone who has been there; Positive relationships.
7.44 Crime Reduction Initiatives is a recovery oriented substance misuse service that works
with service users to inspire them towards appreciating the benefits of abstinence for
their health and wellbeing. CRI works from the basis of respect for user choice and so by
being non-judgemental, will work with service users on longer term treatment journeys.
7.45
Further information: http://www.justice.gov.uk/transforming-rehabilitation and
http://www.rrpartnership.com/
7.46 The contracts for the sale of the CRC to RRP were signed on 18th December 2014 and
the transition date to new ownership is 1st February 2015. The contract is set to run for 7
years with a possible extension period of a further 3 years.
7.47 February 1st coincides with the enactment of the Offender Rehabilitation Act and the
implementation of the new provisions for supervision of short sentence prisoners whose
offences are committed on or after this date. The CRC will then have twelve weeks put in
place its provisions for the Through the Gate service.
37
7.48 The work of the CRC under RRP’s ownership will be underpinned by a payment by
results (Payment by Results (PbR) framework which combines a ‘fee for service’ element
with payments by results, increasing potentially over the life of the contract which are
payable only if there are demonstrable and incremental reductions in reoffending by the
offender cohorts supervised. It is anticipated that the first cohort of offenders subject to
the PbR arrangements will commence supervision in October 2015, with the first
payments under PbR due to be made from late 2017.
7.49 Setting up the new service out of the probation trust has entailed a huge amount of work
however safeguarding children has remained a priority for all staff in the CRC. Training
requirements have been met and CRC staff have continued to contribute to multi-agency
procedures including Early Help initiatives. Solihull probation has contributed to the
LSCB Audit Group’s work and the learning from that exercise has been taken forward
with the team. In summary, the following has occurred:
7.50 We have signed people up to appropriate safeguarding training and will continue to
monitor this;
•
•
•
•
•
A case audit for the Audit Group revealed gaps in inter-agency communication at
referral, assessment and case conference stages which we are seeking to address
through training and, inputs from partners
Probation staff have received input around thresholds including an input from Betty
Lynch re the general context; this linked well with the identified need re
communication
We are establishing closer links with Solihull Families First and will shortly roll out a
case information form re potential familial involvement at case allocation stages;
We will shortly be undertaking orientation work with Solihull CMHT and would like to
pursue similar cross fertilisation opportunities with social care;
We continually stress the importance of HVs and requirement for professional
curiosity and a more reflective approach to staff supervision is underway
Solihull Metropolitan Borough Council
7.51 Organisational change to improve children’s social work provision, addressing concerns
around practice and performance as well as caseloads size, workforce recruitment and
retention have been completed and the resulting structure is currently being embedded.
All of the actions outlined in the SCR action plan have been delivered. The local authority
has invested significantly in the creation of early help services, working with partners on
effective arrangements to deliver. As a result, early help is a LSCB priority for 2015-2016
with an associated performance framework to demonstrate impact on filtration and
workflow volume. It is too early to assess impact but the LSCB will retain a focus on
improved outcomes during and after organisational change.
A summary of developments;
7.52 The large number of CiN cases was reviewed and, as a consequence, reduced as a
large proportion of those children did not meet the threshold for statutory intervention. A
dedicated team is now ensuring robust plans deliver identified outcomes.
7.53 To support workforce development a bespoke training programme for managers has
been commissioned from the Virtual Staff College and the development needs of core
operational teams have been assessed by an external consultant resulting in a detailed
workforce training programme. The consultant also identified a lack of clarity regarding
38
thresholds for services and interventions. This helped explain why, at the time only 47%
of s47s were progressing to ICPC. The revised LSCB Threshold document is now being
applied by all teams, especially the Referral Team and this has now improved.
7.54 A new Quality Assurance Framework has been agreed, with the first report due to go to
children’s services Divisional Leadership Team meeting in July.
7.55
CSWS staff have taken the lead, working with partners on creating a local MASH.
7.56 All first assessments and s47s are undertaken by one team to ensure consistency and
quality.
7.57 A specialist CP and Court team is responsible for these key areas of work. There are no
unallocated CP cases.
7.58 The division also includes the specialist CSE Team and oversees our responsibilities for
Missing Children. The Missing processes are subject to revision to ensure all staff
understand and comply with expectations. The CSE team continue to function well and
the future role of the team is subject to current review by their head of service.
7.59
Positive impact on outcomes is seen as follows;
•
A simple organisational structure aligned to key operational activities provides clarity
around accountabilities and responsibilities.
•
A new quality assurance framework allows for increase challenge and transparency
on performance throughout the infra-structure.
•
Staff caseloads have reduced and performance is more closely monitored by
managers.
•
Performance in areas of past concern, such as assessment timeliness and care
leaver
•
The Child Protection and Review Unit, provides regular challenge and scrutiny to
operations.
7.60 Solihull Community Housing (SCH) is an Arm’s Length Management Organisation
(ALMO), which provides landlord and other housing services on behalf of Solihull MBC.
In addition to providing traditional landlord services for Council tenants, SCH delivers a
cross-tenure anti-social behaviour service on behalf of the Solihull Partnership, housing
options and homelessness services on behalf of the Council and Solihull Independent
Living (SIL), which provides support and adaptations to those in need of such assistance
(including adaptations for the benefit of disabled children).
7.61 2014/15 saw significant changes within SCH. The senior management team has been
restructured with two key appointments, the Chief of Operations and the Chief of
Commercial Activity, replacing the previous Service Director roles.
7.62 SCH continues to be committed to safeguarding, having been a member of the LSCB
since 2006. The importance of housing within a framework of effective multi-agency
39
safeguarding activity is reflected by our involvement in a range of joint working
arrangements including, for example, the LSCB Audit Sub Group and the strategic and
operational groups working towards the establishment of a Solihull MASH.
7.63 SCH’s Delivery Plan for 2015/16 sets out what will deliver in the coming year on behalf of
the Council. The Plan is aligned with the Council’s four key priorities:
•
•
•
•
Improve Health and Wellbeing
Managed Growth
Build Stronger Communities
Deliver Value
7.64 The associated Service Development Plan includes specific actions to review our
safeguarding training needs and to ensure that our internal policies and procedures are
fit for purpose and complement the LSCB’s key priorities.
Youth Offending Services
7.65 Over the period of time there have been changes within the service which have been a
consequence of a) reducing numbers of young people being dealt with, either on a
statutory court ordered intervention or pre court basis, b) our court services moving to
Birmingham, c) as well as developments within the team. To respond to these changes
the youth offending service restructured and sought to improve practice and outcomes for
children, young people, families and communities that we work are engaged with across
the borough. This has included development of our Restorative Practice and work with
Victims be that direct or indirect reparation activities, as well as implementing the findings
in respect of the HMIP (Her Majesty’s Inspectorate of Probation) Audit which had been
undertaken in the early months of 2014.
7.66 Performance over the period has been very positive and equally so when compared with
our regional partners, family group comparators and national averages. At the end of
2014 to 2015 financial year the information is as follows:•
First Time Entrants to the Criminal Justice System - At the end of quarter 4, the
number of First Time Entrants to the criminal justice system had shown considerable
reductions as measured from January to December 14 as opposed to the same time
period, the previous year.
•
Re-Offending - Similarly binary (actual) rates of re-offending, measured from a period
in 2012/2013 as opposed to the previous year continued to demonstrate significant
reductions in re-offending. Albeit there was a slight increase in the frequency of
reoffending, the baseline was significantly lower for Solihull in comparison to others.
•
Use of Custody following Sentence – Albeit there had been a slight increase in the
number of young people sentenced to custody between April 2013 and March 2014
against the following financial year 2014 and 2015 (which was one young person,)
baseline information identifies that per 1,000 of the 10 to 17 population Solihull has a
considerably lower use of custody than our regional neighbour, family averages and
national averages.
7.67 Moving forward into 2015 and 2016, the service both statutory and preventative provision
(Youth Inclusion Support Programme) will become a part of the Early Help Service
currently being developed, for implementation in October of this year. The will mean key
40
changes to staff within both statutory and preventative teams, but the Service will
become part of a much larger provision to support children, young people, families and
communities within Solihull, to target, intervene and address issues at an early stage.
The management of this change process, inclusive of staff development, and continued
delivery of services and outcomes will form a key aspect of transition during the
forthcoming year.
8. Solihull LSCB: A summary of our strengths and challenges 2014/2015
8.1
CSE: Strengths; the National profile of CSE and the success of local arrangements in
Solihull have energised local practitioners and managers to continually improve
outcomes for children and young people, breaking new ground and not accepting
compromise. Further work will inform the CSE steering group about the experience of
children who go missing from home or care, helping to shape services to meet their
needs. Challenges; more work is needed to explore how children at risk of CSE who are
reaching maturity can be safeguarded.
8.2
SCR and other lessons learned from audit:
8.3
Strengths; lessons from the Serious Case Review and ongoing work on serious case
reviews both locally and nationally, continue to inform and influence the LSCB activities
and direction. Case audits have identified strengths around positive partner engagement
in assessments and direct work with the child.
8.4
Challenges; there remain some weakness around core group working, information
sharing and the consistent application of thresholds. These areas are a major focus for
training with the new strategy identifying new partnership competencies with clear
practical skill set to equip practitioners to operate safely in a partnership environment.
Re-audits will help the board to assess the rate of improvement. Whole systems
communications needs further development to ensure the LSCB messages reach a wider
audience and do so faster.
8.5
Building on what we know about our strengths and challenges:
This learning has driven the development of the learning and improvement strategy
review as well as the training review. Developing a continual culture of learning from
multi-agency case audit is now embedding awareness at practitioner level of standards
and expectations. The creation of a new safeguarding learning practitioners’ faculty will
ensure training is in touch with contemporary practice.
8.6
Major organisational change in the Local Authority to ensure continuing improvement in
social work practice is already showing benefits in terms of improved outcomes around
timeliness and consistency. Significant transformation is ongoing to deliver early help
services to provide the foundation for change, is resulting in effective partner
engagement and this work is governed by the LSCB. It will be the LSCB which evaluates
effectives following implementation in autumn 2015. Data analysis already demonstrates
the need for improvements in filtration and triage and plans to deliver this have been
agreed through the MASH arrangements.
8.7
Our priorities are therefore around improving outcomes for children and not process. We
try to ensure that our evidence is informed from practice experience and case audit and
review. We are increasingly informed by the views of children and young people and
practitioners although we need to bring this work together into a more coherent strategy
for engagement.
41
Conclusions and summary
8.8
The opportunity of a look from fresh pair of eyes from our new independent chair and the
appointment of an interim business manager with rich experience in other Councils has
provided an insight into the development of the LSCB.
8.9
A shift in emphasis has been seen as members are challenged to retain a focus on
outcomes for children and not to allow this to be obscured by bureaucracy and process.
The challenges from our lay members has helped us with this and help to keep our
thoughts close to the community. At the time of writing, the Independent Chair is seeking
to meet with the representatives of the faith communities to see if we can engage them
more.
8.10 Partners have been called to account on several levels. Schools accounted for their S157
and S175 responsibilities. The Police accounted on their HMIC inspection and resulting
organisational changes. Health agencies provided a full account of their arrangements
for the purposes of this report as have the 2 agencies providing probation services.
8.11 Agencies have been called to account on their Domestic Abuse responsibilities.
Challenge is provided in and out of meetings and a challenge log keeps track of
challenges and how they have been dealt with.
8.12 This approach has created a shift in emphasis from process to outcomes.
8.13 Meetings are now becoming forums for engaging in analysis on contemporary concerns,
with agenda setting collaboratively agreed. This reduced bureaucracy in and out of
meetings, accompanied by a direct approach enables clear visibility and transparency
across the partnership, encouraging challenge in a safe environment. The
accompanying alignment of priority setting, derived from the learning and
improvement framework provides the rational for clear priorities. The new uncluttered
performance framework has provided a focus on priorities and increasingly there will be
