Agenda and Papers for Public Board Meeting April 2015
Transcription
Agenda and Papers for Public Board Meeting April 2015
Board of Directors’ Meeting – Part I In Public 09.00 30 April 2015 Maple House AGENDA Item No. 15.78 Item Outcome Report type Chairman’s Welcome and 15.79 Apologies for absence Note Verbal 15.80 Declarations of interest Note Verbal 15.81 Minutes of Public Board meeting 26 March 2015 Approve Enc 01 15.82 Matters arising from Public Board meeting 26 March 2015 Note Verbal Note Enc 02 Debate Enc 03 Approve Enc 04 Strategy 15.83 15.84 15.85 15.86 15.87 15.88 15.89 Next Generation Project Update David Melbourne, Deputy Chief Executive & Chief Finance Officer Corporate Social Responsibility Theresa Nelson, Chief Officer for Workforce Development Monitor Operational Plan 2015/16 Matthew Boazman, Chief Officer for Strategy Quality & Resources Quality Report Michelle McLoughlin, Chief Nursing Officer and Fiona Reynolds, Note Interim Chief Medical Officer Performance Report David Melbourne, Deputy Chief Executive & Chief Finance Note Officer Resources Report David Melbourne Deputy Chief Executive & Chief Finance Note Officer and Theresa Nelson, Chief Officer for Workforce Development Executive Update Enc 05 Chief Executive’s Report Sarah-Jane Marsh, Chief Executive Enc 08 Note Enc 06 Enc 07 Other 15.90 Any Other Business Verbal 15.91 Questions from members of the public Verbal Next meeting of the Board of Directors: 20 May 2015, Education Centre, BCH Part II of this meeting will be held in private as the information to be discussed is exempt from public disclosure under the Freedom of Information Act 2000 *Only unstarred items will be discussed. If any Board members wish to have any items discussed, please notify the Company Secretary before the meeting. In exceptional circumstances, it may also be possible for items to be unstarred for discussion at the beginning of the meeting. Starred items will be approved or received as appropriate without discussion. Unconfirmed BOARD OF DIRECTORS MEETING Minutes of the meeting held in public on 26 March 2015 at 09.00 in the Education Centre, Birmingham Children’s Hospital Present: Attending: Ref. 15.49 Christine Braddock Tim Atack Matthew Boazman Alan Edwards Jon Glasby Colin Horwath Michelle McLoughlin David Melbourne Theresa Nelson Vij Randeniya Fiona Reynolds Judith Smith Paul Faulkner Paul Heaven Sara Brown Gwenny Scott CB TA MB AE JG CH MM DM TN VR FR JS PF PH SB GS Chairman Chief Operating Officer Chief Officer for Strategy and Planning Non-Executive Director Non-Executive Director Non-Executive Director Chief Nursing Officer Deputy CEO and Chief Finance Officer Chief Officer for Workforce Development Non-Executive Director Interim Chief Medical Officer Non-Executive Director Associate Non-Executive Director Associate Non-Executive Director Head of Workforce Company Secretary (minutes) Item Welcome from Chairman The Chairman welcomed all Board members and members of staff attending to observe. The Chairman also formally welcomed Alan Edwards and Fiona Reynolds who were attending their first meeting as Board members. The Chairman congratulated the Chief Executive who is featured in the HSJ as one of the top NHS Chief Executives. 15.50 Apologies for Absence Roger Peace, Will Murdoch, Sarah-Jane Marsh. 15.51 Declarations of Interest None. 15.52 Minutes of the Board meeting held in public on 25 February 2015 The minutes were accepted as an accurate record of the meeting. 15.53 Matters arising from the Board meeting held in public on 25 February 2015 There were no matters arising that were not covered by the agenda items. 15.54 Diversity and Equality Strategy TN presented the report which described progress made on the strategy and areas still to improve. TN highlighted the following areas of the report: - NHS Change Day at the hospital focused on the rich diversity within the organisation and the benefits of learning diverse characteristics and different cultures. One area of learning for staff was the impact of Ramadan on the work of Muslim staff. - The Trust is meeting its various statutory obligations but there are areas that need improvement. Page 1 of 7 Action Unconfirmed Ref. MM added the following: Item - Significant benefit was derived from a session with a diverse group of YPAG members who stressed the importance of asking individuals for their views, not making assumptions or worrying about saying or doing the wrong thing. - One of the hospital’s most diverse groups is the volunteers, who represent the Trust’s service community in a way that is not reflected by the staff. The Board was invited to discuss the recommended areas for focused action. The Board discussed the following points: - It is important that focus on one group is balanced to avoid any unintended detriment to other groups. - The data showing a drop-off between application, short-listing and appointment of job applicants from a BME background is of concern. It was noted that at short-listing stage the recruiting manager has no information about equality characteristics so there can be no unconscious bias at this point. It was agreed, however, that there should be further investigation into the reasons behind decisions not to appoint after shortlisting. - Are there other organisations in the public or private sector which perform better on recruitment, from which the Trust could learn? - Attracting those of a BME background into child health academic programmes is a national challenge. - The Trust’s BME Advisory Group has advised that the shortage of BME role models is an issue. - Should the Board use its position to influence change? TN is working with universities on recruitment strategies. - Some of the staff survey results from BME staff flagged areas for focus but others are encouraging, for example in relation to the support provided through the appraisal process. - The Board had previously agreed to include socio-economic status as an additional characteristic in its own diversity and inclusion work. TN advised that much of the work to encourage young people into NHS recruitment focuses on both BME and socioeconomic backgrounds. - The preparation undertaken in the bid for the 0-25 CAMHS contract highlighted a lack of connections with some communities. It is important to develop ongoing relationships with communities rather than single issue engagements. - The family plays a key role in education choices. The Trust is in a position to have some influence through its work with families. - Should there be more focus on how it feels to be a lesbian, gay, bisexual or transgender (LGBT) member of staff? The Board approved the next steps described in the report and agreed that further work should Page 2 of 7 Action Unconfirmed Ref. be undertaken in the following areas: Item • How it feels to be a LGBT member of staff. • The reasons for drop-off between short listing and appointment of people from a BME background during the recruitment process. • A benchmarking exercise with other NHS trusts in the West Midlands in relation to recruitment. • Identifying organisations outside the NHS with a strong history of BME recruitment. • Developing stronger links with community groups. • Working with families to influence education choices. It was agreed that progress will be monitored by the Quality Committee. 15.55 Staff Survey 2014 Results SB presented the very positive staff survey results and focused on areas where the Trust is doing well, where more work is required, benchmarking with other trusts and the areas for focus in the next 12 months. The improvements in staff engagement suggest the work of the last two years – Building Team BCH and Caring for Team BCH – have been successful. This is particularly encouraging in the context of an overall decline in staff engagement across the NHS. One area that requires extra focus is the reporting of errors. The percentage of staff who say they witnessed and error and either they or a colleague reported has reduced slightly from the previous year and is below average. There also continues to be room for improvement in relation to feedback following incidents. The Board discussed the following: • The results in relation to incident reporting and feedback are surprising as there is a strong incident reporting culture. It was noted that the Quality Committee have commissioned a review. • There should be a more sophisticated approach to the content of notices around the premises to ensure we capitalise on good messages such as this. • The focused work on staff engagement over the last three years has had a clear impact and this has been recognised externally. • Changes to the way stress is managed have resulted in a decrease in stress related absences despite the operational pressures being felt by staff. • Medical staff have been encouraged to attend a team maker course which has been well received. • The results in relation to staff satisfaction about the quality of care they are able to provide are surprising. This will be a focus of the Intent to Listen sessions. The Board noted the report and approved the recommendations. Page 3 of 7 Action TN Unconfirmed Ref. 15.56 Item Quality Report Quality and Resources Action The Chairman advised the Board that the report had already been reviewed by the Quality Committee and at the next Board development session consideration would be given to the way in which the report should be reviewed by the Board. FR and MM were asked to present the salient highlights: • Feedback from staff indicates that the Safety Strategy could be simplified and this is under review. • Triangulation of the safety and patient experience data does not indicate any significant areas of concern. All incidents will be investigated to ensure the organisation can learn from them. • Further work will be undertaken on a summary of quality metrics to be included in the report. The Board discussed ways in which the report might be developed and presented. It was agreed that the Board should if possible see more information about clinical outcomes in a more focused way. The Board noted the report. 15.57 Performance Report DM presented the report, focusing on the red areas highlighted by the balanced scorecard. The Finance and Resources Committee (FRC) had debated in detail the performance on diagnostic waits which continues to be an issue despite measures taken. A range of factors have influenced performance and FRC have asked for a deep dive review. TA updated the Board about the decontamination of scopes, which had affected performance, though it has been made very clear by the clinical staff that this has not had an impact on quality of care. It was agreed that in light of the longevity of the issue the review of diagnostic waits TA commissioned by FRC should be reported direct to the Board. DM informed the Board that although the Emergency Department 4-hour wait target was met in February, the spike in demand which always occurs at this time of year for children, as well as some complex and distressing cases, means that performance in March is likely to dip and this could affect performance for the year. MM advised the Board that a CCG representative attended in the previous week to observe flows in ED and to audit patient records. On his estimate 40% of the children and young people seen that day could have been seen in primary care. The CCG are looking at ways of working together with the Trust to provide primary care provision at weekends, however, there are workforce issues and a solution is not yet in place for winter. The Board discussed the need to use the Trust’s leadership role to influence the system in this regard. DM advised that the opening of the new Theatre 10 will help reduce operational issues influencing cancelled operations. Page 4 of 7 Unconfirmed Ref. 15.58 The Board noted the report. Item Resources Report It was noted that the report was reviewed by FRC and gives a similar picture to the last three months. FRC will consider in April the level of surplus to post at year end. The Board noted the report. 15.59 2015/16 Budget DM advised the Board on the following main points that arose from a detailed debate at FRC: 1. The Budget is based on assumptions as the tariff situation has delayed the timetable for commissioner negotiations, so next year’s income has yet to be confirmed. 2. A financially robust organisation goes hand in hand with success in quality, safety and staff engagement. DM recommended that the surplus next year is set at a more realistic level under current circumstances. 3. Efficiency challenge: over the last five years the Trust has delivered 20% CIP, however, the tariff decreases every year and any annual shortfall is cumulative. The Trust therefore needs to deliver major change in 2015/16. 4. There is a degree of financial risk attached to the community CAMHS contract, though protective steps have been taken. CH, as Chair of FRC, advised that following a detailed debate FRC supported the strategy adopted for the overall budget. FRC recommended the Board discuss the achievability of the CIP programme in a private session. The Board approved the draft Budget, noting that a final Budget will be presented in April following completion of negotiations. Executive Update 15.60 Chief Executive’s Report DM, with input from the Executive members, reported verbally as follows: 1. There have been a number of visitors to the Trust during the month: a. Steven Hay, the Director of Strategy at Monitor had a tour of the hospital and met with the Chief Executive to discuss the tariff and funding of the new hospital. b. Jane Cummings, England’s Chief Nursing Officer met with MM about the Trust’s innovative workforce programmes and the way in which the Trust manages to avoid using agency staff. She also asked MM’s advice on taking forward the recommendations of the Shape of Care review. c. The Managing Director of Deutsche Bank sought to learn from the Trust regarding staff engagement. d. Siobhan Dunn of the Teenage Cancer Trust visited to look at how the TCT Unit Page 5 of 7 Action Unconfirmed Ref. Item will be transferred to the new cancer block. 2. In response to the Freedom to Speak Up review the Trust is holding Intent to Listen sessions with staff. This is an annual programme of small focus groups to collate intelligence to inform the basis of the next Intent event. Board members were encouraged to attend the sessions which are a powerful way to hear directly from staff about how they feel. 3. The plans for Magnolia House have been unveiled. This is a calm, quiet place to deliver difficult messages to families and to meet with bereaved families away from the clinical setting. The plans have been developed based on engagement with families. It is charitably funded and is already generating a lot of positive interest. 4. Dragonfly TV have just completed static camera filming within the hospital for a 10 programme series to be aired on Channel 4 in September. It is hoped that the programme will have a positive impact on recruitment and fundraising. The Chief Executive will fully brief the Board at a later date. 5. The Trust is now number one in the NHS for flu vaccinations of front-line staff (91%). 6. The West Midlands Genomics centre partnership bid was successful. UHB, the lead partner is now finalising the contract negotiations with Genomics England and will starting recruitment this month. BCH should start recruiting its proportion of patients to the programme from April onwards which is important for patients with rare diseases. Reputationally this is also significant in terms of research and development. 7. The Trust is also a core partner with UHB in the development of a Translational Medicine Unit which is due to open in June. The Trust is also engaged in a regional review of life sciences which is being led by Graham Silk. 8. The Big Hoot Art Exhibition was very successful. It is hoped that the owls will raise £1m at auction. The Board noted the report. Any Other Business and Questions 15.61 Any Other Business CB advised that the due diligence work on the development with Birmingham Women’s Hospital is ongoing and due for completion in May. 15.62 Questions from the Public None. Next Board of Directors meeting: 30 April 2015 Page 6 of 7 Action Unconfirmed Decisions and Actions Item 15.54 Diversity and Equality Decision/Action Responsibility Decision/Action: The Board approved the actions described in the report and agreed that further work should be undertaken in the following areas: • How it feels to be a LGBT member of staff. • The reasons for drop-off between short listing and appointment of people from a BME background during the recruitment process. • A benchmarking exercise with other NHS trusts in the West Midlands in relation to recruitment. • Identifying organisations outside the NHS with a strong history of BME recruitment. • Developing stronger links with community groups. • Working with families to influence education choices Action: Progress will be monitored by the Quality Committee. TN 15.55 Staff Survey Decision: The Board approved the recommendations. 15.57 Performance Report Action: The review of diagnostic waits commissioned by FRC shall be reported TA direct to the Board. 15.59 Budget 2015/16 Decision: The Board approved the draft Budget, noting that a final Budget will be presented in April following completion of negotiations. Page 7 of 7 Item 15.84 Board of Directors Public Meeting April 2015 Strategic Objective/ Enabler Trust Strategy Report Title Corporate Social Responsibility Sponsoring Director Chief Officer for Workforce Development Author(s) Previously considered by Enc 3 Chief Officer for Workforce Development N/A Situation Corporate Social Responsibility (CSR) at BCH means making a positive contribution to the many societies we serve. Our services are at the heart of local, national and international communities and it is essential that we help the young people who make up these communities to thrive and be successful – This is at the heart of our Mission and Vision. This report/presentation gives the Trust Board an overview of the many strands of our work at BCH to provide assurance that we are a socially responsible organisation. Background The Trust Board received a report last year on Corporate Social Responsibility at BCH. The Trust has further developments which demonstrate their social responsibility as an organisation. Assessment The Trust meets its corporate social responsibility in a number of ways whether this be locally, regionally, nationally or internationally. These are outlined in more detail in the attached presentation. The key areas are: • • • • • Our People – how we provide sustainability within the community through employment opportunities and training Our Built Environment – how we ensure that we minimise our impact on the environment through sustainable building development Our Business – how we do business in the city, regionally and nationally, and how we manage procurement in a sustainable Our Population, Health and Wellbeing – how we support our population and staff to self-care, manage their health and wellbeing and focus on prevention of chronic health conditions Our Presence in the City – how we maintain our reputation, especially around our • fund-raising to ensure BCH remains in the hearts and minds of our population Our International Impact – how we take our clinical expertise to reach across the world and support the development of health and care The detailed report/presentation will be taken as read for the Trust Board, and the focus for presentation and discussion will surround our work in Malawi. Recommendations The Trust Board is asked to: 1. Receive the report describing the range of activities influencing our role and reach across the city, the region and the world. 2. Discuss the Trust Board ambitions in this area and agree key areas of activity for the executive to explore. 3. Discuss the specific components of the Malawi partnership and in particular the role the board wishes to have in relation to: • A link on the Birmingham Children’s Hospital Website • Inclusion in local induction • Support the funding for the salary of the coordinator Risk Description As per above Key Risks Controls Trust board sub committees/SWC Assurances Regular reports to chief officers, TLT, SLT, SWC and the Trust Board. Standards of compliance and assessment Key Impacts Strategic Objectives CQC Registration (state outcome) NHS Constitution Other Compliance (e.g. NHSLA, Information The People Strategy Education delivery, employment compliance, engaged staff who deliver quality care. This will support how the trust embeds the NHS constitution and the BCH values This will ensure that all legislative other requirements pertaining to employment are met and monitored. Governance, Monitor) Equality, diversity & human rights Trust contracts Other Ensuring we have a productive workforce which aligns with the financial forecasting outlined in the monitor plan. This supports the delivery of the Equality Delivery System and ensures that we embed inclusion into the core of everything we do. Corporate Social Responsibility Making an impact locally and around the world Introduction At Birmingham Children’s Hospital we put our children, young people and families at the heart of all we do to make sure their experience and care is the very best it can be. In our role as advocates for children and young people our responsibility extends much wider than our hospital walls and we acknowledge and embrace the important role we play in Birmingham’s economy too. As a large employer of 3,700 staff we’re committed to making sure that we do business responsibly and where possible create more opportunities to improve the health, wealth and environment of Birmingham, the West Midlands and beyond. We buy our services locally and ethically and set ourselves ambitious targets around sustainability. Whether that’s reducing our water use or finding more sustainable sources of power, we’re committed to doing all we can to make a big impact on as many people’s lives as possible, with the least impact on our environment. We strive to be ‘a hospital without walls’ and work closely with local and international health partners to share our expertise so that children’s healthcare in this country and around the world is continually improving for all. We provide additional support through our health promotion work to families to make healthy life choices, and further afield we are helping doctors establish better health services, in countries like Africa and South America, that is making a real difference to the lives of children in some of the poorest parts of the world. This report will be supported by a presentation by the Malawi Partnership team to further explore the board role in support of this charity. But there’s always more we can do and we will work with our stakeholders to further crystallise our ambitions for the next 3-5 years. Sarah-Jane Marsh Chief Executive 2 Corporate Social Responsibility (CSR) at BCH means making a positive contribution to the many societies we serve. Our services are at the heart of local, national and international communities and it is essential that we help the young people who make up these communities to thrive and be successful – This is at the heart of our Mission and Vision. Our Mission To provide outstanding care and treatment to all children and young people who choose and need to use our services, and to share and spread new knowledge and practice, so we are always at the forefront of what is possible. Our Vision Birmingham Children’s Hospital is the leading provider of healthcare to children and young people in the UK, whatever their condition and wherever they need our expertise. Originates from Dr Heslop’s statement when he founded the hospital in 1862. CSR Components 1 Our People This section will explore our provision for education, training and employment ensuring our reach and impact is felt across the region 2 Our Built Environment Stabilising and reducing our impact on the environment through sustainable development 3 Our Business Procurement, the way we do business, 4 Our Population Health & Wellbeing Public health opportunities, influence and reach across the local and national population 5 Our Presence in the City Business partners, fundraising and provision for supporting region wide initiatives 6 Our International Impact Spreading our clinical expertise both Nationally and Internationally Our People – Caring for Team BCH Our people are our most important asset and our work on Health and Wellbeing work supports our staff, patients and families and is aimed at improving personal responsibility for health, and focus on the key health risks around obesity and smoking. We also place significant importance on mental health. Many of our staff live in the community that the hospital serves so our wellbeing approach has a positive community impact. We provide our staff with psychological support in a range of ways. We also provide fitness classes, slimming clubs, and have regular health and wellbeing events. We train our staff to support their patients and families around improving their health and wellbeing and taking more responsibility. The Voice of Young People – How we ensure young people are at the heart of decisions about our services YPAG was created in December 2009 to develop a forum that encouraged and empowered the voice of young people from our local community, within the organisation. The group is open to any young person between 11-19 years of age and draws on its membership from local community, comprised of a combination of current patients, ex patients and those young people living within Birmingham who are passionate about health care delivery for all children and young people. Within Birmingham Children's Hospital (BCH) the group, its visibility and influence has grown significantly over the last 4 years with the active recognition of the importance of participation of young people in the overall strategic direction of the organisation. The group's active participation and influence has widened beyond BCH into its community, developing working partnerships locally and regionally. It has also received national recognition and Birmingham Children’s Hospital is seen as a current leader in children and young people’s engagement. This has led to broader community opportunities to work in partnership other organisations such as the police, clinical commissioning groups, Healthwatch Birmingham, other NHS organisations, third sector organisations and education. We have worked in partnership with education, working directly with a number of schools and colleges. examples include a community gallery, where local schools exhibit their artwork and a fully funded and ethically approved research project, which has led to bedside theatre performances from drama students - improving the health and well-being of children in hospital through the use of the arts. Through liaison with community police officers a member of YPAG has participated in a Princes Trust project, helping the homeless within the West Midlands. Volunteering Birmingham Children’s Hospital has 270 volunteers who provide 25,000 hours of support each year. They provide a unique and valuable contribution towards the experience of our patients and their families, and 32 wards and departments benefit from their support. Volunteers wish to be involved with the hospital for many reasons, and represent our diverse community including students, members of YPAG, local residents, expatients and their families, retired employees and those looking to change career into the NHS. Volunteers have directly contributed to improving the patient and parent experience, including Play Centre activities, coffee afternoons, helping parents of children with learning disabilities to complete Hospital Passports, supporting Health Promotion campaigns and visits from Pets as Therapy dogs. They have also contributed towards the Friends and Family CQUIN, by receiving and collating patient and parent feedback. We regularly welcome volunteers from Birmingham-based companies who assisted patients to write a Letter to Santa, and Father Christmas joined us for the second year from Wesleyan Assurance whose Head Office is in the city. We have also set up a leadership mentoring partnership with an external private sector organisation Links have been also been forged with local colleges and universities, and over the last year the demographics of new volunteers joining the organisation have changed to reflect our patients, visitors and the local community. This has resulted in volunteers being able to engage with BME families who have commenting that they feel comfortable talking to volunteers and receiving support from them. Volunteering at BCH Every year Birmingham Children’s Hospital Fundraising Team work hard to facilitate volunteering and engagement opportunities for local companies and groups to experience first-hand the work we do here at the hospital. We continually look for opportunities that enable us to provide expertise from our corporate partners to the Trust that will allow us to save money while truly aligning business objectives and expertise. We are currently working with several law firms and financial organisations that wish to offer to support the Trust and the patients and families that we support. Christmas Ward Decorations: Each year in November, we invite our corporate supporters to decorate a ward or department within the hospital. Park View Gardening Project: We have hands on volunteering opportunities for our corporate partners ranging from painting fences, tending to vegetable plots and garden landscaping projects. Play Department Parties: Our play department is one of the busiest areas in the hospital and we often work with clinical staff and play specialists alongside our corporate partners to provide ad hoc parties and activities for the patients within our care. This can include providing food and drink, entertainment or just some hands on help on the day to make our patients experience one they can enjoy and remember as part of their hospital experience. A Volunteer Story – Liz Inchley “While studying Psychology at Aston University, I decided to increase my experience working with children to fulfil my future ambitions. Coincidentally, I received an invitation to attend a presentation at the university about volunteering at Birmingham Children’s Hospital. Lisa Robinson painted the picture of exactly what I wanted to do; arts and crafts activities. My fellow students and I applied through the Student Outreach service at the university, and I began my volunteering role in the summer of 2014. My first day in the Oncology Day Clinic is something that I’ll never forget: being introduced to the staff, the children, and the work I would be doing. I spent the whole shift smiling and I left with a huge amount of pen on my hands! When I made it back home that day, I had to sit quietly for a moment and let it wash over me that I was finally doing what I “want to do when I grow up”. I had created smiles and brightened my own day in the process, and that felt incredible. Since then, my 2 hour shift every Wednesday morning has been such a rewarding experience. Understandably, patients may be quiet or tired, but it’s amazing to know that I can be there to help. The children get to know that the person walking through the door with the bright red top on will be the one they can play with, show their drawings to, and be a little more relaxed around. This role has given me confidence, responsibility, trust, and a sense of pride in what I do. Soon, I am leaving the hospital to concentrate on university exams. I suspect my last day will be a difficult one; I’m definitely going to miss those faces lighting up when I walk around the corner with an armful of exciting things to create. On the brighter side though, this experience has given me the opportunity to take my university placement year with a company called City Year, who recruit volunteers to work in schools. I have no doubt that I will use everything I’ve learned at the hospital in my future career. I feel privileged to have been part of BCH, and perhaps my chosen career path will lead me back here at some point. The experience I’ve had here has been invaluable to me, and I have treasured every minute”. Our youth offer - Aspire@BHC Aspire@BCH is our umbrella brand for a range of programmes that support young and/or disadvantaged people to gain access to work experience, traineeships and apprenticeships. We work closely with local schools and colleges and have seen a significant increase in access and those going on to secure employment. Alongside this, we have our innovative employability scheme which, in partnership with Calthorpe school, has provided four young people with a learning disability with employment at BCH. These programmes have a positive impact on the community in terms of supporting young people into training or employment. This, in turn, supports positive mental health and wellbeing, can support improved lifestyles, reduce reliance on benefits, provide improved prospects and ultimately support future careers in the NHS. “I enjoy working here as I have always wanted to work with children and in a hospital. I have gained loads of experience and learnt new things while I have been working here. My department are all lovely and are all helpful. I am hoping that I can get a full time job after within my department.” Katie Grove (Clinical Apprentice in Radiology) Programmes of Work Employability Programme For young people with a learning disability – 5 opportunities and 2 open days Work Experience Over 300 places in 2013/14 Traineeships New programme, doubled intake to 20 Apprentices Interns Growing now have between 60-80 each year and 85% conversion to permanent role 16 trust wide and many converting to permanent posts All supported by the Information, Advice & Guidance service (IAG) CSR Components 1 Our People This section will explore our provision for education, training and employment ensuring our reach and impact is felt across the region 2 Our Built Environment Stabilising and reducing our impact on the environment through sustainable development 3 Our Business Procurement, the way we do business, 4 Our Population Health & Wellbeing Public health opportunities, influence and reach across the local and national population 5 Our Presence in the City Business partners, fundraising and provision for supporting region wide initiatives 6 Our International Impact Spreading our clinical expertise both Nationally and Internationally Our Built Environment Energy Use in Our Buildings The Trust reduced its total energy consumption in 2013/14 from the previous financial year (2012/13)*. ‘Sustainability in terms of sustainable development is making sure that we meet the needs of today, without compromising the ability of future generations to meet needs of their own. This means stabilising, and then reducing, our impact on the environment is essential in ensuring we live within environmental limits. Oil Gas Electricity TOTALS 2010/11 2011/12 2012/13 2013/14 18.03 16,637.7 5 71.51 226.80 22,035.0 2 - 7,518.36 24,174.1 4 7,238.90 10,044 32,305.3 7 10,085.91 13,247.72 20,558.13 15,141.43 Future Ambitions A large proportion of the Trust’s carbon emissions come from the use of fossil fuels to heat, light and ventilate the buildings. Every effort will be taken to ensure that new buildings are constructed sustainably (using sustainable materials) and that renovations employ the highest possible standards available. 