Board of Directors - Royal Berkshire Hospital · – Part 1. Topic Lead Time 1. Opening and...

Board of Directors Wednesday 27 March 2019, 9.30 – 11.40 Seminar Room, Trust Education Centre, Royal Berkshire Hospital We provide a comprehensive service, based on clinical need, not an individual’s ability to pay. We aspire to the highest standards of excellence and professionalism and to put patients at the heart of everything we do. We are accountable to the public, communities and patients that we serve.

Board Meeting – Part 1 Topic Lead Time 1. Opening and Apologies for Absence

Graham Sims

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2. Staff Story*

Caroline Ainslie 9.30

3. Patient Story*

Lindsey Barker 9.40

4. Health & Safety Update*

Nicky Lloyd 9.50

5. Minutes of 30 January 2019 and Outstanding Actions Schedule and Declarations of Interest

Graham Sims 10.00

Executive Team Performance update 6. a) Chief Executive’s Report

b) Integrated Performance Report c) Integrated Care System Update

Steve McManus Caroline Ainslie Andrew Statham

10.05 10.15

7. Corporate Risk Register

Caroline Ainslie 11.05

8. Health & Safety Annual Report Nicky Lloyd

11.15

9. Staff Survey Results Don Fairley

11.25

Minutes of Board Committee Meetings and Committee updates 10. a) Finance & Investment Committee 21 January

2019, 18 February 2019 and 18 March 2019* b) Quality Committee 12 February 2019 c) Audit & Risk Committee 13 March 2019* d) Charity Committee 23 January 2019 and

13 March 2019* e) Workforce Committee 18 February 2019

Sue Hunt Helen Mackenzie John Petitt Graham Sims Julian Dixon

11.35

11. Board Work Plan

Caroline Lynch -

12. Date of Next Meeting and Close Wednesday 29 May 2019 10.00 -13.30

Graham Sims -

Agenda

* verbal

‘Working together to provide outstanding care for our community’ Our Values: Compassionate | Aspirational | Resourceful | Excellent

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Agenda Item 5

Board Wednesday 30 January 2019 9.30 – 13.30 Seminar Room, Trust Education Centre, Royal Berkshire Hospital Members Present Mr. Graham Sims (Chair) Mr. Steve McManus (Chief Executive) Ms. Caroline Ainslie (Director of Nursing) Dr. Lindsey Barker (Medical Director) Mr. Julian Dixon (Non-Executive Director) Mr. Brian Hendon (Non-Executive Director) Mrs. Sue Hunt (Non-Executive Director) Mrs. Helen Mackenzie (Non-Executive Director) Mrs. Nicky Lloyd (Chief Finance Officer) Mr. John Petitt (Non-Executive Director) Ms. Mary Sherry (Chief Operating Officer and Deputy Chief Executive) In attendance Mr. Craig Anderson (Director of Finance) Mr. Don Fairley (Director of Workforce) Mrs. Caroline Lynch (Trust Secretary) Mrs. Victoria Parker (Director of Communications & Engagement) Mr. Andrew Statham (Director of Strategy) Apologies There were two governors, five members of staff and two members of the public present. The Director of Nursing introduced the team from Redlands Ward and explained that, Redlands were the seventh of eight wards in Planned Care to successfully achieve their ward accreditation. The Director of Nursing highlighted that the Chief Operating Officer had expressed her personal thanks to the team as the response from Redlands Ward had been excellent during the Winter period. Helen Slade, Ward Sister, advised that the accreditation process had been challenging. However, there had been good support from her team and she was proud of their hard work. The Board congratulated the team. The Director of Nursing introduced a video of an interview with Mrs Walker who was a carer for her husband that suffered with dementia. Mrs Walker highlighted that on a number of occasions when admitted to the hospital she had to continually remind staff that her husband had dementia and to ensure he was identified as such. Mrs Walker had previously worked as a nurse at the Trust and she advised that when she informed staff of this their approach to her changed. Mrs Walker had also noticed that tables with wheels were in ward areas where patients were at risk of falls. The Director of Nursing advised that processes were in place for dementia patients and there was need to ensure that staff were aware of these processes. The video was used as part of staff training. Mrs Walker would also be attending the Trust’s Falls Steering Group to share her experience as

Minutes

Minutes of the Board – 30 January 2019 1

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part of dementia action week. Poster would also be display in ward areas. The Medical Director highlighted that a dementia screening tool was also incorporated on the Electronic Patient Record (EPR) system so staff had to use this as part of admission processes. The Chair welcomed Mrs Nicky Lloyd and Mrs Helen Mackenzie to their first Board meeting. 01/19 Minutes: 28 November 2018 and Matters Arising Schedule The minutes of the meeting held on 28 November 2018 were approved as a correct record

and signed by the Chair subject to the following amendment: Minute 147/18: Integrated Performance Report (IPR): The last sentence of the first

paragraph would be amended to state: However, there had been no Grade 3 or Grade 4 pressure ulcers during November.

There were no declarations of interest. The matters arising schedule was noted.

02/19 Chief Executive’s Report The Chief Executive highlighted that the Chief Operating Officer had chaired the Berkshire

West A&E Delivery Board to ensure robust planning for the Winter period. This collaborative work had been really positive ensuring that the system as a whole was extremely well prepared. The Board acknowledged the hard work of the teams involved.

The Chief Executive advised that the Staff Excellence Award had been launched and the

ceremony would be held on 23 May 2019. 2019 was the 180th anniversary of the Royal Berkshire Hospital and a number of events supported by the Royal Berks Charity would be held during the year. The Chief Executive expressed his thanks to Jacobs the Jewellers who had raised a total of £93,588.94 for the Berkshire Cancer Centre as part of their 70th anniversary celebrations.

The Board noted that a public engagement workshop had been hosted by Berkshire West

Integrated Care System (ICS) in collaboration with NHS England during December 2018. The event welcomed over 70 delegates to review public involvement across the region. The Trust’s Safeguarding Team had also hosted a ‘Join the Dots’ conference held at the University of Reading in November 2018. The event involved representatives from local voluntary services, police, social care and Clinical Commissioning Groups.

The Chief Executive advised that the first wave of the innovation fund from the Joint

Academic Board between the Trust and the University of Reading had been awarded to eight projects totalling £115,000. In addition, the Trust and the University of Reading launched the academic department accreditation process in December 2018. This formed part of the on-going collaboration between both organisations to support and encourage academic excellence. It was agreed that an update would be submitted to the Board when the first department was awarded its accreditation. The Chief Executive suggested that the Vice Chancellor could be invited to attend a future Board seminar to review the projects at the end of the first year. Action: S McManus

The Board noted that the Urology team had recently been awarded the prestigious title of

European Centre of Excellence for Robotic Surgery by the European Association of Urology (EAU). This award acknowledged the hard work of the team.


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The Chief Executive advised that in relation to Brexit, national guidance had been issued

and internal work was on-going. The Chief Finance Officer had been nominated as the Trust lead for Brexit and had attended a recent planning event. The Trust was working with the local system in relation to contingency planning. The Chief Finance Officer advised that work was also on-going with ICS partners to develop a risk register for Brexit.

03/19 Integrated Performance Report (IPR) The Medical Director introduced the report and advised that the Trust had achieved

compliance against all core cancer access standards. The Quarter 3 target for A&E performance had not been achieved. However, the trajectory had been achieved and Provider Sustainability Funds (PSF) had been booked as a result. The Board acknowledged the achievement of the A&E trajectory. The Medical Director advised that the department had been busy but staff experience had improved due to the robust planning ahead of Winter.

The Medical Director advised that there had been two avoidable Grade 3/4 pressure ulcers

and investigations were on-going. It was considered that these incidents could be related to workload and vacancies. However, the practice educational team were reviewing this and this area remained a high priority for staff. There had also been a further Never Event during December. This related to a patient receiving medical air instead of oxygen. The Medical Director highlighted that this category had only recently been added to the list of Never Events and it was considered that by raising awareness staff had reported further incidents. The Board noted that action had been taken and piped air had now been removed from all ward areas with the exception of respiratory wards. The Board discussed the increase in Never Events. The Chief Executive suggested that a report should be submitted to the Board to outline the patient safety culture in the Trust as well as the learning as a result of incidents. Action: C Ainslie

The Medical Director advised that there had been an increase in single sex accommodation

breaches that were as a result of demands on capacity, flu and patient activity. The majority of the breaches occurred during late evening.

The Medical Director advised that mortality was better than expected and highlighted the

Copeland's Risk Adjusted Barometer (CRAB) data in the report. The Medical Director explained how CRAB data provided more detailed information and gave an overview of the CRAB methodology. A training session would be arranged for the Board in relation to mortality data. Action: L Barker

The Medical Director explained that there had been a second possible avoidable death for

September that was due to be discussed the Mortality Surveillance Group. This related to recognition of a deteriorating patient and had been reported a serious incident.

The Medical Director highlighted stroke performance and advised that there had been a

high level of both high and low risk patients accessing the service. The Medical Director advised that the Trust remained compliant against the 92% standard for 18 week Referral to Treatment (RTT) although performance had reduced slightly. The Medical Director advised that the Trust remained non-compliant in relation to DM01 performance. This was due to separate issues in echocardiography, endoscopy and an MRI machine that had broken down. Cancer performance had been achieved despite a high number of urology referrals. The Medical Director highlighted that patient choice over the Christmas period could affect January performance figures.


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The Medical Director advised that there had been an increase in appraisals and mandatory training compliance and agency spend remained low. The Board noted that annual leave for clinical teams was restricted over the Christmas period. The Board discussed the Clinical Admin Team (CAT) dashboard. The Chief Operating Officer advised that there had been some challenges in the CATs in relation to the implementation of MModal. However, morale in the area was not an issue. The Chief Operating Officer advised that the metrics in the dashboard required review. The Board noted that the CATs would be considered as part of the planned work in relation to the modern administrator. The Board discussed the A&E trajectory in relation to obtaining PSF monies. The Chief Operating Officer advised that the trajectory for Quarter 4 would be based on performance during March. The Chief Operating Officer gave an update on current operational performance and advised that the Trust had declared ‘black’ alert status and this had been the case for the last 48 hours. However, internal efficiency work and the Trust’s work with ICSA partners would continue. In comparison with the previous year performance this was a significant improvement and the additional capacity implemented had assisted. The Board acknowledged the work of all the teams over the Winter period. The Director of Finance advised that December finance performance was in line with the financial control total. Performance in the month had benefited from a number of non-recurrent one off items including release of accruals for purchase orders receipted more than six months ago for which no invoice had been matched, recovery of VAT through quarterly review and release of £1m of income provisions. The Director of Finance advised that discussions were on-going with Berkshire West Clinical Commissioning Group (CCG) and a variation to contract had been agreed. £1.5m had been recognised in the month of December. The cash position remained strong. The Chair of the Finance & Investment Committee advised that the Committee had discussed risk to the delivery of the financial control total and the challenges in the underlying run rate. An additional governance process had been undertaken with discussions of both the Chairs of the Finance & Investment and Audit & Risk Committee. The Chief Finance Officer advised that that detailed reviews with Care Groups were on-going in relation to their variances to budget.

04/19 Integrated Care System (ICS) Update The Director of Strategy introduced the report and advised that a key focus for the ICS

during Quarter 3 included a number of patients and governor engagement events on the ICS, development of a Berkshire West Urgent Care Strategy for the next 5 years and population health management. Priority programmes for 2019/20 had also been a key area of work including the reduction of the number of schemes to focus on those schemes that could achieve material progress. The Director of Strategy highlighted that, as Berkshire West ICS was a self-assuring system, this required less regulatory discussion. The Board noted that a single performance report for the ICSA was currently being developed.

05/19 Minutes of Board Committee Meetings The Board received the minutes of the Finance & Investment Committee held on 19

November and 19 December 2018

The Board received the minutes of the Quality Committee held on 4 December 2018. The Board noted that the Quality Committee were due to receive a further update at the next meeting in relation to the Dermatology service. The Chief Executive advised that the


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Executive Management Committee had discussed this recently and the impact on external agencies had been recognised as a result of the Trust’s decision to restrict referrals The Board received the minutes of the Audit & Risk Committee held on 16 January 2019. The Chair of the Audit & Risk Committee highlighted that the Committee had received the Health & Safety audit report that would be discussed by the Board. The Board received the minutes of the Charity Committee held on 18 December 2018. The Chief Finance Officer advised that the Charity Accounts had now been signed and submitted to the Charity Commission. The Chair highlighted that an interim Charity Director was in post and responsibility for the Charity had moved to the Director of Communications & Engagement. As a result the terms of reference for the Charity Committee would be reviewed and updated at the next meeting.

06/19 Information Item: Board Work Plan The Board received the work plan. The Chair highlighted that Health & Safety would be a

key focus for the Board going forward and this would be incorporated into the work plan. Action: C Lynch 07/19 Date of Next Meeting

It was agreed that the next meeting would be held at 9.30am on Wednesday 27 March 2019.

The Chair highlighted that this would be the last meeting for the Director of Finance. The Board expressed its gratitude to the Director of Finance for his valuable contribution over the last eight and half years as a member of the Board.

Chairman Date


Board Schedule of Matters Arising and Outstanding Actions Agenda Item 5

Board Date Board Minute

Subject Decision Owner Expected Submission

Update

30 January 2019

02/19 Chief Executive’s Report

The Chief Executive suggested that the Vice Chancellor could be invited to attend a future Board seminar to review the projects at the end of the first year.

S McManus Noted. An invite could be sent to the Vice Chancellor in 2020.

30 January 2019

03/19 Integrated Performance Report (IPR)

The Chief Executive suggested that a report should be submitted to the Board to outline the patient safety culture in the Trust as well as the learning as a result of incidents. A training session would be arranged for the Board in relation to mortality data.

C Ainslie L Barker

Item on the agenda. A Training Session has been scheduled for the next Quality Committee in April 2019

30 January 2019

06/19 Information Item: Board Work Plan

The Chair highlighted that Health & Safety would be a key focus for the Board going forward and this would be incorporated into the work plan

C Lynch Health & Safety Item included on the Work plan

March 2019

Title: Chief Executive’s Report Agenda item no: 6a Meeting: Board of Directors Date: 27 March 2019 Presented by: Steve McManus, Chief Executive Prepared by: Caroline Lynch, Trust Secretary Purpose of the Report • To update the Board with an overview of key issues since the

previous Board meeting. • To update the Board with an overview of key national and local

strategic environment and planning developments • This includes items that may impact on policy, quality and financial

risks to the Trust.

Report History None

What action is required?

For information and discussion: the Board is asked to note the report.

Assurance Information Discussion/input Decision/approval

Resource Impact: None Relationship to Risk in BAF:

Strategic objectives This report impacts on (tick all that apply):: Provide the highest quality care Invest in our staff and live out our values Drive the development of integrated services Cultivate innovation and transformation Achieve long-term financial sustainability Well Led Framework applicability: Not applicable

1. Leadership 2. Vision & Strategy 3. Culture 4. Governance

5. Risks, Issues & Performance

6. Information Management

7. Engagement 8. Learning & Innovation

Publication Published on website Confidentiality (FoI): Private Public

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Key Issues 1. Provide the Highest Quality Care 1.1 As part of my role as Chief Executive Officer I have had the opportunity of visiting a variety of

teams in my ‘back to the floor’ sessions. This has given me a great opportunity to support the work that happens behind the ‘scenes’ in all different departments and meet the staff that embody the Trust values and help keep services running.

1.2 I had the opportunity to spend time with the Emergency Department (ED) team in January and it was fantastic to see how everyone worked together to ensure patients received great care and treatment. The team were in perpetual motion with new patients arriving all the time the team had to move existing patients into different parts of the department to create the space to assess new arrivals. I helped the team clean trolleys and moved patients around the department and was impressed at how well all different members of staff helped each other to ensure that patients had a positive experience whilst being in an environment which can be very emotional when someone acutely unwell.

1.3 I also had the opportunity to meet with the cardiac imaging service in February and was

impressed at how imaging technology has become a vital part of how the Trust diagnose and treat cardiac patients within our heart attack centre. It is fantastic to see that technological innovation had enabled the team to increase the quality of diagnosis that can be made and the efficiency of diagnosis that the service offers.

1.4 I spent time with the security team in February and it was impressed with the way in which the

team work across the site 24/7 to keep staff, patients and property as safe and secure as possible. The team are called to a wide variety of situations, from supporting clinical teams to safety of staff when moving around the site and fire alerts. The team also spend a lot of time in the ED department when their presence is required to diffuse situations of violence and aggression towards staff from both patients and visitors. The team handle difficult situations sensitively whilst also dealing with the conflict that they are confronted with.

1.5 I was privileged to attended the newly formed Allied Health Professional (AHP) Forum on 28th

February 2019. In line with the national agenda the Trust has committed to working with our AHP body to review and strengthen the role of AHPs within the Trust in both clinical and non clinical roles, and to ensure that the voice of this key group of staff is represented appropriately at all levels of the organisation. The newly formed Forum have come together strongly and are working closely with the Executive to progress this exciting work, using a ‘100 days’ model with commitments from all parties to drive forward progress. The Forum have committed to working closely with the Assistant Director of Nursing to explore the use of non-traditional roles to work towards addressing some of our challenges in a new way, and to providing new exciting career progression opportunities for our AHPs.

2. Invest in our staff and live out our values

2.1 The winner of the January StarCard was Agostinho De Souza who works in the housekeeping team. Agostinho was nominated for the award as he always goes to the extra mile in his work, has an unfailingly friendly attitude and always demonstrates the Trust values of ‘Compassionate’ and ‘Excellent’ to anyone he comes into contact with around the Trust.