an even greater focus on the child’s experience and improving outcomes.
8.14 In summary, this report and its analysis provides the rationale for the priorities
agreed by the LSCB going forward into 2015-2016 which are;
•
To help children at risk of sexual exploitation
•
To promote positive practice on neglect, including a focus on children living with
domestic abuse, a parent with mental health problems and/or substance misuse.
•
To support the delivery of Early Help services
8.15 The remainder of this report is the business plan, showing how the Board plans to take
these priorities forward and what resources it has to do this.
9. The business plan 2015-2016
9.1
This business plan explains how the LSCB will deliver on its priorities. It shows a set of
objectives, using the priorities as headings in simple table format. These tables also act
as a performance monitoring tool for the LSCB, the executive group and sub-group so
42
that they can clearly see progress being made and address any areas that are not
progressing as they should.
9.2
The first table is an overall LSCB action plan. This shows how the LSCB priorities will be
delivered by each of the LSCB sub-groups. This is followed by a table on each of the
priorities.
9.3
Child protection data will continue to be monitored by the executive group.
9.4
Finally, a budget statement is provided to aid understanding of how the priorities and
activities will be resourced.
9.5
The budget plan is subject to fluctuations in the event of emerging imperatives, such as
further serious case reviews or national policy directives. The budget deficit is well known
and understood and at the time of writing discussions are being led by the Independent
Chair to seek ways to resolve this.
43
Group/
Workstream
LSCB work plan in sub-groups
LSCB priorities for 2015/2016
Neglect /toxic trio
Ensure SCR finalised and impacts on
practice
Ensure delivery of neglect strategy.
LSCB MAKES
DECISIONS
S11 Audit
CSE
Early Help
Communications
Full LSCB
Analyse and challenge CSE
Analyse impact on work
strategy
(In addition to
reports
volume and links with
Ensure LSCB is
all of below)
MASH.
participating in
planning. Maintain a
risk and challenge log
Training faculty Ensure high quality CSE
Ensure high quality training on neglect,
All training to include
Training review.
training is provided to
(including neglect strategy and graded care thresholds and early help Training strategy,
appropriate professionals
profile), information sharing, toxic trio and
developments and
Evaluation. Training
non-compliance is provided to appropriate MASH
needs analysis. Deliver
professionals.
training and evaluate
quality.
Case Audit
Carry out case audit
Case audit involving neglect, adult mental
Analysis of case audits
Carry out annual audit
group
involving CSE cases.
health and substance misuse and domestic to include early help
plan and
abuse.
issues.
Report to LSCB
CSE
Analyse return interviews.
Exec group: CO-ORDINATES
Campaigns on CSE in
Highlight reports to
Target Children at risk using Agree on agendas, ensure the right issues schools and in the wider LSCB.
the problem profile.
are dealt with in the right forum.
community.
Receive reports on CSE
All sub-groups report to Exec and on to
training. Engage the SAB in LSCB.
work on children at risk who All chairs are members of the LSCB
are reaching maturity.
Analyse performance data set and
highlight to LSCB.
Safeguarding
Raise awareness/evaluate
Lead on neglect strategy, ensuring schools Engage in early help
Engage in the
in schools
impact of awareness raising access multi-agency training which
development, including
safeguarding faculty.
group
on CSE in schools
includes neglect, info sharing and the toxic CAF and thresholds
Provide an annual
trio, and promoting the strategy through a
work.
report on safeguarding
LSCB conference.
children in schools.
P&P
Ensure CSE policies are up Revise range of DA tools, including signs
Support Early Help
Ensure all policies and
to date. Deliver MASH and
of safety and DASH. Ensure policy on non- policy and protocol
procedures are up to
DA triage protocols.
compliance is sound.
developments.
date.
Annual reports from CDOP, LADO and Private fostering.
*Read vertically for actions on priorities and LSCB core functions, read horizontally for tasks for sub-groups.
44
Performance framework 2015-17 Solihull Local Safeguarding Children Board Priority: Neglect
Lead: Education Providers and Early Years sub-group
This data informs the LSCB about the impact of the neglect strategy using high level key performance indicators. Data on the impact of
communications and training is provided. The majority of children with child protection plans will be living with domestic violence, substance
misuse and/or parental mental health problems violence. Data on children with child protection plans for 2 years or more provides insight into
drift and delay. A downward performance trend on this indicator should prompt further enquiry.
LSCB objective
To promote the neglect
strategy through training
and communications
Ensure high quality
training on neglect
including the impact of
domestic violence,
substance misuse and
parental mental health.
Assess the impact of
supervision in enabling
reflective practice and
challenge.
Monitor indicators to
ensure sound multiagency decision making
and reduce risk of drift
and delay.
Data Owner
Key Performance indicator
2014Q1
15
Nos of professionals reached through communications.
Q2
LSCB
Trainer
Denise Lewis Nos of professionals reached through LSCB training on neglect.
monitored by
the executive
group
Practitioner evaluation.
Q3
Q4
Qualitative
reports to EXEC.
Impact of training strategy assessed.
Simon
Stubbs;
_______
Simon
Stubbs
AD
Safeguarding
__________
Jim
Edmunds
Case audit.
Nos of Children with
CPP
Qualitative
reports to EXEC.
ENG
Children with child
protection plans for 2
years or more
Nos of police incidents involving
children.
45
SN
201415
Q1
Q2
Q3
Q4
March
2016.
Performance framework 2015-17 Solihull Local Safeguarding Children Board Priority: Early Help
Lead; Tina McGrath Interim Assistant Director Early Help, Children’s Services
“The LSCB should; critically evaluate the effectiveness of early help and publish these findings in the LSCB annual report” (Whose
responsibility? Ofsted 2015) Increased early help provision and a sound understanding of the threshold document will reduce workflow volume
through social care while ensuring children get the services they need.
LSCB objective
Data
Key Performance indicator
2014Q1
Q2
Q3
Q4
Target
Owner
15
March
2016.
Deliver high quality early
Tina
Nos of early help assessments.
N/A
N/A
help assessments.
McGrath
Evaluation report to LSCB, March 2016
Assess the impact of early
help on volume of referrals
to social care.
Assess the quality of
management oversight
and supervision in relation
to early help.
Evaluate the effectiveness
of the LSCB threshold
document
Simon
Stubbs
Simon
Stubbs
Inappropriate referral rates to social care
Referral rate to social care
Eng
SN
Re referral rate to social care
Eng
SN
Proportion of referrals proceeding
to S47 enquiries
Eng
SN
Proportion of S47 enquiries
proceeding to child protection
conference
LSCB Case audit programme
Eng
SN
Qualitative
reports
Simon
Stubbs
LSCB case audit programme
Practitioner survey
46
CSE Solihull Local action plan 2015-2016 SOLIHULL LSCB
CSE strategic objective one: Children and young people have an increased awareness of safe and healthy relationships.
Action
Lead
KPI’s (the local CSE QA data set) as at March 2015- 4th Quarter
Raise awareness
Safeguarding
Percentage of secondary schools where health and safety relationships is delivered as
among children and
in schools sub- part of the PHSE curriculum.
young people about
group
Percentage of secondary schools where governors have had training on; 1) CSE;
2) Online
safe and healthy
Lorraine Lord
safety;
relationships, including (Chair)
on line safety.
3) Relationships and sex education
CSE strategic objective two; Increase community awareness about CSE
Action
Lead
KPI’s
Raise awareness in
Shabnam
Nos of businesses reached
business
Beattie
establishments
(Police)
Provide leaflets for
parents.
CSE strategic objective three: Children and young people who are being sexually exploited are effectively supported ( March 2015)
Action
Lead
By age
KPI’s Nos at risk of CSE;
11yrs 12yrs =
13yrs =
=
By gender:
M =
F =
With CPP,
14yrs =
CLA
15yrs =
With CIN plan
16yrs =
17yrs=
18yrs =
Target children at risk
CMOG chair
By ethnicity:
of CSE using the
Jim Edmonds
regional problem
profile and local
intelligence.
Assess quality of help
CMOG chair
Nos Risk level
Level
to these children by
Jim Edmonds
ensuring the risks are
reduced.
Missing children.
Shelley Ward
Nos missing Nos missing LAC Nos missing age, gender, ethnicity location
CSE strategic objective four: Perpetrators are disrupted and/or held to account using appropriate criminal and/or civil interventions
Action
Lead
KPI
Use available criminal Police
No of harbouring notices
and civil interventions
No of those on remand
to disrupt local
Other civil interventions.
perpetrator activities.
No of arrests
No of criminal investigations/prosecutions
47
LSCB BUDGET AND SPENDING 2014/2015
Contributions Made
Solihull MBC – Children's Services
Schools Forum
Solihull Partnership
Child Death Grant
Solihull Clinical Commissioning Group
Heart of England Foundation NHS Trust
Solihull Specialist Careers Service
CAFCASS
Safer Solihull Partnership
Youth Offending Service
Staffordshire and West Midlands Probation Trust
External Income
Serious Case Review funded by Solihull MBC
Carried Forward from previous year
Shortfall - met by SMBC
TOTAL
2014/15 Summary
Pay and Overheads
Training
Professional fee’s - SCR
Office Expenses including car allowance, general office expenses,
furniture, IT Equipment, ICT, building maintenance and telephones
Other fees - CDOP
Other fees - Independent Chair
Grants and Subscriptions and advertising/publicity
Internal Room Hire (including Training venues)
Total Expenditure
Income
Net Underspend
48
2013-14
£
115,273
14,250
21,565
19,600
0
67,165
4,600
2,299
550
4,000
1,995
1,862
3,000
1,565
20,000
63,272
11,214
352,210
2014-15
£
151,520
13,540
0
12,400
0
67,160
12,400
2,190
550
10,000
19,600
1,770
3,000
0
0
0
0
294,130
Budget
207,830
25,000
0
Actual
180,688
28,556
250
13,000
7,955
13,000
18,000
7,500
2,000
286,330
-286,330
0
13,000
14,044
907
5,088
250,488
-294,130
-43,642
LSCB Attendance at Board Meetings 2014/15
Attendance by
Designated LSCB
Representative
Agency attendance
33%
100%
33%
100%
100%
100%
100%
100%
83%
100%
100%
100%
83%
83%
83%
83%
NHS England
17%
17%
Third Sector
100%
83%
UK Visa and
Immigration
50%
67%
100%
100%
Attendance at LSCB
meetings 2014/15
(1st April 2014 – 31st
March 2015)
Birmingham & Solihull
Mental Health NHS
Foundation Trust
Solihull Clinical
Commissioning Group
CAFCASS
Heart of England NHS
Foundation Trust
Solihull Metropolitan
Borough Council
Solihull Community
Housing
National Probation
Service
Community
Rehabilitation Company
Also the Lead Member for children and young people is a participant observer
and attended 50% of meetings in 2014/15
49
[email protected]
www.solihull.gov.uk/staysafe
50
DRAFT
AUDIT COMMITTEE
Minutes of a meeting of the Audit Committee held in the Board Room, Devon House,
Birmingham Heartlands Hospital on 25 November 2015 at 10.00am
PRESENT:
Alison Lord (Chair)
David Lock
Jammi Rao
IN ATTENDANCE:
Richard Bacon (PwC)
Lorna Barry (Deloitte)
Kate Eccles (Head of Comms – part meeting)
Alison Fuller (Deputy Director Governance)
Carl Holland (Head of Ops, BHH – part meeting)
Angie Hudson (minutes)
Angeline Jones (Chief Financial Controller)
Gus Miah (Deloitte)
Julian Miller (Interim Director of Finance)
Jessica Seymour (Deloitte)
Natalie Shaw (PwC)
Kevin Smith (Company Secretary)
Claire Whittle (Acting Deputy Dean of Faculty)
15.065
APOLOGIES
A Lord welcomed everyone to the meeting and introduced Andrew Corbett-Nolan and
Hannah Campbell from Good Governance Institute who were observing the meeting.
Apologies had been received from Sam Foster and Hazel Gunter (Claire Whittle was
attending on behalf of H Gunter).
15.066
MINUTES OF LAST MEETING & MATTERS ARISING
The minutes of the meetings held on 30 September 2015 were approved as a true record.
Matters Arising
15.058 Send communication to line managers reminding them of their responsibilities
regarding leavers. C Whittle advised that the action had been completed and payroll would
monitor the responses.
15.058 Include commentary in LCFS update on ‘hot spots’ in payroll processes that apply
when staff leave the Trust. L Barry advised that the doctor concerned had refunded the
overpayment and that the LCFS investigation had therefore been closed. There was e-mail
evidence to show that the revalidation manager had been advised that the doctor had left
the Trust (although not the line manager); it was understood that Clive Ryder and Alison
Money (HR) would be undertaking an internal investigation. A Lord indicated that the wider
implications should be considered by the IA Payroll review.
Page |2
15.067
FINANCE REPORT
A Jones outlined the main points of the report. There had not been any feedback following
the Monitor consultation on the ARM; it was hoped this would be received before the end of
December 2015. The Finance team had commenced preparation for the 2015/16 reporting
year with the month 6 submission going as expected with no surprises. Preliminary
progress had begun on the fixed asset revaluation and the fee (£20k) for the work had been
agreed with GVA; a programme of work had been agreed in order to achieve the March
valuation date. The preliminary values for the two new builds were expected to be available
in January 2016. Significant work had been undertaken to reduce the outstanding IA
recommendations; some were now being referred to other committees, which A Jones was
attending, where necessary. The IA reviews on key internal controls had been completed.
The PwC position regarding an admin and clerical review was being reconsidered.
The cost of Ernst & Young (EY) work programme was £650k plus VAT (recoverable). J
Miller advised that the business case for the second part of the work had been submitted to
Monitor and a decision was awaited. The focus for the first phase had been on cash
control, pay controls and quick wins; Monitor was keen to understand how much
improvement was EY related, versus other factors implemented by the Trust. The second
phase of the EY work would be around rebasing costs.
Deloitte had not received any additional instructions since the last meeting.
A Lord questioned what progress had been made in the tender process for the appointment
of external auditors. A Jones advised that the framework had been revisited in order to
avoid unnecessary long list interviews and that the Trust needed to move to tender shortly
in order to appoint by 1 April 2016. The tender documentation was complete, subject to
approval by the Finance Director following which it would be submitted to the Council of
Governors Audit Appointments Committee; following its decision, a recommendation would
be presented to the full Council of Governors for approval of the appointment.
ACTION – A Jones to keep A Lord apprised of progress on appointment process for
external auditors.
15.068
INTERNAL AUDIT
15.068.1
Progress Update
G Miah presented the Progress Report. There were three deep dives on budgetary control,
where work was already underway and expected to be complete by Christmas:



Budgetary control fieldwork had been completed and initial findings fed back to
management; a report would be presented to the next meeting.
Quality Indicators - RTT 18 Weeks fieldwork was due to be completed by the end of
December 2015.
The ToRs for the Workforce Planning and Recruitment Controls review had been
agreed and fieldwork was due to commence.
Work had continued to reduce the number of outstanding actions; progress was noted.
Page |3
There were two high priority actions; IG Toolkit and Medical Revalidation, action was being
taken to ensure resolution of these.
J Rao noted that Quality Committee was sighted on Medical Revalidation and that the
system of utilising outcomes for medical revalidation and as part of appraisal process was a
national problem; this was less of an issue for surgical outcomes where the data was more
widely available. The Trust was in line with other trusts with the exception of a couple of
specialities; PROMS data was not published nationally and was difficult to use. J Rao was
comfortable that the Trust wasn’t an outlier.
15.068.2
Updated Strategic Internal Audit Plan
G Miah advised that, following the discussion at the last audit committee meeting, further
consideration of critical recovery work streams had been undertaken by the Exec team and
a revised internal audit plan for the balance of 2015/6 was now being proposed. This
included the three budgetary control related reviews already referred to, balanced by a
deferral of the Fixed Asset Management audit to 2016/17, which had been rated as a low
priority in the current year, and deferral of the 18 Weeks RTT follow up review in order to
extend the scope and allow controls to be embedded within the follow up review in 2016/17
(some testing would be undertaken as part of the PwC external audit). The Governance
Review was also deferred as much work was still on-going in this area, not least the
involvement of the GGI, so it was too early to review progress as yet. Taken together this
meant there was no change to the total number of days included in the work plan.
It was noted that the Waiting List Initiatives review was separate from the RTT review and
was a priority. D Lock wanted to ensure that conflicts of interest were considered as part of
the Waiting Lists Initiatives review
The meeting referred to the findings of the theatre utilisation review in the previous year and
the need to improve theatre capacity and questioned what action had subsequently taken
place to achieve this. it was noted that this was intended to be addressed as part of the
Surgery Reconfiguration exercise but that programme was now on hold. J Miller noted that
work around theatre efficiency was reported to EMB and embedded into the EY financial
recovery work. The Committee requested J Miller provide a brief update to the next
meeting on what current and planned activity there was in this regard.
ACTION - KS to e-mail interim Medical Director to ascertain whether theatre utilisation and
associated systems had improved; also to report on this to the Finance & Performance
Committee Meeting at the end of November.
ACTION – J Miller to provide a brief update to the next meeting on current and planned
activity around theatre efficiency improvement
15.068.3
Cash Management, Income & Debtors, Payments & Creditors
The Terms of Reference for these reviews had been agreed in early summer and the
reviews completed during September so they predated more recent concerns around
financial performance. G Miah advised that he had undertaken a post completion review in
each area and provided some updated conclusions.
The Cash Management review had focused on the controls around cash movement and
Page |4
access and had received a substantial assurance rating with one medium priority and two
low priority recommendations. The deteriorating cash position brought greater emphasis to
the importance of cash flow management where it was noted that although controls were in
place, greater focus and tighter controls around cash maximisation were now being
implemented.
Income and Debtors had received a substantial assurance rating with two medium and two
low priority recommendations – some of the procedures had been out of date, so needed
updating. Chasing of aged debts required improvement as it appeared that all correct
procedures were followed and finance staff chased outstanding amounts to the extent that
they were able but once reported up to Exec level, nothing seemed to happen. Day to day
debtors were generally up to date but large debts arose where there was confusion or lack
of agreement with the other party over contractual terms and these generally required very
senior level, DoR to DoR, intervention before settlement could be reached. Previously this
has had not been a priority but had now become so and Darren Cattell had taken
responsibility for agreeing some of the larger balances in the last week or two. D Lock
confirmed that these matters were reported to FP&C on an on-going basis.
Payment and creditors had received a substantial assurance rating with four medium and
two low priority recommendations. Controls were in place but written procedures were not
always reflective of what happened in practice; these needed to be updated. It was noted
that there were self-authorisation rights for ordering in some areas (Obstetrics and Renal)
to facilitate urgent ordering of consumables for theatre but no limits were set eg by product
or requisition type. J Miller commented that this type of “urgent’ ordering as not required at
UHB and he would seek to stop it at HEFT if there was no evidence to support it being
necessary here.
G Miah stated that it was important in the current financial environment to stop the practise
of paying suppliers earlier than was required under their contractual terms and J Miller
advised that work was on-going to delay payments as appropriate to conserve cash. G
Miah observed that, overall, controls were in place but procedures did not reflect current
practice or the current financial position and should be updated accordingly. Reporting to
committees (e.g. F&PC) was in place but needed to be more robust to improve the
effectiveness of controls and actions. The meeting discussed debtors further and J Miller
assured the meeting that work was underway on debt recovery including FD to FD dispute
resolution conversations.
15.068.4
Charitable Funds
G Miah reported that a full assurance rating had been given. The Committee recorded its
thanks to the team for its adherence to controls.
15.068.5
Payroll
A substantial assurance rating had been received with one medium priority and two low
priority recommendations. In relation to overpayments, it was noted that managers might
not always understand why an overpayment had been made because the policy of crediting
the overpayment as soon as the recipient had been invoiced was unhelpful in this regard
and consideration should be given to changing the process or, at least, writing to the
manager to ensure that they understood what had gone wrong. The meeting discussed the
wider issue around the lack of consequences where staff did not adhere to policies. J Miller
Page |5
and H Gunter would discuss this and bring a proposal back to the next meeting. D Lock
noted his concern that locums were being hired against non-existent budgets; J Miller
believed this was due to a lack of accountability and cultural issues, which were being
reviewed.
ACTION – J Miller/ H Gunter to bring back proposal for consequences for failure to adhere
to payroll policies and procedures.
R Bacon confirmed that there were no concerns from PwC regarding the underlying
financial systems for the purposes of the external audit.
15.069
LCFS UPDATE
L Barry presented the LCFS progress report and highlighted that to date 62.75 days had
been delivered across the four key areas of the work plan. There had been nine further
fraud referrals bringing the total to 22. The changes to the plan had been driven by the
number of referrals. The e-rostering review was almost complete. L Barry was working with
the Deputy Director of Governance to progress the ‘Sunshine rule’ which was an area of
concern due to the amount of work involved. L Barry had written to a number of
pharmaceutical companies and initial results had shown areas of concern. K Smith
reminded the Committee that the Code of Conduct policy already covered the requirement
on staff to declare conflicts of interest and hospitality and that Workforce had undertaken to
include a requirement in the appraisal process to question staff’s compliance with the Code
in the annual appraisal process from spring 2016. Following a discussion J Miller agreed to
look with others at ways to raise its profile and bring back proposal to a future meeting.
ACTION – J Miller to look at how to raise the profile of the obligations of staff to report
conflicts of interest and hospitality in accordance with the Code of Conduct and appropriate
consequences for failure to report and report back to the next meeting.
J Rao commented that he was particularly concerned diagnostic/ medication creep, where
doctors could go unquestioned when they requested tests or prescribed ‘preferred’ drugs.
The meeting considered the referrals and noted that around half related to staff allegedly
working whilst on sick leave. L Barry explained that latest advice suggested these cases
could be difficult to prosecute because alternative activities could sometimes be regarded
as therapeutic. The key was earlier intervention by occupational health to help manage the
situation and potentially vet requests to undertake alternative activities. Generally it was
agreed that more rigour was required around the rules for working when on sick leave. L
Barry confirmed that the current wording within the policy regarding working elsewhere
whilst on sick leave was appropriate. It was agreed that Workforce should issue a message
to all staff and report back on this to the next meeting on progress. J Miller observed that
ownership of the issue at local management level was key.
ACTION: Workforce to issue message to all staff highlighting the correct processes around
sanctioning any work undertaken whilst on sick leave and report back to the next meeting
on progress. H Gunter/ C Whittle.
Page |6
15.070
EXTERNAL AUDIT – DRAFT PLAN
R Bacon presented the draft external audit plan for 2015/16 and referred to the context
described therein. The audit for 2014/15 had gone very well and there was no reason to
expect anything different for 2015/16. Materiality limits would be assessed at the year end.
The Deloitte controls review would be important.
The economy, efficiency and
effectiveness opinion was likely to be qualified again and the Quality Account position
would be considered again, both as in 2014/15. The Risk Assessment Framework for NHS
Foundation Trusts had been updated in August 2015 and reflected the challenging financial
context foundation trust were operating in and strengthened Monitor’s regulatory regime to
support improvements in financial efficiency across the sector. The risks affecting the trust
were discussed and noted. The Committee was reminded of its obligations regarding fraud.
The proposed base audit fee was slightly below last year. Estimates had been included for
the revaluation and VFM work. Once the scope of the work was known, the final fees could
be agreed.
It was noted that N Shaw was due to go on maternity leave in March 2016 and Joanna
Watson would take over from her.
15.071
FIRST ED QUARTERLY DATA QUALITY AUDIT REPORT
Carl Holland joined the meeting and presented an update based on the IA review of the
Emergency Department undertaken the previous year. There had been concerns around
lack of controls to alter times on transfer of patients from ED that could have led to
alteration of performance around the 4–hour target time. All recommendations set out in
the report had been actioned, including the removal of staff access and ability to alter times.
The meeting discussed ‘clock starts’ i.e. when a patient presented in the ED department,
currently the clock commenced when the patient was booked in. In response to a question
from D Lock, C Holland advised that a breach review was taken for all relevant cases and
only where it was clearly documented in the notes that a patient had not breached would
revalidation take place. A Lord questioned the number of patients who were discharged
just prior to the 4-hour deadline, C Holland advised that staff continually chased discharges
but noted that targets did drive behaviour; 4-hour performance was reviewed daily. The
Committee agreed no further updates were required at present.
C Holland left the meeting.
15.072
PLAN FOR ENHANCED DECLARATIONS IN APPRAISALS FROM 2016/17
Claire Whittle referred to the pre-circulated paper that set out how a mandatory declaration
of interests and hospitality would be required in the annual appraisal documentation for all
staff from April 2016. The appraisal process rolls out over the six months following April.
It was agreed that a communications plan was needed to ensure all staff were aware of the
Code of Conduct and revised appraisal process.
Page |7
15.073
FEEDBACK ON O/S RECOMMENDATIONS FROM CLINICAL REVIEWS
K Smith explained that the Committee had requested a report on progress in addressing
outstanding recommendations from IA clinical reviews.
There were 5 actions outstanding and these were already known to the committee, having
been discussed when reviewing outstanding audit actions generally.
15.074
ANNUAL REPORT & ACCOUNTS 2015/16 - PLAN
Kate Eccles joined the meeting and explained that the outline plan for the Annual Report &
Accounts (AR&A), including the Quality Account, for 2015/16 essentially followed the
previous year’s plan. The Communications team were awaiting Monitor guidance before
revising this. This was consistent with the approach being taken by UHB.
It was noted that it was important to agree an early date for PwC’s review of the document
in final draft form and for the Executive lead to attend the Audit Committee earlier in the
process to confirm that the Executive team was content with the messaging and content. It
was also noted that the stories needed to be balanced and accurate.
ACTION - J Miller undertook to ascertain who would be the Executive lead for the AR&A
2015/16.
ACTION – K Eccles would bring a detailed timetable and key themes back to the January
2016 meeting in conjunction with the Exec lead.
15.075
QUALITY ACCOUNT UPDATE
A Fuller referred to the pre-circulated update on the priorities for 2015/16;
 Reduction of grade 2 hospital acquired pressure ulcers
 Reduction of incidence of patients who have multiple falls in hospital
 Improvement in response rates and overall scores for Friends and Family Tests in
ED
 An improvement in response rates to stroke
A Lord noted that the content of quality accounts was largely prescribed but requested that
a simple key be introduced to make it clear whether or not improvements were being made
for each priority (e.g. RAG rating).
D Lock noted that there was a potentially very positive story to be told on the Heartlands
HASU and stroke outcomes.
15.076
ANY OTHER BUSINESS
A Lord had invited the Governors to send an observer to future meetings if they wished to
do so.
It was noted that the next meeting was scheduled for 27 January 2016 but would re-
Page |8
scheduled to 20 January.
A Lord thanked everyone for their attendance and contribution.
There was no further business so the meeting closed.
.......................................
Chair
Minutes of a meeting of the Donated Funds Committee of
held in the Boardroom, Devon House, Birmingham Heartlands Hospital
on 20 November 2015
15.034
PRESENT:
P Hensel (Chair)
A Fletcher
A Jones (part meeting)
L Lawrence
K Smith
IN ATTENDANCE:
J Creba
E Hale
A Hudson (minutes)
M Hammond (QEHB Charity – observing)
M Turner (Investec – part meeting)
APOLOGIES AND WELCOME
P Hensel welcomed Mike Hammond, Queen Elizabeth Hospital Birmingham Charity, who was
observing the meeting and undertaking a review of the HEFT Charity.
P Hensel noted that it was L Lawrence’s last meeting and thanked him for his contribution to
the Committee over the last three years. A Fletcher seconded the vote of thanks.
15.035
MINUTES OF PREVIOUS MEETING
The minutes of the meetings held on 29 July 2015 were approved as a true record.
15.036
MATTERS ARISING
15.003 Trust-wide communication exercise. E Hale advised that she had met with Fiona
Alexander, Director of Communications at UHB, to discuss how fundraising would be
supported by Communications going forward; a report would be presented to the next
meeting. (Action: EH)
15.037
FUNDRAISING REPORT
E Hale reported that Q2 fundraising performance was slightly ahead of Q1 and year to date
was slightly ahead of previous year to date but was still behind plan.
Good Hope and Heartlands fetes had been delivered but lost money. Due to the large number
of planned community and staff engagement events a Community Fundraising Strategy had
been developed that would encourage the focus on lower risk and higher return initiatives.
E Hale then presented the community fundraising strategy that set out the objectives and
targets for community based fundraising up to December 2018. In the past some charity led
events arranged had cost more than had been raised. There had been a decline in the amount
of fundraising income, despite additional resources put in place within the fundraising team
and it was anticipated that fundraising income would fall significantly below the planned target
and previous year’s performance. The current target was to raise £150,000 through
Page| 2
community fundraising, however this would not be achieved within the current strategy and a
review was required. It was suggested that the fundraising department would cease delivering
charity led events until it had increased it supporter base and had focussed its efforts on third
party event delivery. A benchmarking exercise had indicated that there was potential to
increase income, but there was sufficient recourse within fundraising to recruit and steward
fundraisers whilst the team were engaged in the delivery of charity led events.
An order had been raised for the outright purchase of new payment kiosks for the baby scan
facilities in the maternity department at each hospital and a commissioning plan was being
rolled out. There was a large amount of work underway to expedite the installation of the
machines including new Chip and Pin requirements; subject to estates facilitation works the
machines were due to be commissioned in March 2016. It was felt that this would provide a
rigorous system and see an increase in revenue.
A £277k grant submission to the Sutton Coldfield Charity had been approved at a value of
£200k for prostrate equipment; the trust had 12 months in which to spend the grant;
associated revenue costs for the equipment and the process for ordering were being
examined. This would be the Charity’s largest grant to date. .E Hale recorded a vote of thanks
to L Lawrence and A Catto for their support in reassuring the Sutton Coldfield Charity following
the latest Monitor enforcement action.
A new cancer services appeal was being developed. The current cancer fundraising focussed