25,227.34 *Some of the data for energy and water has been estimated as at the time of compiling this report the data is not yet available from suppliers. The Trust will aim to design the built environment to encourage sustainable development and low carbon usage in every aspect of their fabric and function. Works will also be undertaken to the existing estate to improve the energy efficiency performance of buildings (e.g. LED lighting, use of renewables where possible, etc.) Table 1: Total energy consumption 2008/9 – 2013/14 (MWh) Our Built Environment- Water Consumption Water consumption has increased year on year over last three years. Future Ambitions The Trust will monitor and reduce (where possible and only when it is safe to do so) our water consumption in accordance with water regulations, targets and actions. All measures will be approved by the Water and Air Safety Group prior to implementation. Our Built Environment Waste Reduction and Recovery The Trust has reduced general waste sent to landfill by 87 tonnes and increased the amount of general waste that is sent for recycling by 60 tonnes. Future Ambitions The Trust will aim to minimise the production of waste through good purchasing practice. Improvements in waste recycling are currently being reviewed by the Trust. Figure 2: Waste generation (tonnes) by treatment type 2011/12 to 2013/14 Our Built Environment Travel and Transport • The Trust is working to improve the use of alternative (i.e. more sustainable and healthy) modes of travel (e.g. cycling, walking, public transport). It facilitates a cycle scheme where staff can purchase cycles. The trust is dependent on transportation systems for many of its functions and this will remain a necessary part of the access to and delivery of healthcare provision for the foreseeable future. • The Trust will endeavour to reduce the environmental impact of travel associated with our activities, particularly through vehicle emissions, fuel consumption and our impact on local congestion. Carbon Management • A sustainable, low carbon Trust offers an opportunity to save money while helping to create a quality resilient healthcare service. The management of carbon emissions across the Trust will save resources now, improve health today and help to deliver high quality and sustainable services for the future. • The Trust is working to operate in an energy efficient way to continually reduce carbon emissions, resources, consumption and costs and has developed a Sustainability Action Plan to help us work towards this. CSR Components 1 Our People This section will explore our provision for education, training and employment ensuring our reach and impact is felt across the region 2 Our Built Environment Stabilising and reducing our impact on the environment through sustainable development 3 Our Business Procurement, the way we do business, 4 Our Population Health & Wellbeing Public health opportunities, influence and reach across the local and national population 5 Our Presence in the City Business partners, fundraising and provision for supporting region wide initiatives 6 Our International Impact Spreading our clinical expertise both Nationally and Internationally Our Business – Ethical & local Procurement Our Procurement Strategy’s principles require us to: • Pursue and demonstrate fair and open competition; • Operate legally and to the highest ethical standard; • Encourage environmentally products and services; • Have a reputation for fairness in the decision making process, commissioning and award of contracts. Our key Procurement partners include: • NHS Supply Chain; • Health Trust Europe; and • Crown Commercial Services. All the above partners have sustainable development procurement strategies. For NHS Supply Chain, whose contract scope covers £5bn, a Five Theme approach is followed – outlined opposite. Carbon and Greenhouse Gas Emissions Community Waste Reuse, Reduce, Recycle Health Trust Europe seeks to address sustainable procurement through: • Reducing fossil fuel usage to minimise climate change • Reducing usage of hazardous materials and reducing waste • Improving public health and quality of life • Increasing levels of employment, skills and equality in the geographical areas covered by its customers • Ensuring fair pay and working conditions through the NHS Supply Chain Corporate Social Responsibility and Social Value NHS Supply Chain Natural Resources Pollution Prevention and Environmental protection Crown Commercial Services, as with all Central Government bodies, operate under the Greening Government Commitment targets and meet mandatory Government Buying Standards. Ethics and Responsibility Labour Standards CSR Components 1 Our People This section will explore our provision for education, training and employment ensuring our reach and impact is felt across the region 2 Our Built Environment Stabilising and reducing our impact on the environment through sustainable development 3 Our Business Procurement, the way we do business, 4 Our Population Health & Wellbeing Public health opportunities, influence and reach across the local and national population 5 Our Presence in the City Business partners, fundraising and provision for supporting region wide initiatives 6 Our International Impact Spreading our clinical expertise both Nationally and Internationally Public Health There is now good evidence that the journey from birth to adolescence establishes a critical path for future life opportunities, not only around health and wellbeing, but also education, employment and outcomes for future generations. Risk factors acquired during this period are carried into adulthood, and if not addressed, limit quality and length of life. BCH understands that the child is so much more than their illness, and that circumstances both within and outside of their family’s control will be affecting this life course. The figure below, by Barton and Grant, and derived from seminal work by Dahlgren and Whitehead, demonstrates the complex interplay of factors, and how health must be viewed through a much wider lens. Population Health Birmingham, and many of the communities that the hospital serves, have high levels of challenge in many of these domains. Over half of the children in the city live in households in the most deprived fifth of areas nationally, and the majority of children admitted to the hospital come from these areas. Similar patterns of inequalities across the social gradient exist for each of the factors affecting the individual, and the combined consequences of these factors mean that children and young people do not achieve their full potential across their life course. The early negative outcomes in behaviours can be easily observed in the young population of Birmingham. These factors not only have immediate impacts, but will become the determinants of ill health and missed opportunity for many decades. You will see from the next page how our role in influencing these behaviours through schools and other public health initiatives supports families to lead more health lifestyles. Population Health – On-going actions Aligned to this, BCH understands that, as well as the specific responsibilities about the health of members of staff, that those it employs are themselves affected by this same wide range of factors, and experience their consequences in the same way. In response to this, we commit to continuing to develop how we use our place and voice in the city, our connection with many thousands of families, our buildings, and our people, to address these inequalities and to ensure that all children have a fair and good start to their life course. Specifically, we will; Continue to use and evolve the 'Making Every Contact Counts' to ensure that both can support children and families to take positive steps towards improving their health Develop appropriate services or referral pathways to enable parents to go smokefree, improve their physical activity, and enjoy a healthier diet, and continue to challenge any failure of quality in these services where they are provided by any organisation Ensure that we provide opportunities for families to be signposted to support services outside of health, including housing, financial support and local community development Seek to advocate and influence on key policy areas that affect the health and wellbeing of children, young people and families Proactively engage with other local and national organisations, including Birmingham City Council, on consultations that affect children, young people and families, across the wider determinants of health and wellbeing Ensure we consider the wider health and wellbeing impacts of major investment projects, including their accessibility by active transport, and by communities in higher areas of deprivation Ensure our buildings and physical spaces provide opportunities and nudges to take healthy actions, not limited to increasing stair usage, reducing nicotine usage, and feeling positive about healthy eating Use our resources to develop the assets and abilities of the people that connect through the hospital to enable young people and families to be agents of positive change within their own communities of interest Maximise the potential health benefits through fundraising and group activities, for example through support of charity marathons and fun runs Ensure staff, patients and visitors are aware of the evidence based steps to achieving wellbeing Explore the role of art and other creative activities in improving health and wellbeing Actively participate and consistently promote citywide initiatives aimed at improving health, for example the Birmingham Cycle Revolution Support staff and patient led activities that benefit health and wellbeing, for example a community allotment project Develop our work with local schools to include a clear health and wellbeing curriculum component supported by the Birmingham Children's Hospital identity Ensure that our investments and commitments as an organisation are not linked to the tobacco industry, and consider the appropriateness of potential sponsors and partners to us as an organisation in terms of their impact on health and its key determinants Undertake research to understand the role of the paediatric hospital in improving the health and wellbeing of children, young people and families. CSR Components 1 Our People This section will explore our provision for education, training and employment ensuring our reach and impact is felt across the region 2 Our Built Environment Stabilising and reducing our impact on the environment through sustainable development 3 Our Business Procurement, the way we do business, 4 Our Population Health & Wellbeing Public health opportunities, influence and reach across the local and national population 5 Our Presence in the City Business partners, fundraising and provision for supporting region wide initiatives 6 Our International Impact Spreading our clinical expertise both Nationally and Internationally Our Presence in the City We run many fundraising initiatives across the city that both develops the brand of BCH and our role as ambassadors for child health together with continuously exceeding our fundraising ambitions. Our latest project The Big Hoot is a partnership between BCH and Wild in Art. It aims to promote local artists, is sponsored by local businesses, will attract families to visit and promote health and wellbeing, and will fund-raise for BCH through the sale of the owls in Autumn. We have linked this with our Aspire@BCH work when a number of our apprentices, trainees and interns undertook challenge week to seek to promote the Big Hoot to children and families as an exciting day out and to promote physical activity. CSR Components 1 Our People This section will explore our provision for education, training and employment ensuring our reach and impact is felt across the region 2 Our Built Environment Stabilising and reducing our impact on the environment through sustainable development 3 Our Business Procurement, the way we do business, 4 Our Population Health & Wellbeing Public health opportunities, influence and reach across the local and national population 5 Our Presence in the City Business partners, fundraising and provision for supporting region wide initiatives 6 Our International Impact Spreading our clinical expertise both Nationally and Internationally Supporting Children’s healthcare around the world Many of our talented teams and individuals have very important international links that support the development and improvement of children's healthcare around the world. We also very proud to have an established and very successful relationship with the Queen Elizabeth Central Hospital in Malawi, Africa, which has created a strong educational link and the sharing of best practice, knowledge and skills. 25 Malawi Partnership The Malawi Partnership with the Queen Elizabeth Central Hospital Paediatric Department is unique as it crosses department and professional boundaries and involves staff from a wide variety of disciplines and backgrounds. Malawi is one of the poorest countries in the world, (ranked 170 out of 187 on the Human Development Index) with 74% of people living on less that 80p per day. UNICEF estimates that there are a mere 56 nurses per 100,000 people; this lack of qualified and motivated healthcare staff combined with poverty, the HIV epidemic and lack of resources means that 1 in 10 children will die before their 5th birthday. Dozens of our doctors, nurses, technical staff, administrative staff and medical students have worked and taught in Malawi since 2004, with many of their teams visiting our hospital to observe and learn from our staff. There are now five fully trained paediatric consultants at the Queen Elizabeth Central Hospital - in 2004 there were none. Benefits of this partnership for BCH • • • • • Enhanced reputation internally and externally. The BCH Malawi Partnership is considered one of the leading paediatric global health partnerships, this can enhance our existing prestigious reputation as one of the UK’s leading children’s Hospital’s and make the organisation more attractive when being considered for service contracts, education and research grants, and recruiting new staff. Higher levels of cultural competence following placement at QECH. Culturally appropriate services for NHS patients are essential in reducing health inequalities in the UK. BCH staff on longer secondments have developed professionally and personally. They have developed resilience, learnt how to deal with adversity, developed leadership skills, improved awareness of resource management and increased motivation. A more highly skilled workforce with staff who have experience and knowledge of managing diseases that are becoming increasingly common in the UK such as TB and HIV Many staff returning from Malawi have gone on to receive promotions and further their careers within BCH The Trust Board And the Partnership The Malawi project team are keen to involve the board in the on-going development of the partnership and the board is specifically asked if this can be demonstrated by the following: 1. Confirmation that the BCH Malawi Partnership is supported at the highest level 2. An organisational commitment to encourage BCH employees to take part and support the BCH Malawi Partnership through promotion 3. Ongoing support from a member of the Executive Management Team, currently Theresa Nelson 4. Other practical considerations to include: • A link on the Birmingham Children’s Hospital Website • Inclusion in local induction • Pick up the small salary of the coordinator – currently paid at minimum wage from the partnership charity funds 27 Other expertise that is shared around the world • Anaesthetist Doug Johnson and Plastic Surgeon, Hiroshi Nishikawa, are regular visitors to Ethiopia to support craniofacial reconstructive surgery for children suffering from the devastation skin condition, Noma, and those with tumours, trauma and congenital abnormalities. • Nephrology Consultant, David Milford, has spent time in Trinidad in the West Indies to help develop paediatric kidney services. His two missions to date have already resulted in six children receiving life changing transplants from their parents. • Liam McCarthy, Urology Consultant, has spent time in Zanzibar to support their team and operate on children with congenital and traumatic genital abnormalities. David Milford, far right Doug Johnson Liam McCarthy, top right Sharing our expertise around the world • David Barron, Consultant Heart Surgeon, has been working with hospitals in Spain and India has performed operations on two of their complex patients. He is also helping the Australian Health Authority review its national Hypoplastic Left Heart Syndrome service provision. • Bill Brawn CBE, Consultant Heart Surgeon, has been helping Munich in Germany review their cardiac surgery programme. • And Consultant Heart Surgeon, Tim Jones, has been helping set up an ECMO life support programme at the Red Cross Hospital in Cape Town, South Africa. David Barron, left Bill Brawn CBE Tim Jones Supporting our wider aspirations Benefits for the City Broader Health Economy and Region Globally Supporting our people Providing economic growth A unique offer for the UK Improving health and wellbeing Creating jobs & future opportunities Spreading our clinical expertise Enhancing the City profile Protecting our environment Enhancing our reach What is the scale of our ambition? Individual Focus Supporting our people Health Information Individual Focus Population Focus Health Education & Skill Development Population Health & Wellbeing Presence in the City Individuals Impact Population Impact CURRENT PROVISION BCH POTENTIAL OFFER National impact International Impact Population Focus Global Impact FULL STAKEHOLDER INFLUENCE This report has detailed a number of work streams that demonstrate that BCH is not only aware of the broader impact we have on our environment and the communities we serve, but we are striving to increase this positive impact. We have the unique opportunity to also make an impact around the world and the examples included in the report are just a snap shot of the brilliant contribution that BCH staff are making. The Trust Board is asked to discuss and consider how ambitious we want to be with this agenda, the above model is just one way to frame the discussion . How involved do we want to be and what resources do we want to commit? ‘Optimised’ Status Quo.. Advocacy, Policy & Topic Commentary Community Resourcing / Small Scale Asset Interventions Stewarding +/- Resourcing of wider networks of change National and Global Interventions DIALOGUE & COPRODUCTION Status Quo Recommendations The Trust Board is asked to: 1. Receive the report describing the range of activities influencing our role and reach across the city, the region and the world. 2. Discuss the Trust Board ambitions in this area and agree key areas of activity for the executive to explore. 3. Discuss the specific components of the Malawi partnership and in particular the role the board wishes to have in relation to: • A link on the Birmingham Children’s Hospital Website • Inclusion in local induction • Support the funding for the salary of the coordinator 33 Board of Directors 30th April 2015 Item 15.85 Report Title Sponsoring Director Author(s) Previously considered by Enc. 04 Monitor Annual Operational Plan 2015/16 Matthew Boazman, Chief Strategy Officer Matthew Boazman, Chief Strategy Officer Finance & Resources Committee – 22nd April 2015 (Approved) Situation The Trust is required to submit an operational plan to Monitor on an annual basis as part of the Annual Planning Review (APR) process- this is a requirement for all NHS Trusts. Background The APR framework for 2015/16 has again changed when compared to the previous year’s planning requirements. Some of the key differences are summarised briefly below: No requirement for a strategic planning submission for 2015/16 Only an operational plan is required for 2015/16 Key focus for current APR is one year - 2015/16 only Continued requirement to self-declare organisational viability throughout 2015/16 Overall, the planning requirements from Monitor have been reduced significantly for 2015/16. There is no requirement for a strategic plan submission and the primary focus is on organisational viability throughout 2015/16 with a clear emphasis on establishing whether or not organisations are in “distress” – financially or performance related. The other key change to the planning cycle this year was the requirement to submit an initial shortened (5 page) draft operational plan for primary evaluation by Monitor before completing the more detailed operational version for the 14th May 2015. As with previous years the format of the plans (both draft and final) in terms of content, key areas that need covering, heading and length are prescriptive and this is reflected in the attached planning document and areas covered. The timetable and dates for submissions have also been amended as a result of the delays nationally regarding both contracting and tariff negotiations with the key dates outlined below. It is important to note the additional challenges this presents in terms of Board and sub-committee approval, especially given uncertainty about the timing of the Monitor feedback to individual providers. - Submission of summary operational plans - 7th April (originally 27th February) Monitor draft plan feedback to providers – between 7th April- 13th May Submission of final operational plans - 14th May (originally 10th April) Assessment In order to comply with the planning requirements set out by Monitor the draft and full operational plans must cover the following key areas within the document. Summary Operational Plan - Maximum 5 pages Brief Narrative Setting out major assumptions on: - Activity Tariff and financial projections Statement on organisational sustainability throughout 2015/16 A brief overview on the organisational response to the 5 Year Forward View Final Operational Plan – 14th May 2015 - Maximum 20-25 pages (excludes declaration and front sheet) Establishing the Strategic Context External environment Commissioning and funding National and local commissioning priorities Changes to organisational performance Government policy Response to the Five Year Forward View - Delivery and operational requirements Key performance areas and mitigations Operational capacity Workforce - Quality Priorities Overview of any specific quality concerns Overview of quality priorities - Financial Forecasts One year financial projections and narrative Key assumptions Overview of capital programme Cost improvement programme Impact on risk ratings Recommendations At this stage it is unclear when we will receive feedback, if at all, from Monitor to our earlier summary submission. However, in order to comply with the revised planning timetable for the final submission it is necessary to approve the Operational Plan at the April Board recognising that some amendments may be necessary between the Board meeting and final submission deadline of 14th May 2015. It is worth noting that we do not expect to receive any feedback from Monitor on our summary plan and our two previous year’s submissions have both been green rated with no amendments necessary. The Board of Directors is asked to approve the Operational Plan for 2015/16 Key Impacts Strategic Objectives CQC Registration (state outcome) The operational plan 2015/16 contributes to all of the strategic objectives NHS Constitution Other Compliance (e.g. NHSLA, Information Governance, Monitor) Equality, diversity & human rights Other None The Operational Plan is a core component of the Monitor annual planning and compliance requirements None None Operational Plan 2015/16 Birmingham Children’s Hospital NHS Foundation Trust Version Control: Version 3.0 1 Operational Plan - 2015/2016. This document completed by (and Monitor queries to be directed to): Name Job Title e-mail address Tel. no. for contact Date Matthew Boazman Director of Strategy and Planning [email protected] 0121 333 8533 22/04/2015 1. Declaration of sustainability Based on our analysis the Board of Director’s declares that Birmingham Children’s Hospital NHS Foundation Trust will be financially, operationally and clinically sustainable according to current regulatory standards throughout the operational period 2015/16. The rationale for this assessment is summarised below and covered in detail within the remainder of this planning document. 2. Evidence of organisational sustainability – summary of key factors 2015/16 2.1. Clinical sustainability Our future clinical workforce is critical for ensuring that we are able to continue to provide sustainable clinical models over the next five years. We have a good understanding of the specific challenges that we will face over the next five years and are confident that we will be able to respond to these. As an organisation we continue to invest heavily in the development and expansion of our workforce through the Next Generation people work stream to ensure that we are able to deliver viable clinical services in the future. 2.2. Operational sustainability In order to ensure that we are able to continue to be operationally sustainable it is important that we are able to manage the predicted growth in demand. To meet this challenge we launched the Next Generation programme in April 2014, and have subsequently approved investment in a new mobile operating theatre to provide additional term capacity (2015/16) and approved the Outline Business Case (OBC) for a larger £35 million investment to support the medium term estates strategy. Based on our detailed capacity and demand analysis this will provide us with the required capacity throughout both the short and medium term to be able to manage our current and predicted growth in demand. Longer term we continue to develop proposals for the planned new children’s hospital, either on our existing Steelhouse Lane site or on our preferred location at Edgbaston within the healthcare and life sciences campus. Our overall programme of investment will provide us with the capacity required to ensure that we will continue to be operationally viable between now and the planned new hospital in 2022. 2.3. Market demand As with previous years demand for our services continues to be strong both in terms of NHS England and CCG commissioned activity with minimal risks identified from current or emerging competitors. During 2015/16 we expect demand and market share to grow in line with the trajectory that we outlined in our strategic planning submission that was completed in 2014 and this was reinforced in our latest refresh of both the demographic and 2 market share data trends developed as part of the Next Generation OBC. 2.4. Financial sustainability Our financial plan demonstrates that the Trust will remain financially sustainable over the period 2015/16. Whilst there is a significant overall reduction in income assumed through 2015/16 (£6.0m) mainly as a result of new tariff proposals, reduced educational income, the reduction in Community CAMHs and reduced donated asset receipts income there is also an associated reduction in total expenditure levels which mitigates the majority of this risk (£4m). The remaining difference will result in a reduction of the planned in year 2015/16 surplus from £4.01m to £2.11m compared to the original plan that was developed before the new tariff arrangements were released. The reduction in anticipated donated asset receipts has had a significant bearing on the previously planned 2015/16 surplus with anticipated receipts now due to be realised in future years. The key financial planning assumption, which forms one of the Trust’s key financial risks, was the acceptance of the Enhanced Tariff Option (ETO). Although this was financially preferable to the Default Tariff Rollover (DTR) in 2015/16, the nature of the Trust’s services (75% of Clinical Income received via NHS England) combined with the growth of clinical activity and drug/device pass through arrangements, will be to the Trust’s detriment in future years. Although we have mitigated for the impact of increased drug and device in 2015/16 further modelling is required for future years to assess the longer term impact of this. The overall risk ratings remain strong and unchanged throughout the planning period. 3 3. Our vision & strategy Our overall Trust strategy for 2015/16 remains largely unchanged from the framework that we set out in our strategic planning submission for 2015-2019. The strategy continues to be based on our mission, which is “to provide outstanding care and treatment to all children and young people who choose and need to use our services, and to share and spread new knowledge and practice, so we are always at the forefront of what is possible.” This is supported by a clear set of strategic goals and our vision of being the leading provider of healthcare to children and young people in the UK, whatever their condition and wherever they need our expertise. Our Mission To provide outstanding care and treatment to all children and young people who choose and need to use our services, and to share and spread new knowledge and practice, so we are always at the forefront of what is possible. Our Vision To be the leading provider of healthcare to children and young people in the UK, whatever their condition and wherever they need our expertise Our Strategic Goals Figure 1: The Trust Vision for 2014-2016 We will be undertaking a full review of our priorities during the April and May 2015 Board development sessions in order to refresh our strategic objectives going forward in light of our successful performance during 2014/15 and also following the positive feedback that we received from the well-led Board review undertaken by Deloitte in early 2015. 