2.2 As a Trust we strive to employ staff from a range of backgrounds ensuring that we represent the communities that that Trust serves. This continues to be a key focus in our peoples strategy published in 2018. Over this period the Trust continues with a number of programmes that we are involved with.

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• Our Project Search programme is now entering its 7th year at the Trust. This is a unique

collaboration which supports young people with learning disabilities transition from education into the world of paid employment. 60 young people from our community have come through the Project since 2012, with 90% of students graduating. 20 graduates have secured employed at the RBFT in a variety of areas and 7 graduates have secured paid roles working in their local communities. Our successes have achieved National recognition and the programme commended in our latest CQC inspection as an area of outstanding practice.

• The Trust for the past six years has been accredited as a ‘Two ticks employer’ and has continued this commitment through engaging with its successor programme, the Disability Confident Employer scheme run by the Department of Work and Pensions. Our on-going engagement with the scheme signals both our commitment to the principles and practice of disability inclusion.

• We are also working in collaboration with the training provider that provides ad hoc disability awareness training sessions to managers and mentors in the workplace who want to improve inclusivity and experience of disabled team members at the Trust.

• As a Trust we are also working to ensure that we make reasonable adjustments in the Workplace to enable staff that have a disability remain in work. This is also supported by the positive staff feedback received through the NHS staff survey.

2.3 The Staff Excellence awards will take place on 23 May 2019 and it was great to see that our staff

had submitted over 200 nominations for individuals and teams across the Trust. The judging panel met recently in order to identify both winners and highly commended nominations across 12 different categories. It was fantastic to read through all the nominations and judging was really hard however congratulations in the first instance to all the nominees.

3. Drive the Development of Integrated Service

3.1 The Integrated Care System has been developing a 2019/20 operational plan in line with guidance from NHS Improvement (NHSI). It is one plan that will happen at Royal Berkshire Hospital and with our system partners. The Plan identifies six priority programmes for the system and how we will maintain constitutional standards for our patients and begin delivery of the NHS long term plan. A draft of the operational plan was taken to the Governor Strategy Committee in March. Feedback had been received from Governors and NHSI and this will be included in the updated Operational plan that will be submitted to NHSI.

4. Cultivate Innovation and Transformation

4.1 As part of digital transformation some trusts have been part of a Global Digital Exemplar (GDE) Programme that delivers improvements in the quality of care, through the world-class use of digital technologies and information. The Trust is partnered with a GDE as a ‘fast follower’ that supports best practice and innovation. The Trust was recently assessed for a level 5 accreditation by the Healthcare Information and Management Systems Society (HIMSS) that assess the level of digital maturity with the highest level being 7. The assessment covered more than 100 individual checks including completeness of digital use and depth of IT security. It was a great achievement that the Trust was awarded a level 5 accreditation and is also the first Trust to meet the level 5 accreditation level as part of the GDE Programme.

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5. Achieve Long-Term Financial Sustainability

5.1 We have been developing our budget plans for 2019/20, work which started in November 2018. We have analysed our underlying financial position and even though we had recognised in our 2018/19 budget that we would deliver a deficit of £3.684m this year, our run rate of expenditure has been higher than this, and we have an underlying deficit which is in excess of this. We need to be able to reduce our running costs by £14m while monitoring high quality care, so we are planning a two year period to get back to financial balance, while we transform the way we deliver care.

5.2 Over the past 3 months I have been overseeing the development of our budget for 2019/20, which is due for submission to NHSI on 4th April 2019. This work requires us to understand what we are currently spending, what pressures we will encounter in the year ahead, the costs of improving our services, the scope our commissioners have to increase our funding and the potential for our teams to improve the efficiency of our frontline and support services.

5.3 On 18th March 2019 the Finance & Investment Committee reviewed the emerging picture from this programme. While there is further work to do, the Committee supported Management's view that a combination of the underlying position of our finances, and the need to conduct targeted investments to maintain constitutional standards, means The Trust is unlikely to be in a position to accept the control total set by NHSI, without further transitional support from local or national bodies.

5.4 The consequence of this position, should it be confirmed by the board by 4th April, will be that the Trust will be unable to access £12.2m of Provider Sustainability and MRET funding during 2019/20. This is likely to have an impact on our forward looking capital programme. Given this impact, the Trust board will be undertaking further discussions internally and externally in the run up to the 4th April and will report to the public on our final determinations in due course.

6. Brexit

6.1 The NHS approach continues, using the resilience and emergency planning framework to

manage potential issues arising from the exit of the United Kingdom from the European Union. Regular meetings are taking place between the Royal Berkshire NHS Foundation Trust Brexit Senior Responsible Officer (SRO) and workstream leads at the Trust. Regular ‘check in’ conference calls and meetings have been taking place at a regional level and situational reports have been underway since early February, and the Trust is participating fully in all data requests from regional and national teams.

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Title: Integrated Performance Report Agenda item no: 6b Meeting: Board of Directors Date: 27 March 2019 Presented by: Caroline Ainslie, Director of Nursing Prepared by: Performance Team Purpose of the Report The purpose of this paper is to provide the Board of Directors with an

analysis of quality performance to the end of February 2019.

Report History None

What action is required? The Board is asked to note the report.


Resource Impact: None

Relationship to Risk in BAF:







March 2019

Integrated Performance Report

The purpose of this paper is to provide the Board of Directors with an analysis of quality performance to the end of February 2018. The report covers performance against the NHS Improvement (NHSI) Risk Assessment Framework as well as national and local key performance indicators. Contact: Caroline Ainslie, Director of Nursing Lindsey Barker, Medical Director Mary Sherry, Chief Operating Officer Don Fairley, Director of Workforce Nicky Lloyd, Chief Finance Officer

Contents

Integrated Performance Report Page 2

The purpose of this report is to provide assurance to the Board of Directors on compliance against the NHSI Risk Assessment Framework, national and local key performance indicators. It acknowledges significant and notable achievements, and highlights and discusses areas of concern or where performance has a less than favourable forecast.

Introduction


NHSI Compliance (Access)


CQC - Excellence CARE - Excellent

Accident & Emergency (A&E) o Performance against the A&E 4 hour standard in February reported at 88.7% combined (87.5% Type 1 only).

o Our February position is above our Provider Sustainability Fund (PSF) in month target.

o The Q4 PSF requirement is to achieve 95% in March 2019.

o We continue to have a strong focus on breach management and improved bed capacity/flow.

o The key focus for the Trust remains on service improvement across the whole pathway to secure sustainable performance and improved patient experience. This includes measures to strengthen winter performance.

o Key event taking place in March – Reset Fortnight, designed to engage internal senior management and external partners in understanding issues at ground level, helping to resolve issues in pathways and identifying issues for resolution going forward

Cancer Waiting Times (Jan 19) o The Trust has achieved compliance against all core cancer access standards with the exception of 62 day first definitive

treatment (FDT) and 31 day subsequent surgery (low volume). Performance against the 62 day standard was projected to fall below the 85% standard in December and January and we expect to see an improved position in the February reporting (April).

o We will continue to work closely with local commissioners, NHS Improvement and the Thames Valley Cancer Network in relation to 62 day standard sustainability as well as implementation of the new 28 day diagnosis standard.

18 Weeks Referral To Treatment (RTT) o The Trust remains compliant against the RTT 92% standard for February 2019.

February 2019 Summary



21/03/2019 Page 5

Provide the highest quality care

• Friends and Family and Inpatient Survey: We continue to perform well against the Friends and Family test and Inpatient Survey. • The Trust mortality metrics continue to report at as expected levels in SHIMI and CRAB. • Our diagnostic waiting times remain non-compliant. However have improved as we continue to reduce the backlog caused by events earlier in the year. • Most Safety and Patient Experience metrics continue to perform well and show a stable trend. • The has been one Never Event reporting in February. The investigation is underway. • The 62 Day Cancer access standard remains below target in the January as expected as a result of the holiday period. Performance is expected to improve from February • Areas of on-going concern:

o A&E Access: Performance through Q1 is showing a significant improvement when compared with the same period in in 17/18. However performance remains below the 95% standard. Work to improve the position is underway and we continue to work closely with NHSI/E to identify areas for support.

Invest in our staff and live out our values

• Appraisal rates in February are the highest they have been since May, and continues to be a priority. • Recruitment and retention continues to be a strong focus, in comparison with national and regional trends, we have seen small improvements and held off deterioration. • Job redesign work continues to be developed and will build further momentum through next year’s transformation programmes.

Drive the development of integrated services

• The ‘Patient Flow Matters’ programme continues, in collaboration with colleagues across the Berkshire West system to both react to the day to day challenges of winter and plan for long term improvements. During February the Trust has been preparing to undertake a ‘System Reset’ over a two week period in March. Work also continues on the development of a West Berkshire UEC Strategy.

• Both RBH and ICS transformation programmes continue to develop through an integrated system working approach including consideration of how various teams can work more collaboratively, with discussions active currently with transformation teams.

Cultivate innovation and transformation

• Across the Berkshire West ICS teams are working collaboratively to produce an ICS Operational Plan for delivery over the coming years. • A significant focus of this work is to identify areas of opportunity to work differently, whether enabled by a new innovation or by working in closer collaboration with our

system partners.

Achieve long-term financial sustainability

• The Trust is reporting that we are behind both budget and forecast in month and year–to-date ( YTD), driven by adverse pay and non-pay variances. YTD the Trust is behind the adjusted control total.

• PSF: The Trust has recognised PSF income for the achievement of M11 financial and A&E performance. • QIPP: The YTD delivery is £12.5m against a budget of £14.2m. Month 11delivered £1.4m against a budget of £1.9m and a forecast of £1.2m. As at 12 March 2019, for 18/19 the in

year risk adjusted figure stands at £13.9m. Work is underway to develop the Trust 19/20 programme. In order to deliver the 19/20 control total, the Trust needs to deliver £16.8m of efficiency savings in-year. This is a considerable challenge and carries a number of risks to this being the final number.

1. Safety – Provide the highest quality care

Infection Control 2 Trust apportioned cases of Clostridium difficile (C.diff) were reported for February 2019. The total number of cases reported to date for 18/19 stands at 17, against an upper limit of 26 for the full year. 5 Trust apportioned Escherichia coli (E.coli) bacteraemia were reported in February 2019. No common themes / lapses were identified with the E.coli Bacteraemia. Zero Trust apportioned Klebsiella and Pseudomonas bacteraemia were reported in February 2019. Sepsis remains compliant against standards. Integrated Performance Report Page 6

CQC – Teamwork / Integrity CARE - Aspirational

Harm Free CareTarget

variance

Infection Control Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type

Month +/-

Meeting the C.Diff objective 3 0 4 2 2 1 1 1 1 0 3 2 ▼ N 2 0C.Diff due to lapses in care 1 0 1 1 1 1 0 0 1 0 0 0 ◄► N 0 0C.Diff (Cummulative) 19 0 4 6 8 9 10 11 12 12 15 17 - N 26 -9MRSA 0 0 0 0 0 0 0 0 0 0 0 0 ◄► N 0 0MSSA surveillance (trust acquired) 5 3 1 0 0 3 0 3 1 2 7 1 ▼ - - -Ecoli (trust acquired) infections 7 5 5 4 3 4 7 2 5 4 5 5 ◄► - - -

Sepsis: % of the patients meeting the screening criteria should be screened for sepsis in ED

94.0% 94.0% 94.0% 92.0% 92.0% 94.0% 94.0% 96.0% 92.0% 94.0% 96.0% 96.0% ◄► - 90.0% 6.0%

Sepsis: 90% of patients with sepsis should receive antibiotics within one hour (Inpatients)

92.0% 92.0% 90.0% 93.0% 90.0% 92.0% 90.0% 90.0% 90.0% 91.0% 100.0% 91.0% ▼ - 90.0% 1.0%

Target Type: N - National / L - Local / H - Hospital

Target Actual

Hospital acquired Category 3/4 Pressure Ulcers: Zero avoidable category 3/4 pressure ulcers. Hospital acquired Category 2 Pressure Ulcers: Following review of the 10 confirmed Hospital Acquired Category 2 Pressure ulcers: 5 avoidable. Common themes were long periods when patients were not repositioned and inaccurate Waterlow assessments. 4 unavoidable. 1 not able to review. Nutrition risk assessment The drop in performance continues to be monitored through Care Group performance meetings and we continue to educate staff around carrying out MUST (Malnutrition Universal Screening Tool) assessments using EPR.


1. Safety – Provide the highest quality care CQC – Teamwork / Integrity CARE - Aspirational

Incidents ReportingTarget

variance

Falls and Ulcers Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type Month +/-

Pressure Ulcer Incidence per 1 000 bed days 0.85 0.85 0.72 0.44 0.89 0.36 0.53 0.76 0.55 0.64 0.87 0.46 ▼ N 1.00 -0.54Catergory 2 Pressure Ulcers 15 16 14 8 17 7 10 11 10 11 17 10 ▼ N - -Category 3 or 4 avoidable pressure ulcers (SI) 1 0 1 1 0 0 0 3 0 2 2 0 ▼ N 0 0Patient Falls per 1 000 bed days 4.6 4.2 3.7 3.5 5.0 3.6 4.0 4.6 4.3 4.3 4.1 4.1 ▲ N 5.0 -0.9Patient falls resulting in Harm (SI) Avoidable 1 2 0 0 0 0 0 0 1 0 0 0 ◄► - - -Patient falls resulting in Harm (SI) Unavoidable 0 0 0 0 0 0 0 0 0 0 0 0 ◄► - - -Nutrition risk assessment in 48 hours of Admission to Hospital

97.3% 98.4% 97.3% 98.2% 97.2% 97.8% 93.0% 90.4% 85.9% 92.7% 92.1% 89.8% ▼ N 95.0% -5.2%


Target Actual

21/03/2019 Integrated Performance Report Page 8

1. Safety – Provide the highest quality care

1 Never Event was reported in February: West Berkshire Community Hospital – Wrong site surgery (invasive procedure). Investigation underway.


Incidents ReportingTarget

variance

Other Incidents Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type Month +/-

Patient safety incidents reported (approved) 624 620 688 686 752 677 611 701 682 719 773 653 ▼ - - -Number of incidents reported (unapproved) 103 74 56 77 94 61 59 65 71 81 95 91 ▼ - - -Patient Safety Incidents/1000 Bed days 34 35 36 38 45 34 35 36 38 39 40 34 ▼ - - -Patient Safety Incidents/100 Admissions 8.9% 8.1% 7.9% 8.4% 9.2% 8.3% 8.2% 7.9% 8.0% 9.7% 9.1% 8.6% ▼ N 7.0% 1.6%All serious incidents (SI) 9 8 5 7 4 3 6 6 7 4 8 3 ▼ - - -Duty of Candour breaches (SI) 0 0 0 0 0 0 0 0 0 0 0 0 ◄► N 0 0Never Events 0 0 1 0 0 1 1 1 1 1 0 1 ▲ N 0 1


Actual Target

• The number of mental health related attendances to the Emergency Department (ED) in February were 263 compared to 318 in January. • Children and young people’s (CYP) attendance decreased from 61 to 40; of those 37 were <16 years. • 7 new patients detained to the RBH under the Mental Health Act (MHA); 1 patient brought to ED under section 136. • 4 patients detained under Sec 2 between 13 – 16/02/19. The capacity issue was managed effectively. • 58 of 97 child safeguarding concerns raised by the Trust (56%) were for CYP who presented with mental health issue or where there were parental mental

health issues. Of the 58, 40 were seen by Children & Adolescence Mental Health Services (CAMHS) and 18 were due to parental mental health disorder. • There was one 4 hour A&E breach attributed to mental health services in January – 0 due to CAMHS. • 7 Deprivation of Liberty (DoLs) applied for, 4 assessments on going, 1 regained mental capacity, 1 transferred to PPH, 1 discharged pre local authority

assessment. • 1 safeguarding concern raised against the Trust both related to adults – investigated not taken forward as safeguarding. • Compliance for Level 1 child safeguarding training for non-clinical staff remains just below the agreed target. • There continues to be focus on circulating compliance figures to Care Group and Corporate Directors, exception reporting and data quality. • The ways that Level 1 CP training updates are delivered to hard to reach groups within the organisation will change during Q4.