around ward 19 at BHH; however other cancer services would be included as set out in the
presentation pack included in the papers. The new fund would be administered through a
committee which will act as joint fundholder. The need for consistent branding was noted.
The presentation on the Cancer Services Fund was noted.
More generally there were a lack of suitable projects for funding applications; it was
understood that Project Pelican and the Infusion Unit were now unlikely to proceed.
Other income was slightly up both year on year and against plan.
The content of the dashboard was noted.
A Jones joined the meeting.
In response to a question from P Hensel on the likely full year out turn, E Hale explained that
HEFT had taken a decision to terminate all agency staff and put permanent recruitment on
hold which only left one colleague in the Fundraising Team 9and a second on maternity leave.
A Jones confirmed that this was about preserving cash within the Group and that it came as a
recommendation from EY, who were assisting HEFT with its short term financial recovery plan.
K Smith reported that D Cattell, Finance Director, had confirmed that the SLA would need to
be adjusted to reflect a lower level of service being delivered to the Charity.
A Fletcher observed and others agreed that this supported the Charity’s case for greater
independence. L Lawrence noted that the decision was dismissive of the Charity and was a
concern to the Committee. It was agreed that P Hensel should meet with D Cattell to get a
better understanding of the reasoning behind the decision and the options available to the
Charity. (Action: P Hensel)
15.038
FINANCE REPORT
A Jones outlined the key financial information for the 7 months to October 2015 stating that
Page| 3
total income received was £699k, £334k below plan, expenditure was £862k, £163k below
plan, there was a loss on revaluation of £257k, resulting in a net deficit of £420k, £609k worse
than plan. The value of the fund at 31 October was £7,263k.
A Jones also referred to the following:
 There was £387k cash on deposit with RBS at a rate of 0.92%.
 Three main funds may take a sizable hit because of the revised policy on realised
gains/losses.
 Large receipts had been received from Friends of Solihull (£3.6k), Learning beyond
Commissioning (£3k) and a grant from Sutton Coldfield Charities (£200k).
 Large payments had been made for a CPAP breathing system at Heartlands (£29k); a
cellcheck specular microscope for Solihull Ophthalmology (£16.5k), a patient hoist for
ward 10, GHH (£5k) and an electro therapy kit for GHH physiotherapy (£5k).
 Bequests to the value of £61k had been received; there were £224k legacies pending.
 There had been a loss on the value of investments managed by Investec that equated
to an approximate loss of £257k on revaluation as at 31 October 2015.
 The year end cash forecast was £272k
J Creba advised that fund holders had been encouraged to provide spend plans and it was
anticipated that funds may be spent more quickly than previously, due to the Trust’s current
financial situation. There was a plan to consolidate unrestricted funds if no spending plans
were submitted. It was noted that restricted legacies or monies donated for a specific purpose
were exempt from the planned consolidation.
The large receipts and payments were noted.
A Jones advised that there was a further potentially large payment to be noted; D Cattell had
advised that consideration was being given to funding the Christmas lunch for all staff from the
three main site charitable funds. The value was unknown at the present time. The meeting
discussed the decision at length and it was noted that P Hensel would discuss this with D
Cattell when they met. (Action: P Hensel)
The summary of the 303 group funds was noted.
15.039
DRAFT INTERNAL AUDIT REPORT
A Jones reported that a full assurance Internal Audit report had been received and formally
thanked Alison Evans, Jeff Creba, Maria Lloyd and Janet Gray for their contributions to achieving
this.
15.040
OPERATIONS COMMITTEE
K Smith commented on the Operations Committee Actions Log and noted an e-mail had recently
been received from the Good Hope League of Friends to advise that their charity would be wound
up and the £2,027 they were holding would be transferred to the GHH General Fund.
15.041
REVISED FUNDRAISING POLICY
E Hale advised that the Fundraising Policy had been reviewed and updated in line with the HEFT
policy review process. Changes and updates had included recommendations made by the
Marsden Review following the Saville investigation. HEFT had developed its own VIP/ Visitor
policy that was reflected in the document, as was the requirement for all visual materials for
Page| 4
marketing and PR to comply with branding guidelines.
In response to a question from P Hensel, E Hale advised that there had been a communications
exercise when the policy was first launched three years previously. The policy was regularly
referred to and generally understood.
The revised Fundraising Policy was approved.
15.042
FUNDHOLDER SPENDING PLANS AND CASH IMPACT
A Jones advised that D Cattell had written to fundholders and asked for their spending plans;
advising that their plans would be bought to the Committee for review. Responses had been
received from 144 with overall plans to spend £3.5m of total funds of £7.3m (of which £1.7m was
restricted and £5.6m unrestricted). £2.1m of the plans indicated spend in the current financial
year. Fund holders who had not yet responded would be reminded that plans for spending were
required.
P Hensel noted a slight governance concern that the letter had come from the Finance Director
and it needed to be ensured that the right governance was being followed for identifying spend for
donated funds. The meeting discussed the purpose/objectives of the Charity to spend money for
the benefit of patients and staff and that due to the current financial climate there may be capital
plans that would not be funded by HEFT but could be funded by the Charity.
A Jones clarified the current SFI authorisation expenditure limits:
£1- 10K fund holder
£10k - £50k fund holder and Finance Director
£50k+ Donated Funds Committee.
A Fletcher noted that the number of positive responses was to be celebrated.
It was agreed that A Jones would to bring back a list of equipment with spending plans for
consideration by the Committee. It was agreed for reasons of administrative convenience to
delegate approval of those plans and the associated expenditure to any 3 from 5 members of the
Committee by circulating resolution. (Action: A Jones/ K Smith)
A Jones left the meeting.
15.043
INVESTEC INVESTMENT REPORT
M Turner, Investec, joined the meeting to report on the performance for the six months to 30
September 2015 and tabled his presentation.
Prior to receiving the report P Hensel explained the Charity’s plans to receive spending plans from
fund holders and initial indications showed that these could be in the order of £2m in the remainder
of the current financial year. It was agreed to confirm a more accurate estimate as soon as
possible. M Turner confirmed that the current investment strategy remained appropriate and that
with the exception of property, all other classes of investment were ‘daily dealing’ so quick
disinvestment wouldn’t be problematic.
The value of the fund at 30 September 2015 was £7,578k and at 17 November 2015 was £7,718k.
Performance was on track to delivery £200k of income for the full year.
Page| 5
Performance was noted as:
Q1
Q2
6 months
HEFT
-1.2
-3.4
-4.5
Benchmark
-2.2
-2.4
-4.5
Property had offset weakness seen elsewhere in the market.
Q3 to date
2.3
2.4
Investec still believed that bonds were overvalued and would fall, particularly longer dated bonds.
They were continuing to rise but this was not sustainable. The Chinese slowdown had impacted
but was likely to re-balance. There was concern over pace and size of the expected increase in US
interest rates. Commodity prices were falling causing a negative impact on inflation.
In response to a question from P Hensel, M Turner advised that Investec’s expectations included
more volatility in the market and a US interest rate rise.
The account signatories were confirmed; K Smith agreed to complete and return the revised forms.
(Action: KS)
The report from Marlborough was received and the summary noted.
The pre-circulated paper from Marlborough was noted. It confirmed that Investec had delivered a
one year return of around 5.1% against benchmark of 4.9% and 7.1% against benchmark of 9.3%
since inception (31 March 2014) in a very difficult period in which to outperform, given the volatile
nature of the markets. K Smith reminded the Committee that Marlborough’s role was to provide an
element of expert independent scrutiny to Investec’s performance.
15.044
HEFT REVIEW BY QEHB CHARITY CEO
P Hensel thanked M Hammond for undertaking the review of the HEFT Charity and looked forward
to receiving his report upon completion of the review.
15.045
ANY OTHER BUSINESS
There was none.
15.046
29 January, 2016; Boardroom, Devon House, Birmingham Heartlands Hospital.
........................................
Chairman
Minutes of a meeting of the Monitor Standing Committee of the Board
held in the Board Room, Devon House, Birmingham Heartlands Hospital
on 29 October 2015 at 8.00am
15.22
PRESENT:
Mr L Lawrence
Mr D Cattell
Dr A Catto (by phone)
Mr A Foster
Mr D Lock (by phone)
(Chair)
IN ATTENDANCE:
Mr K Smith
Mrs A Fuller
(Company Secretary)
APOLOGIES
Apologies were received on behalf of Mr Foster (Dr Catto was in attendance on his behalf),
Mrs Foster (Mrs Fuller was in attendance on her behalf) and Dr Rao.
15.23
APPROVAL OF MONITOR QUARTER 2 RETURN
Mr Cattell confirmed that the Monitor quarter 2 return had been completed in accordance with
the Risk Assessment Framework.
The meeting reviewed the pre-circulated papers.
The Board was expected to sign the combined Governance Statement. This would confirm
three things:
•
The board anticipates that the trust will continue to maintain a Continuity of Service
risk rating of at least 3 over the next 12 months;
•
the board is satisfied that plans in place are sufficient to ensure: ongoing compliance
with all existing targets (after the application of thresholds) as set out in Appendix A of the
Risk Assessment Framework; and a commitment to comply with all known targets going
forwards; and
•
the board confirms that there are no matters arising in the quarter requiring an
exception report to Monitor (per the Risk Assessment Framework page 21, Diagram 6) which
have not already been reported.
Governance
The Trust has failed to achieve the four hour A&E waiting target for the thirteenth consecutive
quarter. Recovery work on this target was being led through the Integrated Improvement Plan
(‘IIP’). Improvement was on the most likely trajectory, however, was below the best trajectory.
The Trust expected to consistently meet the target from quarter 1 2016-17.
In line with national reporting deadlines, the Trust’s performance against cancer targets had
not yet been fully validated for the quarter. The results in the return were provisional and fully
validated results would be notified in November. At this stage, however, it was known that the
Trust would not hit the two week targets for both breast and other cancers. The Trust was
committed to deliver the two week wait cancer targets and it had been agreed with
stakeholders that this would be consistently achieved from quarter 4 2015-16. The Trust had
recognised in year demand increases and recognised the potential for increased demand as
a result of the latest NICE guidance which may provide further challenges.
As disclosed in the previous quarter, the ‘Cancer 62 Day Waits for first treatment (from urgent
GP referral) - post local breach re-allocation’ target would not be achieved. This was due to a
flood in Endoscopy at Solihull Hospital in quarter 1. This led to a loss in cystoscopy capacity,
blocking the 2 week wait pathway in Urology and resulted in sharply reduced volumes
achieving the 62 day pathway. Delivery of the standard was expected from January 2016.
Also as previously disclosed the Trust failed to hit the 18 week RTT target in the quarter. The
Trust has agreed with a wider stakeholder group a trajectory to return to compliance with the
RTT targets by quarter 1 2016-17; this was part of the IIP.
The Trust also provided supplementary governance information to Monitor. Amongst other
things it includes information on serious untoward incidents (‘SUIs’), contacts with the CQC,
information governance breaches, dealings with the Coroner and exchanges with other
regulatory organisations such as the Health and Safety Executive.
Finance
The Trust’s Financial Sustainability Risk Rating was 2, reflecting deterioration in financial
performance between quarters 1 and 2.
The Trust remained subject to Monitor enforcement undertakings. The Trust had developed
the IIP over the last several months. The IIP identified trajectories, agreed with stakeholders,
for performance improvement. There was some evidence that the Trust was meeting those
trajectories. This has come at a financial cost higher than planned as significant investment
in services has been made to meet trajectory targets and improve clinical quality. It was clear
that the current cost of improvement was unaffordable. Urgent work was in progress in order
for the Trust to re-establish a sustainable financial position while maintaining improvements in
operational performance. This work had been agreed by the Board and Monitor and included
support from Ernst & Young.
In the quarter 2 the Trust had reported a deficit of £21.3m, £19.7m adverse to Plan. The year
to date deficit of £35.9m was £26.8m adverse to the Plan. .
In quarter 2 overall operating income of £160.8m was £0.5m favourable to Plan, year to date
income of £324.1m was £5.9m above Plan. NHS Clinical Income of £145.3m outperformed
the Plan by £1.5m contributing to half year over-performance of £5.7m. The Trust was
recognising income under full Payment by Results (‘PbR’) terms and conditions using the
Enhanced Tariff Option (‘ETO’). However, a bad debts provision of £2.6m year to date was
included in the position, relating to ongoing payment queries from the CCGs and risks
associated with moving to PbR.
The modest favourable variance on operating income was offset by an overspend of £20.5m
on operating expenses of £180.7m in the quarter. At the half year operating expenses of
£356.9m were £33.2m over Plan. Notable year to date overspends against Plan were
recorded on employee expenses £11.2m (unfilled vacancies, extended enhanced bank rates,
additional WLI work, high levels of agency nurses and locum doctors), drugs, including pass
through expenses £3.3m (activity driven predominantly in CHONC and Gastroenterology),
clinical supplies £2.4m (activity driven notably in T&O, extra focus on performance notably in
A&E and on 18 weeks RTT), non-clinical supplies £2.3m (extra capacity still open impacting
on laundry, cleaning and security), purchase of healthcare services £0.3m (18 week RTT
backlog driven) and other non-pay expenses £13.8m (including extra governance costs,
impairment of receivables, consultancy for project management office, contingencies).
There had been a reduction in the Trust’s liquidity. Cash and investment balances of £34.1m
were below Plan by £37.5m. Lower than planned operational performance has resulted in
adverse to plan cash flows of £18.7m for the quarter, £25.9m for the half year. Changes in
2
working capital balances were £3.5m worse than planned for the quarter, £14.7m for the half
year. Cash capital additions were £2.8m below Plan for the quarter and for the half year.
Urgent work had already been undertaken and would continue to preserve cash balances
over the remainder of the financial year.
Mr Lock confirmed that the return was consistent with the deliberations at the Finance &
Performance Committee meeting the previous week.
The Committee noted that it would have to highlight in the Governance Statement any
exceptions to the confirmations noted in a similar way to the previous quarter and delegated
authority to Mr Cattell to complete this by reference to failure to meet the 4-hour A&E target,
the 18 week RTT target and the 2 week cancer targets, the financial Plan and the agreed
trajectories for compliance.
After due consideration and subject to the foregoing the quarter 2 return was approved and
two directors were authorised to sign it on behalf of the Trust.
15.20
ANY OTHER BUSINESS
There was none.
15.21
DATE OF NEXT COMMITTEE MEETING
29 January 2016.
………………………………
Chairman
3
Consultant and SAS Job Planning Policy and
Procedure
Ratified Date:
Ratified By: JLNC, HR Committee
Review Date:
Accountable Directorate: HR Consultancy
Corresponding Author: HR Business Consultant
1
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
If you are reading a printed copy of this document you should check the Trust’s Policy
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
For copyright insert “©Heart of England NHS Foundation Trust” include year document was
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2
Meta Data
Document Title:
Consultant and SAS Job Planning Policy and Procedure
Status
Active
Document Author:
HR Business Consultant
Source Directorate:
Human Resources Consultancy
Date Of Release:
December 2015
Approval Date:
December 2015
Approved by:
JLNC
Ratification Date:
December 2015
Ratified by:
JLNC
Review Date:
December 2018
Related documents
Medical and Dental terms and conditions
Superseded documents
Job Planning Policy March 2010
Relevant External
Standards/ Legislation
Key Words
Job planning
3
HEART OF ENGLAND FOUNDATION NHS TRUST
CONSULTANT AND SAS JOB PLANNING POLICY AND PROCEDURE
1.0
Circulation
This polices apples to all Consultants and SAS staff employed by the Trust directly and those on
honorary/clinical academic contracts.
2.0
Scope of Policy
A job plan is designed to be a prospective agreement that sets out a Consultant’s/SAS duties,
responsibilities, accountabilities, objectives and expected outcomes for the coming year.
Both consultants who have remained on the ‘old’ contract and those appointed on the ‘new’
contract are expected to participate in job planning. The two contracts have different
arrangements for scheduling and timetabling of activities and the currency for the ‘old’ contract
is Notional Half Days (NHDs) and, for the ‘new’ contract, Programmed Activities (PAs).
Similarly, all Specialty and Associate Specialist doctors, whether on the 2008 or pre-2008
national contracts, are expected to participate in job planning.
This policy supersedes any previous policies relating to job planning.
3.0
Definitions
The Trust is aware that there are some Consultants, Staff Grades and Associate Specialists
who have elected to remain on their previous terms and conditions. However, for the purposes
of this policy, the term ‘programmed activities’ will also denote ‘sessions’, acknowledging that
the period denoted by a session is in accordance with those terms and conditions.
PAs
Programme Activities
DCC
Direct Clinical Care
SPA
Supporting Activities
APAs
Additional Programmed Activity
NHD
Notional Half Day (old consultant contract)
A standard job plan will be based on 10 Programmed Activities (PAs), which will comprise of:
4