4. Understanding our strategic context For effective strategic planning, an organisation must maintain a good understanding of the key factors that impact on its future strategy. In the context of the Trust, this is to ensure that it can both meet future demand for services, and ensure that it is able to mitigate against any potential risks due to changing policy and service models. Threats to the future strategy of healthcare organisations include; 4 Changing demand for services due to population change Impact of market trends and emerging competition Changes in national policy, including service designation The key challenges that influence the Trust and its ongoing strategy are outlined in figure 2 and our assessment of their impact on the Trust has already been explored in detail within the strategic plan that was submitted to Monitor during 2014. These were refreshed for the 2015/16 operational plan and also to support the completion of our Next Generation OBC in February 2015 in order to take into account the proposals outlined within both the 5 year Forward View document and the revised ETO tariff for 2015/16. Demographic Change Clinical Evolution and Technology Changes in Patient Flows BCH Patient and Family Expectations Policy and Finance Workforce The changing face of secondary care Figure 2: Key Strategic Factors affecting Birmingham Children's Hospital As part of our assessment it is clear that these elements will impact at different rates with some factors having a much greater immediate impact on our planning than others. As a result we have only considered in detail those areas that are likely to impact during the 2015/16 planning year within the remainder of this document, in line with the Monitor planning guidance. 5. Modelling our future demand- 2015/16 impact We undertook a detailed demand analysis as part of our Next Generation OBC development in February 2015 in order to understand the future activity for our services in the short, medium and long term as a result of both demographic and market share changes. We have refreshed this to support the operational plan for 2015/16 and the key highlights from this analysis in terms of population growth and market shifts are summarised below. 5.1. Demographic & population changes Demographic changes continue to be one of the key factors that will impact on our future hospital model with the birth rate in the West Midlands currently rising. This trend is set to continue with the age profile reducing further across both Birmingham and the broader West Midlands- ONS data predicts an increase of almost 8% (016 year olds) between 2014 and 2021 in Birmingham with similar figures for the West Midlands region. At an organisational level we have developed an adapted trend model that adjusts for local authority specific population projections derived from the ONS data. This provides us with both a short and long term forecast on 5 likely activity change and is based on 2013 data, with forward projections to 2021 by year, and a long term forecast to 2030. This shows a 7.1% increase in total hospital activity by 2021 from 2013 baseline, rising to a total increase of 8.5% by 2025 through demographic changes and associated demand (Figure 3). Figure 3: Demographic Changes for West Midlands 2013-2030 (ONS Data) During 2015/16 we will continue to see increased demographic pressures across our services with particularly noticeable growth across the 0-5 year old age cohort. 5.2. Market share growth Maintaining a strong market share is an important element of the Trust’s longer term strategy of developing a world-class paediatric centre in Birmingham. As part of our recent OBC development we undertook a detailed market assessment in order to understand our market opportunities and current and future competitor risks. The strategic analysis provides good evidence that market share will continue to increase, with more activity transferring to the Trust within the planning period. There is no anticipated change to this assessment that would impact on our activity during 2015/16. The assessment used the Monitor and PWC guidance issued during the 2014 strategic planning round and covered an assessment of:‒ ‒ ‒ BCH historical market share and forecast trends in market share Competitor analysis (PESTLE, Porter 5 Forces & organisational SWOT analysis) Impact of market growth on future demand The detailed analysis illustrates that the Trust has experienced a significant increase in market share and an increased penetration into the market. Following correction for seasonal factors, a statistically significant shift in market share towards the Trust has consistently occurred over the last eight years. By regression, this equates to an approximate 0.7% shift in the number of admissions from the West Midlands towards the Trust on an annual basis, or an estimated 3.4% change in market share over a five-year period, following correction for demographic changes within the same area of analysis. 6 Figure 4: Forecast changes in Market share based on time series Subgroup analysis identifies specific types of activity where this growth is particularly prominent, for example short stay electives have shown consistent growth of 1.25% per year. We have developed both out strategic planning and 2015/16 planning assumptions to take into account this predicted future trend in market share. 5.3. Market share and demographics combined- implications for future demand As part of our demand planning we have developed a model to illustrate the combined impact of the demographic growth and projected market share shifts outlined above. The model uses forward projections and statistically significant trends to generate synthetic estimates of ‘maximum reasonable’ growth in our activity. Using our 2014 base, we have added demographic growth, and market shift. We have reduced our market shift by the relative proportion of demographic growth across the West Midlands during the previous 5 year period to reduce the impact of double trend counting within the estimate. The combined impact is illustrated in figure 5 which shows the potential impact across the 2015/2016 planning period. Figure 5: Maximum growth projections- demographics and market share combined 6. National policy- responding to the Five Year Forward View NHS England released the Five Year Forward View (5YFV) in October 2014 which outlined the challenges faced by the NHS and set out how the health service needs to change. The document outlined a series of future possible provider models for supporting the delivery of this vision and the relevant areas are briefly explored below and have been considered by our Trust Board and will form the basis of future Board development sessions; 7 The 5YFV outlined a series of future clinical models for supporting the delivery of the future vision; Multispecialty Community Providers (MCPs) Primary and Acute Care Systems (PACs) Urgent & Emergency Care Networks Retaining viable smaller hospitals Specialised care Supporting modern maternity services In the context of the Trust, this provides evidence that the hospital is likely to have the opportunity to participate and lead diffused networks of care. This would give it increased responsibility for centralised delivery of specialised functions such as surgery, whilst also increasing access to network sites for the delivery of pre-surgical and post-surgical care. It is however unlikely that there will be any significant changes or impacts during the 2015/16 planning period to Trust activity in these areas. 6.1. Concentration of specialised care The provision and growth of the Trust’s specialised services portfolio is a key component of the future strategy, and has been developed in line with a persistent national direction of travel to rationalise the number of providers delivering specialised and complex care. The policy trajectory is illustrated in figure 6, below. Specific 5YFV proposals on the approach to achieving the rationalisation of specialised provision of care include; Concentration of care: a strong relationship between the number of patients and the quality of care Standardisation: Focus on greater standardisation of care Consolidation: NHS England will develop networks of services Contractual models: prime contractor and/or delegated capitated budgets will be developed There is strong evidence that the Trust has potential to increase the volume of care that it delivers to these patients, providing it has adequate resources and planning to do so. It can achieve this through quality, contracting and choice mechanisms. Figure 6: Developing Model for Specialist Service Provision 8 At a regional level, the Trust is effectively the monopoly provider for the majority of NHS England commissioned services with no other major competitor. Competition for the specialist paediatric market is therefore primarily at a national level and continues to be influenced by service designations and direct competition with specialist nationalist providers. The strategic analysis undertaken by the Trust has not identified any major threats to its position within the market, providing it sustains the capacity and capability to deliver quality care within financial constraints. 6.2. Urgent & emergency care networks The 5YFV outlined proposals for supporting urgent and emergency care networks which are consistent with previous national policy and builds upon the work of established approaches in areas such as trauma and stroke. This is consistent with the Trust policy and strategy that has been implemented to date. The relevant elements of the national policy are; Access to care: Evening & weekend access to GPs and community nurses Networks: developing networks of linked hospitals for specialist emergency care (drawing on the success of major trauma centres) Acute care: Ensuring hospital patients have access to 7 day services Mental Health: integration of mental health crisis services This area of policy is unlikely to have a materially significant impact on future activity flows during 2015/16. 6.3. Viable smaller hospitals A key theme within the 5YFV document is the focus on retaining viable smaller local hospitals and DGHs. A range of models are proposed and these all enable local hospitals to remain viable through a series of partnership and/or networked models. The key elements are outlined below: Amending the Payment structure: NHS England & Monitor will review the NHS payment regime (Foundation Trust EBITDA 5% vs -0.4% smaller providers) Staffing: Redesign of the workforce model to support sustainable cost structures, particularly for smaller providers Organisational structure: creating new organisational models for smaller providers, building on recommendations from the Dalton review: - Shared management or back office functions - Provision of specialised services by another provider (e.g. Moorfields Hospitals NHS Foundation Trust providing eye services through satellite clinics across London NHS sites) - Create viable local hospital through a PACS model This is an important area within paediatrics as there is evidence to suggest that some providers are starting to withdraw from providing the full range of paediatric services and there are many areas where the future viability of paediatric provision is potentially at risk. The impact of provider withdrawal can be significant and potentially destabilising as it can lead to dramatic activity shifts above and beyond those projected through demographics and market share growth alone. From a Trust perspective, any significant activity increase above demographics and market share growth could present a significant challenge to the sustainability of the Next Generation Phase 1 development in terms of capacity. 9 6.4. Short to medium term opportunities Whilst it is unlikely that any of these potential new models will have any significant impact on either service delivery or activity during 2015/16 we have briefly considered their relevance and fit with our strategy below. These will also be explored in more detail at our Board development session in May due to their relevance to our longer term organisational strategy. 6.4.1. Multispecialty Community Providers (MCPs) The 5YFV clearly outlines the expectation that organisations start to deliver care across traditional organisational boundaries with a particular focus on integration across primary and secondary care. As part of this thinking two different future clinical models are proposed and both present new challenges and opportunities to the current Trust organisational strategy. The first area is Multispecialty Community Providers (MCPs), which outlines the future vision for primary care and a series of radical changes which would see secondary care activity delivered in primary care with secondary care clinicians potentially being directly employed by expanded GP practices. Expert generalists: extended group practices will be able to form as federations, networks or single organisations Expanded services: directly employing consultants, paediatricians, social workers etc. Changing delivery of care: majority of outpatient and ambulatory care delivered outside of hospital settings Hospitalist model: direct admitting rights Pooled funding: combined health & social care budgets In terms of the Next Generation phase 1 development, the most important element to consider is the intention to shift activity (outpatient and ambulatory) into primary and community care. As part of the Trust’s strategy, there is clearly the potential to develop a primary and community offer which would mitigate any potential activity transfer as we would be the provider either as a MCP partner or as a Primary and Acute Care System (PAC) provider. 6.4.2 Primary and Acute Care System (PACS) PACS models deliver improvement through vertical integration, where a single organisation delivers both listbased GP services and hospital services, alongside mental health and community care. It is a population based approach, with the PACS provider taking accountability for the whole health needs of a registered list of patients, creating Accountable Care Organisations. The strategic analysis identifies two mechanisms for implementation within the NHS; New ownership of GP services: Hospitals could be permitted to open up their own GP surgeries with registered lists Extension of MCP model: the MCP tales over the running of its main district general hospital The risks associated with this area are similar to those outlined above with regards to future activity shifts. However, the analysis suggests that the risk of loss of market share to another PACS provider is minimal. The more likely outcome would be that the PACS model provides the Trust with an additional opportunity to increase market share and expand service provision outside of the hospital site through development of a paediatric PACS service. At this stage, the Trust is considering its approach to the PACS and MCP elements of the 5YFV, as both 10 cover areas of provision that have not previously been considered in detail as part of the overall Trust strategy. 7. National & local commissioning priorities 2015/16 It is important that our operational plan is aligned with both national and local commissioning priorities and to ensure that it seeks to address some of the challenges that are being faced across our Local Health Economy (LHE) during the next twelve months. Having an affordable and realistic financial offer from local, regional and national commissioning bodies continues to be important for the organisation to ensure financial viability throughout 2015/16. Within our LHE we have engaged through the local Joint Clinical Commissioning Group and with both CCG and NHS England contract negotiations in order to progress our contract discussions for the 2015/16 financial year. We have also undertaken an assessment of the proposed commissioning intentions going forward and have evaluated our experience of the 2014/15 commissioner/provider discussions in order to consider the potential implications for the 2015/16 plan and the key headlines are summarised below: - National service specifications Risk share arrangements for specialised and highly specialised services Provider led networks Funding for high cost drugs and devices and new treatments Impact Risk/Opportunity Mitigation/Action National service specifications are now in place for all prescribed services- previously there were no such arrangements. Compliance exercise highlighted a small number of specifications where the Trust was not compliant. There is an associated risk that there will need to be investment if specifications are not changed. Actions identified for all specifications where there are gaps however several of the specifications there would need to be significant investment. There are approximately 60 service specifications that are applicable to the Trust. Risk share arrangements come into effect with st NHS England from 1 April 2015. With the exception of CAMHS, performance above/below an agreed threshold is subject to a 70% marginal rate. This includes drugs and devices. Issues have been raised directly with commissioners and through clinicians that sit on the Clinical Reference Groups. Opportunity to increase market share for services that are able to demonstrate full compliance with service specifications Derogations currently in place but not yet received clear feedback on the future impact, the issues raised are not unique to BCH. Represents a significant change in payment mechanism. Negotiation of threshold with Local Area Team to include agreed service developments as a minimum. Financial risk if the threshold is not set at an appropriate level. NHS England has advised that the threshold will be based upon 2014/15 plans. 11 Move to provider led networks for some specialised services. As a specialist trust this will mean that BCH will be acting as the lead for the network and so commissioning services from other providers e.g. Cystic Fibrosis where a shared arrangement with BCH as the host has been in st place from 1 April 2013. High cost drugs and devices and innovative treatments not on the approved list which previously would have been funded through individual funding requests are difficult to gain approval for use causing delays. Trust is accountable for the performance of all members of the network and if standards are not met the Trust would be responsible for improvement. Consolidates position as specialist provider. Increases the opportunity to improve standards and care across network and drive innovation. For Cystic Fibrosis work stream an internal project group has been established which considers: Contracts and finance Quality standards In addition a wider stakeholder group is in place which will look at the development of the network. BCH is heavily engaged in a range of national networks and is also leading on the development of regional network models for surgery Delays in treatment or treatment not authorized. Internal process strengthened to identify new drugs and treatments as well as process for Individual Funding requests. Financial risk if drugs are authorized for use and funding not secured. Internal group established for BCH staff who are members of Clinical Reference Groups Figure 7: Commissioning Changes & Implications 2015/16 Under the current commissioning arrangements approximately 75% of services are prescribed services and commissioned directly by NHS England. Contract negotiations for 2015/16 are based on forecast outturn for 2014/15 with 2% growth on ED, inpatients and outpatients included. Given the demographics for the region there is an expectation that there will continue to be an increase in demand. This is acknowledged by commissioners. However, there is limited opportunity for new developments except where these can deliver QIPP. 7.1. Service reviews and reconfigurations There are also a range of other commissioner led initiatives and proposed service reviews that are relevant for the 2015/16 plan and these are outlined below. Impact Risk/Opportunity Mitigation/Action Presents a significant to improve capacity across the region and support improved flow across BCH BCH is fully engaged in the review both clinically and operationally. Critical care review As part of the national Clinical Utilisation Review CQUIN NHS England commissioners are going to undertake out a review of critical care provision across the region. This will include intensive care and high dependency care provision across all providers. 12 QIPP and demand management NHS England are proposing two CQUIN schemes linked to the delivery of transformational QIPPs. This includes the delivery of the nationally mandated Clinical Utliisation Review (worth 0.4% of CQUIN monies) and a ‘Right Care, Right Setting’ CQUIN (worth 1.1%), which focuses on reducing hospital outpatient attendances. NHS England has previously refused to fund non face-to-face outpatient appointments. The ‘Right Care, Right Setting’ CQUIN provides an opportunity to redesign the way in which outpatient services are delivered to improve capacity. Joint Neonatal & Paediatric Transport Service There is an expectation from NHS England that the merger will deliver QIPP. However, the current NTS is under-staffed and failing to meet the neonatal service specification. Therefore, additional investment from commissioners will be required. The region is currently served by two separate transport teams – KIDS (hosted by BCH) and NTS (hosted by BWH). Commissioners are keen to configure a joint service, hosted entirely BCH. BCH is actively engaged in the QIPP process and is working with commissioners to identify where QIPP could be safely delivered for commissioners. BCH is currently exploring options for a dedicated HDU facility, which would fit with the Clinical Utilisation Review CQUIN and improve patient flow on PIC. BCH is awaiting approval of the business case and confirmation of the funding arrangements from NHS England. It is possible that a single ambulance contract would deliver cost savings but this will not be clear until the tender process is underway. Figure 8: Service Reviews 2015/16 and Impact Assessment 8. Delivering our operational plan in 2015/16 The Trust continues to experience increasing demand for operational capacity due to the factors outlined earlier within section 4. The combination of demographic and market pressures has resulted in more activity having to be delivered through our facilities and by our workforce. This impact affects our organisational performance, access to services and ultimately the quality of our patient experience. 8.1. Demand and the impact on patient experience The growth in Trust activity in recent years has exceeded the expansion in physical estate, and this has begun to impact on the patient and family experience of care, particularly through delays and cancellations, as well as the time taken to receive definitive treatment due to both increased diagnostic waiting times (6 week standard) and access to theatres for surgical patients. 8.1.1. Operating theatre capacity and cancellations The number of cancellations at the Trust has risen in the last twelve months, as shown in figure 9 below; 13 Figure 9: Number of cancellations at Trust by type, by month, for last twelve months Despite additional investment and initiatives to protect patient flow, this has been accompanied by a gradual rise in Trust waiting list size, as shown in Figure 10. Figure10: Total Trust waiting list size on rolling weekly basis since April 2014 In Winter 2014/15, the highest number of emergency attendances and general paediatric admissions created further pressure on the Trust’s capacity, and elective surgery needed to be cancelled for consecutive weeks to release capacity for unplanned admissions. Root cause analysis of these surgical cancellations highlights a lack of physical capacity, both in terms of ward beds and operating theatres, as well as problems with mixing of emergency and elective surgical flows. This supports the need for an estate development that not only adds capacity, but also provides discrete pathways of care for different types of patient and formed the basis of the Next Generation proposals. The importance of maintaining sufficient operating capacity is also important in terms of the impact it has on the 18 week referral to treatment performance for admitted patients. Whilst we have continued to meet the standard this has regularly been by small margins and our inpatient and outpatient waiting lists are above the ideal maximum levels (as defined by IMAS) to ensure that all children and young people are treated within 18weeks. In the short-term we will be investing in additional mobile theatre capacity which will allow us to operate on 35 additional surgical cases per week enabling us to clear our current inpatient backlog by Q4 of 2015/16. 14 8.1.2 Diagnostic waiting times Access to diagnostics and meeting the six week waiting time target, driven by demand for MRI scans, remains our most difficult operational challenge. Despite increasing the capacity significantly throughout 2014/15 demand has continued to increase at a faster rate with an annual increase of 15.5% in terms of new referrals per annum (Figure 11). This has been due to a combination of higher patient volumes, increased patient complexity and increasing utilisation of MRI scans for clinical decision making. As a result the Trust has not achieved this key performance target since January 2013. Additions to WL 700 600 500 400 300 200 100 0 Figure 11: Demand for MRI 2012-2015 In order to address diagnostic performance in 2015/16 the operational team will be focusing on three key areas: Demand management – working with our top 6 referring specialties to improve demand management controls (i.e. follow-up scans at local hospital, reducing scans through implementation on new clinical protocols such as the headache protocol, tighter controls on levels of authorisation for scan requests) Increasing capacity – the options are outlined in section 8.2.2 and will potentially provide up to 200 additional scans per week. Productivity- increasing the throughput of scans through the current scanners by improving scheduling and optimising patient flow Assuming that the demand continues to increase at the current 15.5% per annum we expect to have cleared the current backlog and to be routinely meeting this performance standard by June 2015. However, it is important to note that if demand increases beyond this level or capacity reduces below plan for any reason then this will potentially impact on delivery beyond this date. 8.2. Increasing our capacity- responding to demand Whilst it has been possible to mitigate some of this increasing demand through redesigning our clinical pathways and improving operational productivity it is clear from our analysis that we needed to invest in the estate and workforce in order to increase the capacity across the organisation to address both in the short and medium term. 15 8.2.1. Medium term The medium and longer term investment proposals were outlined within our strategic plan submitted in 2014 which considered our proposed development of a new ambulatory care and haem-oncology facility (Next Generation Phase 1) – this was subsequently approved at Outline Business Case stage by the Board in February 2015 with Full Business Case review later this year. 8.2.2. Short term 2015/16 capacity As part of the short term challenges the Trust has also supported investment in a range of clinical areas in order to increase available capacity for 2015/16. This is particularly relevant for the key performance challenges we are facing with regards to the 6 week diagnostic waiting time and operating theatre capacity outlined earlier. The key areas of additional support include: - Installation of mobile Vanguard operating theatre Vanguard- operational March 2015 Purchasing of additional MRI Capacity @ Aston Brain Centre – operational January 2015 Increased operating of existing 3T research scanner- operational March 2015 Using spare MRI capacity within the independent sector – May 2015 Commissioning Newton work on clinical variation- May 2015 9. Our workforce priorities for 2015/16 As well as investing in our estate and physical capacity is it also essential that we are able to develop an effective workforce that is able to respond to both the increased demand and increasing complexity of the care that we deliver. Some of the particular challenges that we face in terms of both increased demand and the overall reduction in workforce supply have been explored in detail within our strategic plan and Next Generation OBC. 9.1. The future for paediatric nursing The Trust has considered the future of the paediatric nursing workforce in detail given the particular risk that is presented by that element of workforce supply. Whilst the forecast workforce supply developed by Health Education England (HEE), figure 12, indicates that the volume of future training programmes being commissioned should be adequate, this has been assessed as being overly optimistic. It is likely that the national supply and demand predications do not reflect the situation that is actually being experienced across paediatric services nationally, and the Trust expects recruitment to continue to be challenging over the planning period. Figure 12: Health Education England Forecast Workforce Supply 16 9.2. Responding to the challenge Based on national and regional workforce predictions and our local analysis we have been able to identify and fully understand our supply risks. This has enabled us to develop clear short and long term mitigation plans, specifically around nursing, as well as reviewing our workforce models. We have engaged with our clinicians and have established new governance arrangements to ensure we are strategically monitoring our risks, plans and programmes of change. Key programmes of work for 2015/16 include: Growth of advanced practice roles Development of Trust funded pre-registration nursing cohort through the Open University via a workbased learning route. Development of a redesigned practitioner framework to introduce the role of associate practitioner and other support roles. International fellowship programme for oncology nurses from Canada and the US. Increased nursing commissions Developing the assistant practitioner workforce Creating new pathways for development and entry into qualification Talent management and leadership development Retention strategies Underpinning this is a clear emphasis on creating the right organisational culture for change in order to support our ambitious plans. Our People Strategy has a key focus on culture development and ensuring that we focus on what is important to our staff, our patients and our business. The work that we launched in 2014 on our people strategy has had a significant impact across the organisation and this is clearly reflected in our strong national staff survey results. Given the progress made over the last twelve months it has been important for us to revisit and ultimately refresh our people strategy so that we can move to the next stage in our organisational development and specifically increase our focus on supporting and embedding bottom up change and innovation across our clinical teams. An overview of our refreshed People Strategy and the associated priorities for 2015/16 is outlined in figure 13 below. This takes into account some specific feedback we have received on ensuring that our strategy adequately supports the development of our bands 1-4/support workforce and also support our BME staff and equal access to career progression opportunities. 17 Figure 13: Refreshed People Priorities 2015/16 10. Delivering high quality and safe care - priorities for 2015/16 One of our strategic objectives is that “Every child and young person cared for by BCH will be provided with safe, high quality care and a fantastic patient experience.” In order to deliver this objective we developed our quality strategy for 2014-2017. The strategy is built around five key themes and the individual priority areas within each of these themes has recently been refreshed following both a review of our 2014/15 delivery and based on feedback received as part of the well-led Board review undertaken by Deloitte. 10.1. Theme one: Ensuring that things go right- a proactive approach to safety Safety has been traditionally defined as the absence of harm. Application of this definition to healthcare has engendered a culture of reactive safety management and focused investigation efforts onto specific incidents that resulted in serious harm. A paradigm shift is occurring where instead we need to consider safety as the ability to succeed under varying conditions, so that the number of intended and acceptable outcomes is as high as possible. By looking at what goes right as well as what goes wrong with the clinical care we deliver, we learn from what succeeds as well as from what fails. In order to support this approach we are developing an excellence reporting system so that we can learn from events with a better than expected outcome and apply this across the organisation. This “IR2” reporting system will allow us to learn from things going well as well as the traditional learning from errors. 