1. Safety – Provide the highest quality care CQC – Teamwork / Integrity CARE - Aspirational

Health and Safety Indicators Target variance

Health and Safety IndicatorsMar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type Month +/-

Number of detentions under the Mental Health Act to the RBH 6 5 5 0 8 7 7 8 7 7 5 6 ▲ - - -

Number of DOLS (Deprivation of Liberty) applications applied for 4 2 1 4 3 3 1 8 11 7 7 7 ◄► - - -

Number of DOLS (Deprivation of Liberty) applications granted

0 0 0 0 1 0 1 0 0 0 0 0 ◄► - - -

Number of Child Safeguarding concerns raised by the Trust

74 60 79 86 62 63 103 71 89 94 108 97 ▼ - - -

Number of Adult Safeguarding concerns raised by the Trust

16 27 24 6 20 21 28 25 29 30 29 26 ▼ - - -

Number of Safeguarding concerns raised against the Trust3 3 1 6 5 1 5 3 4 0 2 1 ▼ - - -


SafeguardingTarget

variance

Safeguarding Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type Month +/-

Staff training in safeguarding of Adults (to incl introductory DoLS & MCA)

89.6% 91.7% 91.8% 92.4% 93.6% 91.2% 92.4% 93.5% 93.5% 93.5% 93.5% 93.8% ▲ L 90.0% 3.8%

% of relevant staff who have had Safeguarding Children Level 1 Training

88.2% 93.5% 93.7% 93.5% 93.3% 92.1% 92.6% 93.9% 93.4% 92.6% 92.8% 92.8% ◄► N 95.0% -2.2%


94.2% 85.6% 94.6% 94.5% 94.5% 93.5% 93.5% 92.7% 92.6% 92.6% 94.2% 94.3% ▲ L 85.0% 9.3%


91.0% 84.9% 89.4% 88.8% 86.9% 86.0% 86.0% 92.4% 88.1% 87.4% 87.1% 93.8% ▲ N 85.0% 8.8%

Mental Capacity Act (MCA) and Deprivation of Liberty (DoL)s enhanced training

81.1% 80.0% 80.5% 80.2% 83.1% 81.9% 84.5% 83.2% 83.9% 92.6% 82.7% 82.4% ▼ L 80.0% 2.4%

A&E staff with appropriate training in conflict resolution incl restraint training: ALL ED Staff

64.7% 73.1% 87.3% 88.9% 87.7% 82.2% 84.9% 85.5% 84.5% 93.5% 94.4% 95.0% ▲ N 80.0% 15.0%


Actual Target

Actual Target

28 complaints were received in February and 21 were closed. Analysis of the 28 complaints received has shown that Clinical Treatment (14) and Communication (12) were the top two themes. Of the complaints closed in February - 4 were well founded, 4 were partially well founded and 4 were unfounded. We are awaiting outcomes for 9 complaints; these are being actively chased up. The severity rating was: 3 Amber (moderate), 9 Yellow (low) and 9 Green (very low). Patient Advisory Liaison Service (PALS) - Planned Care received the highest number of PALS, at a total of 77 (71 informal PALS concerns and 6 concerns originating from GP surgeries directly). Out of the 218 PALS concerns where we have been contacted by the patient or relative/carer, 34 of these related to Integrated Medicine and 26 to Abdominal Surgery. The main themes across all of the PALS received were administration (76), clinical treatment (58) and communication (57). The GP PALS response rate has increased this month. We continue to meet regularly with the teams for those areas to ensure we are providing a swift response to the concerns raised.


2. Patient Experience – Provide the highest quality care


Target

variance

Patient Complaints Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type Month +/-

Number of Complaints 9 23 26 13 25 20 23 19 28 21 23 28 ▲ - - -Complaints avg response (days) 27 23 22 25 27 22 25 30 27 24 25 27 ▲ L 25 2Number of complaints returned for a second review

- - - - - - 4 2 0 6 1 1 ◄► - - -

Number of Patient Advisory Liaison Service (PALS) concerns

244 243 262 177 237 156 185 236 236 147 219 218 ▼ - - -

Number of Complaints to Ombudsman 0 1 0 1 0 0 0 1 0 0 0 0 ◄► - - -

Number of Complaints upheld by Ombudsman

0 0 1 0 0 0 0 0 0 0 0 0 ◄► - - -

Number of compliments recieved to Patient Relations Department

164 100 61 4 7 75 101 12 35 9 71 0 ▼ - - -


Actual Target

The Trust remains focused on Mixed Sex Accommodation (MSA) avoidance.


2. Patient Experience – Provide the highest quality care


Surveys and FeedbackTarget

variance

Trust Patient Survey Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type Month +/-

Trust Inpatient Survey - overall rating 97.4% 98.6% 99.3% 99.2% 98.7% 97.9% 97.0% 95.9% 97.1% 98.6% 99.3% 99.4% ▲ N 97.0% 2.4%

Friends and Family Test (FFT) Response Inpatients

41.2% 45.1% 59.6% 52.4% 41.8% 47.0% 42.4% 52.0% 51.1% 40.3% 50.8% 47.7% ▼ N 30.0% 17.7%

FFT Recommendation Rates Inpatients 99.4% 99.0% 99.9% 99.7% 99.6% 99.6% 99.8% 99.7% 99.3% 99.6% 99.8% 99.4% ▼ N 98.0% 1.4%

FFT Recommendation Rates Maternity 98.0% 98.5% 96.9% 98.5% 95.8% 97.4% 96.6% 96.3% 97.0% 96.8% 96.5% 97.4% ▲ N 95.0% 2.4%

Single sex accommodation - breaches 279 220 74 15 49 79 - - - - - - ▼ N - -

Single sex accommodation - breaches (Excluding Emergency Department Observation Bays)

- - - - - - 41 62 64 105 138 87 ▼ N 0 87

Number of positive feedback posted on NHS Website

9 15 9 15 15 11 9 7 16 9 11 10 ▼ - - -

Number of negative feedback posted on NHS Website

4 3 0 3 6 1 2 11 1 1 2 2 ◄► - - -


Actual Target

Crude mortality has decreased in February due to lower deaths even though the volume of patients has remained high during the winter period. Summary Hospital-level Mortality Indicator (SHMI) remains as expected however it is published 6 months in arrears – next publication is due at the end of May. The Clinical Data Quality Group (CDQ) and Clinical Outcomes and Effectiveness Committee (COEC) will continue to review any outlying variability in both the data and the clinical performance. The Mortality Surveillance Group (MSG) continues to monitor possible or probable avoidable harm related to hospital care and shares learning points across the Trust.

3. Clinical – Consistently Delivering Quality Care and Healthcare Outcomes


CQC - Effective CARE - Excellent

Trust Mortality



Surgical Risk Adjusted mortality for our own case-mix is better than expected. Risk Adjusted Surgical complications are lower than expected for our case-mix. Cardiothoracic have alerted for mortality for the 3 months to December 2018. This relates to interventional cardiology procedures. A deep dive meeting has been set up to review this data, undertaking a coding review and clinical review, triangulating with the MINAP data that is reviewed monthly. General Surgery have alerted for complications, the department is reviewing the data.

CQC – Excellence / Integrity CARE - Excellent

Surgical Mortality and Morbidity

Specialty Overview November 2018 – January 2019

Overall Surgical Risk Adjusted Mortality (30 day & in-hospital)



Medical patients continue to show a high number with 4 or more triggers. The specific conditions contributing to this are Sepsis, Acute Kidney Injury (AKI), Shock, Pressure Ulcers and Hospital Acquired Pneumonia (HAP). Each condition is under review by the subject experts. Specialty level data is being derived and circulated to specialties. Training session on CRAB software at the Quality Committee on the 9th April.


Medical Mortality and Morbidity

Mortality Trend (Feb 2018 to Jan 2019) Mortality Trend (Feb 2018 to Jan 2019)

3. Clinical – Provide the highest quality care

The number of Births in February was 378 and deliveries 369. Work has been carried out with forecasts, which gives an estimated number of births for 18/19 of 4850. The number of term admissions to the neonatal unit has increased again this month. A review of all cases is being completed.



Monitoring Clinical OutcomesTarget

variance

Maternity Care Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type Month +/-

Women giving birth: 1:1 delivery of care 99.0% 100.0% 100.0% 100.0% 100.0% 99.0% 100.0% 99.0% 100.0% 100.0% 100.0% 100.0% ◄► N 98.0% 2.0%

Midwife : birth ratio (utilised workforce) 1:30 1:30 1:29 1:28 1:29 1:29 1:28 1:27 1:27 1:27 1:28 1:25 - L 1:30

Caesarean Sections - Elective 14.1% 14.3% 13.0% 12.9% 16.1% 16.2% 12.9% 16.4% 17.6% 13.5% 13.4% 11.7% ▼ N 12.0% -0.4%MLU No of deliveries (proportion of total)

17.0% 20.0% 16.0% 14.0% 20.0% 17.0% 17.0% 13.0% 15.0% 22.0% 16.0% 19.0% ▲ N 20.0% -1.0%

No of times women diverted 3 0 0 0 0 0 2 4 0 0 0 0 ◄► N 0 0Percentage of Unexpected NICU admissions over 37 weeks

3.8% 2.8% 4.5% 2.5% 3.0% 3.3% 3.0% 5.1% 7.8% 4.5% 4.8% 6.5% ▲ N 6.0% 0.5%

Number of births 388 390 448 403 422 416 402 448 411 400 415 378 ▼ N - -Target Type: N - National / L - Local / H - Hospital

Actual Target





variance

Other Clinical Indicators Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type Month +/-

VTE Risk Assessment 95.4% 95.2% 98.3% 96.6% 96.8% 96.8% 95.9% 97.3% 96.5% 97.3% 95.3% 96.9% ▲ N 95.0% 1.9%VTE Incidence (Hospital & Community Acquired)

48 45 46 43 45 55 44 62 58 32 72 66 ▼ N - -

Datix: Number of VTE Incidence (Hospital Acquired)

0 0 1 0 0 0 0 1 0 0 1 0 ▼ N - -

Datix: % VTE Incidence (Hospital Acquired)

0.0% 0.0% 2.2% 0.0% 0.0% 0.0% 0.0% 1.6% 0.0% 0.0% 1.4% 0.0% ▼ N - -


Actual Target


Stroke Care: The two acute thrombolysis standards are being met, however there are ongoing capacity issues affecting access to stroke ward beds, SALT support and length of stay and the TIA standard. These issues are subject to review to determine corrective action. Cardiac Care: • MINAP figures provided 1 month in arrears due to validation. • RBFT performance remains above national average.




variance

Stroke Care Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type Month +/-

Proportion of patients spending 90% of their inpatient stay on a specialist stroke unit (national target)

63.0% 73.0% 82.0% 84.0% 86.0% 85.0% 89.0% 82.0% 82.0% 72.0% 77.0% 65.0% ▼ N 80.0% -15.0%

Proportion of stroke patients scanned within 12 hours of hospital arrival

- - 97.0% 99.0% 93.0% 88.0% 95.0% 92.0% 96.0% 94.0% 98.0% 92.0% ▼ N 0.0% 92.0%

Proportion of people with high risk TIA fully investigated and treated within 24hrs (IPM national target)

91.0% 97.0% 86.0% 97.0% 92.0% 87.0% 94.0% 83.0% 71.0% 82.0% 63.0% 71.0% ▲ N 90.0% -19.0%

Average Length of Stay (LOS) from admission to discharge (days)

- - 22 14 12 11 15 15 14 17 16 15 ▼ N 14 1.0

Door to needle time <60mins - - 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% ◄► N 95.0% 5.0%

Proportion of S&LT communication assessments <72 hrs

- - 96.0% 97.0% 100.0% 100.0% 90.0% 90.0% 86.0% 86.0% 82.0% 79.0% ▼ N 95.0% -16.0%



variance

Cardiac Care Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type Month +/-

Myocardial Ischaemia National Audit Project (MINAP): Call to Balloon target less of than 150 minutes

100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 89.0% 100.0% 100.0% ◄► N 82.0% 18.0%

Myocardial Ischaemia National Audit Project (MINAP): Call-to-Balloon target of less than 120 minutes

93.0% 100.0% 93.0% 100.0% 88.0% 100.0% 93.0% 100.0% 89.0% 82.0% 100.0% ▲ N 86.0% 5.7%

Myocardial Ischaemia National Audit Project (MINAP): Door-to-Balloon target of less than 90 minutes

100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% ◄► N 97.0% 3.0%


Actual Target

Actual Target

18 weeks RTT The February RTT incomplete position remains compliant against the 92% standard. DM01 Performance against the 6 week waiting list target has been a significant challenge throughout 2018/19 with all but one month not meeting the 99% threshold. An exception report is provided to update the board on the contributing factors and sets out the issues going forward and potential impact.


4. Access – Provide the highest quality care.


18 weeks RTTTarget

variance

Waiting Times: 18 weeks RTT Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type

Month +/-

18 Weeks: incomplete pathways (%) 92.3% 92.5% 92.2% 93.1% 92.4% 92.6% 92.5% 93.2% 92.6% 92.5% 92.2% 92.3% ▲ N 92.0% 0.3%18 Weeks: incomplete pathways (number) 30930 31814 32417 32198 32738 32537 31408 30994 30105 29974 29916 29253 ▼ - - -18 weeks complete patients (Admitted clock stops)

1570 1649 1617 1805 1866 1934 2326 2418 2691 2427 3037 2739 ▼ - - -

18 weeks complete patients (Non Admitted clock stops)

5873 5741 6361 6182 6338 5266 5552 5634 6130 5234 6884 5869 ▼ - - -

52 Weeks - Admitted 0 0 0 0 0 0 0 0 0 0 0 0 ◄► - 0 052 Weeks - Non-admitted 0 0 0 0 0 0 0 0 0 0 0 0 ◄► - 0 052 Weeks - Incomplete 0 0 0 0 0 0 0 0 0 0 0 0 ◄► N 0 0Diagnostics Waiting < 6 weeks (DM01) (%) 99.1% 98.4% 97.5% 96.8% 97.6% 98.4% 99.1% 98.8% 98.5% 97.0% 94.8% 98.1% ▲ N 99.0% -0.9%Diagnostics in 6 weeks: active (number) 5494 5751 5816 5434 4934 4814 5027 4938 5373 5304 5336 5612 ▲ N - -


Target Actual

Reporting Coverage (aggregate of)

Avg seen per month

17/18

Avg seen per month

18/19Average WL Size 17/18

Average WL Size 18/19 Risks

MRI 1589 1380CT 789 819NON_OBSTETRIC_ULTRASOUND 1602 1470DEXA_SCAN 106 99AUDIOLOGY_ASSESSMENTS 564 451ECHOCARDIOGRAPHY 89 285PERIPHERAL_NEUROPHYS 89 72SLEEP_STUDIES 15 19URODYNAMICS 0 0COLONOSCOPY 187 242FLEXI_SIGMOIDOSCOPY 73 116CYSTOSCOPY 126 120GASTROSCOPY 174 231

7980 8670 5402 5303

6964

1132

574

An end of month snapshot of the 'still waiting' diagnostic waiting list. Calculating how long a patient has been waiting from the request for a diagnostic test to the end of the reporting month (adjusting for patient choice).

The DM01 reports the proportion of patients waiting within 6 weeks against a nationally defined 1% tollerance (c.50-55 patients).

The key risk to DM01 within the RBH relates to unforseen / unplanned events (loss of critical workforce / equipment failure) displacing large numbers of patients or prolonged capacity constraints.

IP

OP

Rad 6137

1225

618

Diagnostic Monitoring Standard (DM01 99% @ 6 Weeks) – Exception Report. The complex mix of components monitored in this overarching standard means that volatility in any single or combination can have a detrimental impact. During 2018/19 a number of specific events have directly impacted performance resulting in a consistent pattern of under performance. In addition, in certain areas tests supporting cancer diagnosis will be prioritised above routine tests at times when there is a capacity constraint.. The illustration below shows the events that have caused a short term reduction in capacity resulting in a backlog of patients. Whilst each event has been responded to and resolved quickly within the service the resulting backlogs have all contributed to the pattern of underperformance.







DMO1 Exception Report continued. Return to compliance As a 1% tolerance standard this standard is particularly susceptible to the impact of any single or combined unforeseen issue presenting as a risk to the sustainability of the 6 week standard. Currently, the Trust anticipates that with the reduction in the MRI backlog predicted to continue a return to compliance will be achieved at the beginning of Q1. Continuing risks Endoscopy: Whilst relatively low volume the number of >6 week waits remains high for the service (c.30). This is largely driven by urgent/cancer/surveillance pathways being given priority. Demand and capacity work is on-going in this service to determine current and future requirements. CT echo equipment: Whilst the clinical team have worked hard to recover from CT echo equipment failure new/replacement equipment will be needed to mitigate future failure. These issues fall into the annual considerations on capital investment. MRI: Capacity and demand pressures continue to be a risk and are closely monitored. Due the volume dealt with by each machine any equipment failure presents a material risk. Strategic considerations going forward All relevant services continue to work on how to provide a consistent service in a way that will support all urgent and routine requirements. Consideration of the various necessary investments (revenue and capital) are prioritised as part of our financial planning In addition a programme of work has been prioritised into the ICS work programme for 2019/20 in recognition of the important role that diagnostics of all types play in supporting both urgent and routine care.



Cancer 104 days. At the end of February 11 patients have been reported to the Clinical Commissioning Group, 8 of the 11 have now been treated with 3 still in the diagnostic phase of the pathway. Long waits within the cancer pathway remain consistent with previous months with themes of tertiary centre delays and complex pathways. However patient fitness and patient choice have been a factor. The Trust continues to work closely with NHS Improvement and the Thames Valley Cancer Alliance to ensure reporting definitions are clearly identified for this complex standard.