Direct Clinical Care activities (DCCs)
Supporting Professional Activities (SPAs).
Additional NHS Responsibilities (ANRs)
External Duties
Additional Programmed Activities (APAs) up to a maximum of 2 (and maximum total of 12 PAs)
can be offered, subject to the agreement of the Associate Medical Director or Deputy Medical
Director. These will be offered on a temporary basis.
Part-time substantive contracts will be advertised and paid at a

Maximum of 9 PA’s for those not undertaking private practice

Maximum 8 PA’s for those undertaking private practice
Consultants who work privately are required to offer first call on their ‘spare time’ to the NHS
and may be requested to work 1 additional PA (e.g. 11 PA’s total) or their pay progression
maybe withheld in accordance with the Terms and Conditions – Consultants (England) 2003.
Pre Consultant Contract 2003
5-7
3.0
Fixed Sessions (DCCs)
Flexible Sessions (Patient admin and SPAs)
The SPA allocation for part time doctors will be pro rata to the number of PAs worked.
No job plan will exceed 12 PAs. Clinical Directors and General Managers must ensure a
consistent and flexible approach is taken to the job planning process.
4.0
Reason for Development
The purpose of this document is to introduce a clear procedure for job planning that will ensure
job plans are linked to the needs of the service and development needs of the doctor. The
process will be led by the Associate Medical Director, Clinical Director and Operations
Manager/General Manager for the service. Individual or team job planning meetings will be
conducted between the doctor(s) and the appropriate clinical director (and service lead if
appropriate) and operations or general manager.
5.0
Aims and Objectives
This policy and procedure aims to provide a uniform and equitable approach to the job planning
process.
5
6.0
Job Planning
The job plan will set out the duties, responsibilities and expected outcomes for DCC, SPA and
any additional PAs awarded to the doctor. The job plan will include any duties for other NHS
employers, HEE or external agencies and must also identify any regular private practice work
undertaken.
All job plans should include an agreed annual amount of clinical activity and supporting
professional activity that is relevant and appropriate to the doctor’s role and not necessarily
related to direct patient contact. 1.5 PAs of SPA will be offered to Consultants and a minimum of
1PA of SPA will be offered to SAS doctors. More details of SPAs can be found in section 5 of
Procedure for Job Planning.
The job plan will be reviewed every year or more frequently where working arrangements and
responsibilities change. Job planning should take place between Jan – Mar each year and must
be aligned to the service plan. At the job planning meeting the expected personal objectives
and outcomes agreed in the previous job plan will be discussed. At the same time the
consultant’s/SAS doctor’s expected personal objectives and outcomes for the coming year will
be agreed. Annual leave requests should also be discussed at the job planning meeting where
possible.
All consultants/SAS doctors must develop and seek to agree an individual job plan, based on
either a regular cycle (weekly, monthly etc.) or on an annualised basis. In some specialties a
team approach to job planning may be developed. In such cases, each individual must still
agree a schedule of commitments and ‘sign-up’ to the job.
7.0
Appraisal
The appraisal process will provide an important opportunity to draw together information and
data from which the job plan and a work programme are shaped.
The Appraisal process will support revalidation and Clinical Excellence awards and should be
conducted in line with National Appraisal and Good Medical Practice frameworks.
The appraisal should precede job planning and should be held separately from the job planning
meeting. The appraisal must be undertaken by an appropriate individual who has received the
necessary training to undertake appraisals.
The following appraisal/job planning cycle should be used:
Appraisals of all consultants/SAS doctors to be completed
Apr - Sep
Job Plans of all consultants/SAS doctors reviewed and agreed
Jan – Mar
6
As business planning usually occurs in the autumn season each year, this will ensure that the
agreed job plan can take into account service requirements for the following financial year.
Clear objectives and outcomes should be outlined within the job plan. These should be
achievable and must support the needs of the service and personal development of the
consultant.
8.0
Responsibilities
Medical Director/Deputy Medical Director





Undertake performance and job plan review for Associate Medical Directors.
Ensure all Associate Medical Directors have agreed job plans for consultants/SAS
doctors within their area on an annual basis.
Ensure the job plans of all consultants/SAS doctors meet the needs of the service.
Identify key objectives to be delivered by the consultant workforce.
Chairs Appeals panel for disputes concerning job plans/pay awards.
Associate Medical Director






Undertake performance and job plan review of all Clinical Directors within their area
annually.
Ensure all consultants/SAS doctors within their area receive an appraisal and job plan
review each year.
Review the directorate summary report of job plans to ensure the needs of service are
delivered.
Approve/Not approve PAs awarded above 10.
Mediate job planning disputes.
Mediate disputes against pay award.
Clinical Director/Operations/General Manager






Ensure all appraisals and job plans are conducted for each consultant/SAS doctor within
their area of responsibility on an annual basis.
Ensure the job plans deliver the needs of the service.
Ensure objective setting is aligned to the needs of the service.
Ensure consultants/SAS doctors deliver agreed objectives and outcomes.
Submit an annual summary report to the Associate Medical Director following completion
of job plan reviews.
Complete change forms and notify Employee Services as appropriate.
7
7.0
Monitoring and Review
This policy will be monitored and reviewed by the Workforce Director and updated as necessary
and amended through the JLNC.PROCEDURE FOR JOB PLANNING
1.0
Introduction
This procedure sets out the Trust process for Consultant and SAS Job Planning.
Annual job planning is a contractual obligation for all Consultant and SAS Medical Staff (both
substantive & honorary), irrespective of the contract type held.
An IT infrastructure will be implemented which will support the job planning framework and allow
a consistent application to be used. All doctors’ job plans will be entered into the IT framework
supplied for this purpose and job planning meetings will utilise this IT framework.
Reports on allocation of PAs and other service planning, capacity and activity information will be
generated by the system and reviewed by the Clinical Directors and Associate Medical Directors
as required to support and facilitate service development
2.0
Job Planning Principles
A Job Plan is a prospective agreement that sets out a consultant’s / SAS doctor’s duties,
accountabilities, objectives and outputs for the coming year, with the identified support and
resources to be provided by the Trust to facilitate the delivery of agreed work.
The job plan must include any duties for other NHS employers and must identify any regular
private practice work undertaken.
The job planning process will be led by the Associate Medical Director, Clinical Director and
Operations/General Manager for each service area.
Job Planning will be based on a partnership with the consultant/SAS doctor.
A standard full time job plan will contain ten Programmed Activities.
Additional PAs above the standard 10 PA’s may be offered to consultants and SAS doctors for
additional clinical activity subject to a maximum of 12 PAs. Where agreed, the additional PAs
will be an addendum to the substantive contract and will be reviewed on an annual basis.
Additional PA’s may be terminated by mutual agreement, at the end of a fixed term period or by
3 months’ notice.
Part-time substantive contracts will consist of a:

Maximum of 9 PAs for those not undertaking private practice

Maximum 8 PAs for those undertaking private practice
8
The SPA allocation for part time doctors will be pro rata to the number of PA’s worked.
The job plan will be reviewed every year and at this review meeting the expected personal
objectives and outcomes agreed in the previous job plan will be discussed. At the same time the
consultant’s/SAS doctor’s expected personal objectives and outcomes for the coming year will
be agreed.
All consultants/SAS doctors must develop and seek to agree an individual job plan, based on
either a regular cycle (weekly, monthly etc.) or on an annualised basis.
In some specialties a cumulative or team based approach to job planning may be developed. In
such instances there may have been “team” job planning of some elements of the timetable, for
example, on-call, emergency cover, departmental SPA, patient related admin time for specified
clinical activities and it is inadvisable for this to be revisited on an individual basis. In such
cases, each individual must still agree a schedule of commitments, outputs and ‘sign-up’ to the
job plan.
If there is a significant change in any aspect of the job plan during the year it might be
necessary to have an interim job plan review.
A Programme Activity (PA) will have a working allocation of 4 hours in standard time unless it
falls within 7pm to 7am Monday to Friday, weekends or bank holidays when premium time
applies and 1PA has a working time allocation of 3 hours.
A Consultant/SAS doctor can agree with the Clinical Director and Operations/General Manager
to allocate a PA to work flexibly, and where this occurs, additional work may be undertaken on
an ad hoc basis to ensure efficient use of resources e.g. additional cover whilst a colleague is
away. Flexible work must be recorded and agreed output measures must be achieved to
ensure the obligations for work and payment are met.
If it is agreed that a PA may be worked flexibly they will automatically be counted as being a
standard PA (4 hours in time) regardless of when the work is undertaken unless otherwise
agreed with the clinical director.
3.0
Objectives
As part of the job planning review all consultants and SAS doctors will be set objectives for the
forthcoming year. Clinical Directors and Operations/General Managers must ensure that
objectives and outcomes are agreed and recorded on the supplied IT system. The objectives
and outcomes should be reviewed annually or sooner if there is a significant change in role.
Objectives and outcome measures must be aligned to the needs of the service and objectives of
the Trust and the allocation of supporting programme activity.
A standard job plan will comprise of:
9




Direct Clinical Care activities (DCCs)
Supporting Activities (SPAs).
Additional NHS Responsibilities
External Duties
The job plan will include appropriate and identified personal objectives and outcome measures
that have been agreed between the doctor and the Clinical Director/General Manager. The
personal objectives and outcome measures will depend in part on the specialty but may include:










Quality improvement
Activity and efficiency
Clinical outcomes
Clinical standards
Local service objectives
Management of resources, including efficient use of NHS resources
Service development
Multi-disciplinary team working
Continuing professional development and continuing medical education
Output required from additional SPA activity
Supporting Activities must be aligned to service needs/objectives where appropriate. Objectives
may refer to protocols, policies, procedures, number of meetings to attend, outcomes from audit
and work patterns to be followed. Where objectives are set in terms of output and outcome
measures, these must be reasonable and agreement reached.
Consultants may also be asked to undertake corporate roles outside of their specialty. The SPA
allocation will be agreed in discussion with the Clinical Director and Deputy Medical
Director/AMD.
4.0
Direct Clinical Care
Direct clinical care means work that directly relates to the prevention, diagnosis or treatment of
illness. It may include the following:








Emergency duties (including work carried out or arising from on call)
Operating Sessions including pre-operative and post-operative care
Ward rounds
Outpatient Activities
Clinical diagnostic work
Other patient treatment
Public Health Duties
Multi-disciplinary meetings about direct patient care
10

Patient related administration linked to clinical work i.e. directly related to the above
(primarily but not limited to, notes letters and referrals)
In order to maintain a consistent approach to the job planning process Directorates should
where possible agree standard times to undertake direct clinical care activities for example a
ward round may equate to 1 PA per week or clinical administration may equate to 0.5PA per
week The allocation of direct clinical care activities will depend upon the specialty and must be
agreed between the Clinical Director, Operations/General Manager and Consultant/SAS doctor.
External benchmarking data should be used where possible.
Administrative Time
If timetabled administrative time beyond that included within Direct Clinical Care PA time is
required, the nature of these tasks should be detailed and recorded within the Job Planning
process
The same ‘evidence based’ approach regarding SPA time should be applied to this area.
The proportion of administrative time to DCC should be discussed as part of the preliminary
Team Job Planning session
5.0
Supporting Activities
The Trust is committed to paying for reasonable, agreed amounts of SPA activities which are as
defined in the contracts. It is not expected that all doctors will undertake all of these activities. It
is likely, therefore, that the SPA time within job plans will vary. It is also likely that time allocated
to SPA will alter as activities change throughout the course of a consultant/SAS doctor’s career.
It is a fundamental requirement that SPAs are directly relevant to the individual consultant/SAS
doctor and to the Trust.
The consultant contract currently provides for a typical weekly split of 7.5 DCC to 2.5 SPA. The
SAS contract provides for a typical weekly split of 9 DCC to 1 SPA. However this is neither a
universal allowance nor an entitlement and the job planning process should develop a range of
SPA activities for individuals linked to personal continuing professional development (CPD)
requirements and the agreed needs of the team of doctors and the service. Therefore, there
may be a variation in the number of SPAs, and in the range of activity, within individual job
plans. Consultants will receive up to 2.5 PA, with a minimum of 1.5 PA in order to revalidate
and an additional jointly negotiated 1PA for agreed clinical objectives.
Up to one additional SPA can be awarded for additional responsibilities (see section 5.1) at the
discretion of the CD or Clinical Service Lead where appropriate, with an expectation of 2 PAs on
average per consultant per directorate. This could be increased in exceptional circumstances.
The SPA will be allocated at a basic level to cover the following:
11









Quality Improvement, Audit and Governance programmes
Continuing Professional Development
Local clinical governance activities including mortality and morbidity review meetings
Participation in essential training including mandatory and statutory training
Formal teaching
Appraisal and Revalidation
Job Planning
Personal administration
Team/service/directorate business meetings
Given that these activities are required of all doctors. This must be documented in the job
plan Monday to Friday, although for some activities the actual location and timing can be at
the consultant’s discretion. For the avoidance of doubt participating in audit and quality
improvement includes:
 Participating in mortality and morbidity reviews
 Attending audit/quality improvement meetings
 Contributing data and to its analysis
 Implementing agreed audit recommendations in your own practice
Where consultants/SAS doctors undertake work for other NHS Trusts, SPA time should be split
pro rata to the DCC activity undertaken for that organisation.
SPA activity should be scheduled within the job plan, although by agreement may be worked
flexibly subject to the outcome measures being agreed.
5.1
Additional SPA activity
Additional SPA allocation up to a maximum of 1PA can be for specific lead roles. Examples
include:
 Corporate Roles as agreed with the Clinical Director and Deputy Medical Director
including Case Investigation Role or Case Manager role
 Lead roles in Clinical Governance/Quality Improvement Activities
o
o
o
o
Audit or guideline development
Service Development
Risk Management
Research
 Service lead roles
12
Where SPA time is allocated for research this should be reviewed annually by the Trust
Research and Development committee chaired by the Medical Director. It should be noted that
Audit is not a research activity and should not be counted as such.

Education and training roles
o Post Graduate
o Undergraduate
Educational work should have measurable outcomes which could include;






Definite Objectives if in a formal education role
Attendance at timetabled teaching sessions
Number of students and trainees taught and supervised current timetables and
programmes of work
Feedback from students and trainees or end of placement feedback evaluations
E-portfolio evidence of use and number of work placed based assessment carried
out
Audit/research outputs with trainees and undergraduates
General Teaching Commitments
Clinicians are expected to participate in education as part of their employment. It is important to
recognise that time spent teaching in clinics and ward rounds is not additional, it is part of those
fixed clinical units of PA (DCC).
It is recognised that workplace based teaching may affect the volume of activity which can be
undertaken within a clinical session. Variations in activity will be identified and accommodated
as part of the job planning process.
Undergraduate teaching – this relates to specific undergraduate teaching in SPA time and is
separate from contact time during a fixed activity such as a clinic. The amount of SPA time for
this activity will be individually negotiated as part of the job planning process with the
involvement of the Directorate and the Undergraduate Department of Education through an
evidenced based approach.
Postgraduate Education and Training
Postgraduate Doctors in training should have an assigned Educational Supervisor along with a
Named Clinical Supervisor, the Trust acknowledges the roles and time that Consultants will take
delivering their commitment to train and supervise. An average of 0.25 SPA per recognised
training post in each specialty may be allocated per trainee. The Clinical Director will need to
agree with the consultants how the Educational Work will be provided. Individual job plans will
reflect the explicit allocated time.
Trainees can only have one nominated educational supervisor at a time. It is acknowledged that
in some departments, the role of Assigned Educational Supervisor is undertaken by different
Consultants at different times during a Training Placement. Where this is the case the allocation
13
of SPA time associated with this work should be agreed at Specialty Level and the total time
allocated must not exceed 0.25 SPA per week for each trainee in the specialty.
Consultants appointed as Trust Specialty Tutor or College Tutor should be allocated adequate
time to perform the role. The time required should be agreed on a case by case basis and
should be based on the objectives the individual is required to achieve. This time can either be
recorded as SPA time or Additional Responsibilities As a guideline the Deanery suggests that
Consultants performing this role be allocated 0.5 PA/week in specialties with up to 10 trainees
(excluding Foundation Trainees, for whom appropriate arrangements are already in place), 1
PA/week in specialties with over 10 trainees
The Trust will also support other educational roles such as STC chairs, Regional Advisers and
Training Programme Directors. PAs allocated for supporting these roles will be included in job
plans. Doctors are required to seek and obtain the support of their clinical director before
putting themselves forwards for these roles. The Trust expects these roles to add value to
education and training in the organisation and the Education Faculty will provide advice to the
doctor about the Trust’s expectations. Further guidance on STC roles is contained within
Appendix A.
Undergraduate Education
Consultants performing the role should be allocated adequate time to perform this role.
Consultants appointed as the module lead for each of the Universities should be allocated a
maximum of 0.5 SPA/week, but will be asked to maintain a diary over the course of the year to
assess the actual time spent performing this role.
In both cases specific measurable objectives should be agreed and included in the Consultants
Job Plan
Objective setting around SPA time could include preparation of teaching materials usable by
others, utilisation of student feedback, planning/managing teaching courses.
Such evidence should be discussed at the annual job planning and appraisal
Acting as a medical appraiser
The Trust recognises the contribution that Appraisers make to ensuring that colleagues and the
Trust are able to meet their obligations for Revalidation. Appraisers will be allocated 0.2 SPA
per week for the role in entirety and are expected to undertake a minimum of 4 and a maximum
of 12 (an average of 6) appraisals per annum. In addition, the appraiser will also be expected to
attend any appraiser training and update sessions as required and organised by the Trust
throughout the year.
The time and place where additional SPAs (i.e., those over and above the 1.5 per week
allocated to all Consultants) are performed must be clearly documented in the Job Plan. These
activities should be performed on Trust sites unless an explicit agreement is made to the
contrary with the Clinical Director. Supporting resources such as office space and appropriate
access to a computer will be provided by the Trust to facilitate this.
14
The Clinical Director and Operations/General Manager must agree with the consultant/SAS
doctor the activity to be undertaken and the outcome to be achieved. For example a consultant
undertaking the role of Quality Improvement Lead must agree the output to be delivered which
could include:



agreement on the number of audits meetings to be undertaken within the directorate
the audit programme to be delivered
Engagement agreement with the Governance Department.
The outcome must be evidenced in the appraisal documentation and job planning review.
It is important that activities are not counted twice. Any of the activities outlined above
undertaken during DCC time cannot be taken into account. For instance teaching during a ward
round or theatre session or slide reporting, cannot be counted as SPA. Likewise missing a DCC
activity like theatre or out-patient clinic and attending a management meeting cannot be counted
separately.
In the event that a full time consultant/SAS doctor does not wish to work more than 1.5/1 SPA,
then an agreement can be made to either convert the PA into a DDC activity or alternatively a
reduction in the contractual value of the contract can be made.
The factor underpinning job planning with regard to SPAs is transparency in the activity that
occurs during this time.
Supporting activities should be linked to the delivery of service objectives or personal
development. Evidence may need to be provided during the course of the year.
Consultants/SAS doctors must be able to demonstrate that the time spent on SPAs is needed
for the identified activities and that these activities are undertaken. The supporting evidence can
come from two sources:


The Trust asks consultants to keep a work diary which includes details of SPA activities.
The output from this SPA time (for example research outputs, articles, evidence of
teaching sessions & preparation, audit project outputs etc.) will be reviewed and
discussed at the Job Planning session
Consultants/SAS’s have an obligation to attend key sessions (such as audit meetings, teaching
sessions or clinical governance activities) unless they are on annual leave, study leave or a
substitute activity is agreed with the relevant Clinical Director. Consultants are also expected to
comply with 100% of mandatory training. Job plans will be selected at random for review by
Internal Audit to ensure there is compliance with the policy and procedure.
6.0
Management Responsibilities
These will vary between consultants; an appropriate PA allowance will be negotiated at the time
of the Clinical Director’s job planning.
15
For a part-time Associate Medical Director a substantial part of the job plan will be taken up by
management component of the job plan with less time for clinical activities. The job plan should
allocate and timetable programmed activities within the total working week accordingly.
7.0
Additional NHS Responsibilities/External Duties
If a Consultant/SAS Doctor is asked to take on a wider NHS role that is likely to have a
significant impact on the job plan, discussion must take place with the Clinical Director and
Operations/General Manager and colleagues and this should be agreed by the Associate
Medical Director prior to accepting this role.
Examples of special responsibilities may include being a clinical audit lead, governance lead,
undergraduate dean, postgraduate dean, clinical tutor, regional education adviser, cancer
service work and other similar roles. This must be agreed with the Clinical Director prior to
accepting the role.
The consultant/SAS doctor must be able to fully account for these activities in terms of interest
to the Trust, Professional Society, College or wider NHS. Time should be allocated for such
activities in the overall weekly job plan after discussions between the Clinical Director and
Operations/General Manager undertaking the job plan review and the consultant/SAS doctor, if
these are undertaken over and above the agreed job plan commitments with the Trust.
The Trust will not pay for travel or expenses claims for the external duties.
A consultant may not take annual leave from PA’s assigned to the Trust for any leave accrued
through external PA’s in an individual job plan.
Where a consultant/SAS doctor wishes to perform an additional NHS responsibility on an ad
hoc basis they must first discuss this with the Clinical Director and must provide at least 6
weeks’ notice where a scheduled commitment may be missed. Where the commitment which is
displaced for a different category of PA the displaced activity should be paid back in time
allocated to the PA category of the commitment undertaken.
8.0
Private Practice and Fee paying Services
The consultant/SAS doctor is responsible for ensuring that the provision of Private Professional
Services or Fee Paying Services for other organisations does not:


Result in detriment of NHS patients or services
Diminish the public resources that are available for the NHS
16
The Consultant/SAS doctor must inform the Clinical Director and Operations/General Manager
of any regular commitments in respect of private professional services or fee paying services.
This must include the planned location, timing and broad type of work involved and must be
documented on the job plan.
Where a Consultant/SAS doctor undertakes Private Practice it is agreed that the 11th PA is
offered to the Trust first. Where the doctor declines the 11th session pay progression will be
withheld.
All private practice must be arranged and undertaken within the requirements of the Private
Practice Code of Conduct.
Consultants/SAS doctors must not undertake any Private Practice work when they are
contracted to work at HEFT including when the consultant/SAS doctor is on call for NHS
emergency work.
Where a concern arises that private work has been undertaken when the Consultant/SAS
doctor was required to fulfil contractual obligations as agreed in the job plan the Trust will notify
the Counter Fraud department and may implement MHPS.
If a Consultant/SAS doctor wishes to undertake fee paying service duties in NHS time the
express permission of the Clinical Director or Operations/General Manager is required.
Permission should be sought a minimum of six weeks in advance.
If such duties are undertaken in a doctor’s own time, they keep the fee: in NHS time, they must
remit the fee to the Trust with the exemption of cremations and family planning fees.
Where a Doctor currently undertakes such duties on a regular basis the Clinical Director or
Operations/General Manager must demonstrate how the Direct Clinical Care PAs will be
delivered on an annual basis.
Time shifting is the process whereby one activity e.g. fee paying work is carried out during the
scheduled time for another activity e.g. DCC.
Time shifting of DCC/SPA can only be done with the expressed agreement of the Clinical
Director and Operations/General Manager. Time shifting of a PA will not be authorised to enable
a consultant/SAS doctor to undertake private practice. All time shifting requests must be
recorded and monitored. Where time shifting has been agreed the equivalent amount of missed
activity will be carried out at another time.
17
9.0
Study Leave and Professional leave
Study Leave
The total amount of study leave granted is a maximum of 30 days over a 3 year period which
can be taken as 10 study days a year.
This includes:




Study, usually but not exclusively or necessarily on a course or programme.
Taking examinations
Visiting clinical and attending professional conferences
Undertaking specialist training skills
Note the difference between the SPA allocation and study leave is that the SPA allocation is
used to underpin direct clinical care activities and is of benefit to the service whereas study
leave should be used to develop the skills of a consultant and the service offered to our
patients.
Study leave should be identified with the PD. Study leave that is not contained within the PDP
may not be authorised.
Professional Leave
Professional leave is discretionary and must be approved by either the Clinical Director, Clinical
Service Lead, or General Manager prior to the Consultant/SAS doctor agreeing to the
commitment. It is expected that the individual will minimise the impact on direct clinical care
activities.
The consultant should attempt to schedule duties outside the Trust so as to minimise loss of
commitments such as clinics, operating lists, on call etc. Any leave granted is subject to the
need to maintain the service and where possible should be factored into the job planning
process for example, a consultant who has a regular external commitment that falls on Tuesday
pm which also coincides with a clinic scheduled for Tuesday pm must ensure that the clinic is
moved to another time to ensure activity is not lost.
Professional leave can be granted for the following:






Teaching or lecturing outside the Trust e.g. on ALS or ATLAS courses, MSc or
Conferences.
Examining outside the Trust for Medical Schools, Royal Colleges, others.
Duties as an officer, committee member or member of a working party of a Royal
College, Faculty, Professional or Scientific Society or NICE.
Attendance as a college Assessor at an Advisory Appointments Committee
inside/outside the Region
Attendance at officially constituted bodies giving advice to the department of Health
Attendance at external appeals committee
18


Duties as a member of the Medical Research Council
Duties in relation to Postgraduate educational activities outside the Trust
If a consultant/SAS doctor is considering taking up a significant external position (e.g. Regional
Training Advisor etc.) they must discuss this with the Clinical Director and General Manager and
gain approval prior to taking up the role.
Where the leave is granted the consultant/SAS doctor, must not undertake any other paid work
during the leave of the period without the Clinical Director’s approval.
Consultants/SAS doctors may not claim expenses from the Trust for participation in professional
activities.
The following activities are regarded as official duties and do not form part of the
study/professional leave and can count toward SPA allocation:



Attendance at Coroners inquests
Specialist Cancer Network Meetings e.g. Cancer, Cardiology
Meetings with local commissioners
Where the requirement for professional or study leave is known in advance, this should be
included within the job plan.
Otherwise 6 weeks’ notice should be given to minimise the impact on direct clinical care.
11.0
Special Leave
Special leave for circumstance such as time off to care for a dependant, attending jury service
or domestic emergency should be taken and paid in agreement with the Time off Work policy
which can be accessed via the Trust intranet.
12.0
Job Planning Process – Pre 2003 Consultant Contract
The job planning process for consultants employed on the pre 2003 contract will be the same as
defined above with the exception of the following:
Consultants employed on the pre 2003 contract may be classed as whole time, maximum part
time or part time.
Job Plans are based on a minimum of 10 Notional Half Days (NHD’s)
A Notional Half Day (NHD) equates to 3.5 hours.
They comprise of fixed and flexible commitments:
19
Fixed commitments consist of clinical wards rounds, theatre lists are counted as DCC’s under
the new contract. These commitments are normally at the same time/day each week, but this
can be varied and should normally account between 5 - 7 NHD’s depending for whole and max
part time. (Source Medical and Dental Whitley Council Duties of Practitioners, section 30 9d).
Flexible commitments which consist of patient admin (this is a DCC in the new contract),
research, audit and medical management.
A Maximum Part time consultant is paid ten elevenths of the whole time salary and of any
distinction award if applicable. The minimum work commitment is equivalent to ten national
half days (35 hours).
The split between Fixed/Flexible NHD’s will be as follows:
Those employed on a whole time contract/Max part time:
5 - 7 Fixed NHD’s
3 Flexible NHD’s (note this includes patient admin)
Those employed on part time basis will receive NHD’s on a pro rota basis.
13.0
Travel Time
Where a doctor is expected to spend time on more than one site during the course of the day,
traveling time to and from their main base to other sites will be included as working time within
the programmed activity. It is therefore more effective use of a doctor’s time to schedule
activities at one base for a working day. However it is acknowledged this may not be possible in
a number of cases.
Travelling time between a doctor’s main place of work and home or private practice premises
will not be regarded as part of working time with the exception of a Consultant/SAS who is
called back to work premises whilst on call.
14.0
On Call Consultant New Contract
There are three requirements in relation to the consultant on call which need to be determined
in job planning:
Determination of the frequency rota commitment i.e. 1 in 4 or 1 in 8
This is simply done by referring to the number of doctors on the rota.
Determination of the category of consultant on call duties
20
This is done by considering the nature of the calls typically taken by a consultant in determining
whether:
CATERGORY A:
The consultant is typically required to return immediately to site
when called OR has to undertake intervention with a similar level of complexity to those
normally taken when on site.
CATERGORY B: The consultant can typically respond by giving telephone advice
and/or by returning to work later.
Determination of the average amount of time a consultant is likely to spend on
unpredictable emergency work when on call and the time of day this work takes place.
These must be counted towards Direct Clinical Care PAs and will normally be up to one
programmed activities per week.
Directorates must assess and agree the category and time allocated for on call. The Clinical
Director/Lead will assess with the doctor on a prospective basis the number of programmed
activities that are to be regarded for these purposes, as representing the average weekly
volume of unpredictable emergency work arising from a doctor’s on call duties.
The following calculation provides an example of how the on call can be assessed and
allocated:
Average number of hours spent in hospital per day out of hours (audited over a 1 month period
twice a year) divided by the number of people on the rota multiplied by 7 (to get the hours per
week per consultant) divided by 3 (the number of OOH hours for 1 PA).
Where this work exceeds 2 PAs in an average week the Clinical Director/Lead must review this
with the consultant and either:


Re-organise other Direct Clinical Care Activities during weeks of on call
Explore recognition of this work via time off or additional remuneration
It is the Trust’s expectation that the former of these options will provide a mutually acceptable
solution in the majority of cases.
Where unpredictable emergency work occurs between 7am and 7 pm the following allocations
should be made:
Average emergency work per week likely Possible allocation
to arise from on call duties
Activities (PA’s)
½ hour
of
Programmed
1 PA every 8 weeks, or half a PA every 4
21
weeks
1 hour
weeks
11/2 hours
3 Pas every 8 weeks
2 hours
1 PA every 2 weeks, or half a PA every
one week
3 hours
3 PA’s every 4 weeks
Where unpredictable emergency work occurs between 7pm and 7am the following allocations
should be made:
Average emergency work per week likely Possible allocation
to arise Out of Hours from on call duties
Activities (PAs)
of
Programmed
½ hour
weeks
1 hour
1 PA every 3 weeks
1 ½ hours
1 PA every 2 weeks, or a half PA per
week
2 hours
2 PAs every 3 weeks
3 hours
1 PA per week
4 hours
3 PAs every two weeks
6 hours
2 PAs per week
Where on call work averages less than 30 minutes per week, compensatory time will be
deducted from normal Programmed Activities on an ad hoc basis.
SAS On Call New Contract
There are two requirements in relation to SAS on call which need to be determined in job
planning:
Firstly the determination of the frequency rota commitment i.e. 1 in 4 or 1 in 8
This is simply done by referring to the number of doctors on the rota.
22
The on call availability supplement is as follows:
Frequency
Percentage of Basic Salary
More frequent than or equal to 1 in 4
6%
Less frequent than 1 in 4 or equal to 1 in
8
4%
Less frequent than 1 in 8
2%
Secondly the expected average amount of time that a doctor is likely to spend on unpredictable
emergency work each week whilst on call and directly associated with on call duties will be
treated as counting towards the number of Direct Clinical Care programmed activities.
This will normally take up to a maximum of two programmed activities per week.
The Clinical Director/General Manager must assess with the doctor on a prospective basis the
number of programmed activities that are to be regarded for these purposes, as representing
the average weekly volume of unpredictable emergency work arising from a doctors on call
duties during a period between one and eight weeks.
Where unpredictable emergency work occurs between 7am and 7 pm the following allocations
should be made:
Average emergency work per week likely
to arise from on call duties
Possible allocation of Programmed
Activities (PA’s)
½ hour
weeks
1 hour
weeks
11/2 hours
3 Pas every 8 weeks
2 hours
1 PA every 2 weeks, or half a PA every
one week
3 hours
3 PA’s every 4 weeks
4 hours
1 PA per week
23
6 hours
1 ½ PA’s per week, or 3 Pas every 2
weeks
8 hours
2 PAs per week
Where this work exceeds 2 PA’s the Clinical Director/General Manager must review this with the
doctor and either:


Re-organise other Direct Clinical Care activities during weeks of on call
Explore recognition of this work via time off or additional remuneration
It is the Trusts expectation that the former of these options will provide a mutually acceptable
solution in the majority of cases.
Where unpredictable emergency work occurs between 7pm and 7am the following allocations
should be made:
Average emergency work per week likely
to arise Out of Hours from on call duties
Possible allocation of Programmed
Activities (PAs)
½ hour
weeks
1 hour
1 PA every 3 weeks
1 ½ hours
1 PA every 2 weeks, or a half PA per
week
2 hours
2 PAs every 3 weeks
3 hours
1 PA per week
4 hours
3 PAs every two weeks
6 hours
2 PAs per week
Where on call work averages less than 30 minutes per week, compensatory time will be
deducted from normal Programmed Activities on an ad hoc basis.
24
15.0
Annualisation
Annualisation is an approach to job planning in which a doctor contracts with the Trust to
undertake a particular number of PAs or activities on an annual, rather than a weekly, basis.
Annualisation of all or part of job plans or agreed annual numbers of certain activities for
example clinics can enable employers and doctors to match variations in demand with the
available resources. Others may want to arrange their work so that they can spend the
maximum amount of time at home with their families and would like, for example, to have as
much leave during school holidays as possible.
As with all aspects of job planning the decision whether to annualise a job plan or not must be
by mutual agreement as the needs of the service must be delivered. At the outset the doctor
and their Clinical Director must agree that activity relates to measurable outputs and that
arrangements reflect the professional nature of the consultant contract the doctor’s continuing
responsibility for care as described in the GMC’s Good Medical Practice. At the same time the
Trust should clarify a doctor’s responsibilities when they are not scheduled to work and not
undertaking any other planned activity, on-call or when they are on leave, for example whether
they are required to return to work in the event of an emergency.
Key principles of annualisation

Annualisation is a flexible working arrangement which needs to meet both the needs of
the individual and the Trust. Consultants/SAS doctors work an agreed annual total of
programmed activities instead of the same number each week.

An alternative approach is for there to be an agreement as to the number of specific
activities, for example out-patient clinics, to be delivered over the year.

Either arrangement must be compatible with the Consultant/SAS doctors’ contract and
job planning best practice. This provides for working time measured in programmable
activities and also for paid leave.

The arrangement must be agreed. As for job plans, this agreement is between the
doctor and their Clinical Director.

Agreement must be reached on how many programmed activities or specific activities
are to be done in a year.

For programmed activities this is usually expressed as a mean number per week
multiplied by the number of weeks in the working year. For example, on a 10PA fully
annualised contract, this would be the number of weeks in the working year multiplied by
ten.
25

For individual components (e.g. clinics, lists) this is usually expressed as the number
normally undertaken in a week multiplied by the number of weeks in the working year.

The number of weeks in the working year is not a fixed number. It is equal to 52 less the
number of weeks granted as leave (annual, study, professional). This number will vary
for Consultants/SAS doctors and cannot be assumed to be 42 or any other fixed
number. The Annual leave policy for Medical and Dental staff outlines the annual leave
entitlement by grade and years service. This will identify the number of weeks leave that
will be taken. If during the year it becomes apparent that significantly more or less leave
than anticipated will be taken then the annualised total should be reviewed and adjusted
as appropriate.

All parties should agree on the outputs and outcomes expected from activity in the job
plan, and the means by which they will be measured and reported.

Agreement will be reached regarding the arrangements by which Consultants/SAS
doctors will notify the Clinical Director/Operational Manager when objectives or agreed
levels of activity are not being met. These arrangements may form part of a wider
system of review which tracks progress against objectives; are able to take into account
changing circumstances and other external factors and allow for agreed modifications to
the job plan where necessary.

Programmed activities do not always run to the scheduled time and a professional
approach should be taken to this. In the short term such variances will often balance out
but if an activity consistently lasts longer or for less time than the PA time allowed then
an interim job plan review should be held.