18 Improvement Initiative Target to be achieved by 2016/17 Re-design incident investigation to promote staff and parent carer participation - improved feedback in terms or reporting back incident outcomes and findings To improve patient/carer satisfaction with the process to 95% against the agreed metrics Implement Favourable Event Reporting (IR2) Trust wide to learn from what succeeds. To deliver a 50% increase in favourable event reporting Trust wide Understanding everyday performance adjustments- creating systems that are fit for purpose 50% of reported system workarounds to be designed out of our systems Responding to commonly reported clinical incidents 10% reduction in clinical incidents causing harm To improve staff satisfaction with the process to 95% against the agreed metrics Figure 14: Theme 1 Improvement Initiatives 10.2. Theme two: Building capability - embedding quality improvement and patient safety science We have a range of expertise in Human Factors Science, Quality Improvement Methodology, Safer Clinical System Design, Risk and Safety, Resilience Engineering and Coaching already within the organisation. We plan to build a patient safety and quality improvement faculty, bringing all this expertise together with patient representatives into a multi-professional team. The faculty will deliver training in quality improvement and patient safety science to the rest of the workforce in order to embed quality improvement and patient safety science into everyday practice across the organisation. Improvement Initiative Target to be achieved by 2016/17 We will establish a quality improvement and patient safety science training programme 30% increase in workforce trained in quality improvement and patient safety science We will develop a coaching programme to support frontline teams to deliver quality improvement and patient safety projects 30% increase in safety improvement initiatives that are supported by a named coach and able to demonstrate an improvement in patient safety We will increase the use of patient and parent co-design in supporting service improvement. We will demonstrate an increase in codesigned service improvement and patient safety initiatives across the organisation Figure 15: Theme 2 Improvement Initiatives 10.3. Theme three: Designing safer systems - understanding human factors Human performance is influenced by a range of factors including workload, distractions, team cultural norms and cognitive biases. Human Factors refers to the science of understanding these performance influencing factors. Application of human factors science in other industries, particularly aerospace, has significantly improved safety. 19 To date in healthcare, application of human factors science has largely been limited to strategies for individuals and teams to recognise and attempt to mitigate their variable performance. We plan to take the application of human factors science a stage further and use it to design safer clinical systems. The system components that we are targeting are detailed below. Improvement Initiative Target to be achieved by 2016/17 Full implementation of the Paediatric Sepsis 6 Trust wide 75% of patients with sepsis to receive antibiotics within 3 hours of diagnosis Introduction of a re-designed neutropenic sepsis pathway 90% of patients to achieve a door to needle time of <1hour Develop a targeted programme to reduce the level of blood stream infections on ward 15 Implementation of a new clinical system with reduced preventable BSI rates Improve the reliability of medication error measurement Implementation of the “Medication Safety Audit” Trust wide Improve medication error classification Implementation of the MERP classification Implement a paediatric electronic prescribing system System will be rolled out in 2016 across the organisation Figure 16: Theme 3 Improvement Initiatives 10.4. Theme four: Continual learning – better use of patient safety and quality information We have a wealth of patient safety and quality information across the organisation. We plan to enhance our analysis of this information so that it can better inform decision makers and provide greater assurance to the organisation and children, young people and their families. In partnership with NHS England, we are developing the NHS Safety Thermometer© for the paediatric population and plan to implement this across the organisation. Improvement Initiative Target to be achieved by 2016/17 Develop a set of proactive safety measurement performance indicators To achieve a 1:1 ratio of past harm: proactive safety measures Enhanced analysis of patient safety and quality information. A new quality and safety dashboard will be developed and introduced in 2015 to support the Board and Quality Committee Paediatric NHS Safety Thermometer© Full Trust wide implementation Figure 17: Theme 4 Improvement Initiatives 10.5. Theme five: Openness & transparency – enhancing the culture of safety Openness and sharing of our patient safety and quality performance data is essential for ensuring that we are able to create the right culture to support and enhance our approach to patient safety. Such openness will engender trust from the children, young people and families that we serve which in turn will promote the safety culture within our organisation in order to drive continual service development. 20 We plan to actively engage in the sharing of our patient safety and quality data with our staff, users of our services, other NHS organisations and the wider public. Improvement Initiative Aims to achieve by 2017 Increased transparency of patient safety and quality measurement performance indicatorsreporting of Quality Committee dashboard and KPIs 100% of reported patient safety and quality measurement KPIs will be made visible to staff. Developing safety cases- publishing safety cases and learning from experience. We will implement a safety case methodology to enable us to publish learning from safety case reviews within the public domain 100% of reported patient safety and quality measurement KPIs will be made visible to children, young people and families in the public domain Figure 18: Theme 5 Improvement Initiatives 11. Financial strategy 2015/16 The Trust’s organisational strategy and future development plans are predicated on striking a balance between the short and the long term; the need to invest today whilst also securing the required resources to meet the future requirements of the Trust and the development of the new hospital. In order to do this, the Trust has established a financial strategy based on delivering a surplus every year and in order to consistently deliver this it is important that the future income and expenditure profile for the organisation is described, and that potential changes to it are examined. Analysis of the external policy and economic environment suggest the following themes outlined below will be critical for our strategic financial planning. 11.1. Resource prospects The NHSE Five Year Forward View document was supported by a several policy papers including the direction of a new payment system (Reforming the Payment System for NHS Services: Supporting the Five Year Forward View: Monitor December 2014). This confirmed that the objectives of any new payment system should be to facilitate: Continuous quality improvement. Sustainable service delivery. Appropriate allocation and management of risk. 21 Figure 19: Proposed development of payment models (Source Monitor 2014) For many of the elective and specialised services provided by the Trust, the policy that is emerging suggests payment approaches that: Are standardised nationally, to ensure equity of access. Allow patients to choose provider with money following the patient. For some specialised services allow approaches tailored to their characteristics e.g. where fixed costs are high and demand is unpredictable. Use payments to incentivise best clinical practice. Based on the initial analysis of the information available the future strategy of the Trust is aligned and fits well with the funding models that are being proposed. As part of these proposals it is likely that there will be a move to HRG4+ payment mechanism over the medium term. The advantage of this system in classifying the services provided across the NHS is that it better reflects the costs of delivering more complex care. The Trust is part of the NHS England / Monitor working group examining the impact of this shift and the impact that this would have on the paediatric ‘top-up’ system. Commissioners will continue to put pressure on activity growth across the system; market share increases will have to show substitution of activity from other providers across the health economy if they are to be affordable. New developments will be limited to those areas that can show that they provide value across both the Trust and broader health economy. Inflation in the health sector will continue to be a challenge. The Trust’s supplier base in some key segments continues to withdraw from specialist markets with the prospect of reduced competition and increased cost. In terms of managing the pay bill national measures to reduce the cost of staff are counter balanced by a scarcity of staff in the more specialist groups. 22 11.2. Revenue expenditure The Trust is a relatively high cost provider and this is expected to continue given the nature of services delivered. However, improving flow and pathways through the hospital will provide scope for further efficiencies to be delivered. The Trust will need to continue to deliver greater efficiency in terms of supporting costs and overheads during the next five years- looking at how it can share services and explore how technology and partnerships can deliver support to clinical teams at lower cost will become a key theme. The basis of a sound financial position is continued and persistence scrutiny on cost control and delivering agreed efficiencies. The Trust is committed to continuing this approach over the course of this financial plan 11.3. Capital expenditure Traditional Private Finance Initiative (PFI) funding will continue to be an expensive mechanism to deliver new or major capital schemes and the Trust will need to seek out best value commercial funding for planned major development. Internally generated cash will have to be a significant source of capital funding, and this will need to be supported by fundraising to deliver maximum value and quality. The asset base of the Trust will also need to be used as a lever for funding. Maximizing value of the Steelhouse Lane site through its inclusion in the Local Enterprise Zone and proximity to the Colmore Business District of Birmingham and future HS2 Curzon Street developments will form a key element of this. 11.4. Clinical engagement in the resource challenge Clinical engagement is central to delivering the financial agenda; having clinical leadership at the centre of resource management will help make the right decisions to generate value for patients and the taxpayer. Developing a clear narrative explaining the direction of travel and engaging with staff will be central to successful delivery 11.5. Strategy for Trust resources The resources strategy has been developed from this analysis and underpins the five-year financial plan. It has six key components: Using a mixed funding strategy for major infrastructure investments to reduce the weighted cost of capital to close to the Public Works Loan Board (PWLB) rate +1.25% Developing a clear financial management framework, providing clarity and allowing staff at the right level to make the right decisions based on up to date information and support Delivering the necessary revenue efficiency savings through: o Continued and persistent focus on cost control o Improving patient pathways and flow Using the built environment to facilitate change and clinical efficiency Continuing to focus on the composition of Trust workforce, ensuring that staff with the right skills are undertaking the right roles o Exploiting the benefits of new technology o Improving financial literacy across the organisation Growing fundraising income, embedding this approach within service planning, and ensuring it is a core component of the funding mix of major developments 23 11.6. 2015/16 Tariff assumptions and implications One of the other key areas that impacts on our operational planning for 2015/16 is the proposed new tariff arrangements. The Trust has selected to proceed with the proposed Enhanced Tariff Option (ETO) and its financial plan for 2015/16 is built upon a number of key planning assumptions. Growth, as agreed with Commissioners, is included- 75% (£1.9m) of this will be subject to the marginal specialised rate of 70%; Significant reduction in income levels Deflator built into the national tariff (£3.9m) Reduction in Education income as 2015/16 Adjustment to donated asset income Implied impact of marginal rate on 2014/15 growth Underlying changes in the structure of the tariff reducing profitability on services Reduced Community CAMHs income from 1 October 2015 Removal of winter/RTT monies Reduced Road Traffic Accident income Income levels will increase through the impact of revenue generating efficiency schemes 2014/15 2015/16 +/Outturn Plan £m £m £m % NHS Clinical Income 226.6 225.8 -0.8 -0.4% Non-NHS Clinical Income 0.4 0.4 -0.0 -8.9% Category C Income 14.4 13.6 -0.7 -5.2% Donated Assets 0.2 0.5 0.3 110.1% Education 8.8 6.3 -2.5 -28.2% RTA 0.6 0.2 -0.4 -63.7% Total 251.1 246.9 -4.2 -1.7% Figure 20: 2015/16 Income levels compared to 2014/15 outturn The financial plan for 2015/16 has also built in a range of expenditure reductions and assumptions around cost pressures which reduce the total expenditure. These are summarised below and the impact is outlined in Figure 21. • Efficiency set at 4% of total budget • Pressures and provisions made in respect of: £2.7m pay awards £2.5m Community CAMHs £2.0m Costs associated with growth £1.9m non-pay inflation reserve £1.2m CNST impact £0.5m Nursing Commissions £0.5m cost pressures £0.45m to offset ETO drug and device impact 24 2014/15 Outturn £m 159.6 82.9 6.9 249.5 Pay Non-Pay "Below the Line" Total 2015/16 Plan £m 159.7 77.6 7.4 244.8 +/£m 0.1 -5.3 0.5 -4.7 % 0.1% -6.4% 7.2% -1.9% Figure 21: 2015/16 Expenditure summary compared to 2014/15 outturn The overall impact of this on our financial plan is summarised below. Total Income from Activities Other Income Operating Expenses EBITDA Interest Receivable Depreciation PDC Dividend Interest Paid Net Surplus/(Deficit) 2015/16 2014/15 Annual Provisional Plan 2015/16 Plan Year 2 of 2014/15 Provisional Plan Op Plan £'000 £'000 £'000 217,785 215,159 225,799 19,877 21,086 21,088 -225,841 -223,855 -237,334 11,821 12,390 9,553 243 188 150 -4,624 -5,291 -4,559 -2,762 -2,979 -2,730 -300 -300 -300 4,378 4,008 2,113 Figure 22: 2015/16 Summary Financial Plan The forecast Continuity of Service risk ratings remain unaffected as a result of the financial planning assumptions for 2015/16. Statement SOCI SOCI SOCI SOFP SOFP SOFP Risk rating COSRR COSRR COSRR Metric EBITDA EBITDA margin Net Surplus/(Deficit) Cash and Cash Equivalents Net Current Assets (Liabilities) Total Assets Employed Liquidity ratio score Capital servicing capacity score OVERALL Continuity of Service Risk Rating (CoSRR) Actual Outturn 2014/15 8.6 3.4% 1.6 51.5 27.5 134.6 Original Plan 2015/16 9.0 3.8% 4.1 37.7 18.0 137.3 Revised Plan 2015/16 9.1 3.7% 2.1 40.8 16.9 133.7 4 4 4 4 4 4 4 4 4 Figure 23: 2015/16 Summary COSRR Ratings 25 11.7. Capital expenditure The Board approved the financial strategy in March 2012 and reviewed it again in 2014. This indicated that given the cost of capital and the continuing global banking and sovereign debt crisis, traditional bank and bond funding alone would no longer be affordable. As a result if the Trust wants to develop and invest in its infrastructure in order to compete successfully then it is necessary to develop a financing plan that is affordable and sustainable by utilising a range and combination of resources. The 2015/16 capital programme has been developed in this context and will have to be accommodated within the resource envelope set out as part of the Trust’s financial strategy. The Trust’s Capital Programme has been developed via the following process: - Specialty and Corporate Department Business Plans outlining capital requirements for the short-medium term Identification of trust-wide capital requirements that fell outside of specific specialty plans Prioritisation process led by nominated Executive leads with full Quality Impact Assessment taken for unsupported schemes The single largest element of the capital programme over the duration of the operational plan is the proposed new clinical block on the Steelhouse Lane site. The £35m set aside for developing the site will be spread over 2015/16-2017/18 and is linked to the Trust’s fundraising strategy. Prior to this the Trust has committed to supporting a number of short-term plans, outlined earlier, which will deal with immediate capacity issues using a combination of revenue and capital schemes. The planned capital spend in 2015/16 remains within the overall forecast contained within the 5 year Capex Forecast submitted to Monitor in January 2014, which was subsequently updated in January 2015. The 2015/16 Capital Programme, as approved by the Finance and Resource Committee in April 2015 is as follows: Capital Expenditure Building - Non-Clinical Departments Building - Clinical Groups Carry Forward - Building Schemes Carry Forward - Medical Equipment Carry Forward - Estates - Backlog Maintenance Carry Forward - Facilities Carry Forward - IT Strategy Carry Forward - Patient Experience Carry Forward - Strategic Schemes Donated Assets Medical Equipment Estates - Backlog Maintenance Facilities IT Strategy and Replacement Other Patient Experience Strategic Investment - Next Generation Strategic Investment - Forward Thinking Birmingham Gross Capital Programme less Grants and Donations Net Capital Programme 2015/16 Plan £'000 50.0 250.0 623.5 550.5 287.3 157.8 2598.0 283.7 324.9 500.0 1950.0 1500.0 80.0 907.2 700.0 225.0 6457.0 2000.0 19,444.8 -500.0 18,944.8 Figure 24: Forecast capital expenditure 2015/16 26 Outside of the proposed Next Generation development the other key aspects of the programme are: - - Completion of Phase One of the CAMHs Tier IV development Continued implementation of the IT Strategy (assisted by funds received from the Safer Hospitals, Safer Wards Technology Fund - Wave One and charitable monies for the development of an e-prescribing system) CT scanner and Gamma Camera projects concluded Adding additional physical capacity at the Steelhouse Lane site Backlog estates maintenance programme Replacement medical equipment programme including replacing one of the Trust’s 3 MRI scanners in 2016/17 (procurement process will commence in 2015/16); A reduced level of donated assets. This will increase as the year progresses and schemes are finalised. 11.8. Cost improvement schemes and governance As part of the operational planning for 2015/16 there has been an increased shift towards more transformational and Trust wide Cost Improvement Programmes (CIP). The historical performance of NHS Trusts across the FT sector and the past performance of BCH against annual CIP targets is an important driver for supporting this move towards a more transformational approach. The historic CIP performance for The Trust is illustrated below in figure 25. Plan £k Actual £k Shortfall £k % Delivered 2010/11 5,559 5,313 -246 -4.4% 2011/12 9,488 9,212 -276 -2.9% 2012/13 10,730 8,118 -2,612 -24.3% 2013/14 8,436 5,358 -3,078 -36.5% 2014/15 9,460 6,910 -2,550 -27.0% Figure 25: Historic CIP delivery BCH 2010-2015 The level of CIP achievement has reduced over the last five years due predominantly to an increasing overreliance on traditional CIP programmes and cost-cutting which has become increasingly more challenging on an annual and cumulative basis when compared to more sustainable and transformational programmes of service improvement and redesign. In 2014/15 a more transformational approach was taken to developing our CIP programme for a number of large schemes and these were generally more successful than the more traditional CIP schemes within the plan, although the longer lead times for some projects resulted in lower levels of CIP performance than planned. Building on the Trust’s forecast outturn position we have tracked Monitor’s assumptions around the level of efficiency required on an annual basis, but also assumed levels of inflation and key financial pressures. These assumptions have been benchmarked with other FTs and Trusts and have been tested through an ongoing due diligence process. In generating the financial plan an overall CIP target of £10.0m is required for 2015/16. This incorporates legacy CIPs carried forward from 2014/15 and will provide funding to offset key internal cost pressures. The constituent parts of this and the size of the challenge in % terms is outlined in figure 26. 27 % of Spend NHS Clinical Income Pay Inflation Non-Pay Inflation Cost Pressures Legacy CIP Total £m 3.4 2.3 2.3 1.0 1.0 10.0 Total 1.4% 0.9% 0.9% 0.4% 0.4% 4.0% Influenceable 1.7% 1.1% 1.1% 0.5% 0.5% 4.9% Figure 26 CIP requirements for 2015/16 The approach for 2015/16 is to continue with the transformational approach and structure the programme in two elements- hospital wide schemes and schemes at individual clinical group or service levels. The Trust is also identifying schemes with a total value in excess of the £10m full year target as it is recognised that there will always be some schemes that fail to deliver the full planned value. - Hospital wide schemes account for £6.1m. A number of these form part of the Next Generation project Clinical Group and Corporate specific schemes account for £3.9m Clinical Groups - 2% Corporate Departments - 2% Drug Expenditure Group Procurement Initiatives IT and Data Quality Pathways Workforce Initiatives Commercial Schemes Reducing Variation Other Reduction Schemes Technical Gains Others CIP "buffer" Total £m 3.3 0.6 0.5 0.8 0.6 2.7 1.0 0.2 0.5 0.5 0.5 0.6 -1.7 10.0 Figure 27 CIP programme for 2015/16 11. Board Assurance Framework 2015/16 The Board Assurance Framework (BAF) provides a structure and process to enable the Board to understand and focus on the risks to achieving the organisation’s strategic objectives and to assist the Board in discharging its responsibility for internal control. The BAF is presented to the Board for review at each monthly Board meeting. The content of and process surrounding the BAF were reviewed by the Internal Auditor in 2012/13. The review gave significant assurance, but a number of recommendations were made for improvement, and these were implemented in 2014. Each risk that is identified on the BAF is now explored in detail through a deep-dive review by the relevant Board sub-committee as well as being considered by the Audit Committee. *** END OF DOCUMENT *** 28 Item 15.86 Report Title Sponsoring Directors Contributors Previously considered by Board of Directors 30th April 2015 Enc 05 Quality Report Dr Fiona Reynolds, Chief Medical Officer & Michelle McLoughlin, Chief Nursing Officer Governance Services, Corporate Nursing, Education, Infection Prevention and Control, PICU & Cardiac Services Quality Committee, CRAQA, SLT Situation The enclosed report provides an update on key clinical safety and quality topics. Background The report is collated from a number of information sources and provides assurance that key risks are being escalated and monitored until sufficient action has been taken to address the concerns. The report includes information on key risks, serious incidents, mortality data, cardiac arrest, respiratory arrest, other acute life threatening events, infection control data, Net Promoter Question results, and data from the PED database. Information on Never Events and other safety information is included by exception. Assessment SIRIs & Never Events There were 2 new Serious Incidents Requiring Investigation (SIRIs) in March. • Concern that a laminoplasty carried out in July 2014 may have been done on too narrow a range and the patient will now require an additional procedure as a result. • A patient who underwent a cervical fixation procedure has lost some function in the lower limbs. There were zero new Never Events. Complaints There were 9 new formal complaints. PALS There was a peak in PALS contacts over a 2 week period in March. A high proportion of these contacts related to cancelled operations due to bed shortages. Infection Control • There were zero MRSA Bloodstream Infections • There were zero MSSA Infections • There were zero C-diff Infections • There was 1 E. Coli pre-48 hour bacteraemia case which was unpreventable We saw only one MSSA bacteraemia during the last 3 months, which is our best ever three month performance. Last summer we introduced antiseptic skin washes for children with central lines, which appears to have been highly effective; the last hospital-acquired MSSA line infection that we diagnosed was in June 2014. Mortality There were 9 Inpatient deaths (<3 per 1000 admissions). They will be individually reviewed through the normal specialty Morbidity & Mortality meetings. Recommendations • Review the enclosed report Risk Description Failure to correctly identify the greatest risks to the quality of care and safety of our patients. Key Risks Controls • Directorate Governance systems • Board Assurance Framework • Risk Register • Safety Strategy • Safety Dashboard Key Impacts Strategic Objective Strategic Priorities CQC Registration NHS Constitution Assurances • • • • Monthly Board Safety Report Mortality Review Monitoring of incident trends Monitoring of complaints trends Every child and young person cared for by Birmingham Children’s Hospital will be provided with safe, high quality care, and a fantastic patient and family experience 3. Further develop our approaches to gaining feedback from staff, children, young people and families to ensure that their voice is heard at every level of the organisation. 4. Further innovate our systems to promote and enhance patient safety and reduce avoidable harm. Standard 16 - Assessing & monitoring the quality of service provision could be affected by a failure to manage risks highlighted by the report. Risks to compliance with other standards may be highlighted by the reports. Patient Rights • Quality of Care and Environment • Treatments, Drugs • Respect • Consent and Confidentiality Other Compliance Equality, diversity & human rights • Informed Choices • Complaint and Redress The report supports compliance with NHSLA and Monitor requirements Right to life Quality Report: Safety & Patient Experience April 2015 Fiona Reynolds, Interim Chief Medical Officer Michelle McLoughlin, Chief Nurse 1 Summary March 2015 Complaints There were 9 new formal complaints. SIRIs Zero new Never Events There were 2 new Serious Incidents Requiring Investigation (SIRIs) in March. • Concern that a laminoplasty carried out in July 2014 may have been done on too narrow a range and the patient will now require an additional procedure as a result. • A patient who underwent a cervical fixation procedure has lost some function in the lower limbs. Infection Control Zero C-diff cases Zero MRSA cases Safeguarding Zero new safeguarding complaints Patient Experience 78% of Patient Experience feedback is positive. Monthly in-patient CYP F&F – 80 (81% response rate) Zero MSSA pre-48h Zero new position of trust cases 1 E-coli pre-48h Training above the Trust KPI Zero E-coli post-48h Monthly ED CYP F&F – 70 (26% response rate) ED F&F response rate was on target at moving from 18% in February to 26% in March Mortality 9 in-patient deaths - < 3/1000 admissions 2 Quality Report -New Events & Concerns There have been no new Never Events since 27/12/14 There has been 2 new SIRIs 14/15:88 A letter of complaint has highlighted a concern that a laminoplasty carried out in July 2014 may have been done on too narrow a range and the patient will now require an additional procedure as a result. 14/15:87 A patient who underwent a cervical fixation procedure has lost some function in the lower limbs. 25 20 No. Complaints 15 Issues with communication with a Consultant Hepatologist. Mother feels unsupported in managing her daughter's condition. 10 5 2 2 1 2 1 Mar-15 Feb-15 Jan-15 Dec-14 Nov-14 Oct-14 Sep-14 Aug-14 Jul-14 Jun-14 0 May-14 0 Quality of Treatment Communication Other Q3 Q4 Jan-15 Mar-15 Jul-14 Sep-14 Mar-14 Nov-14 Concerns about the level of care provided through the Complex Care team. Quality of medical care received over the past year from the Neurosurgery team. Issues with communication concern that a procedure has resulted in a deterioration of the child’s condition. Staff Attitude Q2 A father believes that the child’s mother is being given priority over him in relation to care. Concerns about the cancellation of an exercise tolerance test, as the family had not brought the child’s inhaler. Mother was unhappy that BCH could not offer a replacement inhaler and the family were sent home without the test. Waiting delays and cancellations Q1 May-14 Concerns about the quality of care provided in managing a procedure and the placement of a plaster cast. This is the second complaint from this family. Complaints top 5 categories 50 45 40 35 30 25 20 15 10 5 0 Jan-14 Nov-13 Jul-13 Sep-13 May-13 Jan-13 3 Mar-13 3 Sep-12 3 May-12 3 Nov-12 0 4 Jul-12 SIRIs Apr-14 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 Linked to completed SIRI 14/15:52 Unexpected death during craniofacial surgery. Following the inquest mother has raised concerns that their son's death was preventable. There have been 9 new Formal Complaints Mum feels that the service provided by CAMHS has been slow to offer a realistic care plan for her daughter and not taken her daughters mental health problems seriously. Mother has raised concerns about the medical advice received in 2002/2003 to not operate on her son's undescended testicle. Peak in PALS Contacts In March we experienced bed shortages due to record levels of emergency activity and tertiary demand, and essentially running with 20 less beds due to an increase in our longer stay children. The bed pressures have led to high cancellations, an increase in our inpatient waiting list and a sharp increase in children waiting over 18-weeks Waiting delays & Cancelations by location PALS Categories 11/03/15 – 25/03/15 Ward 5 Surgical Day Care Respiratory Radiology Plastics Paediatric Surgery & Urology Orthotics Main Out-Patients Dept General Paediatrics Gastroenterology ENT Cardiac Surgery Audiology Waiting, Delays & Cancellation Quality Of Medical Care Provision Of Written Info To P Provision Of Oral Info To Pts, Parent Facilities And Accommod Lost/ Missing Records Attitude Of Nursing Staff Attitude Of Medical Staff Admission, Discharge & Transfe 0 5 10 15 20 0 1 2 3 4 5 4 Completed SIRI & Complaint Investigations There were 2 completed SIRI reports in March Conclusions 14/15:66 A patient under the respiratory team suffered with a misplaced nasogastric tube. The patient received 6mls of milk (and some medication totalling approximately 11mls of liquid) before starting to show signs of respiratory distress and so the milk was stopped and further review requested. The patient required an admission to PICU for ventilation support and monitoring, but has since been discharged from PICU with no permanent consequences expected. Other similar incidents: We had a misplaced NGT which was used and caused significant harm in April 2013. 