Outpatient ExperienceTarget

variance

Cancer Pathways Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type

Month +/-

Cancer 2 week wait: cancer suspected 96.4% 95.7% 95.6% 92.7% 94.4% 95.0% 95.1% 95.9% 98.0% 96.6% 93.3% 98.2% ▲ N 93.0% 5.2%Cancer 2 week wait: cancer suspected - QTR 96.2% 0.0% 0.0% 94.7% 0.0% 0.0% 94.8% 0.0% 0.0% 96.8% 0.0% 0.0% ▲ N 93.0% -Cancer 2 week wait: breast patients 97.8% 96.1% 92.4% 94.0% 96.4% 96.8% 94.5% 97.4% 99.5% 98.6% 97.8% 98.4% ▲ N 93.0% 5.4%Cancer 2 week wait: breast patients - QTR 97.2% 0.0% 0.0% 94.4% 0.0% 0.0% 95.9% 0.0% 0.0% 98.5% 0.0% 0.0% ▲ N 93.0% -Cancer 31 day wait: to first treatment 98.2% 97.5% 97.8% 98.1% 94.5% 96.3% 98.7% 97.9% 98.5% 97.5% 98.2% 95.9% ▼ N 96.0% -0.1%Cancer 31 day wait: to first treatment - QTR 97.4% 0.0% 0.0% 97.8% 0.0% 0.0% 96.6% 0.0% 0.0% 98.0% 0.0% 0.0% ▲ N 96.0% -Cancer 31 day wait: drug treatments 100.0% 98.4% 98.5% 100.0% 98.9% 97.7% 100.0% 100.0% 100.0% 98.2% 98.9% 98.1% ▼ N 98.0% 0.1%Cancer 31 day wait: drug treatments - QTR 99.5% 0.0% 0.0% 98.9% 0.0% 0.0% 99.0% 0.0% 0.0% 99.6% 0.0% 0.0% ▲ N 98.0% -Cancer 31 day wait: surgery 100.0% 100.0% 89.5% 95.5% 94.4% 100.0% 96.4% 98.3% 97.7% 100.0% 90.3% 86.7% ▼ N 94.0% -7.3%Cancer 31 day wait: surgery - QTR 100.0% 0.0% 0.0% 94.9% 0.0% 0.0% 96.4% 0.0% 0.0% 98.4% 0.0% 0.0% ▲ N 94.0% -Cancer 31 day wait: radiotherapy 97.5% 94.7% 98.1% 96.2% 93.3% 96.8% 94.5% 95.6% 91.8% 96.3% 94.3% 95.0% ▲ N 94.0% 1.0%Cancer 31 day wait: radiotherapy - QTR 96.6% 0.0% 0.0% 96.3% 0.0% 0.0% 94.8% 0.0% 0.0% 94.4% 0.0% ▼ N 94.0% -62 day consultant upgrade: all cancers 100.0% 40.0% 75.0% 100.0% 92.3% 77.8% 100.0% 50.0% 77.8% 62.5% 75.0% 0.0% ▼ - - -62 day consultant upgrade: all cancers - QTR 93.3% 0.0% 0.0% 66.7% 0.0% 0.0% 90.0% 0.0% 0.0% 64.0% 0.0% 0.0% ▼ - - -62 Day GP Ref 90.4% 85.5% 85.5% 87.7% 71.0% 71.4% 83.0% 86.5% 87.0% 80.7% 83.1% 82.3% ▼ N 85.0% -2.7%62 Day GP Ref - QTR 87.3% 0.0% 0.0% 86.2% 0.0% 0.0% 75.1% 0.0% 0.0% 85.1% 0.0% 0.0% ▲ N 85.0% -62 Day screen Ref 82.8% 68.4% 82.4% 100.0% 100.0% 93.3% 92.3% 81.3% 100.0% 82.6% 95.6% 86.7% ▼ N 80.0% 6.7%62 Day screen Ref - QTR 86.5% 0.0% 0.0% 84.8% 0.0% 0.0% 94.4% 0.0% 0.0% 86.0% 0.0% 0.0% ▼ N 80.0% -Incomplete 104 day waits 6 5 7 5 6 7 9 8 6 10 11 11 ▲ N 0 11


Actual Target


4. Access – Provide the highest quality care. CQC - Excellence CARE - Excellent

January Performance The Trust has achieved compliance against all core cancer access standards with the exception of 62 day First Definitive Treatment (FDT) and subsequent surgery. As reported to the Board in February, December and January are very challenging months for all cancer performance standards. As has been the case in previous years, the impact of the Christmas holiday period has reduced the number of patients seen/treated in December (as a result of patient choice) and we expect this to result in a higher number of >62 day patients treated in January (deferral from December). January has performed better than expected against the 62 day FDT standard. Quarter 4 At this early point in the quarterly reporting cycle we anticipate good performance across all core access standards. However the 62 day FDT standard is expected to be a challenge due to the need to over perform during Feb/Mar. Residual Risk – • Fragility of cancer waiting times and the need to carefully consider the Trust ability to respond to unexpected increases in demand. • Increasing pressure on the Endoscopy service with extremely limited capacity • PET-CT. There are growing concerns related to the provision of the current PET-CT service (Tertiary) which is reporting an waiting time of up to

4 weeks. This has been raised with the service provider and Thames Valley Cancer Alliance (TVCA).

January Upload 2019Category Standard Seen/Treated In target Breaches Performance(%)Two Week Wait 93% 1483 1383 100 93.32WW SBR 93% 185 181 4 97.831 day 1st treated 96% 224 220 4 98.231 day Chemo. 98% 91 90 1 98.931 day Surgery 94% 31 28 3 90.331 day Radiotherapy 94% 141 133 8 94.331 day Other 94% 29 29 0 100.062 day (2ww) 85% 106.5 88.5 18 83.162 day screening 90% 22.5 21.5 1 95.662 day upgrade Local 85% 4 3 1 75.0


A&E ExperienceTarget

variance

Waiting Times: A&E Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type

Month +/-

A&E 4hr Limit (RBH combined) 83.1% 93.3% 96.1% 96.5% 95.6% 95.8% 93.7% 87.9% 88.2% 86.1% 89.4% 88.7% ▼ N 95.0% -6.3%A&E 4hr Limit (RBH combined) - QTR 82.79% 95.34% 95.08% 87.41% ▼ N 95.0% -A&E 4hr Limit (Type 1 only) 78.9% 92.0% 95.4% 95.9% 95.0% 95.5% 92.9% 85.6% 86.1% 83.2% 87.1% 87.5% ▲ N 95.0% -7.5%A&E 4hr Limit (Type 1 only) - QTR 78.3% 0.0% 0.0% 94.5% 0.0% 0.0% 94.4% 0.0% 0.0% 85.0% 0.0% 0.0% ▼ N 95.0% -A&E Type 1 (number) 9119 8870 9346 9313 9881 8925 9263 9827 9741 9423 9350 8685 ▼ - - -

Trolley Waits: 12 hour decision to admit (DTA) 0 0 0 0 0 0 0 0 0 0 0 0 ◄► N 0 0

Ambulance Handover : 30 Minutes 98 32 2 29 32 37 105 105 91 125 167 ▲ N 0 51Ambulance Handover : 60 Minutes 32 1 0 0 1 2 3 4 9 2 20 ▲ N 0 2


Actual Target


Performance for February has remained challenging at 88.7%. Admission conversion rate in February was 34.01%.

Attendances Breaches All Admits

Feb-19 8685 1086 2646

Feb-18 8154 2166 2954

When comparing Feb 2019 to Feb 2018, ED has seen a 6.5% increase in attendances, a decrease of 49% in breaches and an increase in admissions.

Primary Care streaming; continues to stream similar numbers to last year to the GP service. 909 in total for February averaging 34 per day.

• The department continues to see a steady increase in patients conveyed over the age of 70yrs.

• Since collaborating on the Primary Care Streaming project, the department is working well to stream as many suitable patients to the service. This in turn means that the acuity in the department has increased which is putting additional pressure on the department. A recent Skill mix staffing review suggests the increase in acuity requires additional staffing.

CQC - Excellence CARE - Excellent 4. Access – Provide the highest quality care.


Acuity remains high with continued increases in Ambulance arrivals. There was on average of 109 ambulances per day. Looking at the heat map, there was slightly more demand in the evening compared to January 19, but towards the end of the month this spread out more evenly through the day. The department was top for the South East for all of February.

The breach analysis undertaken in February shows an increase in bed delays and Clinical Exceptions in line with January, which matches the increase in ambulance demand . We have continued to reduce the number of ED delays primarily in the evening and overnight when there has been high numbers of late ambulance arrivals, with the additional medical staff out of hours. 7th – 17th Feb average ED Delays = 6.45 patients. 8th – 24th Feb average ED Delays = 4.14 patients. 25th – 3rd March average ED Delays = 10 patients.


CQC - Excellence CARE - Excellent 4. Access – Provide the highest quality care.

The Trust position for stranded patients (patients staying longer than 7 days) has increased significantly through January and continued to grow in February. This remains an area of strong focus for the Trust particularly as we move through the most challenging time of year. On comparison with the same period in 2018 the Trust is showing a significant reduction in both the number of stranded and super stranded patients.

16/17 17/18 18/19298 266 249

- 112 86

STRANDED PATIENTSAverage number of stranded patientsAverage number of super-stranded patients

4. Access – A&E Performance Dashboard



- - 95%

91.5% 92.1% 95.5% 95.6% 91.4% 90.5% 92.6% 91.6% 86.0% 87.2% 81.2% 95.0%

93.29% 96.09% 96.54% 95.63% 95.81% 93.71% 87.89% 88.18% 86.08% 89.44% 89.54% 91.26%95.53% 97.43% 97.73% 97.08% 97.19% 95.78% 91.83% 91.96% 90.56% 91.19% 92.74% 93.74%

92.4% 88.5% 95.2% 95.0% 90.0% 89.1% 91.2% 86.8% 79.5% 82.3% 73.4% 78.8%

92.0% 95.4% 95.9% 95.0% 95.5% 92.9% 85.6% 86.2% 83.1% 87.0% 87.2% 89.0%

92.5% 90%

Monthly TARGET

Quarterly TARGET

Quarterly PERFORMANCE (RBH) 95.34% 95.08%

96.91% 96.70% 91.14%

2017/18 Type 1

2018/19 Type 1

Monthly PERFORMANCE (ED-DB)

Quarterly PERFORMANCE (ED-DB)

Monthly PERFORMANCE (RBH)

89.91%

92.75%

Must be 95% in March 18

Q1

INFORMATION CORRECT AT 19/03/2019

Better than Q1 17/18 Better than Q2 17/18 90 % or better than Q3 17/18

Feb-18 Mar-18Q2 Q3 Jan-18

87.41%

93.1%

93.29% 96.09%96.54%

95.63% 95.81%

93.71%

87.89% 88.18%

86.08%

89.44% 89.54%91.26%

95.53%97.43% 97.73%

97.08% 97.19%95.78%

91.83% 91.96%90.56% 91.19%

92.74%93.74%

0

2000

4000

6000

8000

10000

12000

14000

70.00%

75.00%

80.00%

85.00%

90.00%

95.00%

100.00%

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

A&E Performance Tracker

2017/18 Activity Projected Activity (Combined) 2018/19 Activity (RBH) 2017/18 Performance £££ STF Trajectory 2018/19 Performance (RBH) 2018/19 Performance (Delivery Board)


4. Access - Exception Report Emergency Department CQC - Excellence CARE - Excellent


4. Access –Provide the highest quality care. CQC - Excellence CARE - Excellent

Admitted Patient ExperienceTarget

variance

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type Month +/-

Delayed Transfers of Care (%) 3.4% 4.8% 4.0% 4.2% 3.7% 4.8% 3.8% 3.6% 3.7% 4.2% 2.7% 4.7% ▲ N 3.5% 1.2%Number of Delayed Transfers of Care (No. of patients)

78 94 81 62 70 84 70 73 76 101 84 134 ▲ N - -

Number of Delayed Transfers of Care (Lost bed days)

640 775 605 608 617 741 592 612 652 926 724 1112 ▲ N - -

Average elective length of stay - excluding 0 day LOS

2.8 2.7 2.7 2.5 2.7 2.6 2.9 2.7 2.6 2.7 2.8 0.0 ▲ N - -

Average non-elective length of stay - excluding 0 day LOS (Length of Stay)

6.0 6.7 6.1 5.9 5.5 5.5 5.7 5.5 5.5 5.9 5.8 0.0 ▼ N - -

Percent of Ambulatory Care of Non elective Admissions

28.7% 28.7% 30.0% 30.7% 30.1% 32.3% 31.0% 28.2% 23.4% 22.4% 23.6% 29.2% ▲ N - -


Actual Target

Delayed Transfers of Care (DTOC) During February the DTOC position has worsened significantly with a 37% increase on the previous month of the number of patients reported. As a result the number of lost bed days and the over all proportion of patients formally reported as DTOC have increased to the highest level seen through 18/19. The Trust is working closely with local authority colleagues to manage the position will continue to focus attention on working with our partners to drive improvements against this metric.

Hospital Cancellation on the day of surgery (non-clinical) There were no patients booked outside of 28 days following a hospital cancellation on the day of surgery. In list utilisation In list utilisation has improved in February to 88%. Delayed starts have increased to an average of 15 minutes delay per list, with General and Breast Surgery leading the way with a delay of only 7 minutes per list. On the day cancellations have remain stable at 7% with unwell on the day as the largest group of patients.



Theatres Patient ExperienceTarget

variance

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

Month +/-

Hospital Cancelled Ops on day of surgery - non clinical (Numbers)

21 19 15 15 15 25 11 13 34 12 18 17 ▼ - - -

Hospital Cancelled Ops on day of surgery - non clinical (Percentage)

0.5% 0.5% 0.4% 0.4% 0.3% 0.6% 0.3% 0.3% 0.8% 0.4% 0.3% 0.4% ▲ - - -

Cancelled Ops not re-scheduled < 28 days 18.2% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 2.9% 0.0% 0.0% 0.0% ◄► N 5.0% -5.0%Urgent Operations Cancelled 2nd time 0 0 0 0 0 0 0 0 0 0 0 0 ◄► N 0 0In List Theatre Utilisation 87.2% 87.1% 88.0% 86.9% 86.6% 87.7% 86.5% 88.6% 86.9% 85.7% 87.1% 88.2% ▲ L 90.0% -1.8%Sessional Theatre Utilisation 92.0% 93.0% 93.0% 91.0% 88.0% 92.0% 96.0% 92.0% 93.0% 91.0% 94.0% 93.0% ▼ L 90.0% 3.0%


Actual Target

The Trust is continuing with its modernisation and data quality programme in outpatients. As reported in previous months Outpatient metrics remain under review as part of the Trust’s Data Quality Assurance Programme and we continue to interrogate the information capture, processing and assurance processes. Advice and Guidance (A&G) is an area that the Trust will be working with local commissioners and NHS England to increase utilisation over the next 12-24 months (CQUIN). The current measure used locally is to assess the proportion of requests through A&G that are responded to within 7 working days however this only includes requests for A&G through the e-Referral Service (eRS) system. Requests via other communication routes e.g. telephone are not included in this calculation. We are exploring the capability and development need of the national eRS system, to deliver a useable mobile platform that would enable ease of use for both primary care and hospital clinicians using a 24 hour turnaround as the aim. In the interim, the Trust will work with primary care to pilot new technologies to support advice and guidance.



Outpatient ExperienceTarget

variance

Waiting Times: Outpatient Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type

Month +/-

Appointments cancelled by RBFT (%) - - - - - - - - - - - - - - - -Appointments cancelled by patient (%) - - - - - - - - - - - - - - - -DNA Rate - - - - - - - - - - - - - - - -New to Follow Up Ratio 1.9 1.9 1.8 1.9 1.9 2.0 2.0 1.9 1.9 1.9 1.9 1.8 ▼ L - -% Advice and Guidance 84.1% 84.5% 92.3% 94.8% 82.3% 89.7% 89.2% 87.6% 75.2% 83.6% 82.3% 89.6% ▲ L 90.0% -0.4%% Appointments at Virtual clinic 3.9% 4.1% 4.1% 4.1% 4.2% 3.9% 3.8% 3.5% 3.5% 3.7% 3.6% 3.6% ◄► - - -


Actual Target


4. Access – CAT Dashboard

February 2019


5. Workforce – Invest in our staff and live out our values.

Appraisal Rate - Appraisal compliance jumped to 89% - the highest since May 2018. Follow up by the Director of Workforce (DoW) to low compliance areas appears to be having an impact with improvements in all Care Groups. Planned Care and Estates and Facilities are now above the Trust target of 90%. Completed Mandatory Training - Recent improvements in Mandatory and Statutory Training (MAST) compliance have stalled at 88.3% the same as the previous month but still at historically high levels. Compliance amongst training grade medics continued to improve - up a further 1.5% points on the previous month. Rolling 12 month Sickness absence - The sickness absence rate had remained at a consistent level, around 3.25% for the previous four months and has slightly reduced in the last month. The Employee Relations (ER) team continue to work closely with managers to ensure sickness is monitored and managed within the policy. Currently the team is experiencing a large number of cases to review, but this is being managed with mangers. We will continue to emphasise the need for the proactive management of absences with staff. Training will remain a priority for the future. We are currently looking at potential new ways to implement a drive to further reduce the % rate, so that we can achieve or even outperform the Trust target rate of 3%. Vacancy Rate – The vacancy rate has remained the same at 7.3%. We have new starters currently booked in to join the Trust in, with another 44 going through pre-employment checks with the aim of starting before the end of the financial year. The Trust are holding their next nursing open day on 16th March and we have recruitment events booked for Dublin, Italy and Bedfordshire University careers event all taking place in March. We continue our Philippines, EU and Non EU recruitment. Agency Spend - There has been a 0.5% reduction in agency spend. There has been an increase in medical agency spend but all other staff groups have seen a reduction in agency spend. The most significant reduction has been in admin and management, which has been subject to increased scrutiny. Rolling 12 month Turnover - There has been a slight decrease in turnover this month of 0.3% giving a figure of 14.3%. The Trust are developing innovative new roles and assessing the option of more flexible working and apprenticeship investments within our current workforce. Retention is a key priority for the Trust with the retention steering group meeting monthly to overcoming any challenges raised by staff. We also engaged with NHSI on 6th March to share good work we have done and are continuing to undertake on Retention.