Both the Consultant/SAS doctor and the Clinical Director must keep a record of the work
undertaken against their annualised total. In some circumstances, a minimum number
of PAs per week or month may need to be agreed for annualised plans so that activity
can be delivered in a predictable manner. There should also be agreement on the
frequency and nature of reporting arrangements so that any issues arising can be dealt
with within a timeframe that allows reasonable changes to be made.

It is important that the delivery of annualised clinical activities aligns to patient
demand/waiting times and the capacity of the service to deliver. It is important,
therefore, that agreement is reached on when the annualised activities will be delivered
to meet these.
There is no one agreed or recommended way of annualising a job plan. Different methods
will work for different situations. Examples of how job plans can be annualised are given in
Appendix B. The examples share an adherence to the principles set out above.
26
16.0
Job Planning Process
The Clinical Director or Clinical lead and Operations/General Manager for each division will take
the lead in the job planning process.
Job Planning will be based on a partnership approach.
Preparatory work is necessary to ensure the job planning process is meaningful and helpful to
both the doctor and the Clinical Director or Clinical Lead/Operations Manager. The Clinical
Director or Clinical Lead must undertake robust preparation for the job planning process. This
must include reviewing demand for clinical activities to ensure that the directorate can apply
sufficient resource to deliver a good service.
For service specialisms, this may be easy to predict e.g. theatre sessions require a single
anaesthesiologist. For response specialism this can be predicted often using historic
occurrences.
The Doctor will be responsible for providing a draft job plan based on their current timetable of
activities to the Clinical Director/Service Lead for discussion.
Listed below is a checklist of suggested information to assist the planning process.
Preparation by Doctor











Last year’s job plan
List of main clinical duties to the Trust
Timetable of private practice commitments
List and schedule of any fee paying commitments
CPD/CME requirements
Personal Development plan
List and time commitment of other duties and responsibilities e.g. trade union
etc
Clinical audit and clinical governance dates and issues to be addressed
An idea of required additional support to be provided by the Trust
Ideas for improvements to service, quality range or performance
Evidence to demonstrate achievement of agreed objectives and outcome
measures
Preparation by Clinical Director/ Operations Manager




Quantity and quality targets for the directorate and performance against them
by the team and individually last year
Knowledge of the relevant priorities within the local delivery plan
Changes in services being require of, or offered by the directorate
Clinical audit and clinical governance data and issues affecting the
directorate and the individual
27









17.0
Knowledge of the resource base of the directorate including numbers of staff
changes in skill mix and those services, space and equipment available
Understanding of current and new initiatives within the directorate or Trust
Details of study leave taken within the last year
Changes in practices and/or services of other providers
National clinical audit or clinical governance issues
Changes in the health provision requirements of the local health community
The requirements of related medical schools
The needs of doctors in training
Feedback from trainees
The Job Planning Discussion
This is a suggested format for the meeting to agree the job plan





Discussion about last year’s plan – the positive and negative issues from both
the individual’s and Clinical Directors/General Manager’s perspective
What service needs or individual development needs are there to be
addressed e.g. offer of additional PA
Private Practice: what are the details of current regular contracts and the
impact of work scheduling
What could the schedule look like
Are there any service implications or additional pay as a result of this plan
The job plan will include appropriate and identified personal objectives and expected outcomes
that have been agreed between the doctor and the Clinical Director or Clinical Lead and
Operations/General Manger.
Job plans should be reviewed by the Clinical Director or Clinical Lead and Operations/General
Manager and consultant/SAS on an annual basis or sooner if there is a significant change in
role/service needs.
Consultants/SAS doctors may bring a work colleague to the job planning review meeting if
required.
Following the job planning review, the Clinical Director or Clinical Lead/Operations Manager will
sign off the job plan and inform the Associate Medical Director whether the consultant/SAS
doctor has:


Made every reasonable effort to meet the service commitments in
his/her job plan
Met the personal objectives and delivered the agreed outcomes in
his/her job plan or whether this was not achieved for reasons beyond
the individual consultant’s control and he/she has made every
reasonable effort to do so.
28




Participated satisfactorily in annual appraisal, job planning and objective
setting.
Agreed the prospective job plan for the year ahead.
Worked towards any changes identified as being necessary to support
achievement of the Trust’s service objectives in the last job planning
review.
Met the criteria for pay progression.
If a consultant fails to meet the agreed objectives then these should be reviewed and an agreed
structure put in place to support the achievement of these. Further advice can be sought from
the HR consultancy team.
18.0
Submission to Associate Medical Director
Upon completion of the job planning process Including Clinical Director and Operations/General
Manager sign-off, the job plan will be submitted to the appropriate Associate Medical Director
for sign-off. The Clinical Director and Operations/General Manager will also provide a report
outlining

Existing and proposed Job Plans for all consultants/SAS in the directorate, including
those choosing to remain on the old contract.

A summary of the implications in terms of:
o
Programmed Activities required for individual consultants in excess of 10 PAs
and the justification in each case.
o
Identify the service improvements to be achieved throughout the year.
o
Achievement of the Corporate Business Plan:
Waiting times, including cancer targets
Patient Booking
Length of stay
Use of day case facilities
Discharge of patients
Clinical Governance
29
Financial Balance
19.0

Changes to the impact on inter-dependant directorates e.g. Anaesthetics, Radiology
and the outcome of discussion with Clinical Directors/Leads of those services.

An explanation of the physical resources required to fulfill the job plan, specifically
the clinical, theatre and other treatment facilities required in each of the Trust sites.
Mediation
In the event that a job plan cannot be agreed between the Consultant/SAS doctor and the
Clinical Director/Operations/General Manager the following Mediation process will be used.
The Mediation and Appeal Process applies equally to those Consultants/SAS doctors on both
the old and new contracts.
The consultant/SAS doctor, may refer the matter to the Associate Medical Director, or to a
designated other person if the Associate Medical Director is one of the parties to the initial
decision.
Since the Clinical Directors’ job plans will be reviewed by the Associate Medical Director, the
role of mediator will be taken on by another Associate Medical Director or the Medical
Director/Deputy Medical Director of the Trust.
If a consultant/SAS doctor is employed by more than one NHS organisation, a designated
employer will take the lead (in the case of a disputed Job Plan, a lead employer should have
already been identified). The purposes of the referral will be to reach agreement if at all
possible.
The mediation process should be used where the two parties have failed to reach an
agreement.
If a doctor/Clinical Director feels that the panel is biased then they can request that the panel be
revised to include either an Associate Medical Director from a different area or the Medical
Director.
The party making the referral will set out the nature of the disagreement and his or her position
or view on the matter.
Where the referral is made by the doctor, the Clinical Director and Operations/General Manager
responsible for the job plan review will set out the employing organisation’s position or view on
the matter.
30
Where the Clinical Director/Operations/General Manager makes the referral, the consultant/SAS
doctor will be invited to set out his or her position on the view or matter.
The mediator or an appropriate nominated person will convene a meeting, normally within four
weeks of receipt of the referral, with the doctor and the responsible Clinical
Director/Operations/General Manager to discuss the disagreement and to hear their views.
If agreement is not reached at this meeting, then the mediator (in most cases the Associate
Medical Director) will decide the matter in the case of a decision on the Job Plan or on whether
the criteria for a pay threshold has been met.
20.0
Appeals
In an event that a consultant/SAS doctor are not satisfied with the outcome of a mediation job
planning and pay progression disputes a formal appeal should be lodged in writing to the
Medical Director soon as possible and in any event within two weeks, after the outcome of
mediation process.
On receipt of a written appeal with points in dispute and the reasons for the appeal, the Medical
Director will convene an appeal panel to meet within four weeks.
A formal appeal panel will be convened to set out points in dispute and the reasons for the
appeal.
The parties to the dispute will submit their written statements of case to the appeal panel and to
the other party one week before the appeal hearing.
The appeal panel will hear oral submissions on the day of the hearing. Management will
present its case first explaining the position on the Job Plan, or the reasons for deciding that the
criteria for a pay threshold have not been met.
The doctor may present his or her own case in person, or be assisted by a work colleague or
trade union or professional organisation representative, but legal representatives acting in a
professional capacity are not permitted.
Where the consultant/SAS doctor or the panel requires it, the appeals panel may hear expert
advice on matters specific to a specialty.
It is expected that the appeal hearing will last no more than one day.
The appeal panel will make their decision and will confirm it in writing within 5 days of the
hearing.
No disputed element of the Job Plan will be implemented until confirmed by the outcome of the
appeals process. Any decision that affects the salary or pay of the consultant/SAS will have
31
effect from the date on which the consultant/SAS doctor referred the matter to mediation or from
the time he or she would otherwise have received a change in salary, if earlier.
In the case of a job planning appeal from a Medical Director, mediation would take place via a
suitable individual, for example, a Non-Executive Director.
If a doctor/Clinical Director feels that the panel is biased then they can request that the panel is
revised to include the Medical Director, CEO or Non-Executive Director.
32
Appendix A
Trust position on Consultant Staff undertaking regional education
roles
Health Education West Midlands appoints consultant grade staff to various educational roles at
a regional level. These positions include Specialist Training Committee Chairs (STCs). Over a
period of time the posts move around the region such that each trust will be called on to support
particular posts for a limited period of usually 3 years.
STC Chairs run the training programmes for specialities and are an important part of the
delivery of education and training. As such they are highly prestigious posts and the Trust
supports and encourages its staff to undertake these roles.
HEWM requires the Trust to support individuals in undertaking the role of STC Chair by
providing time in job plans and effectively supporting the role financially. The Trust support
should be reflected in job plans as a reduction in clinical commitment, changes to SPA
responsibilities or additional PAs within the Trust maximum. The Trust should reimburse
directorates for this support. Activity in this role should be reflected in the consultant’s annual
appraisal supported by their annual HEWM appraisal by the relevant Head of School.
Because of this cost it is reasonable that the Trust has certain expectations of individuals
undertaking these roles;






Individuals wishing to apply for the role of STC Chair should first discuss and get the
approval of their Clinical Director for the time commitment. In the case where the CD
does not agree then the potential applicant should appeal to the Director of Medical
Education who will discuss the case with the relevant Associate Medical Director.
STC Chairs within the Trust will be expected to lend their expertise working with the
Trust’s Education Lead in the relevant speciality helping to ensure that the training
programmes delivered are of the highest calibre.
The STC Chair is expected to contribute to the Trust’s wider educational environment by
regular attendance at the medical education management committees as required by the
DME
The STC Chair brings to the Trust a greater understanding of education and training at a
regional (HEWM) and sometimes national level.
The STC Chair will be expected to provide advice to the Medical Director and DME in
issues affecting training and service delivery where appropriate
Undertaking these roles assists in developing the individual with leadership and other
transferable skills that are then available to the Trust.
33
Appendix B
Annualisation of job plans – examples
Example A: Term time working
Doctor A wishes to spend as much time during the school holidays at home. He or she then
arranges their job plan on an annualised basis so that all their elective direct clinical care (DCC)
and emergency work is carried out during term time. Supporting Professional Activities (SPAs)
are worked partly during term time and partly during the school holiday periods. This is how the
job plan is worked out.
Assumptions

Doctor A does 1PA of unpredictable on-call work per week and 6.5 elective direct clinical
care work. Doctor has a weekly ratio of 7.5 DCC and 2.5 SPA Programmed Activities.

There are 35 weeks of term time per year and 17 weeks of school holiday time.

All annual leave (6 weeks plus 2 weeks of bank holidays and extra days = 8 weeks) will
be taken during the school holidays.

A week of professional leave will be taken to teach on a postgraduate course.

That leaves 43 weeks during which Doctor A must work – 430PAs per year (based on a
10PA contract).

Doctor A will work all their DCC programmed activities (PAs) in the 35 weeks of term
time. SPAs will be worked over both term time and school holiday time.

Study leave will be handled on an ad-hoc basis.

On-call duties falling during school holidays will be swapped as they would be for annual
leave.
The detail
Weekly equivalent
(52 weeks)
School holidays
(18 weeks)
(PA per week)
Term time
(34 weeks)
(PA per week)
Direct Clinical Care (DCC)
7.5
0
9.45
Supporting Professional
Activities (SPA)
2.5
3.5
1.4
34
Total Programmed Activities
(PAs) per week
10
Total Programmed Activities
(PAs) per year
3.5
11.9
63
369

During term time Doctor A will work on average an 11.9PA week consisting of 9.45 DCC
and 1.4 SPAs.

During the school holidays and during leave Doctor A will do just 3.5PA per week of SPA
only.

These proportions can be adjusted to the needs of both Doctor A and the Trust.

Over the year, Doctor A will deliver a total of 432PAs.
Example B

Doctor B works 5 DCC PAs per week but would like to work this out on an annualised
basis.

Doctor B takes a total of eleven weeks (55 days; 110 half-days) of approved leave (for
bank holidays, annual leave, study leave, professional leave, sick leave).

This leaves 41 weeks so that means that 205 PAs should be carried out during the rest
of the year.

SPAs can be worked out in a similar way.
Example C

The consultants and the Trust agree that workload for acute medicine is greater during
the winter months and therefore, on average three months are spent working a 12PA
week.

During the summer months, workload is eased and thus the consultant works three
months at 10 PAs per week.

The consultant’s salary is maintained at 11 PAs across the year. This is a simple form of
annualisation which may be useful for specialties with a seasonal variation in workload.
35
Example D

An agreement is reached that a consultant who nominally undertakes two out-patient
clinics per week and has a working year of 42 weeks, to deliver 84 clinics per year.

Flexibility is provided by the Trust that this can at times be delivered at different times in
the week than may have been nominally indicated on the weekly timetable.

Without this flexibility, this annualisation would not have led to a different outcome than a
rigid weekly job plan.
36

agenda - Heart of England NHS Foundation Trust

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