14/15:51 Personal staff information inadvertently disclosed to an external company. Immediately identified and deleted. There were 7 Closed Complaints in March A bandage was removed too early following an ear pinning procedure. This event has been classed as a Never Event. The RCA concluded that the incorrect test was used to confirm placement of the NGT and that this resulted in inappropriate assurance that the tube was correctly placed. This arose because The launch of the NGT guidelines was focused on the staff that have the greatest involvement in the insertion and testing of NGTs. The role of consultants in this task was not sufficiently recognised. Recommendations: We will re-launch the guidance for placement and testing of a NGT and will raise awareness of this guidance across all staff groups. The root cause of the incident was a failure to recognise how pivot tables worked and therefore to appreciate that hidden pivot tables were included in the document. Recommendations: Our information governance training and in-house training into the use of pivot tables will be developed. Good practice that is in place within the Informatics Team will be shared with other key corporate areas. Key Actions • • • • Father disagrees with the reasons given that his daughter was discharged from ED without being given medication. • The family were asked to leave the parents accommodation and security and the Police were called following reported incidents. The family believe that they have been misunderstood and treated unfairly. Mother was told in ED that it was not normal to give a sedative to remove • a bead from a child’s ear an urgent referral to ENT would be made but did not get an appointment for 2 weeks. The child was taken to City Hospital where the bead was removed under sedation.. • A family feel that they were provided with inadequate information at discharge and that a delay in diagnosis has damaged the patient's kidneys. • Concerns about the communication between the General Paediatric team • and Ward 7 Nursing staff, the quality of Medical and Nursing care and • delay in treatmentand a follow up appointment. • • Father was unhappy that a room at Ronald McDonald House was given to • another family. Apology given to family from Consultant and Directorate Management. All staff have received training on pinnaplasty procedures and post-operative care. Ward 5 now have a leaflet containing information on different ear correction surgery. A full explanation was provided to the complainants satisfaction and an apology provided. Explanation and apology. Apology given. A meeting was arranged with a Consultant General Paediatrician who provided a detailed explanation and reassurance. Apology given. Concerns have been raised with the Clinical Lead for Medicine to highlight the need for clear communication. The Medical Directorate gave an apology to the family for the experience. Ward 7 will continue to be audited in line with the Nursing Care Quality Indicators. Safety and Quality Walkabouts are being conducted by the Lead Nurse and Ward manager. An explanation of room allocation and prioritisation was given together with an apology. 5 Enhancing Patient Experience March 2015 The patient experience (PE) report aims to present a rounded picture of the experience of children, young people and families at Birmingham Children’s Hospital (BCH). The report presents information from different sources including, including feedback cards, e mail, ward walkabouts, verbal feedback; all collated on the Patient experience Database (PED), the Friends and Family (F&F) Questionnaire, the Feedback App, Patient Opinion and more qualitative feedback from patient experience and participation projects such as patient stories and quality walkabouts. Utilising a toolkit approach enables the Trust to better understand the patient and family experiences and helps prioritise where to focus efforts on action planning for improvements. Children’s inpatient and day case survey The survey activity for the CQC led in-patient and day case survey, being undertaken by Picker Institute Europe closed at 29.5% The National average was 27.5%. The fieldwork closed in February and the final reports were made available in March – the results are currently being reviewed and analysed. A report will be presented, in the first instance to the Patient Experience Committee and Quality Committee for discussion and prioritising for improvement, prior to wider dissemination. Initial review suggests the areas identified as areas of improvement are within our existing work streams. The results will be published Nationally by the CQC in June. Combined PED and Friends & Family data The ratio of positive v need to improve comments are ……. 78% Top 5 overall positive and need to improve Positive My son come in today. From the minute we walked into ward the staff were friendly, inviting Mr McCarthy operated on my son spoke to me before and after procedure and talked in detail of what he was going to do Waiting time was too long and not knowing when your going to be seen. ED Mark - theatre porter / took my son down to theatre and made it fun for him on a aeroplane he was happy and helpful made it brilliant for him. Cleaning and timing. ED Cleanliness of the bathrooms need to improve. Heathlands Ward, Parkview 22% Need to improve Themes from the need to improve comments related to waiting in ED reflecting what has been another incredibly busy period. There were also a number of comments relating to the environment at Parkview, cleanliness and food – the Patient Led Assessment of the Work Environment (PLACE) due to be undertaken in April will incorporate these issues as part of the assessment process. Meeting F&F CQUIN targets for Q4 1. Target response of 20% for ED and 30% in-patient (based on CYP responses ) 2. Introduce Friends and family to inpatient CAMHS – Following the initiatives to improve the uptake of the Friends and Family questionnaire in ED include, we saw an improvement in March, enabling us to meet the monthly Target and overall Q4 target. Monthly ED CYP F&F Net Promoter Score CYP In-patient 197 Overall Trust Discharges 723 Total number of responses in period 159 Total number of responses in period 187 Number of promoters 132 Number of promoters 147 Number of passives 22 Number of passives 23 Number of detractors 5 Number of detractors 80 70 60 50 100 90 80 70 60 50 17 I Disagree a bit 0 I Disagree a bit 2 I Disagree alot 1 I Disagree alot 3 30% Undecided 4 Undecided 12 25% Response Score (20% Target) 90 Mar-15 Overall Trust Discharges Net Promoter Score 100 CYP ED Mar-15 Monthly in-patient CYP F&F Net Promoter Score 80 81% Net Promoter Score Response Score (15% Target) 70 26% Monthly in-patient CYP F&F Response rate 100% 80% 60% 40% 20% 0% 20% 15% 10% 5% 0% Monthly ED CYP F&F Response rate Feedback App & Social Media BCH App Comments - March Need to improve comments included Finalist •Cleanliness •Waiting in ED •Concern about treatment •Staff attitude All the comments were responded to and the issues addressed. 27% Other 73% Positive “Would just like to say a massive thank you to all the staff in a&e was terrified bringing my daughter in on Thursday, all staff were so helpfulland supportive. Bradley was so good to us made us feel special and supported us all the way,” “If it hadn't been for the play specialist I truly believe his operation would have been cancelled – thank you x” Negative “after arriving in an ambulance with my son I waited 5 hours and still wasn't seen by a doctor!” ED NHS Choices There were no comments made on NHS choices in March. Social Media In March there were 162 comments between facebook and twitter – the majority were positive but there were a couple of negative comments about smoking at the front of the hospital – A consultation on how we can improve and address this issue was launched on ‘No Smoking’ day, 11th March – the consultation closed on 8th April with 345 participants having their say! Smoking outside the hospital drives me mad. People stand under the 'no smoking with within 6 metres of this sign', sign puffing away. You shouldn't have to walk through a wall of smoke to get to the hospital! 8 Participation headlines March 2015 Bedtime reading A new volunteer-led bedtime reading service was launched on World Book Day. In partnership with Heartlands Academy and Birmingham Library, the service will welcome volunteers to our wards at bedtime to read stories to children to enhance their experience and support their development. All volunteers have passed through our recruitment process and the Heartlands Academy students (16-18 years old) will volunteer in small groups accompanied by a teacher for additional support. Change Day There were a week long number of events and activities with a key focus on ‘Knowing team BCH’ and the emphasis on inclusion and diversity. During the week four pieces of artwork by local artist Nicky Dowd and pupils from four schools in the area were unveiled in the Community Gallery situated in the Rainbow Corridor - the art is focused around characteristics of diversity including culture, age and belief. Magnolia House Chief Nurse, Michelle McLoughlin, was joined by two bereaved families to unveil artist impressions of Magnolia House, a state-of-the-art facility that will be built within the grounds of our Steelhouse Lane site this year. Magnolia House will offer a dedicated space where we can hold difficult and often life-changing conversations with families. Magnolia House will be a calm and natural environment where we can support families at the time they need it most. There were a number of positive comments from families on social media about the new facility… This will be fantastic I wish it had been built last January when we lost our baby boy there x As a mother myself I couldn't imagine the pain an heartache that goes through this hospital every day. I will be donating, it's a beautiful cause and will help so many! Xx Monitoring Infection control March 2015 Infection No. MRSA Bloodstream Infections (BSI) 0 MSSA BSI (pre 48 hour) 0 MSSA BSI (post 48 hour) 0 E. Coli bacteraemia (pre 48 hour) 1 E. Coli bacteraemia (post 48 hour) 0 Glycopeptide-resistant enterococci 0 C. Difficile 0 MSSA pre 48 Hours 2013/14 The E. coli case was a baby admitted from home with a UTI and was unpreventable. We saw only one MSSA bacteraemia during the last 3 months, which is our best ever three month performance. Last summer we introduced antiseptic skin washes for children with central lines, which appears to have been highly effective; the last hospital-acquired MSSA line infection that we diagnosed was in June 2014. MSSA pre 48 Hours 2014/15 3.5 3 2.5 2 1.5 1 0.5 0 E-Coli - pre 48 hours 2013/14 5 4 3 2 1 0 We are currently undertaking an evaluation of a rapid (1 hour) test for gastrointestinal pathogens. Patients who test negative are allowed out of isolation which frees up cubicles at least two to three days earlier than with conventional testing. MSSA post 48 hours 2013/14 MSSA post 48 hours 2014/15 3.5 3 2.5 2 1.5 1 0.5 0 E-Coli - pre 48 hours 2014/15 E-Coli - post 48 hours 2013/14 E-Coli - post 48 hours 2014/15 5 4 3 2 1 0 10 Respiratory Arrests, ALTEs and Unplanned Admissions to PICU Explanation of Data Unplanned admissions to PICU are a measure of how well we are monitoring patients on the wards. Good monitoring on the wards means that we will pick up deteriorating patients more quickly, allowing us to admit them to PICU when required. A combination of high levels of unplanned admissions and low levels of cardiac arrests, respiratory arrests and acute life threatening events (ALTEs) means that we are monitoring and escalating clinical deterioration in a timely manner. Details of Cardiac Arrests Number of Emergency Events 3 Cardiac arrest outside PICU, all were out of hospital and not preventable (all ED). The figures from PICU are not yet available. 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 No of Cardiac Arrests (ex PIC) No of Respiratory Arrests No of Cardiac Arrests (PICU) No of ALTEs 11 Safeguarding Key Figures Child Protection Training (includes vulnerable adults) Level 1 98.1 Level 2 91.9 Level 3 89.9 There has been 0 Safeguarding SIRIs There has been 0 new Safeguarding Complaints There has been 0 ‘Position of Trust’ cases There have been no new recommendations from Serious Case Reviews 100% of BSCB Meetings attended by BCH Executive lead or representative 90% of cases which require peer review /clinical supervision have had this There has been 1 child death related to suspected physical abuse/neglect There has been 0 reported cases for Female Genital Mutilation. MASH ( Multi-Agency Sharing Hub ) 28 new referrals to Bham MASH have been recorded during March. 3 Bespoke Training Sessions – Improving the Quality of Interagency Referrals to MASH have been arranged in the BCH Lecture Theatre Speaker: Brendan Seward Interim Assistant Head of Service City Wide Services/MASH. Birmingham Safeguarding Children Board: BSCB has provided a revised online audit tool for Children Act 2004 Section 11 Audit . BCH will complete the annual Audit by 30th April 2015. A child’s Journey through the Safeguarding Process: A 10 week old baby was brought to Emergency Department by his parents. This was their first child and mother was a said to have qualified as a doctor in her own country but was not practicing in the UK. Mum had noted a bruise on baby’s right knee a few days prior to bringing him to ED. She had decided to “observe "the bruise at home before bringing him to hospital. She also thought baby was not moving his right knee. Safeguarding Process: A detailed history was taken from his parents by the doctor. An x-ray of his knee was normal, however, there was no explanation for the bruising. Blood tests were normal and did not any identify any medical causes for the bruise. A full medical examination was conducted with parent’s consent. Baby was admitted for a further medical opinion under the care of General Paediatrics. A referral was made to MASH Voice of the Child: • The voice of the child was heard through the following: • Unexplained bruises in a non mobile baby are of a concern. • To promote baby’s safety and welfare , further discussion was required to rule out Non Accidental Injury. • The Consultant felt that the bruise could be a Mongolian Blue Spot and therefore decided to seek a Dermatologist Opinion. Lessons Learnt: The bruise was a Mongolian Blue Spot . The case illustrates the importance of recognising the causes of unexplained bruises in children, seeking further medical opinion to rule out N.A.I. prior to discharging baby from hospital. There was good interagency working with MASH. Mortality Past Harm Mortality data is presented in a number of ways, and an overall picture can only be gained by using a number of indicators. These are: •Absolute number of deaths per time period. •Number of deaths per time period per 1000 admissions. •Standardised mortality ratio (See next slide) •Cumulative sum (CUSUM) charts. •Review of individual deaths. Inpatient deaths per 1000 admissions This is a simple calculation to overcome any variations in admission numbers over time (e.g. the hospital may have more admissions in the winter months) or between hospitals of different sizes. Data can be compared between organisations by this method as it allows for different admission numbers but it is limited as a tool for comparison as there is no modification for case mix. The graph on the right shows the number of inpatient deaths per 1000 inpatient admissions at BCH since June 2012. Please note that the data does not include deaths which occurred in the Emergency Department. Absolute Number of Deaths The simplest way to represent mortality is as an absolute number of deaths in a particular time period; however it does not take into consideration either the number of admissions to the hospital or the case mix of patients. It is useful only as a sense guide to other data as it has not been modified in any way. Data cannot be compared between organisations in this format. Deaths Deaths per 1000 Admissions 12 10 8 6 4 2 0 13 Standardised Mortality Ratio (SMR) In order to account for differences in case mix for different organisations the idea of standardised mortality ratios has been developed. This attempts to account for differences in patients, such as diagnosis, age and pre-existing medical problems, and allows for comparisons between hospitals. A standardised mortality ratio (SMR) is the ratio of the actual number of deaths in a hospital within a given time period, to the number that might be expected if the hospital had the same death rates as a larger reference population (e.g. all English Hospitals). The SMR scores can be presented in a number of ways. Run Chart This shows how the standardised mortality rate of a hospital changes over time. If there are a small number of deaths in each time period then the month to month variation can be quite wide (as is the case with BCH where there are on average 4-12 deaths a month). Important Note! Unfortunately, the standardisation that is performed to calculate SMR is based on adult diagnoses and data, and doesn’t lead to an appropriate risk adjustment for children. Therefore, in children, the SMR data is not an accurate measure as it does not provide an effective trigger for concern and does not allow appropriate comparison between hospitals. 14 Bar chart presenting data comparing a number of hospitals: This shows the position of an individual hospital in comparison with its peer group. The graph presented below shows 6 months’ worth of data rather than 12 as previously presented. It is important to remember that since the SMR is not appropriately risk-adjusted for children, meaningful comparison between hospitals is not possible. Funnel plot This shows the standardised mortality ratio on the Y axis, and the number of expected deaths on the X axis. Control limits can be applied, so that it is possible to see how likely that the variation from a score of 100 is by chance only. In the example below an amber dot occurs if there is between a 0.3% (1 in 330) and 5% (1 in 20) likelihood that the score is different from 100 by chance and a red dot if there is less than a 0.3% likelihood that the score is different from 100 by chance. Such warnings should be investigated as to cause. The funnel plot below is presented using 6 months’ worth of data. Although we are in the red section of the funnel plot it is important to remember that since the SMR is not appropriately risk-adjusted for children, it does not provide an effective trigger for concern, or reassurance. Such warnings should trigger investigation, by reviewing individual deaths - all deaths occurring at BCH are individually reviewed as standard practice. Movement in last month 15 Deaths in the Paediatric Intensive Care Unit (PICU) CUSUM Charts Another way of representing outcome data is by cumulative sum charts. These can be used where the risk of mortality is calculated for each individual patient based on diagnosis and severity of illness. Currently this method is in use at BCH for intensive care. The charts use data from all PICU patients, not just deaths, and is appropriately risk adjusted using paediatric data and diagnoses. It is therefore much more powerful than SMR in detecting problems. For BCH, the PICU CUSUM is a good reflection of overall hospital mortality as over 70% of deaths at the hospital occur on PICU. There is no evidence of systemic care failures which could have contributed to deaths on PICU. 16 Deaths in Cardiac Services CUSUM Chart One of the Trust’s highest risk specialties is Cardiac Services. The nature of the activity means that proportionally more of our mortality is related to that specialty than others. The team carefully monitors clinical outcomes to ensure that that we are providing high quality care. The CUSUM chart is a graphical representation of the outcome data for the specific procedures which are nationally monitored (70-80% of our patients fall into this group). In addition, the team also monitors overall mortality for all surgical patients. An upward movement in the chart means that the outcome for a specific patient was better than expected. A large increase means that the outcome was significantly better A downward movement means that the outcome for a specific patient was worse than expected, again the size of the decrease is a measure of how much worse the outcome was than expected Overall our outcomes are better than expected. However, please note that the baseline will be reset on a regular basis, so we do not expect to move further and further from the x-axis 17 Deaths in Liver Transplant CUSUM Chart 7 month lag time Another of the Trust’s higher risk activities is Liver transplantation. Although we do not carry out a large number of these, the team monitors the outcome rates posttransplant. The graphs below show that our outcome rates are comfortably within acceptable limits. Interpretation of the charts The O-E chart is a useful tool for observing performance over time. A downward trend indicates a lower than expected rate of mortality compared with the baseline period, whereas an upward trend points to an observed mortality rate that is higher than expected. To identify statistically significant changes the tabular CUSUM chart is used to complement the O-E chart. A significant shift in the underlying mortality rate is evident when the chart crosses the limit and generates a signal. The tabular CUSUM chart can be used to forewarn of possible future signals as the chart approaches the limit. Such ‘signals’ may be due to one of a number of different reasons. A signal may be due to transplantation of patients of higher risk than previously, a short run of adverse events, or it may occur just by chance with no underlying cause (i.e. a false positive result). 18 Item 15.87 Board of Directors Thursday 30th April 2015 Enc 06 Strategic Objective/ Enabler Every child and young person requiring access to care at BCH will be admitted in a timely way, with no unnecessary waiting along their pathway Report Title Performance to End March 2015 - Report Sponsoring Director Deputy Chief Executive Officer and Chief Finance Officer Author(s) Head of Health Informatics, Performance Manager Situation This report provides the update for the position to end March 2015 and year end on the Trust Performance supporting improving our patient experience. The report highlights performance and in particular where performance is not being met and any concerns and improvements planned. The attachment provides further details on our current and comparative performance Background Performance in 2014/15 Regarding access to our services, the most significant concern throughout the 2014/15 financial year has been access to diagnostics, in particular for MRI scans but latterly for the endoscopy service also. Increasing referrals for MRI across the year has placed pressure on this service. Emergency Department access was a major concern in Nov and Dec 14, with unprecedented levels of demand. Performance returned to normal seasonal levels in January and February 2015 but it was anticipated that March would be a challenging month as usual, although we were confident that the four hour wait target would be met for the whole year and in total for quarter 4. We have continued to meet our 18 weeks waiting times targets, albeit only by a narrow margin. Elective demand for our services remains high and finding the capacity to treat all out children and young people within the targets has been a challenge In terms of our facilities and utilisation we had bed and flow issues in particular in the first quarter of 2014/15 leading to lots of ‘on the day’ cancelled operations. This issue then eased although the high winter emergency demand did again affect flow in particular in December 2014. Assessment Summary of Performance in March 2015 There were significant pressures in ED and on our inpatient beds in March. Overall it has proved a challenging month, as is usually the case given the seasonality of our emergency demand in particular. The activity in ED in March 2015 was the second highest monthly total on record. This has had an impact on our performance in the month. The key highlights include; • • • • • • • • • • We again failed to meet the diagnostic waits 6 week target. The position in diagnostics continues to be exacerbated by the ongoing problem within the endoscopy service relating to decontamination of equipment RTT and 18 weeks continues to remain very tight, although we met our national targets for the month by a small margin March 2015 saw an increase in ED attendance and breaches in month, in line with the end of year predicted increase. The four hour wait target was not met in month and but was met for year end and in quarter 4 There were 45 nationally reportable cancelled operations which is below the monthly average There was 1 breach of the 28 day cancelled operations standard The number of long stay patients remained relatively constant in March, but at a higher level than average. A typical day in March saw 120 patients in the hospital who had been here for 7 or more days which is historically a very high figure. Early indications for April show this increasing further. 3 tertiary and urgent patients were not found a bed, one was out of region 8 KIDS patients could not be supported in our PICU network; and CAMHS continue to meet 18 weeks targets, with performance at 97.2% There has been one breach of the Oncology patients to receive first treatment within 31 day from diagnosis. (a) Access to Services Diagnostic waits There were 92 patients at the end of March who had been waiting over 6 weeks for a diagnostic test. This amounts to 92.9% of all patients versus a target of 99%. The longest wait for a diagnostic test is over 13 weeks and these are Gastroscopy patients. There are also 4 at 11-13 weeks, 31 at 9-10 and 40 at 7-8 weeks. For MRI, there are 7 patients waiting over 10 weeks, 16 at over 9, 14 over 8 and 19 over 7. There are 503 patients waiting for MRI in March and currently under 6 weeks. This compares to 432 in the previous month, which reflects the increase in referrals for MRI. MRI Breaches are predicted to continue for MRI, with 66 MRI and 2 CT in March and a predicted 98 MRI in April and 133 in May. The main driver behind this is the demand for MRI and the total additions to the waiting list hit its highest number in March with 182 added to the list in mid March. Of this 182, 61 were GA additions which again is an increase and one of the highest number of GA additions in the last 2 years. The number of GA patients on the waiting list is reducing however as focus is being placed on treating these, however, as previously reported, this is impacting the GA to non GA slot ratio and is resulting in the number of non GA breaches increasing. In March of the 66 breaches, 63 were non GA and in the predicted figures for April and May, the non GA breaches are predicted to be 84 and 111. Managing within 6 weeks remains a challenge across MRI and Gastroenterology. Support at Aston continues but SPIRE support has been suspended (on their side) pending further discussions, which equated to 10 patients per week and had previously been built into the predicted figures. As this is now suspended it is not built into the predictions and is another contributory factor to the increase in predicted breaches. There are other external possibilities being explored, but nothing confirmed at this point. The planned increase in cases per list of the 3T scanner is now operational on most but not all lists and will result in an extra 20-30 scans per month. Endoscopy We are continuing to see endoscopy breaches but this is reduced to 23 gastroscopy and 1 colonoscopy breach at the end of the month. The in house equipment is now fully operational and this, combined with Theatre 10 introduction is planned to reduce the breaches of gastroscopy and colonoscopy to 0 by April/May. Regarding ultrasound scans, performance against target in this area remains challenging, and the Radiology Department have identified some risk around ensuring all patients are seen in 6 weeks. The number of patients waiting 5 weeks or more for an ultrasound has increased from 7 in December to 14 in March. 18 weeks waiting time The 18-week standards were met in March with a very tight margin. Performance for admitted was 90.2%, for non-admitted 95.1% and for incomplete 92.1%. Slide 10 in the Performance Report shows that there are 103 patients either waiting over 30 weeks at the end of March, or whose clock stopped after 30 weeks in month. This had decreased slightly but remains high in comparison to previous months. The total inpatient waiting list remains high and has increased to 4,366. The number of patients who are still waiting after 14 weeks on the list without a TCI date has remained relatively constant across March but remains at its highest levels following the sharp increase reported last month. Regarding outpatients, the numbers on the outpatient waiting list remain very high at 6,661. Emergency Department Attendance in ED increased to 5076 in March from 4212 in February, and performance was at 92.8% against the 4 hour wait standard (367 breaches). We did meet the 4 hour wait target in quarter 4 (96.2%) and at year end (95.2%). Looking at emergency admissions for quarter 3 and 4 2014/15 vs the same period in 2013/14 activity levels have risen quite significantly (8%) Tertiary referrals and Home Referrals Activity levels increased from 178 in February to 185 in March. There were 3 refusals (1 from Redditch, 1 from north Staffs and 1 from Plymouth) and 26 patients had to wait over 24 hours to be offered a BCH bed. PICU (Paediatric Intensive Care Unit) referrals PICU demand – There were 116 referrals to KIDS in March, which follows the seasonal increase in this month and 35% of which were avoided (41 patients). Of the 75 referrals that needed admission, 51% (38) were admitted to BCH, 39% (29) were referred to other WM hospitals and 11% (8) went out of the region. CAMHS Access The CAMHS Tier-4 (Child & Adolescent Mental Health Service) West Midlands service is provided by BCH and other providers (some private) with BCH providing the assessment of all requests, ideally within 4 weeks. CAMHS 18 week performance is met at 97.2% in March. There are 15 learning disability (LD) patients, out of a total 17, waiting over 18 weeks without a planned date. The staff vacancies in the LD team, which were reported previously, have now been recruited to and the 3 band 6 nurses will begin working over April to June. It is anticipated that these new posts will help clear the over 18 weeks patients still waiting, but as they do this it will have a negative impact on the 18 weeks performance as they are then included in the overall performance figure. The average waiting time to first appointment in March is 6.5 weeks from 6.1 weeks in February. 9 patients were referred to T4 and not admitted. (b) Utilisation of Facilities Cancelled operations In March, 45 patients (2.05%) were cancelled on the day of operation or after admission by the hospital for a non-medical reason. 36% of these were due to bed shortages and 31% were due to emergencies. The remaining cancellations were due to equipment failure and ICU/HDU beds unavailable, list overrun and staff shortage There was 1 breach of the 28 day cancellation standard in March. This was a trauma and orthopaedic patient who was cancelled due to lack of beds. Going forward, potential breaches of the 28 day target will be managed in the clinical groups to reduce the number of the 45 cancellations going on to be 28 day breaches. Bed Availability - Long stayers and delayed discharges The overall number of patients who have been in the hospital over 7 days at any point in time was on average higher in March than in the previous 24 months. Levels of bed utilisation were also very high in month and the average inpatient length of stay was also above average. So taken together this is indicative of a month when there was a lot of pressure on beds. In March, there were 4 children who were fit for discharge but waiting for non-hospital related actions before they could be discharged. They had spent 381 days in hospital after being fit for discharge. The longest single wait after being fit for discharge was 216 days (approx. 