CQC - Integrity / Excellence CARE - Resourceful / Excellent

Caring CultureTarget

variance

Workforce Indicators Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type Month +/-

Appraisal rate 88.4% 87.5% 88.8% 87.2% 86.8% 86.9% 85.8% 85.1% 85.3% 87.1% 87.3% 88.4% ▲ L 90.0% -1.6%Completed Mandatory Training 86.1% 86.9% 87.7% 88.1% 88.0% 87.7% 86.7% 87.4% 87.4% 87.9% 88.3% 88.3% ◄► L 90.0% -1.7%Rolling 12 month Sickness absence 3.3% 3.3% 3.3% 3.3% 3.3% 3.3% 3.3% 3.3% 3.3% 3.3% 3.3% 3.2% ▼ L 3.0% 0.2%Vacancy rate 6.8% 10.5% 6.8% 8.2% 7.0% 8.3% 8.3% 7.2% 7.1% 7.4% 7.3% 7.3% ◄► L 6.0% 1.3%Agency spend % of total staff cost 4.1% 4.2% 4.8% 3.9% 3.9% 4.1% 3.7% 3.8% 3.3% 2.4% 3.9% 3.4% ▼ L 5.0% -1.6%Rolling 12 month Workforce Turnover 15.2% 15.4% 14.9% 15.0% 14.6% 14.4% 14.9% 14.4% 14.2% 14.8% 14.6% 14.3% ▼ L 14.0% 0.3%


Target Actual


Nurse staffing levels are monitored daily at the Operational Meeting and Senior Nursing huddle. Risk assessment of any shortfall is carried out and staff movement and/or the use of temporary staff is undertaken to ensure that safe staffing levels are always maintained. The level of planned staffing levels change to reflect the needs of our patients. This may alter depending on the number of occupied beds on a ward, changes in patient acuity or any specific 1:1 care needs. The reduced fill rate of Registered Nurse Shifts (RN’s) in February is likely to be attributed to a number of factors: increase in annual leave and the impact of half term. There was an increase in the use of Health Care (HC) Support Workers to support safety.

6. Staffing Data – Invest in our staff and live out our values.

CQC - Integrity / Excellence CARE - Resourceful / Excellent

Caring CultureTarget

variance

Staffing Data Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type Month +/-

% Fill rate of Registered Nurse Shifts (RN) 89.9% 91.0% 91.9% 91.4% 91.7% 90.3% 90.7% 92.7% 94.2% 90.5% 92.6% 89.4% ▼ N 90.0% -0.6%

% Fill rate of Care Support Worker Shifts (CSW) 105.8% 106.9% 108.3% 104.8% 107.1% 109.2% 108.1% 107.8% 106.8% 107.3% 109.5% 110.1% ▲ N 90.0% 20.1%


Target Actual

21/03/2019 Integrated Performance Report Page 34

The Lord Carter report recommends that all trusts record Care Hours Per Patient Day (CHPPD) as a single, consistent metric of nursing and healthcare support workers deployment on inpatient wards and units. The CHPPD is calculated by taking the actual hours worked (split into registered nurses/midwives and healthcare support workers) divided by the number of patients occupying beds on the ward at midnight. It should be noted that CHPPD does not take into account patient acuity, ward environmental issues, patient turn over, or movement of staff for short periods. It also does not take into account that a number of our wards have day case beds that are not occupied at midnight. Benchmarking is available on the Model Hospital Portal but restricted to data from December 2018 - the national average for December 2018 was 8.0 and the average for RBH in December was also 8.0. The average score for RBH in February 2019 is 7.67.

6. Staffing Data – Invest in our staff and live out our values.

CQC - Safe CARE - Excellent


7. Health and Safety Indicators CQC – Teamwork / Integrity CARE - Aspirational

Health and Safety IndicatorsTarget

variance

Incidents Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type Month +/-

RIDDOR reportable Incidents 4 6 0 1 3 1 2 6 4 2 5 2 ▼ - -Total non clinical incidents reported 77 63 46 49 70 49 39 79 83 69 77 72 ▼ - -Abuse/V&A (Patient to staff) 36 26 12 14 24 18 10 28 47 38 31 30 ▼ - -Body fluid exposure/needle stick injury 16 19 20 8 16 5 8 24 15 16 18 17 ▼ - -Building works 13 9 4 13 19 7 2 15 8 5 11 8 ▼ - -Slips and Trips 4 2 4 1 5 9 4 2 4 3 1 4 ▲ - -Musculoskeletal - Inanimate object 2 0 0 0 0 3 4 2 5 2 1 1 ◄► - -

Staff receiving H&S related training Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Month +/-

Manual Handling non patient every 3 years 86.5% 89.0% 88.7% 89.6% 90.3% 88.9% 89.6% 83.4% 90.4% 90.7% 91.9% 92.0% ▲ > 90.0% 2.0%

Conflict Resolution 80.8% 82.6% 84.2% 85.0% 85.1% 85.3% 85.1% 83.4% 83.4% 82.5% 82.8% 81.4% ▼ > 90.0% -8.6%Fire (Annual) 83.5% 85.0% 85.1% 85.9% 86.0% 84.6% 84.2% 83.4% 85.4% 85.3% 86.8% 86.0% ▼ > 90.0% -4.0%Nursing and AHP Manual handling training every 3 years

90.8% 90.2% 90.1% 89.9% 90.4% 90.3% 90.1% 90.5% 90.3% 91.1% 90.8% 90.7% ▼ > 90.0% 0.7%

Doctors manual handling training every 3 years 61.4% 62.1% 62.0% 61.8% 60.9% 64.3% 65.5% 68.4% 71.3% 71.3% 70.8% 72.4% ▲ > 90.0% -17.6%

Civil and Enforcement Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Month +/-

Personal Injury claims 0 0 1 0 1 0 1 1 0 1 0 0 ◄► - -Interaction with Regulators 0 0 0 0 0 0 0 1 0 0 0 0 ◄► - -


Actual Target

The Overall RAG rating (Red, Amber, Green) is a subjective risk rating determined by the Head of Engineering. By using a variety of records and information, it is an agreed but subjective view of the key item as an overall risk view. The Datix risk assessment accounts for entries which highlight a particular risk in that key item category and using the Datix matrix for scoring.


7. Health and Safety Indicators CQC – Teamwork / Integrity CARE - Aspirational

8. Finance – Achieve long-term Financial Sustainability


Income from Activities (excluding Drugs income) – Income from activities is £0.91m ahead of plan in month due to adjustment to risk share agreement in Berkshire West contract £0.17m and an over performance in Non Elective activity.

Total Cost (excluding Drugs) – Total costs are £(2.18)m overspent against budget driven by pay and under delivery of QIPP. Cash (£M YTD) – The current £12.54m cash variance includes movement in working capital of £5.50m, cash-flows from operating activities of £(10.20)m, a delay in Capex spend and Charity grants of £13.60m and Agenda for Change funding of £3.40m. QIPP delivery – QIPP delivery of £1.36m is below the target by £(0.53)m for M11 (target of £1.89m). Full year risk adjusted programmes represent 87% of full year £16.08m target. Use of Resources - Score of 1.

CQC - Excellence / Integrity CARE - Resourceful

Financial ProficiencyTarget variance

(based on budget)

Financial Efficiency Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb DoT Target Type Month +/-

Income from activities (excluding drugs income)

28.95 26.83 28.15 28.01 28.30 27.91 27.99 29.81 27.39 28.11 28.85 26.96 ▼ >= 25.768 1.193

Total cost, excluding drugs -34.55 -30.84 -30.97 -31.21 -31.58 -32.56 -30.38 -30.98 -31.69 -30.18 -31.71 -31.57 ▼ <= -29.043 -2.522Cash(YTD) £M 41.19 38.15 36.08 32.47 35.85 38.25 36.21 31.10 30.54 33.54 32.61 30.83 ▼ > 18.489 12.337QIPP Delivery (£M) 1.73 0.25 0.49 0.91 1.48 1.30 1.10 1.32 1.60 1.23 1.48 1.36 ▼ > 1.889 -0.528Use of Resources 2 3 3 3 3 3 2 2 2 2 1 1 ◄► <= 2 -1


Actual Target

Title: February Financial Performance Summary Agenda item no: 6b Meeting: Board of Directors Date: 27 March 2019 Presented by: Nicky Lloyd, Chief Finance Officer Prepared by: Michael Clements, Deputy Director of Finance – Central Finance Purpose of the Report To update the Board of Directors on the Financial Performance of the

Trust in February 2019

Report History

What action is required? The Committee is asked to NOTE the report



Relationship to Risk in BAF:

e.g. The BAF should drive the board agenda to ensure sufficient focus is given to those areas presenting the trust with the most risk.







1 Summary

1.1 The Trust has reported results behind adjusted NHS Improvement (NHSI) Control Total for the year to date at M11 2018/19.

(a) Income ahead of plan and forecast

(i) £0.17m accrued relating to Berkshire West Contract

(ii) Non Elective Activity higher than plan and forecast

(b) Costs were over both budget and forecast

(i) Pay £(1.13)m over budget and £0.02m better than Q2F

(a) Primarily care group over spends

(ii) Non Pay £(1.18)m over budget and £(1.17)m over Q2F

(a) Driven by care groups and estates

1.2 The Trust has recognised PSF income for M11, £1.48m

(a) The Trust’s NHSI approved forecast is to deliver revised Control Total

(b) A&E performance is measured on March performance in isolation

2 Conclusion and Next Steps

2.1 The Board is asked to NOTE the report

3 Attachments

3.1 The following are attached to this report:

(a) Appendix 1 – Director of Finance Summary Report

8. Finance – Achieving Financial Sustainability

Director of Finance Report Page 1

CQC - Excellence / Integrity CARE - Resourceful

Income from Activities (excluding Drugs income) – Income from activities is £0.91m ahead of plan in month due to adjustment to risk share agreement in Berkshire West contract £0.17m and an overperformance in Non Elective activity

Total Cost (excluding Drugs) – Total costs are £(2.18)m overspent against budget driven by pay and under delivery of QIPP Cash (£M YTD) – The current £12.54m cash variance includes movement in working capital of £5.50m, cash-flows from operating activities of £(10.20)m, a delay in Capex spend and Charity grants of £13.60m and Agenda for Change funding of £3.40m QIPP delivery – QIPP delivery of £1.36m is below the target by £(0.53)m for M11 (target of £1.89m). Full year risk adjusted programmes represent 87% of full year £16.08m target. Use of Resources - Score of 1.

2 2

Overall Financial Performance for February 2019 – Behind both budget and forecast in month and year–to-date ( YTD), driven by adverse pay and non-pay variances. YTD the Trust is behind the adjusted control total.

Key Messages:

• Control Total missed by £(3.23)m, £(2.40)m behind the adjusted Control Total as a result of offsetting adjustment with Berkshire Healthcare FT

• The Trust has recognised PSF income for the achievement of M11 financial and A&E performance.

• Care Groups £(1.51)m behind budget and £(0.69)m adverse to Q2F

• Income is £0.89m ahead of plan in month due to Non Elective Activity and adjustment to risk share agreement in Berkshire West contract £0.17m

• Operational Corporate departments £(0.31)m behind budget and £(0.19)m off Q2F driven by Estates

• Capital Charges and Corporate-Other £0.47m favourable to budget, £(0.01)m adverse to Q2F

• Use of Resources Rating: 1

Actions: • All care groups and corporate departments embed

actions to reduce rate of expenditure through remaining weeks of the financial year

Results for Month 11£m

Actual £m Vs Q2F

Vs Budget £m

Actual £m Vs Q2F

Vs Budget £m

Income 34.44 0.39 0.89 391.03 2.04 8.30 Pay (20.31) 0.02 (1.13) (221.32) (0.58) (8.95)Drugs (3.76) (0.14) 0.06 (43.10) 0.22 1.79 Non Pay ex Drugs (10.65) (1.17) (1.18) (115.47) (2.94) (5.64)Other (0.61) 0.02 0.01 (6.86) (0.04) (0.07)Exceptional Items (0.00) 0.00 0.00 (0.00) (0.00) (0.00)Surplus/(Deficit) (0.88) (0.89) (1.35) 4.28 (1.30) (4.57)Use of Resources 1 Control Total YTD (7.40) (3.23)

Actual £m Vs Q2F

Vs Budget £m

Actual £m Vs Q2F

Vs Budget £m

Cashflow from Operations 0.70 (0.30) (2.17) 0.70 (0.30) (2.17)

Cash 30.83 12.34 12.34 30.83 12.34 12.34

EBITDA 1.02 1.93 (1.52) 24.35 25.65 (6.92)

EBDITDA margin 3.0% 5.7% (4.61%) 6.2% 6.6% (1.94%)

Net Surplus/(Deficit)Actual

£m Vs Q2FVs Budget

£mActual

£m Vs Q2FVs Budget

£mUrgent Care (8.21) (0.27) (0.72) (87.80) (1.06) (3.22)Planned Care (9.48) (0.46) (0.45) (108.00) (0.43) (3.66)Networked Care (7.19) 0.04 (0.33) (81.32) (0.60) (3.16)E&F (2.04) (0.16) (0.19) (21.95) (0.32) (0.47)Corporate Services 26.04 (0.05) 0.36 303.34 1.11 5.94 Total Trust (0.88) (0.89) (1.35) 4.28 (1.30) (4.57)

IncomeActual

£m Vs Q2FVs Budget

£mActual

£m Vs Q2FVs Budget

£mIncome from Activities 26.96 0.91 1.19 308.31 2.92 5.72 Drug & Devices 3.13 (0.43) (0.66) 38.65 (0.80) (3.32)Other Patient Care Income 0.31 (0.16) (0.06) 4.02 (0.71) 0.07 Other Operating Income 2.57 0.07 0.43 28.85 0.64 5.82 PSF 1.48 0.00 0.00 11.20 0.00 0.00 Total Income 34.44 0.39 0.89 391.03 2.04 8.30

MONTH YTD

MONTH YTD

MONTH YTD

MONTH YTD

3 3

Overall Financial Performance for February 2019 against Control Total – Behind Control Total year to date, driven by adverse variance in pay and non pay

Key Messages: • Trust YTD M11 actual deficit position is behind Plan by £(4.34)m. When donated items and PSF income are removed the variance against

Control Total is £(3.23)m

• Following the offsetting adjustment of Control Total with Berkshire Healthcare FT the Trust is £(2.40)m behind Revised Control Total

Income and Expenditure VariancePlan Actual Variance Plan Actual Vs. Plan£m £m £m £m £m £m

Operating Income 33.55 34.44 0.89 382.74 391.03 8.30Pay costs (18.76) (20.31) (1.55) (209.60) (221.32) (11.73)Non Pay (12.03) (13.12) (1.09) (142.16) (145.36) (3.19)EBITDA 2.76 1.02 (1.74) 30.98 24.35 (6.62)Donations and GrantsDepreciation/Amortisation & loss of disposals (1.45) (1.29) 0.16 (15.58) (13.22) 2.37Net Interest, Finance & Tax (0.06) (0.05) 0.01 (0.71) (0.79) (0.08)PDC Dividend (0.55) (0.55) 0.00 (6.06) (6.07) (0.00)Net Surplus/(Deficit) 0.69 (0.88) (1.57) 8.62 4.28 (4.34)Remove: Donated Asset items (0.15) 0.06 0.21 (1.60) (0.49) 1.12Remove: PSF (1.48) (1.48) 0.00 (11.20) (11.20) 0.00Control Total (0.93) (2.29) (1.36) (4.18) (7.40) (3.23)Offset with Berkshire Healthcare FT (0.08) 0.00 0.08 (0.83) 0.00 0.83Revised Control Total (1.01) (2.29) (1.29) (5.00) (7.40) (2.40)

M11 YTD M11

4

Income – Ahead of Q2F by £0.39m driven by Non Elective activity and additional funding from Berkshire West CCG

Key Messages: • Month 11 Income from Activities – £0.91m ahead of

Q2F with the main variances as follows: – Non Elective is £1.00m ahead of Q2F. This favourable

variance is due to the combination of a complexity increase as a result of full coding from the prior month of £0.70m, and a volume increase in respect of discharged long stay patients in the current month of £0.30m.

– Direct Access Pathology is £0.19m ahead of Q2F, which is largely due to an inclusion this month of £0.16m in relation to December activity that is highly likely to be missing as a result of a system change by BSPS (Berkshire Surrey Pathology Service).

– The ‘Other’ shortfall of £(0.23)m against Q2F is due to the Marginal Rate Emergency Threshold (MRET) impact of £(0.35)m as a result of the increased Non Elective income, partially offset by additional funding from Berks West CCG of £0.10m.

– PSF (Provider Sustainability Funding) income has been accrued at the full rate in Month 11.

• Drug & Devices Income is behind Q2F by £(0.43)m.

• Other Patient Care Income is behind Q2F by £(0.16)m, due to shortfalls in income from Private Patients and Pathology Tests of £(0.10)m and £(0.06)m respectively.

• Other Operating Income is close to Q2F with a variance of less than £0.10m.