7 months), with a total stay of 320 days and is due to care package and social care. In CAMHS, 3 patients remain as inpatients with a delayed discharge and collectively account for 866 delayed discharge days. All patients continue to await placement and the longest wait is 415 fit for discharge days out of a total 693 days length of stay. Oncology The oncology figures are reported 1 month in arrears and in March we are reporting 1 breach to that patients receive first treatment within 31 day from diagnosis target in February. This was a patient who was due to be treated within 31 day, but then contracted scarlet fever and was then unable to be rescheduled within 31 days. In month performance was 92.3% against the 96% target. In year, there have been 2 breaches to this target. Recommendations - to continue to monitor the ED activity and referrals into the department. - alongside the need to manage the ED position we need to monitor inpatient flow through the hospital particularly around long stay patients, where increased long stayers will impact the discharge rate and flow of the hospital. - Further emphasis on actions needed to meet the diagnostic wait target. This covers getting performance against the trajectory for meeting the MRI target back on track, but also resolving the endoscopy decontamination unit problem and continuing to manage ultrasound performance within 6 weeks. It is currently anticipated this will be resolved by the end of April; - to implement recovery plan and explore all avenues to maintain elective throughput and continue to meet our 18 weeks RTT performance. It is anticipated that admitted performance in particular will continue to be challenging. - Board is asked to note the performance and our plans for further improvement Key Risks Risk Description Controls Escalating demand for our Discussions with inpatient elective services, commissioners to be held potential risk of failing access about demand management / 18 weeks targets Bids against operational resilience moneys Assurances Maintaining scrutiny on performance against various RTT targets Validation of waiting lists stepped up Recovery plans in across specialties place Insufficient capacity in place Non GA capacity identified Daily, weekly and monthly to meet diagnostic waiting including additional session reporting in place. times at Aston. Modelling and projection of Continued issue with More GA capacity on site performance in place endoscope decontamination coming on line with extra anaesthetic and theatre staffing time and flexibility provided by mobile theatre City hospital assistance with decontamination unit for scopes Second ED ‘spike’ Winter plan moneys can help anticipated Mid Feb to alleviate, plan for anticipated March ‘spike’ in place March 2015 Discuss demand management with commissioners Failure to meet 28 day Case by case management cancelled operations target Key Impacts Strategic Objectives CQC Registration outcome) NHS Constitution Maintaining scrutiny on performance against target. Clear and major operational priority, with huge amount of effort on behalf of the staff to deliver noted Close scrutiny. plans in place. Escalation This reports covers progress against meeting the strategic objectives linked to supporting improving our patient experience. (state 4: Care and welfare Yes – treatment within 18-weeks is a requirement within the NHS Constitution. Other Compliance (e.g. Many of the indicators are local or national standards NHSLA, Information monitored by the Department of Health, Monitor and our Commissioners. Governance, Monitor) Equality, diversity & human The report considers any particular impact on patients with learning disabilities, and on different ethnic groups. rights Trust contracts Non-delivery of NHS standards can result in financial penalties Other Meeting the strategic objectives raises the profile of Trust locally, regionally and nationally Operational Performance Report Month 12 2014/15 Performance for March 2015 David Melbourne Paul Franklin Victoria Penfold Deputy Chief Executive Officer and Chief Finance Officer Head of Health Informatics Performance Manager 1 How our patients access care 18 weeks RTT Diagnostic waits Tertiary and urgent home CAMHS Access PICU Operational Performance Indicators ED access Oncology Utilisation of our facilities Cancelled operations Theatres RAG ratings in these areas are calculated by the balanced scorecard Clinics Beds Trend in Overall Performance Balanced Scorecard Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 50% 51% 44% 51% 68% 63% 62% 48% 43% 59% 61% 43% 2 Operational Performance Report Month 12 2014/15 Performance for March 2015 How our patients access care 3 Emergency Department : Activity in ED increased in March, in line with previous patterns. Performance against the 95% target was not met in month but has been met in Q4 and the year. Future risk: No short term risk identified but we are continuing to monitor activity levels and working on staffing plans to mitigate against long term risks and winter activity 2016 The issue •92.8% of patients were seen within 4 hours, against the 95% target in March. •14 days in March fell below the 95% target and these days had an average attendance of 170. •The four hour wait target has been met for Q4 at 96.2% and year end at 95.1% •Activity levels increased from around 1100 per week in February to 1200 towards the end of March. •Ambulance triage time continues to be high (40 minutes in March) and is presumed a data quality issue, but it has been an issue since the introduction of patient first. •Time to seen is increasing, in line with seasonal patterns, but higher than in the previous 2 years and in our busy November and December months. Why has it occurred? •In March, ED saw 5,076 attendances, compared to 4,212 in February and 4,944 in March last year (17% increase from February). Activity for March has been above normal seasonal levels but followed the predicted increase •Increase in tertiary specialist admissions Our response •Continued support for ED staff and management of daily discharges •Engaging with Newton to review inpatient flow •Continued escalation of additional medical workforce in the ED and General Paediatrics in line with winter plan •Review of ED medical workforce cover and continued monitoring of ED attendance •Extended cover from on-call managers including evening and weekends Expected impact of our response and responsible persons •Managing the discharges from our inpatient beds will improve the flow of patients in need of admission, out of the ED service. •Improved flow through the emergency department. •Achieving 95% in Q1 and cumulative for the new year Timescales (of actions and expected impact of those actions) •Matt Train leading the collated GP service and it is being looked at for Autumn winter 2015 •Management of ED and discharges is an on going and daily activity •Review of inpatient flow is an 8 month project •Review of ED, General paediatric and medical workforce cover is expected to be in time for next winter 4 Emergency Department Total Time Spent in A&E Standard ≤ 4 hours (95th Percentile) 6.50 95th % time in A&E: 4.0 hours – 92.8% seen in four hours 95th % time to triage (all): 48 minutes Time to be Seen Standard ≤60 minutes (Median) 150 5.50 100 4.50 50 3.50 0 A M J 0 Patients deflected J A S O N D J F M A M J J A S O N D J 2012-13 2013-14 2012-13 2013-14 2014-15 Target 2014-15 Target F M 95th% time to triage (ambulance): 40 minutes Median time to seen: 103 minutes Time to Triage - Ambulance Only Standard ≤ 15 minutes (95th Percentile) % Patients Who Left ED Without Being Seen Standard < 5% 70 60 Left without being seen: 3.86% ED re-attenders for related condition: 6.90% 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 50 40 30 20 A M J 10 A M J J A 2012-13 S O N D J F M J A S O N D J 2012-13 2013-14 2014-15 Target F M 2013-14 5 ED attendance ED attendances SPC chart (1.5 st deviations) ED attendances 6000 6000 5000 5000 4000 4000 3000 3000 2000 2000 1000 1000 Emergency Department (ED) attendances increased significantly in March 2015, with the total being the second highest monthly figure on record, and 9% above the planned level. For the full year 2015/16 activity was 6.4% above plan and 5.6% up year on year. Attendance Total breaches LCI Mar-15 Jan-15 Feb-15 Dec-14 Nov-14 Oct-14 Sep-14 Jul-14 UCI Aug-14 Jun-14 0 Apr-14 2014/15 May-14 M Mar-14 F Jan-14 J Feb-14 2013/14 D Dec-13 N Oct-13 O Nov-13 2012/13 S Sep-13 A Jul-13 J Aug-13 2011/12 J Jun-13 M Apr-13 A May-13 0 Mean The SPC (statistical process control) chart above shows that the activity levels in March 2015 were slightly above the upper confidence limit and above the mean illustrating activity has been above normal seasonal levels. Therefore growth in ED activity in 2014/15 was significantly higher than historical precedents. 6 18 weeks RTT : All targets met, but it continues to be by a very small margin. The number of patients not treated within 18 weeks due to insufficient capacity remains high and has increased from the previous month. The spike in additions to waiting lists for scope patients and backlog that has been formed is likely to have an impact on Aprils 18 week performance. The issue Why has it occurred? Our response •18 weeks targets have been met for admitted (90%), non admitted (95.1%) and incomplete (92.1%) in March •200 patients were not seen within 18 weeks due to insufficient capacity compared to 186 patients last month •103 patients waiting over 30 weeks compared to 117 last month (ENT, Plastics, Ophthalmology and T&O, have the highest number of patients still waiting) •0 patients waiting over 52 weeks •Seeing a reduction in the long waits and overall inpatient waiting list size. •The number of patients waiting over 14 weeks spiked in February and continues to be high (figure 2 on page 9) •18 weeks pressure being put on Cardiac, Gastroenterology and ENT •Working through backlog within Endocrinology and Gastroenterology •Spike in additions to waiting lists for scope patients following reinstatement of normal endocrinology service •Additional beds opened to help with patient flow, in line with winter plans •Theatre 10 opened 23rd March. This will allow us to see an additional 30-35 patients per week •Reviewing RTT processes to improve our ability to predict 18 week performance •All specialties to formulate recovery plan by end of April to achieve 18 week admitted target by specialty and Clinical group •Gastroenterology are going back to 1 additional patient per list, which will become working practice •18 week and forward look meetings consolidated and chaired by Deputy COO •Recovery plans developed by end April 15 by Deputy COO Expected impact of our response and responsible persons •18 weeks will continue to be a challenge. Focusing on reducing patients over 14 weeks without a date, should help to reduce our future problem. •Continued validation of lists will ensure accurate reporting of the 18 week standards. (Directorate management and operational teams) •Focusing on reducing patients over 14 weeks without a date, should help to reduce our future problem. Timescales (of actions and expected impact of those actions) •Actions are on going and will expect to see the impact of those, particularly validation and reducing backlog, immediately and in the future. 7 18 week waits 18 weeks admitted performance 94.0% 93.0% 92.0% 91.0% Admitted: 90.2% 90.0% 89.0% 88.0% 87.0% Non admitted: 95.1% 86.0% A M J 2012/13 J A S O N 2013/14 D J 2014/15 F M Target Patients not treated within 18 weeks due to insufficient capacity Incomplete: 92.1% 11 14 14 10 12 46 82 89 74 69 97 Admitted Feb-15 Dec-14 Oct-14 Aug-14 Jun-14 4 4 Apr-14 Feb-14 Dec-13 Aug-13 Jun-13 Apr-13 Feb-13 Oct-13 8 1 2 128 3 0 8 2 105 118 1189711290 87 90 9711211611210689124117103 3 83 75 61 56 62 73 41 54 7 8 60 90 81 Non admitted 8 18 week waits Performance for patients still waiting for their initial treatment (either admitted or non admitted pathway) is still just above the 92% target at 92.1% (Fig 1.). % still waiting for clock stop (incomplete) under 18 weeks Patients waiting for an admission (Fig. 2), the green line, (which is the total of the red and blue lines) illustrates the overall potential problems we have in managing our 18 weeks admitted demand. 100.0% The blue line illustrates patients with a date to come in who are already over 18 weeks or whose TCI date is over 18 weeks. 94.0% The red line illustrates patients who are waiting 14 plus weeks and do not have a TCI date yet. This has now increases to 442 and indicates a future problem. . 98.0% 96.0% 92.0% 90.0% 88.0% A M 2012/13 Figure 2 J J A 2013/14 S O N D 2014/15 J F M Target CURRENT PROBLEM: patients with a TCI who have already breached 18 wks & patients at 14 - 18 wks with a TCI >18 wks on Lorenzo FUTURE PROBLEM: patients without a TCI who have already breached & patients at 14 - 18 wks without a TCI on Lorenzo TOTAL SIZE OF PROBLEM 30.03.14 06.04.14 13.04.14 20.04.14 27.04.14 04.05.14 11.05.14 25.05.14 01.06.14 08.06.14 22.06.14 29.06.14 06.07.14 13.07.14 20.07.14 27.07.14 03.08.14 10.08.14 17.08.14 31.08.14 07.09.14 14.09.14 5.10.14 12.10.14 12.10.14 09.11.14 16.11.14 23.11.14 07.12.14 15.12.14 22.12.14 05.01.15 19.01.15 26.01.15 02.02.15 09.02.15 16.02.15 23.02.15 01.03.15 08.03.15 15.03.15 22.03.15 29.03.15 05.04.15 12.04.15 800 700 600 500 400 300 200 100 0 9 Whole Inpatient waiting list and long waits 120 Dentistry 1 100 Cardiology 10 Paediatric Thoracic Surgery 1 ENT 9 Ophthalmology 17 Plastic surgery 17 Surgery 9 Trauma and Orthopaedics 14 Urology 7 Paediatric Neurosurgery 1 Neurology 1 Total 87 Inpatients Surg/Cardiac Inpatient 73 69 72 Feb-15 0 0 73 Dec-14 1000 20 41 39 54 49 54 57 61 121 109 117 103 Oct-14 2000 40 Aug-14 60 Jun-14 3000 140140 116 109 107 104 94 99 92 Apr-14 80 Apr-13 4000 Feb-14 5000 Speciality Dec-13 6000 140 Oct-13 7000 160 Aug-13 8000 Specialty break down of the 87 patients still waiting over 30 weeks All Patients Still Waiting or Whose Clock Stopped Over 30 Weeks Jun-13 Whole Waiting List Size (not just RTT patients) Outpatients The overall waiting list for surgical and cardiac has increased to 2,482, inpatient up to 4,366 and outpatients decreased to 6,661. Waiting lists remain high when compared with previous periods and whereas in previous month outpatients has been the increasing trend, in March, it is inpatients which has increased and outpatients decreased. At end of March, there are 103 patients waiting over 30 weeks (either still waiting or who had their clock stopped in the month), compared to 117 last month. Of the 103 patients, 16 had their clock stopped over 30 weeks and 87 are still waiting. 10 Diagnostic waits: We continue to fail to meet this target and saw a rise in referrals for MRI in March. Overall there were 66 MRI breaches and 2 CT, this is higher than the predicted value of 63. The predicted breaches going forward have risen significantly to 98 in April and 133 in March, made up of predominantly Non GA. Spire support is not going ahead as planned, leading to last minute cancellations. There have also been 24 breaches of patients awaiting a gastroscopy or colonoscopy in month which is significantly lower than February which saw 59 breaches. It is anticipated the issue should be resolved by April and breaches won’t continue for these patients. Future risks: As previously reported, the ultrasound waiting list performance continues to be close to 6 weeks. Predicting MRI breaches to increase. The issue Why has it occurred? Our response •Overall diagnostic waits performance against 99% target is 92.9% • Against the 99% target, MRI was at 88.4% (66 breaches) and Scopes was at 54.4% (24 breaches) •Of the 66 MRI patient breaches, 3 were GA and 63 were non •There were 2 patient breaches for CT (both MRI patients) •There was another spike in demand for MRI (182 mid march which is above the upper confidence – see graph on slide 12 ) •An increase in emergency MRI requests that has meant rescheduling of the non emergency MRI’s. •Patients were booked to have their MRI’s done at SPIRE but SPIRE cancelled at the last minute, which led to these patients being cancelled. Anticipated support at SPIRE has been suspended at this time. •Previous months predicted figures has included SPIRE support, equating to around 10 patients per week. Going forward, SPIRE support will not be built into the predicted figures so are anticipated to be higher than previous predictions. •Decontamination equipment is fully operational which is leading to reductions in the breaches for Gastroscope and colonoscope •Continued management of the waiting list and breaches •Continued support with Aston •Additional GA activity is continually being scoped through Waiting List Initiatives both for in-week and Saturday sessions. This is subject to the availability of both anaesthetic and theatre staffing however diagnostic sessions are being prioritised through the ‘Forward look’ group. •Non-GA capacity is being reduced through the necessity to convert sessions to GA. Priority is being placed on treating GA patients. •Through a deep dive into MRI, the speciality is trying to understanding of changes to clinical pathways within top 5 referring specialties •Engaging discussions with SPIRE to try and regain their support and are reviewing additional external support options. Expected impact of our response and responsible persons •Continue to manage the waiting lists and explore all opportunities to list as efficiently as possible •Joint working with Aston to reduce patients waiting. Timescales (of actions and expected impact of those actions) •Waiting list management is on going. •With the onsite system operation, we expect to clear the backlog in Gastroenterology in 6 weeks (0 by April/May) 11 Diagnostic waiting lists MRI Waiting list Patients waiting >6 wks for MRI / CT diagnostic test - actual & forecast Patients 140 120 1400 1200 1000 800 600 400 200 0 100 80 GA WL NON GA WL 2012-03-19 2012-05-09 2012-06-25 2012-08-13 2012-10-01 2012-11-19 2013-01-07 2013-02-25 2013-04-15 2013-06-03 2013-07-22 2013-09-09 2013-10-28 2013-12-16 2014-02-03 2014-03-24 12/05/2014 2014-06-23 2014-08-11 2014-09-29 2014-11-17 2015-01-05 2015-02-23 Total WL 160 Total MRI waiting list additions by week 63 60 200 Patient numbers 40 20 0 150 100 50 0 MRI CT TGT (10) Total external referrals Total Additions by week UpperCI CAMHS Access: Targets have been met by an increased margin this month. Future risks: Using the staff recruited, treating LD patients who are already over 18 weeks across April to June may negatively impact the 18 weeks performance The issue Why has it occurred? Our response •18 weeks performance in March was 97.20% and for the year was 95.5%. •Currently there are 24 breaches of which 16 are within the LD team. There are 17 cases waiting over 18 weeks without a planned date. 15 of these are learning disability patients. • The average waiting time to first appointment in March is 6.5 weeks from 6.1 weeks in February. This is the highest since September with the average for the whole year staying at 6.2 weeks. • There has been a significant increase in T4 gateway referrals from last month (There have been 42 gateway referrals in March in comparison to 30 in February). 17 cases have been recommended for a T4 bed. • 9 patients have been referred to T4 and not admitted due to bed capacity problems •There are currently 3 delayed discharges in Tier 4 – 1 patient due to be discharged on 5th May, the other 2 have plans in place •Staff pressures, sickness and vacancies add to the waiting list pressures in learning disabilities •Patients were not admitted to T4 due to no beds being available. •There has been an increase regionally for inpatient care for eating disorders (Irwin ward). This is a ward where patients usually experience a high length of stay, which impacts on the availability of these beds and flow. • Increasing the number of choice clinics being run at Park view from May as an on-going additional capacity to improve first appointment waits. •There is a daily escalation process in place, currently being revised to identify clinical priorities. •Continue to monitor the capacity issues in LD closely and have a trajectory that is supported by the additional staff recruited as they come into post over the next few months (3 band 6 nurse posts coming into post between April and May). Additional Choice clinics commence in May in LD to support access to first appointment. • Referrals, admissions and discharges are reviewed at the daily CAMHS inpatient HOC. •Following on from the work that the Birmingham complex care nurse undertook in Tier 4, a Tier 4 deputy ward manager has been seconded for six months to manage the delayed discharges in line with the process, working closely with the clinical teams and the NHSE Commissioner. Expected impact of our response and responsible persons •Would expect the actions to reduce the patients breaching 18weeks. •As noted in future risks, as LD patients who are already over 18 weeks are treated, this could have a negative impact upon CAMHS performance against 18 weeks. •A new member of staff has started in Learning disabilities and they have successfully recruited and awaiting a start date for an additional 2 posts. •Managing delayed discharges will be discussed with commissioners but early conversations indicate a positive response to the proposed process Timescales (of actions and expected impact of those actions) •Management of CAMHS patients is on going and done by the CAMHS operational management teams 13 Access to CAMHS CAMHS 18 Weeks Performance Community CAMHS Breakdown of Waiting Time to Assessment 105 100 100% 95 80% 238 519 60% 840 90 20% 80 68 177 929 1048 896 1129 58 538 736 936 40% 85 483 315 706 815 976 616 0% 549 2010/2011 2011/2012 2012/2013 2013/2014 2014/2015 75 Apr May Jun Jul Aug 2012/13 Sep Oct 2013/14 Nov Dec Jan 2014/15 Feb Mar Target Financial Years A:- 0-4 wks B:- 4-8 wks C:- 8-13 wks D:- >13 wks CAMHS Patients that requested a T4 bed and were not admitted (month trend) 20 15 10 5 0 Apr May Jun Jul Aug 2012/13 Sep Oct 2013/14 Nov Dec Jan Feb Mar 2014/15 14 Oncology Overall position: There have been two breaches for first treatment pathways in the year. The first being in May 2014 and the second in February 2015. The patient breach in February occurred due to the patient being diagnosed with Scarlett fever and therefore not being able to receive scheduled treatment. Our performance against the operational standard (>96% patients to receive first treatment within 31 days from diagnosis) is 92.3% in month and 99% against the 96% target YTD. 15 Urgent Tertiary and Home Referrals 185 referrals for specialist beds, 166 admitted Overall position: 185 referrals were made and 166 were admitted. 3 patients were refused a bed in March. In the year 45 have been refused a bed which is 114% of the entire 13/14 reporting year. 26 patients waited over 24 hours for a bed in March and 81.9% of requests were met within clinical timescale, up from 80.4% last month. 2 in region patients unable to get a bed Future risks: The next few months of the same period last year saw increased referrals to the services, this could be a seasonal increase we could see again in 2015. 1 out of region patients unable to get a bed Home Waiting time vs. clinical target time Clinicians can request the patient to be admitted in up to 48 hours, dependent on their assessment. The graph shows the timescales requested for admittance and time of decision to admit. 81.9% of requests were met within clinical timescales in March compared to 80.4% in February. 100 Tertiary 230 Mar-15 Feb-15 185 170 184 159 178 Jan-15 189 Dec-14 Oct-14 Sep-14 Aug-14 159 163 Nov-14 179 Jul-14 Jun-14 209 217 May-14 225 Apr-14 Mar-14 Feb-14 Jan-14 Dec-13 Nov-13 177 188 181 173 163 169 Oct-13 Aug-13 Sep-13 197 172 182 Jul-13 Jun-13 188 191 May-13 26 patients waited over 24 hours to get a BCH bed 250 200 150 100 50 0 Apr-13 16 patients no longer required a bed Urgent Tertiary and Home Referrals Total Performance vs clinical target time for patients provided a bed - home and tertiary referrals 94% 88% 100% 72% 50 50% 0 0% within 12 hours Met 12-24 hours Up to 48 hours Target Time Not met % patients meeting tgt time 16 Urgent Tertiary and Home Referrals Referrals Sent Elsewhere Referrals Waiting over 24 Hours Tertiary and Home Urgent Referrals sent elsewhere Total Rheumatol… Trend - Tertiary and Home Referrals Waiting Over 24 Hours for a Bed T&O Surgery 50 Neurology 45 40 Medical… 35 Clin Haem 30 Hepatology 0 10 20 YTD 14/15 30 40 50 Long Term Trend Tertiary Refusals 25 20 15 10 9 5 8 0 7 6 Mar-15 Feb-15 Jan-15 Dec-14 Nov-14 Oct-14 Sep-14 Aug-14 Jul-14 Jun-14 May-14 Apr-14 Mar-14 Feb-14 Jan-14 Dec-13 Nov-13 Oct-13 Sep-13 Aug-13 Jul-13 Jun-13 May-13 Apr-13 Mar-13 Feb-13 Jan-13 Dec-12 Nov-12 Oct-12 10 Over 24 Hr Waits 5 Avge lower ci upper ci 4 3 There were 3 tertiary refusals – average for the month. 2 were in Paediatric Surgery and the other in cleft lip and palate surgery. One of the paediatric surgery patients was an out of region request from Plymouth. 2 0 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 1 Total avge 17 PICU Demand and KIDS Service 4 WM patient could not be supported within region PICU demand – There were 116 referrals to KIDS in March 2015 of which 35% of referrals were avoided (41 patients). Of the 75 patients/admissions that needed admission, 51% (38) were admitted to BCH, 39% (29) were referred to other WM hospitals and 11% (8) went out of the region. 4 non WM patients could not be supported within region Future risks: Bed availability across the country remains a problem. 14 additional non WM patients were supported at BCH 250 Referrals to KIDS Service Taken Out of Region (Leics or Other Non WM Provider) Year on Year Comparison of Total Referrals to KIDS 30 25 20 15 10 5 0 200 150 100 Feb-15 Dec-14 Oct-14 Aug-14 Jun-14 Apr-14 Feb-14 Dec-13 Oct-13 Aug-13 Jun-13 Total Outcome of Referrals to KIDS (excluding admissions avoided) - Trend 80% Apr-13 Feb Mar Feb-13 Apr May Jun Jul Aug Sep Oct Nov Dec Jan 2012/13 2013/14 2014/15 Dec-12 0 Oct-12 50 Avge Outcome of Referrals to KIDS - (including admissions avoided) Trend 60% 50% 60% 40% 30% 40% 20% 20% Jan-15 Feb-15 BCH Dec-14 Nov-14 Oct-14 Sep-14 Aug-14 Avoided Admission Jul-14 Jun-14 May-14 Apr-14 Mar-14 Jan-14 Feb-14 Dec-13 Oct-13 Sep-13 Nov-13 Out of Region Aug-13 Mar-15 Jan-15 Feb-15 Dec-14 Oct-14 UHNS and Other WM Nov-14 Sep-14 Jul-14 Aug-14 Jun-14 Apr-14 May-14 Mar-14 Jan-14 BCH Feb-14 Dec-13 Oct-13 Nov-13 Sep-13 0% Aug-13 0% 10% 18 Operational Performance Report Month 12 2014/15 Performance for March 2015 Utilisation of our facilities 19 Cancelled operations: 45 patients were cancelled in March, which was 2.05% of elective work in month and 1.63% at year end. There was 1 breach of the 28 day standard. Bed shortages and high emergency demand have caused the most cancellations in March. There were high levels of total cancellations as well as high reportable incidence. Future risks: Possible 28 day breaches in next months figures as the 45 cancellations this month are rebooked. The issue •45 (2.05% of electively admitted) patients had their operation cancelled on the day of admission in March. •YTD in 2014/15, 415 patients (1.63%) have had their operation cancelled on the day of admission (and are nationally reportable) compared to 1.94% in the same period last year. • 1 patients breached the 28 day standard •There were 317 total hospital cancelled operations Why has it occurred? •36% of operations (16) were cancelled due to bed shortage in March. •‘lack of theatre time’ and ‘list over run’ accounted for 16% of cancellations on the day and 31% were due to emergencies. •Bed pressures in PICU remain an issue but in the figures only accounted for 11% of cancellations. •Plastics, Surgery, ENT, Urology and radiology were the highest cancelling specialities for all hospital cancellations. Our response •Continued management of patients from the operational and medical teams, particularly for patients who may breach the 28 day standard •Theatre 10/Ward 17 has been operational since opening on 23rd March, a meeting has been scheduled to reflect on month one of theatre 10’s use so on-going issues/themes can been identified and plans can be put in place to improve these. Early review shows the model used for theatre 10 works In terms of a very low number of cancellations in this theatre. • A surgical escalation process is in development to co-ordinate surgical admissions when there are bed pressures within the Trust. Expected impact of our response and responsible persons •Extra beds should help with patient flow •Managing patients are risk of breaching 28 days may help to reduce and avoid breaches where possible •Theatre 10 (ward 17) will increase capacity, help clear patient backlogs and reduce cancelled operations •Service Managers, COO and DOT are managing this Timescales (of actions and expected impact of those actions) •All actions are being continually implemented with expected immediate response 20 Cancelled operations trends Cancelled Operations On The Day - National Definition Avge for 3 years Data Percentage of Operations Cancelled on the Day 0.5 As a % of Electives Avge % Cancelled 3/1/2015 1/1/2015 11/1/2014 9/1/2014 7/1/2014 5/1/2014 3/1/2014 1/1/2014 11/1/2013 9/1/2013 7/1/2013 5/1/2013 0 10 0 6 4 2 0 3 1 2 Mar-15 Feb-15 Jan-15 Dec-14 Nov-14 7 5 4 3 4 2 3 2 0 2 0 0 0 0 0 Feb-15 20 6 1 Mar-15 1 7 8 Jan-15 30 10 May-13 % Cancelled 40 1.5 11 12 Dec-14 14 Nov-14 60 Oct-14 2.5 16 Sep-14 16 Jul-14 70 50 lci 2stdev Aug-14 3 Total Cancelled 18 2 uci 2stdev Breaches of 28 Day Cancelled Operations Standard 80 3.5 mean Jun-14 2014/15 May-14 2013/14 Oct-14 Aug Sep Oct Nov Dec Jan Feb Mar Apr-14 2012/13 Jul Mar-14 Apr May Jun Sep-14 10 Aug-14 13 Jan-14 20 24 Feb-14 24 18 Jul-14 26 Dec-13 28 Nov-13 28 30 Oct-13 40 Jun-14 45 40 May-14 48 Sep-13 50 Aug-13 54 60 Jul-13 70 400 350 300 250 200 150 100 50 0 Apr-14 66 Jun-13 80 All Hospital Cancelled Operations Contract Trajectory Nationally Reported Cancelled Ops 21 All Hospital cancelled operations year to date by specialty Other Dir 3, 1.2% Other, 2.7% Other Dir 4, 7.4% Plastic Surgery, 11.4% T&O, 4.8% Other Dir 2, 8.5% Cardiology, 4.2% Urology, 7.1% Cardiac Surgery, 6.2% Radiology, 9.3% Haematology,Ophth, 5.1% 4.6% Hepatology, 3.7% Paed Surgery, 13.6% All Hospital cancelled operations year to date by reason Anaesthetist unavailable, Theatre staff 1.2% Administrative unavailable, Error, 3.8% Equipment 1.3%failure, 0 Surgeon unavailable, 2.8% Lack of theatre time, 3.4% ICU/HDU beds unavailable, 3.9% Other, 4.2% Emergencies/Tra uma, 22.9% Unfit with acute illnes (Hosp Canc), 8.2% Bed Shortage, 18.3% Anaesthetist necessary (Hosp Canc), 12.5% Patient not suitable for OP, 17.4% ENT, 12.8% Nationally reportable cancellations by reason – March 2015 Plastics, Paediatric Surgery and ENT continue to be the largest single specialties. The biggest reason for the cancellations in the year is emergencies and trauma (22.9%), Bed shortage (18.3%), patient not suitable for operation (17.4%) and operation not necessary (12.5%) Bed shortage: 16 ICU/HDU beds not available: 5 List Overrun: 6 Equipment failure/unavailable: 2 Emergencies/Trauma: 14 Lack of theatre time: 1 Surgeon Unavailable: 1 22 Discharges and Flow Fit For Discharge Days CAMHS Long Stay Patients (March) – Fit for Discharge Long stay patients After fit for discharge The number of over 7 day patients increased in March but the graph below shows that the numbers are started to decrease again at the beginning of April. As we have seen in previous months, the increase is in patients currently waiting between 7 and 30 days (red line). The graph below also shows a slight increase in the number of patients waiting over 90 days. 160 Inpatient Long Stayers Patient 3 226 Patient 2 226 Before fit for discharge 101 210 140 Patient 1 120 415 279 100 Long stay patients (March) - Fit for discharge 80 Before fit for discharge 60 40 Patient 4 34 0 20 Patient 3 27 10/04/2014 26/04/2014 12/05/2014 28/05/2014 13/06/2014 29/06/2014 15/07/2014 31/07/2014 16/08/2014 01/09/2014 17/09/2014 03/10/2014 19/10/2014 04/11/2014 20/11/2014 06/12/2014 22/12/2014 07/01/2015 23/01/2015 08/02/2015 24/02/2015 12/03/2015 28/03/2015 0 Sum of GT7 Sum of GT7to30 Sum of GT30to90 Sum of GT90 54 Patient 2 Patient 1 After fit for discharge 169 104 111 216 23 Item 15.88 Board of Directors Thursday 30 April 2015 Enc 07 Strategic Objective/ Enabler Every child and young person requiring access to care at BCH will be admitted in a timely way, with no unnecessary waiting along their pathway Report Title Resources report period 1st April 2014 – 31st March 2015 Sponsoring Director Deputy Chief Executive / Chief Finance Officer Author(s) Director of Finance and Procurement, Chief Officer for Workforce, Head of Informatics Previously considered by FRC and SLT Situation This report is to communicate the various aspects of Trust performance for the financial year ending 31 March 2015, and to identify any key risks that are evident within the organisation. The contents of this report will form the basis of the Trust’s Quarter 4 (Q4) Return to Monitor. The Trust is also required to report its predicted status for Governance and Mandatory Services. Background The Trust is required to comply with the finance related legal issues contained within our Terms of Authorisation as well as other key financial targets. This includes: • Performing at plan for Monitor’s Continuity of Service Risk Rating leading to an overall CoSRR of 4; and • Risk Assessment Framework, which may result in formal discussions with Monitor. Delivery against these targets is driven by: • • The volume and mix of demand experienced by the Trust; and How the Trust uses its most valuable resource, its staff, in responding to that demand. The report explores each of these areas in turn and the impact on the financial position and performance. Assessment Monitor Declarations The key ongoing governance issue which impacts upon the Trust’s Monitor Governance rating is the performance against the 18 week target for admitted patients. Performance in month