Analysis of Income from Activities£m Actual vs Q2F vs Budget Actual vs Q2F vs BudgetA&E 1.83 0.14 0.19 17.22 0.28 0.13Non Elective 9.14 1.01 1.22 79.16 0.48 1.19Elective (incl Daycase) 4.47 (0.44) (0.53) 45.86 (0.98) (2.35)Outpatient (incl Procedures) 6.64 (0.06) 0.10 61.69 (0.48) (1.58)Maternity 2.29 (0.17) (0.18) 23.76 0.28 (0.42)Critical Care 0.97 (0.04) (0.05) 9.62 (0.27) (0.51)Renal Dialysis & Post Transplant 0.86 (0.05) (0.05) 8.74 0.00 (0.05)Direct Access (Pathology & Radiology) 0.88 (0.08) (0.05) 9.15 (0.09) 0.18CQUINs 0.58 (0.00) (0.00) 5.76 (0.00) (0.00)Other 1.19 0.02 (0.09) 20.40 2.78 7.93Total Income from Activities 28.85 0.33 0.57 281.35 2.01 4.53

Month YTD

IncomeActual

£m Vs Q2FVs Budget

£mActual

£m Vs Q2FVs Budget

£mIncome from Activities 26.96 0.91 1.19 308.31 2.92 5.72 Drug & Devices 3.13 (0.43) (0.66) 38.65 (0.80) (3.32)Other Patient Care Income 0.31 (0.16) (0.06) 4.02 (0.71) 0.07 Other Operating Income 2.57 0.07 0.43 28.85 0.64 5.82 PSF 1.48 0.00 0.00 11.20 0.00 0.00 Total Income 34.44 0.39 0.89 391.03 2.04 8.30

MONTH YTD

5

Pay costs – worse than YTD budget by £(8.95)m and Q2F by £(0.58)m Key Messages

• The adverse variance to Budget in

Febuary of £(1.13)m is driven by Care Group overspends of £(0.89)m and an adverse variance in Corporate Other of £(0.34)m (offset in income)

• Performance against Q2F was £0.02m favourable in February and this was largely driven by an underspend in NCG

• Pay costs decreased by £0.51m from last month, due to the payroll cycle and decreased usage of staff

• Care Groups reported M11 adverse variances against budget are driven by:

• PCG - Pay is £(0.25)m higher than budget. The main driver of this is Medical £(0.13)m, Nursing £(0.07)m and Admin £(0.05)m staffing costs

• UCG - Pay is £(0.44)m higher than budget. Budget variances are apparent in Medical staffing, £(0.14)m, Nursing £(0.21)m and PAMs £(0.06)m

• NCG – Pay is £(0.20)m higher than budget. Predominantly driven by Medical staffing £(0.09)m, Nursing £(0.05)m and PAMs £(0.05)m

• The reported position is in line with Q2F for the Care Groups in month with Medical and PAM overspends being offset in Nursing

Pay Costs £M

Group Description M06 2018/19

M07 2018/19

M08 2018/19

M09 2018/19

M10 2018/19

M11 2018/19

MoM varMonth vs. Forecast

YTD vs. Forecast

Month vs Budget

YTD vs Budget

Medical Staff 5.85 6.02 6.27 5.99 6.11 6.05 0.06 (0.20) (1.27) (0.35) (2.45)Nursing 7.64 7.58 7.64 7.56 8.16 7.90 0.25 0.23 0.93 (0.51) (3.62)PAMs 1.17 1.23 1.26 1.20 1.28 1.25 0.03 (0.08) (0.33) (0.16) (0.95)Scientist and PTBs 1.08 1.14 1.11 1.17 1.14 1.17 (0.03) (0.01) 0.04 (0.08) (0.36)Pharmacists 0.23 0.24 0.22 0.23 0.24 0.24 0.00 (0.00) (0.04) (0.02) (0.12)Admin & Management 2.84 2.82 2.85 2.76 2.86 2.88 (0.02) (0.03) 0.05 (0.13) (0.52)Ancil lary & Maintenance 0.92 0.83 0.83 0.84 0.90 0.87 0.03 0.03 0.31 0.01 0.19Other Pay 0.14 0.13 0.14 0.26 0.13 (0.04) 0.17 0.08 (0.28) 0.12 (1.12)Pay 19.85 19.99 20.32 20.01 20.82 20.31 0.51 0.02 (0.58) (1.13) (8.95)

By Care Group/DirectorateUCG 6.66 6.64 6.88 6.65 7.23 6.92 0.31 (0.05) (0.67) (0.44) (3.22)PCG 6.16 6.06 6.17 5.95 6.00 6.01 (0.00) (0.07) (0.25) (0.25) (1.54)NCG 4.33 4.42 4.31 4.38 4.48 4.41 0.07 0.12 0.37 (0.20) (1.83)Total Care Group 17.16 17.12 17.37 16.97 17.72 17.34 0.38 0.00 (0.55) (0.89) (6.59)Chief Medical Officer 0.22 0.22 0.23 0.22 0.23 0.26 (0.03) (0.03) (0.02) (0.02) 0.17Chief Nursing Officer 0.33 0.33 0.34 0.36 0.34 0.35 (0.01) 0.02 0.06 0.00 0.07Chief Exec & Non-Execs 0.21 0.20 0.20 0.21 0.21 0.24 (0.03) (0.04) (0.06) (0.03) (0.02)Chief Operating Officer 0.05 0.05 0.05 0.05 0.06 0.06 0.00 0.00 0.02 0.00 0.07Workforce and Organisational Development 0.29 0.29 0.30 0.29 0.28 0.28 0.00 0.02 0.04 0.02 0.17Finance 0.25 0.26 0.26 0.25 0.27 0.26 0.01 0.01 0.03 0.01 0.05IT 0.39 0.37 0.39 0.30 0.42 0.31 0.11 0.08 0.17 0.08 0.24Estates & Facil ities 0.98 0.90 0.91 0.90 0.97 0.94 0.03 0.03 0.31 0.03 0.35Corporate - Other (0.05) 0.25 0.26 0.45 0.33 0.28 0.04 (0.08) (0.57) (0.34) (3.46)TOTAL Other 2.69 2.87 2.95 3.03 3.10 2.97 0.13 0.01 (0.03) (0.24) (2.35)Pay 19.85 19.99 20.32 20.01 20.82 20.31 0.51 0.02 (0.58) (1.13) (8.95)

Vs.Forecast VS BUDGET

6

Non Pay Costs – Drugs – Below budget ytd by £1.79m and forecast by £0.22m

Key Messages • Drugs income as a % of drugs

costs totalled 75.6% in February, which is below plan

Non Pay - DrugsActual

£m Vs Q2FVs Budget

£mActual

£m Vs Q2FVs Budget

£mUrgent Care (0.36) (0.04) (0.04) (3.68) (0.14) 0.12 Planned Care (1.62) 0.12 0.13 (18.94) 0.98 1.36 Networked Care (1.73) 0.02 0.00 (20.28) 0.21 0.34 Other (0.06) (0.24) (0.04) (0.20) (0.83) (0.03)Total Drugs (3.76) (0.14) 0.06 (43.10) 0.22 1.79

MONTH YTD

7

Non Pay Costs – Excluding Drugs – £(2.94)m worse than forecast and £(5.64)m worse than YTD budget

Key messages • February’s non-pay expenditure is

£(1.18)m adverse to budget and £(1.17)m behind forecast

• This is shown in Miscellaneous Services, where QIPP targets sit. Whilst there is some underspend in lines above this does not cover the planned QIPP for the period

Non Pay ex DrugsActual

£m Vs Q2FVs Budget

£mActual

£m Vs Q2FVs Budget

£mClinical Service & Supplies (3.50) (0.11) 0.05 (41.47) (0.62) (0.53)General Supplies & Services (0.53) 0.01 0.02 (6.35) (0.19) (0.10)Establishment Expenses (0.28) 0.01 0.04 (3.54) 0.13 0.07 Other Establishment Expenses (1.60) (0.03) 0.10 (17.67) (0.17) 1.07 Prem, Trans & Fixed Plant (1.89) 0.09 (0.16) (19.52) 0.56 0.46 Depreciation (1.29) (0.00) 0.17 (13.21) 0.03 2.43 Leases (0.22) 0.04 0.04 (2.42) 0.23 0.45 Miscellaneous Services (1.32) (1.18) (1.43) (11.29) (2.89) (9.49)Total Non Pay ex Drugs (10.65) (1.17) (1.18) (115.47) (2.94) (5.64)

Non Pay ex DrugsActual

£m Vs Q2FVs Budget

£mActual

£m Vs Q2FVs Budget

£mUrgent Care (1.20) (0.18) (0.34) (12.90) (0.42) (1.19)Planned Care (2.11) (0.36) (0.30) (26.63) (0.88) (4.11)Networked Care (1.35) (0.05) (0.10) (16.10) (0.89) (1.81)Estates & Facilities (1.38) (0.13) (0.17) (14.92) (0.61) (1.07)HFMS 0.11 0.01 0.03 1.35 0.28 0.44 Other Corporate (4.73) (0.47) (0.29) (46.27) (0.44) 2.10 Total Non Pay ex Drugs (10.65) (1.17) (1.18) (115.47) (2.94) (5.64)

YTDMONTH

MONTH YTD

8

Point of Delivery – Month 11 February 2019

All CCGs (including NCAs)

POD Group POD Detail Activity Value (£'000) Activity Value

(£'000) Activity Value (£'000) Activity Value

(£'000)

A&E Accident & Emergency 129,843 20,134 10,068 1,520 11,206 1,662 1,138 142A&E Total 20,134 1,520 1,662 142

Outpatient Outpatient FA Multi Prof Cons Led 4,163 1,096 367 89 306 80 (61) (9)Outpatient FA Single Prof Cons Led 141,306 25,052 12,529 2,054 11,030 1,989 (1,499) (65)Outpatient FA Single Prof Non-Cons Led 2,522 124 233 10 224 12 (9) 2Outpatient FUP Multi Prof Cons Led 8,309 1,135 737 92 587 80 (150) (12)Outpatient FUP Single Prof Cons Led 240,313 21,300 20,693 1,743 18,910 1,666 (1,783) (77)Outpatient FUP Single Prof Non-Cons Led 5,239 182 456 14 353 13 (103) (1)Outpatient Procedures 129,754 18,841 11,345 1,537 10,785 1,607 (560) 70Diagnostic Imaging whilst Outpatient (Unbundled) 62,222 5,983 5,059 485 5,319 507 260 22Non Face to Face 22,495 955 1,753 70 1,726 74 (27) 4

Outpatient Total 74,668 6,096 6,028 (68)

Elective Elective Inpatients 6,752 21,844 564 1,718 533 1,799 (31) 81Elective Inpatients - Change re Spells in Progress (vs M12 17-18) 21 45 0 0 6 13 6 13Elective Excess Bed Days 877 238 61 15 245 63 184 48Day Cases 41,052 32,495 3,576 2,627 3,139 2,522 (437) (105)Haematology - Regular Day Atts (Chemo & Other Infusions) 7,523 1,369 671 113 548 115 (123) 2

Elective Total 55,989 4,473 4,512 39

Non Elective Emergency Inpatients (Excluding Maternity) 36,674 83,010 3,061 6,502 2,975 7,331 (86) 829Emergency Inpatients - Change re Spells in Progress (vs M12 17-18) (31) 37 0 0 (25) (75) (25) (75)Emergency Same Day 4,823 4,088 377 303 376 295 (1) (8)Emergency Short Stay 4,769 3,687 388 299 392 290 4 (9)Emergency Excess Bed Days 12,184 3,265 1,113 280 1,858 538 745 258

Non Elective Total 94,088 7,384 8,379 995

Maternity Maternity Pathway - Antenatal 7,284 10,899 610 901 558 761 (52) (140)Maternity Pathway - Postnatal 5,270 1,672 440 139 326 188 (114) 49Non Elective Non Emergency (Maternity Admissions) 12,949 15,200 995 1,162 982 1,066 (13) (96)Maternity Excess Bed Days 927 346 72 26 100 36 28 10

Maternity Total 28,118 2,229 2,051 (178)

Critical Care Adult Critical Care 4,488 7,014 357 559 333 534 (24) (25)Adult Critical Care - Change re Spells in Progress (vs M12 17-18) 117 210 0 0 (38) (62) (38) (62)Neonatal Critical Care 7,680 4,187 592 318 883 488 291 170Neonatal Critical Care - Change re Spells in Progress (vs M12 17-18) (223) (91) 0 0 (3) 0 (3) 0Paediatric High Dependency 512 500 41 39 32 30 (9) (9)

Critical Care Total 11,819 916 990 218 74

Renal Renal Dialysis & Post Transplant 70,761 10,478 6,231 874 5,405 818 (826) (56)Renal Total 10,478 874 818 (56)

Other Activity Pre-op Assessments 18,051 736 1,279 48 1,630 67 351 19Rehab Bed Days 5,102 1,521 482 131 210 64 (272) (67)Block Priced Items 17,849 1,472 1,491 19Pathology Direct Access 3,593,576 7,633 301,591 601 375,913 794 74,322 193Radiology Direct Access 79,988 3,418 6,581 281 6,596 278 15 (3)Orthotics Direct Access 4,462 934 396 74 296 66 (100) (8)Anti Coagulant Reviews 78,197 617 7,498 54 5,418 43 (2,080) (11)Heart Failure Pathway 37 47 3 4 4 5 1 1Post Discharge Rehab 286 169 25 14 9 6 (16) (8)Other (DMARDs etc) 44,593 981 3,260 73 4,250 70 990 (3)

Other Activity Total 33,906 2,751 2,884 133

Drugs & Devices PbR Excluded Drugs 39,675 3,237 2,840 (397)PbR Excluded Devices 3,422 324 289 (35)

Drugs & Devices Total 43,097 3,561 3,129 (432)

Adjustments CQUINs 6,907 576 576 0Marginal Rate on Over Performance re BWCCGs 0 0 0 0MRET & 30 Day Readmits Deductions (Net of Reinvestment) (4,761) 0 (743) (743)Contingency Provision re Contract Deductions 547 (795) (406) 389Adjust BWCCG Income to align with Baseline & Trust Cost profile 1,440 0 (60) (60)Agreed additional funding from Berkshire West CCG 0 0 166 166

Adjustments Total 4,133 (220) (467) (247)

Bowel Screening & Scoping 804 25 100 75Others 107 3 3 0

Other Income from Activities Total 911 28 104 76

TOTAL (= 'Income from Activities') 377,342 29,612 30,090 478

Other Income from Activites

*** TRUST TOTAL ***

ANNUAL PER Q2F MTH 11 PER Q2F MTH 11 ACTUAL MTH 11 VARIANCE

9

Point of Delivery – YTD April 2018 to Feb 2019

All CCGs (including NCAs)

POD Group POD Detail Activity Value (£'000) Activity Value

(£'000) Activity Value (£'000) Activity Value

(£'000)

A&E Accident & Emergency 129,843 20,134 119,003 18,451 122,623 18,877 3,620 426A&E Total 20,134 18,451 18,877 426

Outpatient Outpatient FA Multi Prof Cons Led 4,163 1,096 3,825 1,002 3,697 978 (128) (24)Outpatient FA Single Prof Cons Led 141,306 25,052 129,602 22,896 124,093 22,298 (5,509) (598)Outpatient FA Single Prof Non-Cons Led 2,522 124 2,310 113 2,264 115 (46) 2Outpatient FUP Multi Prof Cons Led 8,309 1,135 7,634 1,038 7,332 1,016 (302) (22)Outpatient FUP Single Prof Cons Led 240,313 21,300 221,035 19,470 217,096 19,169 (3,939) (301)Outpatient FUP Single Prof Non-Cons Led 5,239 182 4,825 167 4,617 164 (208) (3)Outpatient Procedures 129,754 18,841 119,210 17,227 119,383 17,589 173 362Diagnostic Imaging whilst Outpatient (Unbundled) 62,222 5,983 56,910 5,473 57,453 5,497 543 24Non Face to Face 22,495 955 20,877 881 21,163 891 286 10

Outpatient Total 74,668 68,268 67,717 (551)

Elective Elective Inpatients 6,752 21,844 6,236 20,046 6,134 19,649 (102) (397)Elective Inpatients - Change re Spells in Progress (vs M12 17-18) 21 45 21 45 42 124 21 79Elective Excess Bed Days 877 238 821 222 1,164 313 343 91Day Cases 41,052 32,495 37,761 29,746 36,386 29,056 (1,375) (690)Haematology - Regular Day Atts (Chemo & Other Infusions) 7,523 1,369 6,913 1,250 6,524 1,229 (389) (21)

Elective Total 55,989 51,309 50,371 (938)

Non Elective Emergency Inpatients (Excluding Maternity) 36,674 83,010 33,589 75,946 33,236 77,481 (353) 1,535Emergency Inpatients - Change re Spells in Progress (vs M12 17-18) (31) 37 (31) 37 (79) (40) (48) (77)Emergency Same Day 4,823 4,088 4,425 3,755 4,448 3,796 23 41Emergency Short Stay 4,769 3,687 4,363 3,359 4,304 3,374 (59) 15Emergency Excess Bed Days 12,184 3,265 11,113 2,963 10,421 2,928 (692) (35)

Non Elective Total 94,088 86,059 87,539 1,480

Maternity Maternity Pathway - Antenatal 7,284 10,899 6,643 9,953 6,570 9,995 (73) 42Maternity Pathway - Postnatal 5,270 1,672 4,808 1,526 4,821 1,614 13 88Non Elective Non Emergency (Maternity Admissions) 12,949 15,200 11,847 13,913 11,834 13,860 (13) (53)Maternity Excess Bed Days 927 346 845 317 887 342 42 25

Maternity Total 28,118 25,710 25,811 101

Critical Care Adult Critical Care 4,488 7,014 4,093 6,395 3,992 6,198 (101) (197)Adult Critical Care - Change re Spells in Progress (vs M12 17-18) 117 210 117 210 55 108 (62) (102)Neonatal Critical Care 7,680 4,187 7,025 3,835 6,942 3,806 (83) (29)Neonatal Critical Care - Change re Spells in Progress (vs M12 17-18) (223) (91) (223) (91) (176) (79) 47 12Paediatric High Dependency 512 500 467 456 593 577 126 121