was, at 90.2%, fractionally above the 90% threshold. This, and the continuing level of performance of the other metrics, enables the Trust to forecast a Green Governance rating. From a financial perspective the ratings will be a 4 under the Continuity of Service Risk Rating. Under the old Compliance Framework a FRR of 4 would also have been reported. These remain strong performances. Activity Activity performance in the year to date against plan and compared to 2013/14 is as follows: Activity Type Against Plan Against 2013/14 Emergency Department +6.4% +5.6% Emergency/Non-Elective -2.5% -1.1% Planned Care +1.0% +2.1% Outpatients +2.3% +6.1% From a financial perspective income has overperformed in the month. This is the tenth month of above plan performance and continues the strong positions experienced since the early summer months. Performance in month has been enhanced by an increasing level of drug and device recharges. Workforce As outlined above, demand remains high and this has brought into sharp focus the short to medium term capacity issues faced by the Trust. Sickness levels in the month stood at 3.65% with the cumulative rate decreasing to 3.34%. Both measures are above the Trust’s 3% target although both show considerable improvement on the previous month. The combined substantive and bank staff level usage increased in March with a 14wte movement, of 6wte which was in substantive staff. Compared to March 2014 substantive wte have increased by 6.2%, which is above the levels of activity increase reported above. Engaging with staff, especially during periods of pressure, is important and appraisals are one indication of how well this is working in the Trust. The reported appraisal rate is now 85%, a similar position to that reported in February. Finance The 2014/15 financial year has concluded with a financial position warranting detailed explanation. The headline surplus is £1.612m. However, following the interim revaluation of the estate (an audit requirement every 3 years) the value of the Trust’s assets has been reduced (impaired) by £2.785m. This technical adjustment directly impacts upon the Trust’s I&E position and was not something that could have been readily forecast. Excluding this technical adjustment the surplus was £4.397m which was exactly where we were forecasting to be at year-end. Although the impairment is an accumulation of revised revaluations across the whole site the predominant causes are the impact of the decision to demolish the car park to enable the building of the new £35m clinical block and the actual value added following the electrical infrastructure work that has been undertaken over the previous 2 years. The £4.4m surplus was per the Trust’s Monitor Plan. Quarter 4 can be financially challenging and there were some major issues dealt with at year-end. These will all be subject to audit so until that process concludes this will remain a draft position. Without these exceptional items the surplus would have been would have been closer to the top end of the range we were predicting earlier in the financial year. However, there remain some major financial challenges ahead for the Trust so the delivery of this financial outcome is crucial. Controlling the costs of care that we provide remains central to our financial success as downward pressure will continue on the tariffs we are paid. It is important that we deliver on efficiency plans so that we can begin 2015.16 ‘on the front foot’. Our year-end cash balances were, as expected, strong. A year-end catch-up on capital spend has caused a small reduction in the overall cash balance but this only served to reduce the above plan level to 13%. Capital spend ended the year within 5% of the reforecast position. Monitor Monthly Data Collection On September 15th all FTs were written to outlining a new monthly data collection exercise predicated on the emerging signs of pressure on NHS finances. This required a return to the DH confirming the Trust’s Forecast Outturn positions on revenue and the overall level of capital expenditure. On 13 March Monitor wrote to all FTs stating that “Monitor no longer require trusts to submit this return (starting from the March 15 DEL return) until further notice.” No return is therefore included in this month’s report. Recommendations The Board of Directors review, discuss and approve the Resources Report. The Board is asked to approve a forecast Governance (Green) and Continuity of Service Risk Rating (“4”) for inclusion in the Monitor Q4 Return, which must be submitted by April 30. Key Impacts Strategic Objectives Staff and finance are key enablers to meeting the Trust’s strategic objectives. CQC Registration (state outcome) N/A NHS Constitution NHS Constitution has a pledge regarding 18-week waits. Other Compliance (e.g. NHSLA, Information Governance, Monitor) Monitor metrics are considered in the report. Equality, diversity & human rights N/A Trust contracts N/A Other N/A Resources Report April 2015 Phil Foster Theresa Nelson Paul Franklin Director of Finance and Procurement Chief Officer for Workforce Head of Informatics 1 Reporting on resources use. 1. Summary 2. Governance - Monitor Assessments and Declarations 3. Financial Performance 4. Income and Expenditure 5. Efficiency 6. Liquidity 7. Workforce 2 Summary. April 2015 The 2014/15 financial year has concluded with a financial position warranting detailed explanation. The headline surplus is £1.612m. However, following the interim revaluation of the estate (an audit requirement every 3 years) the value of the Trust’s assets has been reduced (impaired) by £2.785m. This technical adjustment directly impacts upon the Trust’s I&E position and was not something that could have been readily forecast. Excluding this technical adjustment the surplus was £4.397m which was exactly where we were forecasting to be at year-end. The £4.4m surplus was per the Trust’s Monitor Plan. Quarter 4 can be financially challenging and there were some major issues dealt with at year-end. These will all be subject to audit so until that process concludes this will remain a draft position. Without these exceptional items the surplus would have been would have been closer to the top end of the range we were predicting earlier in the financial year. However, there remain some major financial challenges ahead for the Trust so the delivery of this financial outcome is crucial. Controlling the costs of care that we provide remains central to our financial success as downward pressure will continue on the tariffs we are paid. It is important that we deliver on efficiency plans so that we can begin 2015.16 ‘on the front foot’. Bank staff usage in March was 8.2% lower than the equivalent period last year although March 2014 was an exceptionally high usage month. With substantive staffing levels 6.2% higher in overall terms this is a net 5.4% increase with the combined position once again resulting in a record workforce level at the Trust. Appraisal rates are at 85%, which is equivalent to the February position. In-month sickness increased by 0.17% to 3.65%. Year to date sickness has decreased slightly to 3.34%. Our year-end cash balances were, as expected, strong. A year-end catch-up on capital spend has caused a small reduction in the overall cash balance but this only served to reduce the above plan level to 13%. Capital spend ended the year within 5% of the reforecast position. 3 2. Governance – Monitor Assessments and Declarations 4 Our Month 12 regulatory position remains strong. Quarter 3 - 2014/15 The ratings for Quarter 4 have now been confirmed. Monitor Quarter 3 2014/15 (Confirmed) Finance risk rating - Continuity of Service Risk Rating Governance risk rating Finance risk rating - Compliance Framework Plan Actual G (4) G (4) G G G(4) G(4) Month 12 – Quarter 4 Monitor Quarter 4 2014/15 (Predicted) Based on this performance the predicted measureable Month 12 performance is Green. Finance risk rating - Continuity of Service Risk Rating Governance risk rating The Continuity of Service Risk Rating for March and therefore 2014/15 is a 4 (the highest level). Finance risk rating - Compliance Framework Plan Actual G (4) G (4) G G G(4) G(4) For information under the old Compliance Framework regime a FRR of 4 would have been reported in Month 12. A continuation of the above will result in the Trust achieving its planned Risk Ratings for 2014/15. Forecast ratings for the year are included in Section 3 – Financial Performance. 5 Monthly Reporting Collection Data. On 15 September Monitor wrote to all FTs outlining the requirement for a new monthly data collection process. This has been a feature of the Resource Report since September. On 13 March Monitor wrote to all FTs stating that “Monitor no longer require trusts to submit this return (starting from the March 15 DEL return) until further notice. But please be aware that this return may be required again in the future.” No return is therefore included in this month’s Resource Report. 6 3. Financial Performance 7 Financial Summary. Governance The Monitor Financial Risk rating is 4 per plan, with liquidity remaining strong. This 4 is per the Continuity of Service Risk Rating (CoSRR) and also the former Compliance Framework. Income and Expenditure The I&E position ended the year with a surplus of £1.612m. This included a £2.785m technical adjustment following the revaluation of the estate. Excluding this exceptional item would increase this surplus to £4.397m just £0.02m ahead of the Monitor plan. This £4.397m is per the forecasted position given the one-off items and known year-end adjustments which had been reported during the final quarter. Efficiency Excluding the technical adjustment the EBITDA and Income Surplus margins are 4.6% and 1.8%, respectively. The EBITDA margin was marginally below plan whilst the I&E surplus margin was per plan. CIP at a Directorate level and Trust-wide level ended the year below plan. Performance is reported at 73% although further work is being undertaken to assess the final benefit of the Trust-wide schemes so this position may increase. In value terms the £6.9m was £1.4m higher than 2013/14. Productivity measures associated with income were strong in March due to an improved income performance. Liquidity Cash balances remained above plan in March. Some of the previous gains experienced through the delays in the capital programme were reduced in March as a year-end surge in programme spend was experienced. 8 Financial Balanced Scorecard. FINANCIAL BALANCED SCORECARD - MARCH Category Governance Sub-Set CoSRR I&E I&E and Profitability Metric Period Plan Actual Variance Weight Score Continuity of Service Risk Rating * YTD 4 4 0.00 50% 50% 100% Continuity of Service Risk Rating * Forecast 4 4 0.00 50% 50% 100% Debt Service Cover Rating * YTD 4 4 0.00 0% 0% Debt Service Cover Rating * CIP Efficiency Productivity Temp Spend CQUIN/ Penalties OVERALL 100% 100% 4 4 0.00 0% 0% YTD 4 4 0.00 0% 0% 100% Liquidity Rating * Forecast 4 4 0.00 0% 0% 100% I&E Position (£m) In-Month -0.40 -1.14 -0.74 10% -8% -82% I&E Position (£m) YTD 4.38 4.40 0.02 30% 30% I&E Position (£m) Forecast 4.38 4.40 0.02 30% 30% I&E Position (£m) Underlying 2.10 2.10 0.00 30% 30% In-Month -0.59 -0.65 -0.07 15% 13% YTD 11.82 11.53 -0.29 35% 34% Forecast 11.82 11.53 -0.29 50% 49% Profitability - EBITDA (£m) Capex 100% Metric Forecast Profitability Profitability - EBITDA (£m) Liquidity 100% Sub-Set Liquidity Rating * Profitability - EBITDA (£m) Cash Category 82% 88% 100% 100% 100% 88% 96% 98% 98% 113% Cash (£m) YTD 45.49 51.55 6.05 50% 57% Cash (£m) Forecast 45.49 52.32 6.82 50% 58% Capital Expenditure (£m) YTD 12.74 12.14 -0.60 50% 48% Capital Expenditure (£m) Forecast 12.74 12.14 -0.60 50% 48% CIP Achievement (£m) In-Month 1.32 0.47 36% 10% 4% 36% CIP Achievement (£m) YTD 9.46 6.91 73% 20% 15% 73% CIP Achievement (£m) Forecast 9.46 6.91 73% 35% 26% CIP Achievement (£m) Recurrent 9.46 6.42 68% 35% 24% 68% YTD 1.56 1.57 101% 50% 50% 101% Income per wte (£) In-Month 70.27 80.94 115% 50% 58% % of Pay Bill on Temporary Staff (%) in-Month 5.0% 5.5% 110% 25% 23% % of Pay Bill on Temporary Staff (%) YTD 5.0% 5.3% 106% 75% 71% Contract Penalties/CQUIN Target (£m) YTD 5.01 4.93 -0.08 50% 49% Contract Penalties/CQUIN Target (£m) Forecast 5.46 5.23 -0.23 50% 48% Income per £1 Pay Expenditure (£) 114% 109% 95% 68% 85% 108% 93% 97% 115% 95% 95% 73% 115% 110% 106% 98% 96% 96% 9 Financial Balanced Scorecard – Performance Tracker. FINANCIAL BALANCED SCORECARD - 2014/15 TRACKER Actual Sep Governance Continuity of Service Risk Rating * I&E Liquidity Efficiency Oct Predicted Nov Dec Jan Feb Mar YTD Continuity of Service Risk Rating * Forecast Governance Risk Rating YTD Governance Risk Rating Forecast I&E Position (£m) In-Month I&E Position (£m) YTD I&E Position (£m) Forecast Profitability - EBITDA (£m) YTD Profitability - EBITDA (£m) Forecast Debt Service Cover Rating * YTD Debt Service Cover Rating * Forecast Cash (£m) YTD Cash (£m) Forecast Capital Expenditure (£m) YTD Capital Expenditure (£m) Forecast Liquidity Rating * YTD Liquidity Rating * Forecast CIP Achievement (£m) In-Month CIP Achievement (£m) YTD CIP Achievement (£m) Forecast Income per £1 Pay Expenditure (£) YTD Income per wte (£) In-Month Contract Penalties/CQUIN Loss (£m) YTD Contract Penalties/CQUIN Loss (£m) Forecast * Note - for those Monitor Ratings - 4 is the Highest Rating 10 4. Income and Expenditure 11 Income and Expenditure against Plan. The Trust’s headline I&E position has reduced significantly in March as a result of the impact of the interim revaluation of the Trust’s estate which was an audit requirement. This singularly caused a £2.785m reduction in the position. Excluding this would mean a year-end I&E position of £4.397m. The £4.397m surplus was 0.5% above the planned surplus. Given the one-off issues and pressures the Trust has faced this year, this was a very strong financial performance. Headlines are: • Following the revaluation of the estate the Trust has incurred an impairment of £2.785m. The key areas where this has been impacted are: • Car park – impaired due to its impending demolition; • Electrical infrastructure; • ED, Parkview and Respiratory developments. • The Trust reported a strong surplus against Clinical Income; • Part of this is associated with drugs and devices income for which there is a direct offsetting cost. However, a repetition of this in 2015/16 will see the Trust lose income under the ETO; • There were a number of exceptional items incurred in March which the Board and Finance Committee have been sighted on as part of the forecasting work undertaken; • Additional Directorate pressures have been experienced through the delivery of CIP targets and the costs of agency staffing. CIP performance is detailed in 5. Efficiency section. 2014/15 I&E toMarch 2015 Income from activities Other Income Operating Expenses EBITDA Interest Receivable Depreciation Profit/(Loss) on Asset Disposal Impairment PDC Dividend Interest Paid Net Surplus/(Deficit) Annual Revised YTD Plan Plan per Annual Plan per LTFM LTFM £'000 £'000 £'000 217,995 220,125 217,995 19,666 23,737 19,667 -225,841 -232,081 -225,842 11,820 11,782 11,820 243 247 243 -4,624 -4,559 -4,624 0 0 0 0 0 0 -2,762 -2,762 -2,762 -300 -326 -300 4,377 4,381 4,377 Revised YTD Plan £'000 220,125 23,737 -232,081 11,782 247 -4,559 0 0 -2,762 -326 4,381 YTD Actual £'000 227,475 23,626 -242,356 8,745 176 -4,530 0 0 -2,498 -282 1,612 Variance £'000 7,349 -110 -10,275 -3,036 -71 30 0 0 264 45 -2,769 • The continued use of temporary staffing is adding unfunded costs into the system. The spend in this area over the 12 months is £8.5m and equates to 5.3% of the overall pay bill for the period (which is a slight increase on the Month 11 position); • A detailed I&E breakdown is included as Appendix One; • A detailed breakdown of expenditure by cost category is included as Appendix Two. • Being the year-end position this will only be finalised once audited in April/May. 12 Emergency activity profile ED attendances Emergency Department (ED) attendances increased significantly in March 2015, with the total being the second highest monthly figure on record, and 9% above the planned level. 6000 5000 4000 3000 For the full year 2015/16 activity was 6,4% above plan and 5.6% up year on year. 2000 Therefore growth in ED activity in 2014/15 was significantly higher than historical precedents. 1000 0 A M J J A S O N D J 2011/12 2012/13 2013/14 2014/15 F M 2014/15 Emergency department activity against plan Despite the ED growth, emergency admissions on the face of it did not experience a similar increase in 2014/15. This is due to some extent because the first part of 2013/14 reflected previous working patterns when we admitted more zero length of stay emergency patients who now would go to CDU. If looking at variation on a month on month basis this zero length of stay issue is not a factor when comparing the second half of the year as the change had occurred in the baseline by then too. So we see that we start go get big year on year increases from Q3 onwards. In the 2nd half of the year emergency admissions are 8% above 2013/14 levels. 6000 5000 4000 3000 2000 Emergency /Non Elective FCEs 2000 1500 1000 500 0 A M J J A S O N D 2011/12 2012/13 2013/14 2014/15 J F M 2014/15 Emergency/non elective FCEs activity against plan 2000 1500 1000 1000 500 0 A M J J A S O N D 2014/15 actual J F M 2014/15 plan 0 A M J J A S 2014/15 actual O N D J F M 2014/15 plan 13 Planned activity profile All elective FCEs 2014/15 All Elective FCE activity against plan (incl Reg Day Admissions) 3000 2500 3000 2000 2500 2000 1500 1500 1000 1000 500 500 0 A M J 2011/12 J A 2012/13 S O N 2013/14 D J F M 0 A M J J A S O N D J F M 2014/15 2014/15 actual 2014/15 plan Elective activity in March increased by 3.6% compared to March 2014. The final year end position shows a 2.5% increase over 2013/14. Elective activity finished at 1% above the plan for 2014/15, with activity being 3.3% below plan in month. For the full year day cases over-performed by 500 and overnight electives under-performed bv 350. Haematology/Oncology/Haemoglobinopathy over-performed by 350 combined. Dermatology by 155, Gastroenterology by 118, Neurology by 145 and Paediatric Surgery by 137. 14 Outpatient activity profile New OP attendance There was an 11.7% increase for new attendances in March and 5,6% increase for follow up patients when compared with the same month in 2014. 4000 3500 3000 2500 2000 The final 2014/15 position for activity shows that new attendances have increased by 0.5% and follow ups have increased by 6% when compared to 2013/14. 1500 1000 500 0 A M J J 2011/12 A S 2012/13 O N D J 2013/14 F Follow up OP attendance With regards to Outpatient Procedures, there is a 37% YTD increase from 2013/14. Against plan, all outpatient activity was 6.6% above plan in March 2015 and overall 6.1% ahead of plan for the full year. High volume specialties with big increases include Paediatrics (7%), Paediatric Surgery (24%). Cardiology (12%), Neurosurgery (13%), Oncology (18%) and Respiratory Medicine (38%) 12000 10000 8000 6000 4000 2000 1600 1400 1200 1000 800 600 400 200 0 A M M 2014/15 Outpatient Procedures 2011/12 16000 J J A S O 2012/13 N D J 2013/14 F M 2014/15 2014/15 outpatient activity against plan (excl AHP CNS and Phone) 14000 12000 10000 8000 6000 4000 2000 0 A M 2011/12 J J A 2012/13 S O N D 2013/14 J F M 2014/15 0 A M J J A 2014/15 actual S O N D J F M 2014/15 plan 15 5. Efficiency 16 Profitability against Target. Note – the margins opposite exclude any technical impact of the £2.8m Impairment. EBITDA Margin 8.0% The EBITDA (Earnings Before Interest, Taxation, Depreciation and Amortisation) Margin ended the year 0.4% behind the 5.0% target. This is a reduced margin compared with February and reflects the increased costs and year-end adjustments incurred in the month. In monetary terms EBITDA was also below the Monitor Plan, with a small in-month movement. 7.5% Including the impairment reduces the EBITDA margin to 3.5%. 4.5% 6.8% 7.0% 6.5% 6.0% 6.0% 5.8% 6.2% 5.8% 5.9% 5.7% 5.7% 5.5% 5.1% 5.2% Actual 5.4% 5.0% 4.6% Plan for Year 4.0% Apr May Jun The I&E Surplus Margin ended the year on plan at 1.8%. The lower than anticipated depreciation levels offset the EBITDA shortfall. As with the EBITDA margin, the expected reduction in the I&E margin during March occurred as financial pressures and year-end issues typically experienced in quarter 4 took effect. The inclusion of the impairment reduced the I&E surplus margin to 1.3%. Jul Aug Sep Oct Nov Dec Jan Feb Mar I&E Surplus Margin 5.0% 4.5% 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% 3.9% 2.7% 3.0% 3.2% 2.8% 2.9% 2.9% 2.8% 2.1% 2.2% 2.4% 1.8% Actual Plan for Year Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 17 Productivity. Income Generated per £1 of Pay Expenditure Two productivity metrics were produced for the first time in September. These are updated monthly and assess the: • Income Generated per £1 of Pay Expenditure; and • Monthly income per wte. With staff costs equating to over two thirds of the Trust’s operating expenditure the return on pay expenditure is vital to the Trust’s productivity and profitability. 1.75 1.70 1.65 £ 1.60 Cumulative income per £ of pay expenditure performed behind the 2013/14 level. There were a number of year-end of one-off pay adjustments in March which have suppressed the 2014/15 position. Further analysis will be undertaken to assess whether the underlying position reflects the reduced productivity experienced in January and February. 1.55 1.50 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Inc/£1 Pay In-Month 2014/15 Inc/£1 Pay - Cumulative 2013/14 Inc/£1 Pay - Cumulative 2014/15 Inc/£1 Pay - Cumulative Plan 2014/15 Mar Monthly Income per wte since April 2013 Income per wte was high in month due to a favourable position being reported for clinical and non-clinical income in March. 84 82 80 78 76 74 72 70 68 Income per wte - actual Mar-15 Jan-15 Feb-15 Dec-14 Oct-14 Nov-14 Sep-14 Jul-14 Aug-14 Jun-14 Apr-14 May-14 Mar-14 Jan-14 Feb-14 Dec-13 Oct-13 Nov-13 Sep-13 Jul-13 Aug-13 Jun-13 Apr-13 66 May-13 £ Income per wte - plan 18 CIP. The overall target reflects the following: • Directorate targets; • Trust-wide scheme targets; and • Residual balance of the underlying legacy position from 2013/14. Headlines from Month 12 are as follows: • 3 Directorates over-delivered on their CIP targets; • Corporate and Surgery were the areas furthest from target for overall schemes with Surgery being by far the worst performing; • The shortfall on the trust-wide schemes was within the IT Strategy, Future Fit where workforce savings are not materialising in line with the plan and the Pathways Project; • The Drug Expenditure Group’s target of £0.5m was achieved in full; • Overall achievement for 2014/15 exceeded the level achieved in 2013/14. • The recurrent position has not deviated from the value reported previously. Directorate Annual Target CAMHS Corporate CSS Medicine SSD Surgery Trustwide Totals £389,526 £723,251 £666,136 £1,324,237 £1,390,984 £725,583 £4,240,000 £9,459,716 YTD Plan YTD Actual £389,526 £723,251 £666,136 £1,324,237 £1,390,984 £725,583 £4,240,000 £9,459,716 £399,912 £402,369 £738,902 £1,407,243 £877,627 £252,824 £2,831,366 £6,910,243 YTD Variance % Plan To Date Recurrent Plans £10,386 -£320,882 £72,767 £83,006 -£513,357 -£472,759 -£1,408,634 -£2,549,473 103% 56% 111% 106% 63% 35% 67% 73% £350,050 £359,726 £451,101 £992,784 £937,792 £220,938 £3,110,000 £6,422,392 19 6. Liquidity 20 Cash and Capital. 2014/15 Plan Mar-16 Jan-16 Feb-16 Dec-15 Oct-15 Nov-15 Sep-15 Jul-15 Aug-15 Jun-15 May-15 Apr-15 Mar-15 Jan-15 Feb-15 Dec-14 Oct-14 Nov-14 Sep-14 Jul-14 Aug-14 Actual Rolling Forecast 2014/15 Cumulative and Forecast Capital Expenditure against Plan and Monitor Margins The cash position is included within the Balance Sheet which is included as Appendix Three. The Capital performance to the end of March was only £0.6m behind the revised internal/Monitor plan. The forecast spend for the year of £11.2m was exceeded as work in progress was above estimated levels. Year-end capital expenditure was £12.1m. However, there were still a number of major carry forwards into 2015/16 and these are reflected in the Capital Plan for that year. Jun-14 The graphical analysis includes a cash forecast through to March 2016. This period sees a reduced cash balance as the Parkview development continues along with the first year of the clinical block. Apr-14 60,000 55,000 50,000 45,000 40,000 35,000 £k 30,000 25,000 20,000 15,000 10,000 5,000 0 May-14 The Trust’s Liquidity remains significantly above the Continuity of Service threshold of 4. 2014/15 Cash Position and Rolling Forecast Mar-14 Cash finished the year 13.3% above plan. This equates to £6.1m and is primarily a result of reduced capex against the original plan, the receipt of PDC for the funding of a major IT project and changes in working capital driven by year-end adjustments. Cash reduced in March as there was a greater level of capex spend incurred as the programme moved to within 5% of the revised plan. 16,000 14,000 12,000 10,000 £k 8,000 6,000 4,000 2,000 Apr May 14/15 Actual Jun Jul 14/15 Forecast Aug Sep 14/15 85% Oct Nov 14/15 115% Dec Jan Feb Mar 14/15 Plan - Original 21 Debtors and Creditors. Debtors over 90 days have reduced significantly in March in both actual and % terms. The Private Patient debt remains a high risk of recovery. The outcome of legal proceedings from November are continuing. A report on this will be presented to the Audit Committee in early 2015/16. Of the total £1.7m debtors over 90 days, £1.3m relate to NHS organisations. Although a proportion of these debts result from the early raising of invoices during November prior to a significant period of system down-time, these are being managed appropriately in conjunction with the Trust’s contracting team to ensure money is recovered prior to year-end. These will be progressed as part of the end of year Agreement of Balances process. The Creditors position over 90 days has deteriorated in month. A significant number of unpaid invoices received in December have triggered the 90 day threshold. The vast majority of these are other NHS organisations and will be progressed as part of the end of year Agreement of Balances process. % Debtors and Creditors over 90 days 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Apr May Jun Jul Aug Sep Debtors>90 days % Top 5 Debts Over 90 Days Old Customer Oct Nov Dec Creditors>90 days % 31st March 2015 Jan Feb Mar Target 28th February 2015 Age (Days) 153 Value (£k) 143 Age (Days) 122 Value (£k) 143 Private Patient - MK 1337 139 1306 139 NHS Nene CCG 150 83 119 83 Birmingham Cross City 106 52 HEFT 367 49 336 49 119 46 NHS SE Staff & Seisdon Penninsula CCG NHS Nottingham City CCG 466 461 22 7. Workforce 23 Workforce Report Summary March 2015 Sickness Summary – In month sickness has increased and is now 3.65%, this is lower than this time last year (3.76%). Long term sickness (LTS) has remained constant at around 1.95%, this has been the result of very active management and support. Short term sickness (STS) has increased between January and February 2015 and is at 1.70%. CSS, Specialised and Surgical directorates have seen an increase in their sickness % compared to January 15. The top 3 reasons for sickness during February are, Anxiety/Stress (550.03 WTE days lost), Gastrointestinal problems (525.38 WTE days lost) and Urinary & Gynaecology (270.76 WTE days lost). There is some evidence to suggest that gastrointestinal absences are linked to stress related absences (e.g. IBS exacerbated by stress). A number of support mechanisms have been put into place to reduce stress and improve emotional wellbeing and the new Confidential Care Service is receiving very good feedback. Bank/Agency Usage – Bank usage has increased to 187.30 WTE, compared to February (179.34). Admin usage has decreased to 79.61 WTE, work is being done to make sure that bank shifts are coded to the correct areas so that we can analyse usage in more depth. The figures are showing that there is still an over reliance to use vacancy as the reason when booking a bank shift. This increase is in line with increases in operational pressure over the same period PDR Summary - PDR % has decreased slightly in March and is now 84.53% (February 84.88%). Clinical Support Services , Specialised Services , Medical, Surgical and Corporate all remain above 80%. CAMHS % has decreased and is now at 69.49%. Directorates are continuing to identifying hotspot areas, sending out email reminders to managers and supplying their DMT’s with monthly figures. HR workshops have taken place in CAMHS during February and March with positive feedback and the team are looking at rolling out these workshops to other Clinical Groups. Turnover Summary - 12 month Turnover % for the Trust has decreased slightly for the 12 month period ending March 2015 and remains above the Trust KPI (9%) at 10.62%. The turnover % has decreased slightly for all Directorates apart from Specialised Services, however they all remain above 9%. The main reasons for leaving during March 2015 are voluntary resignation due to relocation (4.00 WTE) and dismissal (1.53 WTE). Exit interview questionnaires are being reviewed and logged on a monthly basis and this report provides a further analysis to inform additional actions. 24 Trust Level Workforce Trends Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2013 4.13% 3.57% 3.32% 2.85% 3.13% 3.39% 3.58% 3.22% 3.36% 3.74% 3.65% 3.43% 2013 2014 3.73% 3.76% 3.69% 3.67% 3.24% 2.98% 3.02% 3.10% 3.06% 3.22% 3.34% 3.97% 2014 9.81% 10.33% 10.97% 11.63% 11.12% 10.90% 11.47% 11.64% 11.01% 10.75% 11.47% 10.96% 2015 11.27% 11.16% 10.62% 2015 3.48% 3.65% 8.37% 7.95% 8.04% 8.00% 8.61% 8.65% 8.69% 8.31% 8.74% 8.88% 9.21% 9.68% Sickness (%) Turnover % 15.00% 5.00% 4.00% 10.00% 3.00% 2.00% 5.00% 1.00% 0.00% 0.00% Jan Feb Mar Apr May Jun 2013 Jan Feb Mar Apr May Jul 2014 Jun Aug Sep Oct Nov Mar Apr Jul Aug May Jun 2013 Sep Oct Nov 0.63% 0.58% 0.57% 0.44% 0.62% 0.67% 0.84% 0.93% 0.82% 0.90% 0.97% 2014 0.97% 0.91% 0.82% 0.79% 0.76% 0.69% 0.52% 0.61% 0.63% 0.68% 0.68% 0.73% Feb 2015 2013 2015 Jan Dec Jan Dec Feb Mar Apr May Jul 2014 Jun Aug Sep Oct Nov Dec 2015 Jul Aug Sep Oct Nov Dec 0.86% 2013 80.96% 80.97% 83.20% 83.13% 83.65% 82.70% 84.13% 84.10% 85.38% 84.63% 84.94% 82.97% 0.77% 2014 82.82% 84.68% 83.66% 82.93% 81.16% 81.70% 83.51% 82.92% 84.75% 84.01% 84.52% 83.78% 2015 86.25% 84.88% 84.53% 0.58% Stress % PDR % Comparison 1.20% 88.00% 1.00% 86.00% 0.80% 84.00% 0.60% 82.00% 0.40% 80.00% 0.20% 0.00% 78.00% Jan Feb Mar Apr May 2013 Jun Jul 2014 Aug 2015 Sep Oct Nov Dec Jan Feb Mar Apr May 2013 Jun Jul 2014 Aug Sep Oct Nov Dec 2015 25 Directorate Workforce Dashboard Indicator Trust Target CSS Medical Specialised Surgical CAMHS Corporate Trust (Previous Month) Trust (Current Month) Trend Sickness % (YTD) <3.00% 3.15% 3.85% 3.24% 3.07% 3.41% 3.18% 3.38% 3.34% ▼ Sickness % (Month) <3.00% 4.28% 3.42% 4.38% 3.40% 2.71% 3.09% 3.49% 3.65% ▲ Episodes LT Sickness % ST Sickness % 115 117 149 89 41 79 652 590 1.97% 1.91% 2.73% 1.55% 1.54% 1.46% 1.94% 1.95% 2.31% 1.51% 1.65% 1.85% 1.17% 1.63% 1.55% 1.70% ▼ ▲ ▲ Stress Sickness % 0.67% 0.25% 1.01% 0.11% 0.96% 0.51% 0.73% 0.58% ▼ MSK Sickness % Cost of sickness 0.44% 0.63% 0.78% 0.19% 0.46% 0.44% 0.46% 0.53% £44,136.49 £49,897.93 £71,704.66 £30,828.38 £17,564.04 £36,939.93 £278,689.19 £251,071.43 ▲ ▼ PDR's % 90% 86.06% 85.71% 88.23% 88.36% 69.49% 82.15% 84.88% 84.53% ▼ Mandatory Training % 95% 84.79% 81.18% 84.99% 81.55% 75.41% 70.92% 77.52% 79.62% ▲ Rolling Turnover % <9% 9.35% 11.37% 9.27% 12.00% 9.92% 11.96% 11.16% 10.62% ▼ WTE in post 526.18 691.53 789.77 463.78 306.34 592.80 3364.79 3370.40 Budgetted WTE 531.52 688.59 840.65 443.15 347.40 573.74 3389.28 3425.05 ▲ 9.34 42.94 59.36 21.82 11.52 42.32 179.34 187.30 ▲ 3.52% 4.86% 3.95% 3.56% 5.02% 2.04% 3.84% 3.77% ▼ Temporary Workforce Maternity Leave % Please note that sickness is still one month behind so we are currently reporting on Februarys data Current months WTE may be slightly lower due to new starters from the 2nd induction still being inputted onto ESR. Turnover % is based on permanent staff leavers only 26 Sickness Absence BCH Sickness Absence - Feb 2015 BCH Total Clinical Support Services Medical Directorate Specialised Services Surgical Directorate CAMHS Services Corporate Priority 3 Number of Episodes Monthly Sickness % Cumulative 12 Month Sickness % 590 3.65% 3.34% 115 4.28% 3.15% 117 3.42% 3.85% 149 4.37% 3.24% 89 3.40% 3.07% 41 2.71% 3.41% 79 3.09% 3.18% Long and Short Term Sickness % 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1.95% 1.97% 1.70% 2.31% BCH Trust Sickness 284 Dir 1 Clinical Support Services 1.91% 2.73% 1.51% 1.65% 284 Dir 2 Medical Directorate 284 Dir 3 Specialised Services Short Term Sickness 1.55% 1.85% 284 Dir 4 Surgical Directorate 1.46% 1.54% 1.63% 1.17% 284 Dir 5 CAMHS Services 284 Dir 6 Corporate Long Term Sickness BCH Sickness Comparison 13/14 April 2.85% May 3.13% June 3.39% July 3.58% August 3.22% September 3.36% October 3.74% November 3.65% December 3.43% January 3.73% February 3.76% 3.67% 3.24% 2.98% 3.02% 3.10% 3.06% 3.25% 3.34% 3.97% 3.48% 3.65% March 3.69% 14/15 Clinical Support Services – Sickness has increased from 3.32% in January to 4.28% in February. There has been 17 LTS cases of which 7 have now returned to work. The outstanding LTS cases relate to urinary/gynaecology, anxiety/stress, injury/fracture, gastro and endocrine/glandular problems. Sickness continues to be monitored closely by management and HR intervention. Medical Directorate – The in month sickness has decreased from 3.57% in January to 3.42% in February. 