Critical Care Total 11,819 10,805 10,610 (72) (195)

Renal Renal Dialysis & Post Transplant 70,761 10,478 65,096 9,605 64,178 9,554 (918) (51)Renal Total 10,478 9,605 9,554 (51)

Other Activity Pre-op Assessments 18,051 736 16,888 685 18,544 760 1,656 75Rehab Bed Days 5,102 1,521 4,653 1,386 4,111 1,262 (542) (124)Block Priced Items 17,849 16,363 16,395 32Pathology Direct Access 3,593,576 7,633 3,319,045 7,004 3,402,295 7,139 83,250 135Radiology Direct Access 79,988 3,418 73,078 3,122 72,725 3,085 (353) (37)Orthotics Direct Access 4,462 934 4,100 856 3,889 838 (211) (18)Anti Coagulant Reviews 78,197 617 71,381 560 64,954 516 (6,427) (44)Heart Failure Pathway 37 47 34 42 33 42 (1) (0)Post Discharge Rehab 286 169 263 155 214 129 (49) (26)Other (DMARDs etc) 44,593 981 41,606 906 45,834 850 4,228 (56)

Other Activity Total 33,906 31,080 31,016 (64)

Drugs & Devices PbR Excluded Drugs 39,675 36,360 35,729 (632)PbR Excluded Devices 3,422 3,097 2,926 (171)

Drugs & Devices Total 43,097 39,457 38,654 (802)

Adjustments CQUINs 6,907 6,331 6,331 (0)Marginal Rate on Over Performance re BWCCGs 0 0 0 0MRET & 30 Day Readmits Deductions (Net of Reinvestment) (4,761) (3,968) (4,851) (884)Contingency Provision re Contract Deductions 547 (580) (459) 121Adjust BWCCG Income to align with Baseline & Trust Cost profile 1,440 1,440 2,860 1,420Agreed additional funding from Berkshire West CCG 0 0 1,833 1,833

Adjustments Total 4,133 3,224 5,714 2,490

Bowel Screening & Scoping 804 778 1,078 300Others 107 104 23 (81)

Other Income from Activities Total 911 882 1,101 218

TOTAL (= 'Income from Activities') 377,342 344,850 346,964 2,114

Other Income from Activites

*** TRUST TOTAL ***

ANNUAL PER Q2F YTD PER Q2F YTD ACTUAL YTD VARIANCE

10

Price/Volume Income Variances

POD Detail Vol Value (£000) Vol

Value (£000) Vol

Value (£000)

Vol (£000)

Price (£000) Price %

Total (£000)

Accident & Emergency 119,003 £18,451 122,623 £18,877 3,620 £426 £561 (£136) -0.7% £426A&E Total £18,451 £18,877 £426 £561 (£136) £426

Outpatient FA Multi Prof Cons Led 3,825 £1,002 3,697 £978 (128) (£24) (£33) £9 1.0% (£24)Outpatient FA Single Prof Cons Led 129,602 £22,896 124,093 £22,298 (5,509) (£598) (£973) £376 1.7% (£598)Outpatient FA Single Prof Non-Cons Led 2,310 £113 2,264 £115 (46) £2 (£2) £4 3.4% £2Outpatient FUP Multi Prof Cons Led 7,634 £1,038 7,332 £1,016 (302) (£22) (£41) £19 1.9% (£22)Outpatient FUP Single Prof Cons Led 221,035 £19,470 217,096 £19,169 (3,939) (£301) (£347) £46 0.2% (£301)Outpatient FUP Single Prof Non-Cons Led 4,825 £167 4,617 £164 (208) (£3) (£7) £4 2.5% (£3)Outpatient Procedures 119,210 £17,227 119,383 £17,589 173 £362 £25 £337 2.0% £362Diagnostic Imaging whilst Outpatient (Unbundled) 56,910 £5,473 57,453 £5,497 543 £24 £52 (£28) -0.5% £24Non Face to Face 20,877 £881 21,163 £891 286 £10 £12 (£2) -0.3% £10Outpatient Total £68,268 £67,717 (£551) (£1,315) £764 (£551)

Elective Inpatients (incl Spells in Progress Change) 6,257 £20,091 6,176 £19,773 (81) (£318) (£259) (£58) -0.3% (£318)Elective Excess Bed Days 821 £222 1,164 £313 343 £91 £93 (£2) -0.5% £91Day Cases 37,761 £29,746 36,386 £29,056 (1,375) (£690) (£1,083) £393 1.4% (£690)Haematology - Regular Day Atts (Chemo & Other Infusions) 6,913 £1,250 6,524 £1,229 (389) (£21) (£70) £49 4.2% (£21)Elective Total £51,309 £50,371 (£938) (£1,321) £383 (£938)

Emergency Inpatients (incl Spells in Progress Change) 33,558 £75,983 33,157 £77,441 (401) £1,458 (£908) £2,366 3.2% £1,458Emergency Same Day 4,425 £3,755 4,448 £3,796 23 £41 £20 £22 0.6% £41Emergency Short Stay 4,363 £3,359 4,304 £3,374 (59) £15 (£45) £60 1.8% £15Emergency Excess Bed Days 11,113 £2,963 10,421 £2,928 (692) (£35) (£185) £150 5.4% (£35)Non Elective Total £86,059 £87,539 £1,480 (£1,118) £2,597 £1,480

Maternity Pathway - Antenatal 6,643 £9,953 6,570 £9,995 (73) £42 (£110) £152 1.5% £42Maternity Pathway - Postnatal 4,808 £1,526 4,821 £1,614 13 £88 £4 £84 5.5% £88

Non Elective Non Emergency (Maternity Admissions) 11,847 £13,913 11,834 £13,860 (13) (£53) (£15) (£38) -0.3% (£53)Maternity Excess Bed Days 845 £317 887 £342 42 £25 £16 £9 2.7% £25Maternity Total £25,710 £25,811 £101 (£105) £207 £101

Adult Critical Care (incl Spells in Progress Change) 4,210 £6,605 4,047 £6,306 (163) (£299) (£255) (£44) -0.7% (£299)Neonatal Critical Care (incl Spells in Progress Change) 6,802 £3,743 6,766 £3,727 (36) (£16) (£20) £3 0.1% (£16)Paediatric High Dependency 467 £456 593 £577 126 £121 £123 (£2) -0.3% £121Critical Care Total £10,805 £10,610 (£195) (£152) (£43) (£195)

Renal Dialysis & Post Transplant 65,096 £9,605 64,178 £9,554 (918) (£51) (£135) £84 0.9% (£51)Renal Total £9,605 £9,554 (£51) (£135) £84 (£51)

Pre-op Assessments 16,888 £685 18,544 £760 1,656 £75 £67 £7 1.0% £75Rehab Bed Days 4,653 £1,386 4,111 £1,262 (542) (£124) (£161) £38 3.1% (£124)Pathology Direct Access 3,319,045 £7,004 3,402,295 £7,139 83,250 £135 £176 (£40) -0.6% £135Radiology Direct Access 73,078 £3,122 72,725 £3,085 (353) (£37) (£15) (£22) -0.7% (£37)Orthotics Direct Access 4,100 £856 3,889 £838 (211) (£18) (£44) £26 3.2% (£18)Anti Coagulant Reviews 71,381 £560 64,954 £516 (6,427) (£44) (£50) £6 1.2% (£44)Heart Failure Pathway 34 £42 33 £42 (1) (£0) (£1) £0 0.5% (£0)Post Discharge Rehab 263 £155 214 £129 (49) (£26) (£29) £3 2.3% (£26)Other (DMARDs etc) 41,606 £906 45,834 £850 4,228 (£56) (£56)Other Activity Total £14,717 £14,621 (£96) (£58) £18 (£96)

Block Priced Items £16,363 £16,395 £32 £32PbR Excluded Drugs £36,360 £35,729 (£632) (£632)PbR Excluded Devices £3,097 £2,926 (£171) (£171)CQUINs £6,331 £6,331 (£0) (£0)Marginal Rate on Over Performance re BWCCGs £0 £0 £0 £0MRET & 30 Day Readmits Deductions (Net of Reinvestment) (£3,968) (£4,851) (£884) (£884)Contingency Provision re Contract Deductions (£580) (£459) £121 £121Adjust BWCCG Income to align with Baseline & Trust Cost profile £1,440 £2,860 £1,420 £1,420Agreed additional funding from Berkshire West CCG £0 £1,833 £1,833 £1,833Bowel Screening Block Contract £778 £1,078 £300 £300Others £104 £23 (£81) (£81)All Other Items Total £59,926 £61,864 £1,938 £1,938

TOTAL (= 'Income from Activities') £344,850 £346,964 £2,114 £2,114

YTD Mth 11Q1F ACTUAL VARIANCE VARIANCE ANALYSIS

11

Extract from January Monthly return to NHSI – included as information for the Board Key data 01AUDITPY 01PLANYTD 01ACTYTD 01VARYTD 01PLANCY 01FOTCY 01VARCY

Audited PY Plan Actual Variance Plan Forecast Variance31/03/2018 31/01/2019 31/01/2019 31/01/2019 31/03/2019 31/03/2019 31/03/2019

Expected Year ending YTD YTD YTD Year ending Year ending Year endingSign £'000 £'000 £'000 £'000 £'000 £'000 £'000

Performance against control totalSurplus/(deficit) before impairments and transfers +/- 8,538 7,928 5,158 (2,770) 10,744 9,844 (900)Adjusted financial performance surplus/(deficit) including PSF +/- 7,734 6,474 4,607 (1,867) 8,989 8,089 (900)Control total +/- 4,617 6,474 6,474 0 8,989 8,989 0

Performance against control total +/- 3,117 0 (1,867) (1,867) 0 (900) (900)Performance against control total excluding PSF

Adjusted financial performance surplus/(deficit) including PSF +/- 7,734 6,474 4,607 (1,867) 8,989 8,089 (900)Less provider sustainability fund (PSF) +/- (11,950) (9,717) (9,716) 1 (12,673) (12,673) 0Adjusted financial performance surplus/(deficit) excluding PSF +/- (4,216) (3,243) (5,109) (1,866) (3,684) (4,584) (900)Control total excluding PSF +/- (4,395) (3,243) (3,243) 0 (3,684) (3,684) 0

Performance against control total excluding PSF +/- 179 0 (1,866) (1,866) 0 (900) (900)Adjusted financial performance as a % of Turnover (I&E Margin)

Including PSF % 1.89% 1.86% 1.30% (0.57%) 2.16% 1.92% (0.25%)Excluding PSF % (1.06%) (0.96%) (1.48%) (0.52%) (0.91%) (1.12%) (0.21%)

EBITDAEBITDA value +/- 25,820 26,349 22,277 (4,072) 32,990 29,864 (3,126)as a percentage of related income % 6.31% 7.59% 6.27% (1.32%) 7.93% 7.07% (0.86%)

Efficiencies iTotal recurrent efficiencies i + 7,951 12,309 7,749 (4,560) 16,080 11,637 (4,443)High risk schemes + 1,704 3,060 233 (2,827) 3,997 1,340 (2,657)Total unidentified efficiencies i + 0 0 0 0 0 0 0Total identified efficiencies i + 15,346 12,309 11,130 (1,179) 16,080 16,188 108

Total efficiencies + 15,346 12,309 11,130 (1,179) 16,080 16,188 108Total efficiencies as a percentage of expenditure (before efficiencies) % 3.68% 3.49% 3.07% (0.41%) 3.80% 3.76% (0.04%)Capital

Gross capital expenditure + 20,583 30,659 16,310 14,349 40,000 34,170 5,830Disposals / other deductions - (4,511) 0 (4) 4 0 (4) 4

Charge after additions/deductions + 16,072 30,659 16,306 14,353 40,000 34,166 5,834Less donations and grants received - (1,334) (2,080) (1,055) (1,025) (2,500) (2,347) (153)Less PFI capital (IFRIC12) - 0 0 0 0 0 0 0Plus PFI residual interest + 0 0 0 0 0 0 0 g p p adjustments +/- 0 0 0 0 0 0 0

Total CDEL +/- 14,738 28,579 15,251 13,328 37,500 31,819 5,681Cash

Cash and cash equivalents at period end + 41,185 20,071 32,607 12,536 18,422 26,369 7,947DHSC capital financing i +/- 5,390 2,000 1,805 (195) 2,500 6,023 3,523DHSC interim revenue financing i +/- 0 0 0 0 0 0 0

Agency and contractTotal agency costs excluding outsourced bank + 9,725 7,290 7,696 (406) 8,748 9,448 (700)Updated agency ceiling + 10,320 7,920 7,920 0 9,502 9,502 0Agency costs as a percentage of gross payroll costs i % 4.28% 3.82% 3.83% 0.01% 3.83% 3.96% 0.13%

TurnoverTotal operating income + 410,660 349,185 356,589 7,404 418,234 424,562 6,328Less capital donations/grants income impact - (1,334) (1,870) (1,055) 815 (2,247) (2,347) (100)Remove impact of prior year PSF post accounts reallocation - 0 0 0Total turnover + 409,326 347,315 355,534 8,219 415,987 422,215 6,228

12

Capital Expenditure Summary

Key messages: • The table to the left is the

latest view of the level of capital expenditure likely in 2018/19

• This has been reported to NHSI as likely outturn

2018/19 Original

Plan

2018/19 Revised Forecast

Spend to Date

Commit-ments

Orders to be raised

Sub Total

£m £m £m £m £m £m

Medical Equipment 11.00 10.84 (5.63) (2.69) (2.52) (10.84)

Major Estates Work 15.00 8.82 (3.56) (3.23) (2.03) (8.82)

Estates Compliance 5.00 4.33 (2.09) (0.75) (1.49) (4.33)

IM&T Department 7.50 8.92 (8.35) (0.47) (0.10) (8.92)

IM&T Other 0.75 0.75 (0.00) (0.00) (0.75) (0.75)

Transformation Fund 0.50 0.50 (0.02) (0.03) (0.45) (0.50)

Other 0.25 0.00 (0.00) (0.00) 0.00 0.00

Total 40.00 34.16 (19.65) (7.17) (7.34) (34.16)

13

Cash Flow Statement

Key messages • Year to date Cash of £30.83m is up on

plan due to the following:

– Movement in working capital £5.50m

– Agenda for Change funding £3.40m

– Cash flows from Operating Activities £(10.20)m

– Capital £13.60m

(As shown in the table below)

ROYAL BERKSHIRE NHS FOUNDATION TRUSTSTATEMENT OF CASH FLOW February 2019

NB - Against 18/19 APR Budget ForecastJanuary 2019 February 2019 February 2019 YTD February 2019

YTD Actual Month Actual YTD Actual 18-19 Q4 Forecast£000 £000 £000 £000

Opening cash Balance 41.19 32.61 41.19 41.19

Income 356.59 34.44 391.03 382.74Expenditure (incl dep'n) (333.25) (33.43) (366.68) (351.46)

Cash generated 23.34 1.01 24.35 31.27

Working Capital(Increase)/decrease in inventories 0.39 0.29 0.68 0.70(Increase)/decrease in receivables (7.65) 2.69 (4.96) (7.80)(Increase)/decrease in provisions (0.69) 0.41 (0.28) (0.65)Increase/(decrease) in payables 1.25 (3.72) (2.47) (7.55)

(6.70) (0.33) (7.03) (15.30)Investing ActivitiesCapex (Capital expenditure) (18.82) (4.46) (23.28) (33.04)Proceeds from sale of property, plant and equipment 0.00 0.00 0.00 0.00PDC receipt 1.81 2.00 3.81 0.00PDC paid (4.25) 0.00 (4.25) (3.79)

(21.27) (2.46) (23.73) (36.83)Financing ActivitiesInterest income/ (expense) 0.21 0.02 0.23 0.01Interest expense (0.85) 0.00 (0.85) (0.76)Other (0.32) (0.02) (0.33) 1.91

(0.96) 0.00 (0.95) 1.16LoansLoan drawdown 0.00 0.00 0.00 0.00Loan (repayment) (3.00) 0.00 (3.00) (3.00)

Net increase/(decrease) in cash (8.58) (1.78) (10.36) (22.70)

Closing Cash Balance 32.61 30.83 30.83 18.49

£mDelay in Capex spend & charity grants 9.8Deficit movement against plan (10.2)Agenda for Change funding 3.4PDC - Capital 3.8Receivables movements 2.8Decrease in creditors, inc suppliers payment withheld 2.7Cash movement 12.3

14

Long term cash scenarios

Key message: the Trust’s cash balance is expected to remain positive across the next 12 months if mitigating action is taken.