23 are LTS cases of which 7 have now returned to work. The outstanding LTS cases relate to pregnancy, injury/fracture, stress/anxiety, MSK and genitourinary problems. Complex Care and Oncology Day Care have been highlighted as hotspot areas and monthly meetings have been arranged to review sickness and take any actions required. 2 sickness cases have triggered for a stage 3 review. Specialised Services – Sickness has increased from 3.75% in January to 4.37% in February. There has been 31 LTS cases of which 19 have returned to work. The outstanding LTS cases relate to MSK, gastro and stress/anxiety. Sickness continues to be monitored closely by management/HR intervention and Occupational Health advice is sought. Surgical Directorate – Sickness has increased from 2.90% in January to 3.40% in February.. There are 9 LTS cases of which 3 have now returned to work. The outstanding LTS cases relate to cancer, nervous system disorders, blood disorders and genitourinary problems. Cochlear implants and Wards 5 and 10 have been identified as hotspot areas. Monthly meetings are scheduled to review sickness and take action. 27 Bank/Agency Usage Nov 14 Dec 14 Jan 15 Feb 15 Mar 15 CSS 6.44 7.61 8.77 9.96 11.03 9.34 Medical 44.95 40.25 32.03 32.63 36.23 42.94 Specialised 49.41 47.15 44.16 45.86 56.35 59.36 Surgical 20.92 22.20 19.38 21.92 22.18 21.82 CAMHS 3.78 3.80 4.98 5.42 9.19 11.52 Corporate 54.54 46.38 46.46 45.70 44.36 42.32 Total 180.03 167.39 155.78 161.49 179.34 187.30 Trust Bank/Agency Usage (WTE) Yearly Comparison 250 204 200 WTE Oct 14 187.3 150 100 50 0 * The latest month is an indicative figure and about 95% accurate. The previous month figure will be updated each month Top 3 reasons for Bank/Agency usage 1. Vacancy – 129.38 WTE 2. Sickness – 22.00 WTE 3. Increase in Ward Beds – 9.90 WTE Bank/Agency Usage by Staff Group (%) 2013/14 2014/15 Priority 7 Admin bank and agency usage = 79.61 WTE is a decrease of 1.15 WTE compared to last month Top 3 reasons for Admin usage are Vacancy (77.61 WTE), Maternity (0.96 WTE) and Training (0.28 WTE) Directorate Admin bank and agency is as follows: 0.74 CSS - 2.42 WTE - Labs Management, Audiology and Surgical Day Care 16.18 Medical – 4.83 WTE - Medical Secretary Areas, Dietetics and Haemophillia Unit 42.50 Specialised – 10.43 WTE – Cardiology, Liver and PICU 40.58 Surgical - 16.77 WTE - Medical Secretary Areas & Ophthalmology CAMHS – 5.89 WTE - East Locality and Tier 4 Management A&C Reg Non Reg Medic Corporate – 39.26 WTE – Health Records, Patient Access Call Centre and Domestics 28 Turnover Analysis The top 4 reasons for leaving for permanent staff for each Directorate (excluding Other/Not known) are: Permanent Staff Turnover % The current turnover % for the period April 14 to March 15 is 10.62%. This excludes all staff on a fixed term contract (such as apprentices, Interns, deanery doctors and other fixed term employees). There has been a slight decrease in turnover compared to 2013/14 which was 10.96%. CSS Specialised 10.43 WTE Relocation 7.77 WTE Promotion 4.40 WTE Work life Balance 3.60 WTE Education/Training 17.47 WTE Relocation 6.63 WTE Work Life Balance 5.00 WTE Health Reasons 4.63 WTE Promotion Medical Surgical 28.80 WTE Relocation 7.00 WTE Promotion 4.81 WTE Work Life Balance 3.69 WTE Retirement 14.00 WTE Relocation 6.15 WTE Promotion 3.80 WTE Education/Training 3.00 WTE Work Life Balance CAMHS Corporate 6.00 WTE Relocation 4.00 WTE Education/Training 2.50 WTE Promotion 2.00 WTE Health Reasons 17.80 WTE TUPE Transfer 9.27 WTE Promotion 4.93 WTE Work Life Balance 4.70 WTE Relocation We have identified that for 80.69 WTE of leavers the reasons for leaving is Other/Unknown. 29 Appraisals CSS PDR’s have decreased slightly from last month however they are still above the Trust target at 88.69%. They continue to be discussed at DMT meetings and all managers are continually reminded of the importance of expediting them annually as well as ensuring staff have quality appraisals. Medical Rates have increased from last month and are now above 85%. Medical Secretary areas for Haematology/Oncology and Rheumatology have all been identified as hotspot areas for low PDR rates and are being monitored. In addition, adhoc support/training is provided for managers where required. Staff Group - Table 1 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Add Prof Scientific & Technical 87.50% 87.56% 85.52% 85.97% 81.65% 80.18% Additional Clinical Services 87.14% 89.81% 88.44% 87.16% 86.02% 83.28% Admin & Clerical 75.54% 75.99% 76.76% 78.98% 77.72% 77.62% AHP's 88.72% 92.54% 92.59% 95.49% 91.91% 90.37% Estates & Anciliary 88.24% 82.84% 82.84% 88.89% 91.37% 93.62% Healthcare Scientists 84.30% 85.00% 82.35% 90.68% 89.17% 85.47% Nursing 86.24% 86.47% 85.57% 88.02% 86.90% 87.65% Table 2 Oct-14 Nov-14 BCH 84.01% 84.52% 83.78% 86.24% 84.88% 84.53% Clinical Support Services 90.23% 93.24% 92.27% 91.91% 88.69% 86.06% Medical Directorate 84.73% 83.41% 80.85% 83.93% 83.23% 85.71% Specialised Services 88.35% 89.49% 89.06% 89.48% 88.61% 88.23% Surgical Directorate 81.08% 83.50% 85.90% 91.05% 89.56% 88.36% CAMHS Services 85.65% 84.35% 80.43% 76.27% 73.50% 69.49% Corporate 74.08% 72.67% 77.12% 80.87% 80.69% 82.15% Priority 3 Dec-14 Jan-15 Feb-15 Mar-15 Corporate PDR’s are now showing an improvement and have been above 80% since January. Reports continue to be sent on a monthly basis and managers are reminded monthly about their PDR completion rates and progress has been made in the last quarter. CAMHS PDR rates have continued to decrease since October 2014. Ashfield Ward, South Locality and Irwin Ward are identified as hotspot areas for low PDR rates. HR workshops took place during February and March which trained managers on how to input PDR’s onto ESR. In addition, ad hoc support/training is provided for managers where required. Specialised Surgical PDR’s have decreased slightly but are still above target at 87.23%. PDR reports continue to be sent out on a monthly basis with links to additional support/training and this will be followed up by the HR Advisory team to ensure that outstanding PDR’s are diarised going forward. Rates have continued to decrease since January 15. Paediatric Surgery, Renal Unit and Medical Secretary areas for Dental, Cranio and Cleft have been identified as hotspot areas for low PDR rates with support/training being provided for managers where required. 30 Mandatory Training Update Mandatory training reporting on Vesper has been aligned to the new clinical groupings effective 1st April 2015. Currently, the Vesper workforce dashboard is presenting statistics for the old and new structure which encompasses thirteen groups. The old structure will be removed on 21st April. In order to provide the most accurate mandatory training statistics, this report will utilise activity data reported on 25th March and prior to any changes taking place. Mandatory training compliance on 25th March was 79.62% representing a 0.3% increase since the last report. The table below shows the Trust Level Breakdown as at 25th March and the trajectory since Dec 2014. Thirteen out of twenty one topics are showing an increase. Following the January launch of the refreshed Moodle modules, Education Reporting continue to see an increase in online course access and completions and the access and reporting issues have been resolved. The “Moodle Amnesty” introduced during March did result in some staff coming forward but not as many as expected and Education Reporting are therefore undertaking a Moodle Amnesty Review for the period of Aug 2014-Dec 2014 to ensure that mandatory training is checked and recorded. Looking back at training activity, attendances at face to face induction and mandatory training topics between 1/4/14 and 31/3/15 were 6176. During this period, Education Reporting recorded 805 Did not Attends and 778 Withdrawals which is an average of 13%. In terms of the impact of winter pressures on training activity, 1802 courses places were booked between 1/11/14 and 27/2/15 and recorded 232 Withdrawals and 220 Did not Attends which is an average of 17% and an increase of 4% on the annual average. Actions to improve: Improving Compliance - Managers need to consider how they allocate staff time to complete online or face to face training and reduce Withdrawals and Did not Attends. Targeting of Red Flags – Education Reporting will continue to focus on targeting departments and topics that are “Red Flags” to make sure any data issues are resolved . This is escalated through DMT meetings/reports . Data Query Management – Education Reporting are managing data queries within the KPI of 21 days (currently resolving queries within 48 hours). Plans to introduce a web based query reporting system via the BCH Intranet. Moodle Amnesty Review – Period Aug 14 to Dec 14 – checks and updates in progress. Exclusions Update – Alignment to new clinical groups requires refresh of competency exclusion rules (90% complete). Face to Face Training Updates – M&H foundation and refresher training updates to be implemented from 1st May 2015. 31 BCH Nursing Staffing: • Capacity: Additional winter capacity has been used as required while normal winter activity continued. PICU had a challenging month with a national pressure being reflected. • Staffing: Sickness levels continued at February levels the overall vacancy level didn’t change. There was an increase in annual leave taken in March ’15 due to staff taking outstanding annual leave before end of the financial year. • Temporary Staffing: A year on year fall in Bank use although specific areas have shown spikes in requirements. • During March no red shifts were recorded Nursing Workforce Summary Monthly Ave: Act vs. Plan Acuity Skill Mix Vacancy Annual Leave Mat Leave Sickness Jan-15 100.3% 95.8% 78.8% 0.1 18.1% 7.7% 7.2% Feb-15 99.8% 91.8% 78.7% 0.2 16.5% 7.0% 6.0% Mar-15 99.8% 92.2% 79.2% 0.1 20.0% 7.3% 6.0% Nursing Workforce March 2015 Nursing Workforce Dashboard: Ward Nursing Staffing Actual vs Planned Registered Care Staff Registered Care Staff Day Feb 15 Day Night Patient Acuity Level Total Night Actual vs Actual vs Actual vs Actual vs Actual vs Planned Planned % Planned % Planned % Planned % % 92.2% 101.2% 98.9% 87.4% 95.0% No of No of No of Green Amber Red shifts shifts shifts Unfille Registere d d Skill Roster Mix% % Planned Resources Unplanned: Actual & Response Actual Mat Non hours Vacanc Leave Leave Clinical vs Staff y WTE % % % in Post Sicknes s Bank Fill % No of Bank Times Used Raised to HoN 87 6 0 76.4% 12.3% 58% 0.2 19% 7% 9% 9% 52.9% 9% Neonatal Surgical 97.2% 110.3% 102.2% 103.0% 100.3% 88 5 0 83.0% 2.9% 68% 0.2 20% 5% 6% 1% 80.0% 0% 0 Ward 1 94.6% 104.6% 99.0% N/A 97.8% 89 4 0 79.5% 17.1% 70% 0.1 17% 4% 5% 8% 33.3% 2% 0 Burns 0 Ward 5 90.0% 112.4% 95.9% 112.2% 97.3% 85 8 0 71.4% 8.1% 62% 0.1 17% 6% 7% 4% 56.8% 3% 0 Ward 9 95.7% 136.8% 97.6% 95.6% 100.5% 75 18 0 76.2% 10.6% 71% 0.1 14% 5% 13% 5% 26.7% 1% 0 Ward 10 96.9% 98.3% 97.4% 93.5% 97.0% 93 0 0 84.7% 5.4% 66% 0.2 17% 6% 8% 5% 73.3% 4% 0 ED 97.9% 97.4% 90.4% 112.5% 95.8% 80 13 0 76.4% 6.8% 71% 0.1 20% 7% 9% 11% 64.5% 17% 0 PAU 94.7% 95.6% 97.9% 99.9% 96.4% 82 11 0 77.4% 14.6% 69% 0.1 18% 7% 3% 5% 58.0% 0% 0 Ward 2 92.1% 82.5% 99.2% 93.2% 92.8% 87 6 0 77.6% 16.7% 69% 0.1 18% 7% 5% 6% 66.7% 6% 0 Ward 7 92.5% 91.1% 96.6% 117.9% 96.2% 88 5 0 84.2% 7.0% 82% 0.0 19% 3% 10% 6% 79.2% 4% 0 MHDU 95.1% N/A 88.0% N/A 91.8% 86 7 0 100.0% 3.7% 70% 0.3 20% 5% 13% 2% 58.5% 9% 0 Ward 15 90.1% 80.8% 96.4% 91.1% 91.0% 76 17 0 87.7% 17.4% 68% 0.2 20% 4% 6% 7% 53.9% 13% 0 ODC* 112.2% 97.5% N/A N/A 107.3% 93 0 0 72.6% 19.5% 67% 0.1 17% 13% 3% 11% n/a 0.0% 0 Ward 8 88.2% 133.4% 98.0% 96.8% 95.3% 62 4 0 88.0% 8.8% 62% 0.3 19% 12% 8% 6% 70.0% 15% 0 Ward 11 94.4% 86.5% 97.9% 93.3% 95.0% 88 5 0 87.7% 2.6% 69% 0.2 20% 6% 5% 8% 61.4% 11% 0 Ward 12 92.5% 110.6% 91.1% 103.6% 94.4% 85 8 0 83.6% 6.6% 69% 0.1 22% 9% 5% 4% 65.7% 13% 0 PICU 103.2% 93.0% 106.4% 163.3% 105.1% 87 6 0 89.9% 43.3% 59% 0.3 21% 6% 12% 6% 47.5% 12% O MDC* 80.0% 99.0% N/A N/A 83.5% 62 4 0 83.8% 17.6% 77% 0.1 15% 16% 8% 1% 63.6% 4% 0 SDC* 88.8% 86.8% N/A N/A 88.2% 66 0 0 66.0% 28.3% 55% 0.1 20% 13% 3% 3% 87.2% 22% 0 Ashfield 108.6% 121.1% 106.6% 146.9% 113.6% 80 13 0 71.9% 27.8% 64% 0.1 22% 0% 15% 3% 81.8% 7% 0 Heathlands 107.2% 114.6% 87.3% 87.5% 99.0% 91 2 0 72.6% 31.6% 57% 0.2 16% 11% 10% 10% 91.2% 12% 0 99.0% 109.3% 123.8% 101.4% 106.0% 93 0 0 52.4% 26.0% 65% -0.1 27% 9% 11% 3% 100.0% 5% 0 96.3% 100.1% 105.0% 99.8% 1823 142 0 79.23% 15.2% 66.7% 7.9% 6% 65.3% 8% 0 Irwin Trust Average: * Excluded from National Upload 99.4% 107.1% 112.7% 0.1 19.0% 7.3% Nursing, Midwifery and Care Staff Staffing March 2015 Submission to NHS England Day Main 2 Specialties on each ward Ward name Specialty 1 Specialty 2 Night Day Night Registered midwives/nurses Care Staff Registered midwives/nurses Care Staff Average fill rate Average fill rate Average fill rate Average fill rate registered registered Total monthly Total monthly Total monthly Total monthly Total monthly Total monthly Total monthly Total monthly nurses/midwives care staff (%) nurses/midwives care staff (%) planned staff actual staff planned staff actual staff planned staff actual staff planned staff actual staff (%) (%) hours hours hours hours hours hours hours hours 171 - PAEDIATRIC 160 - PLASTIC SURGERY SURGERY 1482 1366 338 342 979 968 231 202 92.20% 101.20% 98.90% 87.40% 171 - PAEDIATRIC 171 - PAEDIATRIC SURGERY SURGERY 2223 2161 293 323 1562 1596 440 451 97.20% 110.30% 102.20% 103% Ward 1 171 - PAEDIATRIC 361 SURGERY NEPHROLOGY 1326 1254 436 456 1078 1067 0 0 94.60% 104.60% 99.00% N/A Ward 5 171 - PAEDIATRIC 100 - GENERAL SURGERY SURGERY 2048 1843 780 877 1353 1298 341 383 90.00% 112.40% 95.90% 112.20% Ward 9 171 - PAEDIATRIC 100 - GENERAL SURGERY SURGERY 2145 2053 442 605 1364 1331 341 326 95.70% 136.80% 97.60% 95.60% 2106 2042 449 441 1353 1318 341 319 96.90% 98.30% 97.40% 93.50% 2698 2641 1177 1146 2442 2209 341 384 97.90% 97.40% 90.40% 112.50% 2061 1952 605 578 1452 1422 462 462 94.70% 95.60% 97.90% 99.90% 2080 1916 748 617 1386 1375 649 605 92.10% 82.50% 99.20% 93.20% 1996 1846 475 433 1375 1328 429 506 92.50% 91.10% 96.60% 117.90% 1190 1131 0 0 1012 891 0 0 95.10% N/A 88.00% N/A 3959 3569 1294 1046 3014 2904 220 201 90.10% 80.80% 96.40% 91.10% 2412 2128 312 416 1661 1628 341 330 88.20% 133.40% 98.00% 96.80% 2457 2319 325 281 1617 1583 330 308 94.40% 86.50% 97.90% 93.30% 2386 2206 436 482 1562 1423 308 319 92.50% 110.60% 91.10% 103.60% 11986 12368 702 653 9900 10532 330 539 103.20% 93.00% 106.40% 163.30% Burns Neonatal Surgical Ward 10 ED PAU Ward 2 Ward 7 MHDU Ward 15 Ward 8 Ward 11 Ward 12 PICU 171 - PAEDIATRIC 150 SURGERY NEUROSURGERY 180 - ACCIDENT & 420 EMERGENCY PAEDIATRICS 420 300 - GENERAL PAEDIATRICS MEDICINE 420 300 - GENERAL PAEDIATRICS MEDICINE 420 300 - GENERAL PAEDIATRICS MEDICINE 420 192 - CRITICAL PAEDIATRICS CARE MEDICINE 303 - CLINICAL 420 PAEDIATRICS HAEMATOLOGY 420 171 - PAEDIATRIC PAEDIATRICS SURGERY 170 321 - PAEDIATRIC CARDIOTHORACI CARDIOLOGY C SURGERY 170 321 - PAEDIATRIC CARDIOTHORACI CARDIOLOGY C SURGERY 420 192 - CRITICAL PAEDIATRICS CARE MEDICINE 711- CHILD and ADOLESCENT PSYCHIATRY 711- CHILD and ADOLESCENT PSYCHIATRY 1320 1433 618 748 1012 1079 275 404 108.60% 121.10% 106.60% 146.90% 711- CHILD and Heathlands ADOLESCENT PSYCHIATRY 711- CHILD and ADOLESCENT PSYCHIATRY 1242 1332 403 462 1034 903 396 347 107.20% 114.60% 87.30% 87.50% 711- CHILD and ADOLESCENT PSYCHIATRY 711- CHILD and ADOLESCENT PSYCHIATRY 943 934 631 689 385 477 528 535 99.00% 109.30% 123.80% 101.40% Ashfield Irwin BIRMINGHAM CHILDREN'S HOSPITAL NHS FOUNDATION TRUST Income and Expenditure Summary (Working Document) For the Period Ended: 28/02/2015 Annual Plan to Monitor £'000 Appendix One Revised Annual Plan £'000 In Month Budget £'000 In Month Actual £'000 In Month Variance £'000 YTD Plan to Monitor £'000 Revised YTD Budget £'000 Year To Date Actual £'000 Year To Date Variance £'000 Income NHS Clinical Income Elective Inpatients Elective Day Cases Non-Elective Outpatients ED Other Royal Orthopaedic Total NHS Clinical Income 25,894 16,964 33,478 23,029 4,843 113,102 475 217,785 25,685 16,705 32,831 15,858 4,868 123,491 475 219,914 2,228 1,519 2,965 1,434 455 12,094 (13) 20,683 1,904 1,605 3,010 1,569 462 12,163 (13) 20,700 (324) 86 45 135 7 69 0 18 19,264 12,529 24,623 11,894 3,651 145,467 356 217,784 25,685 16,705 32,831 15,858 4,868 123,491 475 219,914 24,314 17,546 33,102 16,803 5,038 129,616 475 226,894 (1,371) 841 271 945 169 6,124 0 6,979 211 211 211 211 18 18 5 5 (12) (12) 211 211 211 211 581 581 370 370 7,038 2,300 (2,081) 2,546 1,696 1,843 1,021 1,049 4,254 0 0 19,666 7,038 2,300 0 3,198 1,791 2,276 748 1,339 5,047 0 0 23,737 587 230 0 394 149 174 60 118 723 0 0 2,436 1,025 43 0 404 233 139 129 127 1,189 0 0 3,290 438 (187) 0 10 84 (35) 68 9 466 0 0 854 7,038 2,300 (2,081) 2,546 1,696 1,843 1,021 1,049 4,254 0 0 19,667 7,038 2,300 0 3,198 1,791 2,276 748 1,339 5,047 0 0 23,737 7,372 238 0 3,402 1,907 1,912 873 1,233 6,689 0 0 23,626 334 (2,062) 0 204 116 (364) 125 (105) 1,642 0 0 (110) 237,663 243,862 23,137 23,996 859 237,662 243,862 251,101 7,239 Pay Clinical Support Services Directorate Medical Directorate Directorate of Specialised Services Surgical Directorate CAMHs Corporate Pay Inflation Reserve Other Pay Reserves Phasing Adjustment Total Pay 20,381 31,397 40,377 22,854 14,605 19,154 4,158 0 0 152,926 21,195 33,557 40,938 23,124 14,296 20,658 0 1,207 0 154,973 1,804 2,995 3,414 1,992 1,207 2,155 0 1,221 0 14,789 1,880 3,141 3,463 2,120 1,357 4,471 0 0 0 16,433 (77) (146) (49) (128) (150) (2,316) 0 1,221 0 (1,644) 20,381 31,397 40,377 22,854 14,605 19,154 4,158 0 (4,663) 148,263 21,195 33,557 40,938 23,124 14,296 20,658 0 1,207 0 154,973 21,518 34,408 41,243 24,936 14,322 23,179 0 0 0 159,605 (323) (851) (305) (1,812) (26) (2,521) 0 1,207 0 (4,632) Non-Pay Clinical Support Services Directorate Medical Directorate Directorate of Specialised Services Surgical Directorate CAMHs Corporate Leases Non-Pay Reserves and Developments Impairment Total Non-Pay 7,892 19,781 12,760 5,628 1,365 13,586 244 11,659 0 72,915 11,975 22,510 11,291 7,903 1,700 16,865 218 4,646 0 77,108 1,266 1,996 971 1,011 181 1,588 20 1,903 0 8,935 1,543 2,182 1,380 708 261 2,236 0 (92) 2,785 11,002 (277) (186) (409) 303 (80) (648) 20 1,995 (2,785) (2,068) 7,892 19,781 12,760 5,628 1,365 13,586 244 16,322 0 77,578 11,975 22,510 11,291 7,903 1,700 16,865 218 4,646 0 77,108 12,593 22,908 15,148 8,250 1,865 18,949 244 9 2,785 82,751 (618) (397) (3,857) (347) (165) (2,084) (27) 4,636 (2,785) (5,644) 225,841 232,081 23,723 27,435 (3,712) 225,842 232,081 242,356 (10,275) 11,822 11,782 (587) (3,440) (2,853) 11,820 0 4,624 2,762 (243) 300 4,559 2,762 (247) 326 0 380 230 (21) 27 0 369 110 (18) 23 0 11 120 (3) 4 0 4,624 2,762 (243) 300 8,745 3.5% 0 4,530 2,498 (176) 282 (3,036) Loss on Disposal of Fixed Assets Depreciation Dividends on PDC Interest Receivable Interest Payable 11,782 4.8% 0 4,559 2,762 (247) 326 Retained Surplus/(Deficit) For Period 4,379 4,381 (1,203) (3,924) (2,721) 4,377 4,381 1,612 (2,769) Non NHS Clinical Income Road Traffic Act (RTA) Income Total Non NHS Clinical Income Other Income Teaching and Research Donated Assets Other Central Income Clinical Support Services Directorate Medical Directorate Directorate of Specialised Services Surgical Directorate CAMHs Corporate Other Income Reserves Other Total Other Income Total Income Central income only Operational Expenditure Total Operational Expenditure EBITDA 0 30 264 (71) 45 Appendix Two Analysis of Expenditure by Cost Category Plan Actual Variance YTD YTD YTD YTD YTD YTD 7.86 32.47 16.29 56.17 20.69 20.98 7.38 31.44 15.86 54.34 21.87 20.24 0.48 1.03 0.43 1.83 -1.19 0.74 YTD YTD YTD YTD YTD YTD 0.00 0.06 0.10 0.26 0.06 0.04 154.97 0.00 1.80 1.16 4.13 1.05 0.32 159.59 0.00 -1.74 -1.06 -3.87 -0.99 -0.28 -4.62 YTD YTD YTD Total Non-Pay 28.23 22.40 26.48 77.11 29.10 23.85 29.80 82.74 -0.87 -1.45 -3.32 -5.64 Total Operating Expenses 232.08 242.33 -10.25 4.56 2.76 0.33 4.54 2.50 0.28 0.02 0.26 0.04 239.73 249.65 -9.92 Pay Substantive Staffing Senior Management (including Board) Medical Consultants Other Medical Staffing Nursing Admin, Maintenance and Support Workers Professional/Technical and AHPs Bank, Agency and Locum Staffing Senior Management (including Board) Medical Consultants Other Medical Staffing Nursing Admin, Maintenance and Support Workers Professional/Technical and AHPs Total Pay Non Pay Below the Line Drugs Clinical Supplies Other Operating Expenses Depreciation and Amortisation PDC Dividend Expense Interest Expense on PFI Total Expenditure YTD YTD YTD Appendix Three Balance Sheet as at 28th February 2015 31st March 2015 £000 Non-Current Assets PPE - owned PPE - PFI Intangible Assets Non-Current Financial Assets Other Receivables Non-Current Total Non-Current Assets 106,307 3,122 424 500 1,572 111,925 31st March 2014 £000 99,713 1,079 303 600 1,399 103,095 Current Assets Inventories NHS Trade Debtors Non NHS Trade Debtors Debtor re Capital Receipts Provision for irrecoverable debts Prepayments Accrued Income Cash at GBS Cash And Cash Equivalents - non-GBS Total Current Assets 4,278 4,070 2,912 (1,698) 3,744 6,489 51,453 94 71,341 3,817 6,729 2,799 (1,757) 1,691 4,260 48,525 (9) 66,054 Current Liabilities Deferred Income NHS (Trade) Creditors Non-NHS (Other) Creditors Other creditors Capital Creditor Tax and Social Security Provisions<12 Months PDC Creditors Accruals (8,182) (5,262) (6,842) (7,470) (2,177) (3,267) (5,067) (5,566) (5,757) (4,032) (7,507) (4,071) (959) (3,121) (1,462) (8,020) Total Current Liabilities (43,834) (34,929) Net Current Assets 27,507 31,126 139,432 134,220 Total Assets Less Current Liabilities Accrued and Deferred Income Non-Current Provisions for Liabilities and Charges PFI Liability Total Assets Employed (1,031) (2,233) (1,614) (1,417) (3,827) (1,738) 134,554 127,238 Taxpayers' Equity Retained earnings Public Dividend Capital Revaluation Reserve 28,494 89,551 16,509 26,873 87,723 12,642 Total Taxpayers Equity 134,554 127,238 Financed by: Appendix Four Capital Programme - Year to Date and Forecast Positions Area Pre-Commitments Including Parkview CT Scanner Gamma Camera Electrical Infrastructure Estates Building IT Medical Equipment Strategic Development Other Patient Experience Facilities Central Function Other Contingency Total BCH Spending Externally funded schemes Respiratory Services Sensory Garden Theatre Project Transnasal navigation system ePMA Cryoconsole FibroScan Incu Controller Unit End Life Project Magnolia House Total BCH Charity Funded Total Capital Spending Monitor Plan Resubmitted Plan Annual Forecast Forecast Variance £000's 5,818 2,098 866 754 800 1,728 360 3,395 1,650 0 620 170 150 300 0 0 13,571 £000's 5,985 2,098 866 754 800 1,603 370 1,102 1,675 0 737 280 150 307 0 0 11,472 £000's 6,076 2,306 1,137 0 1,287 1,728 135 1,642 1,530 0 706 50 78 578 0 0 11,818 £000's 92 208 272 (754) 487 124 (235) 541 (145) 0 (31) (230) (72) 271 0 0 346 YTD Revised Plan £000's 6,414 2,098 866 754 705 1,603 250 1,033 1,315 0 1,329 280 150 307 592 0 11,944 0 0 0 0 1,469 0 0 0 0 1,469 15,040 1 9 0 0 786 0 0 0 0 796 12,268 (19) 9 12 24 136 18 100 18 19 317 12,135 (21) 0 12 24 (650) 18 100 18 19 (478) (133) 1 9 0 0 786 0 0 0 0 796 12,740 YTD Actual % of Scheme Total YTD Variance £000's 6,505 2,306 1,137 0 1,287 1,728 135 1,573 1,170 0 706 50 78 578 0 0 11,818 £000's 109% 110% 131% 0% 161% 108% 37% 143% 70% n/a 96% 18% 52% 188% n/a 103% £000's (92) (208) (271) 754 (582) (124) 115 (541) 145 0 623 230 72 (271) 592 0 126 (19) 9 12 24 136 18 100 19 19 319 12,137 -1510% 104% n/a n/a 17% n/a n/a n/a n/a 40% 95% 21 (0) (12) (24) 650 (18) (100) (19) (19) 516 642 CEO Briefing notes Tuesday 28 April 2015 Operational update • • • • • • • • • • March turned out to be another record month for emergency demand. This put significant pressures on our services and beds which led to a number of performance challenges. Our ED four hour performance was 92.8%, however, we exceeded the 95% standard for Q4 and the year as a whole, which was our overriding aim. Cancelled Operations were high at 45 - mainly due to beds, but also emergency theatre capacity. We did meet both the non-admitted and admitted 18-week standards though. Our new Ward 17/Theatre 10 opened on March 23rd which provides much needed capacity to help ease our pressure and reduce our waits. Whilst the problems with our Decontamination Unit were resolved in February, we are still clearing the backlog built up over several months and at the end of March, 24 children were waiting over 6weeks for an endoscope. We expect the backlog to be finally cleared in May. MRI demand continues to grow (just under 16% per year) outstripping our MRI capacity, and at the end of March, 68 children were waiting over six weeks for a scan. We are working on a number of projects to (i) see how we can better understand and manage this growth and (ii) increase our MRI capacity. More on this will follow in future months. And for April so far, all was fine for the first two weeks, however, week three has been tight due to a combination of an increase in our greater than seven day inpatients and we have seen especially high levels of emergency admissions on some days. Transport and car parking update • • • • • Following the news that our Whittall Street car park will be closing on Friday 22 May, we have held two really successful transport information days to talk about all the options available to staff. Various transport organisations have come along to support us, including NCP, our preferred car park provider, and the Smarter Networks Team. Hopefully we have addressed all questions and concerns, and presented a full range of options for people to have a think about. There are two further information sessions on Tuesday 5 May and Thursday 7 May All the details of rates, locations of car parks across the city and ticket application guidelines are on the intranet. Transport survey now available on intranet • • • We are keen to continue building on and improving transport options for staff and have launched an online transport survey to help us with this. The results of this will be especially useful if we do decide to move our site in the future. There is a link to the survey from the homepage of the intranet. £30m new clinical building • • • • • We are excited to announce that Interserve will manage the huge project of designing and building our £30m clinical facility on Whittall Street. Interserve is the world’s leading support and construction company and we have no doubt they will do a fantastic job of achieving our vision of creating something outstanding for children and young people. In the coming months we’ll be talking to lots of staff, young people and families about what they want to see in this new building. We are starting off with the big creative ideas – meerkats, pygmy goats and fishtanks have all been discussed so far! The project team got the full YPAG experience a couple of weekends ago and they got some really great ideas about themes and what they feel would make the building extra special. We also need a name for the building and will be asking staff to get involved in this discussion. Friends and Family Test • • • • • • • The results are in from our online staff survey, the Friends and Family Test. The survey closed on 8 March and we’ve since been busy collating all the results and feedback. The survey gives all staff the opportunity to tell us what they think and feel about working here so that we can make their experience as enjoyable and fulfilling as possible. It also asks about whether you would recommend a relative or friend for treatment here. This year we had 124 responses to the survey which was very encouraging! Of those who responded, 98% said they would recommend BCH as a place to receive care and treatment, more than ever before. Meanwhile 74% of staff would recommend BCH as a place to work. Overall, these are very positive results, with staff responding more positively about working here and also the standard of our patient care in comparison to previous years – but there is still room for improvement. New charity number • In order to meet the new guidelines set by NHS Charities, our hospital charity has updated its registered charity number. This is being promoted across the hospital. Cancer Centre Appeal Celebration Event • • Last Wednesday I was incredibly proud to attend a celebration event to recognise the huge fundraising efforts of over 60 of our biggest Cancer Centre Appeal donors. In just 2.5 years they, and many others, helped us reach our very ambitious £4m target. In other news • YPAG tea party • Our fantastic Young Persons’ Advisory Group (YPAG) is five years old and we held a lovely tea party to celebrate in style! The group’s Chair Sophie and its two longest serving members, Ben Taylor and Natasha Dhokiya joined me, Michelle McLoughlin, Janette Vyse and Iona Clayton from the Patient Experience Team. • Ben and Natasha are both previous patients and Ben has been part of the group since its first meeting in January 2010. • YPAG has achieved a huge amount over the past five years; they meet regularly and have previously been involved in consultations, ward walkabouts and staff interviews, raising the voice of children and young people and giving them a say in all of our important decisions. • • • • • • • • • • • Chamber of Commerce Awards Our RAPID research study has been shortlisted - we will find out if we are a winner on Thurs 23 April. Pride of Nursing Awards update The Birmingham Mail closed nominations for the Pride of Nursing Awards at the end of last month and we are now very close to hearing how many of our staff nurses and nursing teams have been nominated for the award! The award is the first of its kind in the West Midlands, and recognises all of the standout nurses in the region that go the extra mile for their patients. Our nurses have received quite a bit of news coverage this month on the back of the awards Stephanie Bryan, one of our PICU nurses, is the newly appointed face of the campaign and our PICU nursing team also made the headlines as a former member of staff put them forward for their outstanding patient care and – in her words - ‘hearts of gold.’ We are expecting the official announcement soon! Give month This month was ‘Give’ month, the third of our ‘Five ways to wellbeing’ months. As part of ‘Give’ month, our Staff Experience team promoted all the ways you can ‘give’ and ‘receive’ every day and how this positively impacts on our health and wellbeing. The team also held two successful self-care workshops this month to explore all the ways we can show compassion for ourselves, what ‘giving’ means to us and practical ways we can give and receive in our daily lives. Coming up • • • • May – new Irwin Unit opens - As of next month we will be opening our doors to our all new Irwin Eating Disorders unit at Parkview. Children and young people will now have single ensuite rooms for the first time. Next month, Dan O’Mara will be doing a presentation on it at a CEO Briefing. Saturday 30 May – We are holding our annual Nurse Open Day. We have launched a campaign to get as many nurses as possible signed up for the event and we are getting a great response. Please pass on the details to any aspiring BCH nurses you might know! Thursday 28 May – Our next Intent2Listen session will be held on Thursday 28 May giving staff the chance to speak with me and the Executive Team about issues that are important to then and their team. Fitness classes – And don’t forget that free yoga classes are ongoing throughout May and June, taking place every Thursday morning in the Education Centre from 7.30am – 8.30am. The sessions will be suitable for all ages and abilities, so why not come along and try your hand at yoga! Presentations held at the April CEO Briefing • Hilary Brown (Partner Governor) and Carl Harris (Staff Governor) – The role of the Governor • Sara Brown – Staff survey results Star of the Month • Winner is – Suzie Hewitt – Site Practitioner