Long Term Cash Scenarios - showing expected mid-month cash low£'000

Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20Scenario 1Month end cash as currently forecast / planned

33,544 32,607 30,826 18,423 18,423 18,423 18,423 18,423 18,423 18,423 18,423 18,423 18,423 18,423 18,423 18,423 18,423

Mid-month low expected £2M lower than month end

(2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000) (2,000)

Scenario 1 33,544 32,607 30,826 16,423 16,423 16,423 16,423 16,423 16,423 16,423 16,423 16,423 16,423 16,423 16,423 16,423 16,423

Scenario 225% underdelivery of QIPPs in 18/19 and 19/20

(470) (684) (898) (1,112) (1,397) (1,682) (1,968) (2,396) (2,824) (3,252) (3,751) (4,250) (4,750) (4,964)

Activity income 1% below plan (319) (619) (919) (1,219) (1,519) (1,819) (2,119) (2,419) (2,719) (3,019) (3,319) (3,619) (3,919) (4,219)Underperformance results in loss of PSF

(4,400) (4,400) (4,400) (4,400) (4,400) (4,400) (4,400) (4,400) (4,400) (4,400) (4,400) (4,400) (4,400) (4,400)

Scenario 2 33,544 32,607 30,826 11,234 10,720 10,206 9,692 9,107 8,522 7,936 7,208 6,480 5,752 4,953 4,154 3,354 2,840

Scenario 3Earlier settlement of DXC payments

Scenario 3 33,544 32,607 30,826 11,234 10,720 10,206 9,692 9,107 8,522 7,936 7,208 6,480 5,752 4,953 4,154 3,354 2,840

Scenario 4Delay in commissioner receipts for contract overperformance

(150) (300) (450) (600) (750) (900) (1,050) (1,200) (1,350) (1,500) (1,650) (1,800) (1,950) (2,100)

Scenario 4 33,544 32,607 30,826 11,084 10,420 9,756 9,092 8,357 7,622 6,886 6,008 5,130 4,252 3,303 2,354 1,404 740

Mitigation AQ2 to Q4 capex spend halved 2,338 2,338 2,338 2,338 2,338 2,338 2,338 2,338 2,338 2,338 2,338 2,338 2,338 2,338

Mitigation B50% reduction in cost relating to activity income below plan - with 6 month delay

0 0 0 0 0 0 159 309 459 609 759 909 1,059 1,209

BW contract income unaffected by activity

207 402 597 792 987 1,182 1,377 1,572 1,767 1,962 2,157 2,352 2,547 2,742

Mitigated Mid Month Low Cash 33,544 32,607 30,826 13,629 13,160 12,691 12,222 11,682 11,142 10,761 10,228 9,695 9,162 8,557 7,953 7,349 7,029

Assume stays flatNHSI Monthly from Annual Plan

Actual

Title: Integrated Care System Update (ICS) Agenda item no: 6c Meeting: Board of Directors Date: 27th March 2019 Presented by: Andrew Statham, Director of Strategy Prepared by: Andrew Statham, Director of Strategy Purpose of the Report To provide the board with an update on the progress of the Berkshire

West Integrated Care System.

Report History Executive Management Committee – 28th January 2019 Board of Directors – 28th November 2018

What action is required? The Committee is asked to note the contents of the report.

Assurance Information ✓ Discussion/input Decision/approval


Relationship to Risk in BAF: Progress on ICS

Strategic objectives This report impacts on (tick all that apply):: Provide the highest quality care Invest in our staff and live out our values Drive the development of integrated services ✓ Cultivate innovation and transformation Achieve long-term financial sustainability Well Led Framework applicability: Not applicable

1. Leadership ✓ 2. Vision & Strategy ✓ 3. Culture 4. Governance ✓

5. Risks, Issues & ✓ Performance


7. Engagement ✓ 8. Learning & Innovation

Positive – supports boards understanding of progress of the ICS Publication Published on website Confidentiality (FoI): Private Public ✓

1 Background and purpose: 1.1 The Trust is part of the Berkshire West Integrated System, a collaboration between health

and social care organisations to improve services for our local population, delivering consistent high quality and safe care, ensuring the best possible outcome and experience for patients, whilst delivering financial stability across the system.

1.2 The BWICS is comprised of the following constituent members:

(a) Acute Hospital Provider – Royal Berkshire NHS Foundation Trust (RBFT);

(b) Community/Mental Health services Provider – Berkshire Healthcare Foundation Trust (BHFT);

(c) Primary Care Provider Alliances – covering four distinct localities – South Reading, Wokingham, Newbury and North and West Reading Alliances; and

(d) Clinical Commissioning Group – Berkshire West CCG.

1.3 Together with our Local Authority partners we are responsible for the health and wellbeing of 528,000 residents living across three Local Authority Areas:

(a) West Berkshire;

(b) Reading; and

(c) Wokingham.

1.4 Our collective aspiration is to deliver:

(a) An improvement in the health and wellbeing of our population;

(b) Enhancements to the experience of using health care services; and

(c) Value for money to local taxpayers and financial sustainability of services

1.5 Delivering on this agenda will require us to:

(a) Make fast and tangible progress in urgent and emergency care reform, strengthening general practice and improving mental health and cancer services;

(b) Manage these and other improvements within a shared financial control total and to maximise the system-wide efficiencies;

(c) Integrate services and funding, operating as an integrated health system, and progressively to build the capabilities to manage the health of the ICS’ defined population, keeping people healthier for longer and reducing avoidable demand for healthcare services; and

(d) Demonstrate to other parts of the health and care system what can be achieved with strong local leadership and increased freedoms and flexibilities.

1.6 The purpose of this paper is to update the board on the progress and activities of the ICS.

2 Key 2018/19 Q4 activities:

2.1 Key achievements during Q4 include:

(a) Completion of the ICS operating planning including the identification of priority programmes for 2019

(b) Progression of the NHSE sponsored Population Health Management Programme

(c) Identification of opportunities for ICS partners to collaborate on and release cost from corporate functions

(d) Planning and commencement of the system “reset fortnight”

3 Summary of progress and forward look priorities:

3.1 In 2017/18 Berkshire West ICS was again recognised for its consistently strong performance clinically, operationally and financially, and for the alignment of its constituent organisations to the ICS vision.

3.2 Appended to this report is the latest ICS delivery report which highlights the progress made against each of the four areas NHSE and NHSI have identified as priority areas for ICS.

3.3 The ICS is currently looking to develop a system assurance report which will seek to integrate information from a number of existing reports in order to provide boards with a comprehensive view of quality, operational performance, delivery of commitments and finance. It is expected that the first of these reports will be available at the start of 19/20.

3.4 The summary delivery report highlights that while current and historic performance remains strong, the programme as a whole is rated as AMBER due to financial forward view and immaturity of ICS projects.

4 Recommendation to board:

4.1 The Board are asked to note the contents of this report.

5 Attachments:

5.1 Appendix 1: ICS delivery report

Berkshire West ICS Programme Delivery Report

MARCH 2019

1

Actions to improve ICS delivery

• WORKING CLOSELY WITH LOCAL AUTHORITIES: Feedback from Programme Boards have been that working closer with Local Authorities would benefit system transformation, such as for long term conditions. Work is underway on integrating BW10 and BWICS.

• STAFF ENGAGEMENT: Staff focus sessions on the ICS are currently being planned. This will address the challenge that staff currently do not understand the ICS or do not feel they are part of the ICS.

• ICS ENABLERS: Enablers such as workforce, communications & engagement and quality need to have a stronger link into the ICS governance structure so that there are clear paths of direction and escalation.

• SYSTEM FINANCIAL GAP: Planning needs to commence now on closing the financial gap for 19/20 with a fundamentally different approach to what was previously CCG QIPP or provider CIP. Paper on system financial gap to be presented at March UE.

Key actions to improve system delivery

• ICS Strategic Priorities for 19/20 – Final list of priorities being presented at March UE which includes new ways of working and updated governance. • ICS Programme Reporting – Following agreement of new strategic priorities, a refresh programme board report will follow which includes process reports from top 6

projects, overview on performance and project updates from Programme Boards. • Alcohol – Consulting group of students from McGill University, Montreal will be visiting on 26th and 27th March to interview stakeholders across the system who have

been working on alcohol. Results from the collaborative learning event will be fed back on the 28th March.

Items for Unified Exec attention

2

Berkshire West ICS: Performance scorecard for MoU Domains 1-4

Objective

1. Make tangible progress on urgent care, general practice, mental health and cancer services

2. Manage the finances within the system control total

3. Develop integrated pathways and build population health capability

4. Provide leadership at both local and national level

AG

G

In year status Commentary

• Challenge with achieving the A&E 4 hour target for Q3 due to increase in demand, high conversion rate and high acuity of patients.

• Outstanding challenges to address are presented in greater detail through the new FYFV Delivery Report • FYFV report being reviewed. On track to deliver all standards by 2020 on current trajectory

• Work underway to determine system financial gap for 19/20 • System control total agreed. • Payment mechanisms and risk share agreed for 18/19 • Working with NHSI pricing team to secure additional support for the costing work stream • Further work required on system efficiency plan • Longer term plan required, DoFs to meet with DoS’

• Berkshire West ICS website is now live (http://www.berkshirewestics.org/) • Berkshire West ICS Twitter now live (@BerksWestICS) • BW PPG Chairs Engagement Event scheduled for 20th Feb as part of the roll out of public comms and engagement

• Completed all KF OD sessions with recommendations for improving programme boards, CDG and UE to support ICS delivery and being a self-assuring system.

• Working with BW Local Authorities to develop a plan for wider integration between ICS and BW10

• The system is in a positive position re delivery of 5YFV priorities but is rated AMBER due to financial forward view and immaturity of ICS projects • Main elements of risk currently reside in Domain 2 – System Financial Position • Assessment of current FYFV delivery status is positive with some focus areas to resolve

Q4 2018/19

Overall System status

A

G

R

Forward status

3

A A

R

A

http://www.berkshirewestics.org/

https://twitter.com/BerksWestICS

https://twitter.com/BerksWestICS

Title: Corporate Risk Register Agenda item no: 7 Meeting: Board of Directors Date: 27 March 2019 Presented by: Caroline Ainslie, Executive Director of Nursing Prepared by: James Brind, Head of Risk Management Purpose of the Report To update the Board on the Corporate Risk Register.


The Board is asked to review and approve the updates to the Corporate Risk Register.

Assurance Information Discussion/input x Decision/approval x



1. Leadership

2. Vision & Strategy

3. Culture

4. Governance



7. Engagement

8. Learning & Innovation

This report is expected to have a positive impact on the Trust performance against the Well Led Framework Publication Published on website Confidentiality (FoI): Private Public

1 Introduction

The March, Audit and Risk Committee reviewed the Corporate Risk Register. This paper summarises that review.

2 Corporate Risk Register

2.1 The Audit and Risk Committee agreed the following changes to the Corporate Risk Register -

• Risk 1.4: Inadequate infrastructures and services management (IM&T) The risk title to include the initials (IM&T) in the title to distinguish the risk from those linked to the Estates infrastructure.

• Risk 2.3: Training Compliance (Workforce & OD) The consequence score to be increased to 4, and the likelihood score decreased to 3. The risk score remains unchanged at 12.

• Risk 5.1: Risk of not achieving financial stability through the delivery of the 2018/19 budget The risk score being increased to 20, and the risk title be amended in the next review cycle to remove the text regarding the ‘delivery of a specified budgetary year,’ so not time limiting the risk.

• Risk 5.2: Achieving agreed performance trajectory re the ED 4 hour standard access PSF monies Due to the Q3 failure against trajectory, it is proposed that the risk score increases to 16.

2.2 Risks for escalation or de-escalation to the Corporate Risk Register

The risk 5.3: Brexit (Finance) was approved for escalation onto the Corporate Risk Register. Following discussion, the initial risk score was agreed to be 12.

This risk potentially impacts on a number of strategic objectives and is presently mapped to Strategic Objective 5: Achieve long-term financial sustainability.

3 Conclusions and Next steps

The Board is asked to review and approve its Corporate Risk Register.

4 Attachments

The following are attached to this report: • Appendix 1 – The Corporate Risk Register

5 10 15 20 25 5 10 15 20 25

4 8 12 16 20 4 8 12 16 20

3 6 9 12 15 3 6 9 12 15

2 4 6 8 10 2 4 6 8 10

1 2 3 4 5 1 2 3 4 5

5 10 15 20 25 5 10 15 20 25

4 8 12 16 20 4 8 12 16 20

3 6 9 12 15 3 6 9 12 15

2 4 6 8 10 2 4 6 8 10

1 2 3 4 5 1 2 3 4 5

5 10 15 20 25 Score Consequence

4 8 12 16 20 1 Negligible

3 6 9 12 15 2 Minor

2 4 6 8 10 3 Moderate

1 2 3 4 5 4 Major

Cons

eque

nce

Possible - harm at the level might happen or occur occasssionally

Likely - Harm at the level indicated will probably happen or recur

Strategic Objective 1: Provide the highest quality care

Cons

eque

nce

Cons

eque

nce

Strategic Objective 2: Invest in our staff & live out our values

Cons

eque

nce

Corporate risks mapped to the Trust’s strategic objectives

Score Guidance

Likelihood

Rare - probably never happen

Unlikely - Do not expect harm at the level indicated to happen but it is possible

Strategic Objective 3: Drive the development of integrated services Strategic Objective 4: Cultivate innovation and transformation

Strategic Objective 5: Achieve long-term financial sustainability

Likelihood Likelihood

Likelihood Likelihood Co

nseq

uenc

e

1.5 1.4

1.2 2.2 2.1 1.1

1.3 2.3

3.1

5.2

5.1

5.3

5 CatastrophicCertain - Harm at the level will undoubtedly happen or

recur possible frequentlyLikelihood

Title: Health & Safety Annual Report Agenda item no: 8 Meeting: Board of Directors Date: 27 March 2019 Presented by: Nicky Lloyd, Chief Finance Officer Prepared by: James Brind, Head of Risk Management

Purpose of the Report To update the Board on the Trust Health and Safety performance in the

calendar year 2018

Report History N/A

What action is required? The Committee is asked to note the report.


Resource Impact: N/A

Relationship to Risk in BAF: N/A


1. Leadership

2. Vision & Strategy

3. Culture

4. Governance



7. Engagement

8. Learning & Innovation


1 Introduction

The purpose of this paper is to update the Board on the Trust’s health and safety performance in the calendar year 2018. In future, reports will be aligned to the Trust financial year end, that is, 31st March.

2 The Risk and Safety Team

The Risk and Safety Team structure is set out below. As of March 2018, the Risk and Safety Team have also provided cover for the Trust Fire Advisor position. The Trust Fire Safety Advisor provision will return to the Estates and Facilities Directorate from the 1st April 2019.

3 The Health and Safety Regulatory Environment

Health and Safety Executive (HSE) enforcement action in the healthcare sector for 2018 was at similar levels to the previous year, with 14 convictions and 62 notices served. Non-compliance, where notices were served, related to building and maintenance management and chemicals management. Since the introduction of new sentencing guidance, the average fine has risen in the Human Health and Social Care Sector from £94,000 in 2016, to £321,000 last year.

The HSE, through its ‘Helping Great Britain work well’ have identified that their key focuses in the healthcare sector will be on an organisation’s arrangements to protect staff from work related stress, musculoskeletal and skin conditions, the strategy to reduce violence and aggression faced by NHS staff and staff training. The HSE has not presently identified the Trust for a planned inspection in 2019. Interaction between the Trust and the HSE in 2018 was limited to the Trust providing further information on reported incidents.

4 Training

There were three health and safety related topics on the Trust Mandatory and Statutory Training (MAST) report in 2018.

• Fire training - The compliance rate for this annually refreshed training rose from 84.8% at the beginning of the year to 85.3%. This included the training of an additional 193 fire wardens.

• Conflict resolution – The compliance rate for this triennially refreshed training rose from 77.3% at the beginning of the year to 82.5%.

• Manual handling – The compliance rate for this triennially refreshed training was - • Doctors compliance rate increased from 59% at the beginning of the year to 71.3% • Nursing and AHP’s compliance rate decreased from 92.1% at the beginning of the year to

91.1% • Non-clinical staff compliance rate increased from 87% to 90.7%

5 Incidents

The number of internally reported health and safety Incidents in the year reduced to 2016 levels after a rise in 2017. There was 765 incidents reported of which –

• 41% related to violence and aggression towards staff

Head of Risk Management

Manual Handling Advisor

Manual Handling Advisor

Health & Safety Advisor

Page 2

• 22% were exposure to body fluids/needle stick injury incidents • 16% reported concerns about the work environment – primarily leaks and heating • 6% were as a result of a fall in the workplace and • 2% due to musculoskeletal injuries

The number of RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013) incidents reported to the Health and Safety Executive reduced with,

• 19 incidents resulting in staff being absent from work for longer than 7 days due to a workplace accident – primary causes were tripping or slipping and injured whilst assisting a patient (4)

• 11 patient harm incidents - 9 due to reportable injuries and 2 due to dangerous occurrences. • 7 dangerous occurrences - staff being exposed to notifiable biological agents • 2 notifiable injuries (fractures) and • 1 confirmed workplace disease

6 Litigation

Personal injury claims are time constrained under the Time Limits & Limitation Act, to three years after the accident or the court has the power to refuse the claim (1). The table below outlines the claims made under the EL/PL scheme in 2018. Number Claims successfully defended and withdrawn

A total of 4 incidents: 1 incident occurred in 2016, and 3 occurred in 2017 Causes 1 Lifting/Loading/Unloading, 2 Moving and handling and 1 due to equipment malfunction

Successfully defended having been listed for trial

0

Claims settled due to early admission

0

Claims settled where court proceedings issued (2)

A total of 5 incidents: 2 incidents occurred in 2014, and 3 occurred in 2015 Causes 4 Falls and 1 damage to a vehicle

Payment in court 0 (1) For certain work related health claims the time constraint is 40 years

(2) In EL/PL claims, even if admission was made within the NHSLA portal early on, these will not usually be settled before proceedings are issued. There are presently two claims made against the Trust relating to contractors and exposure to asbestos. One claim is being handled by NHS Resolution, on behalf of the Department of Health due to the alleged date of exposure. The second claim date of exposure period 1996 – 1999 is for the Trust and it’s insurer to handle. This is being investigated.

7 Monitoring

The Health and Safety Committee, which reports to the Integrated Risk Management Committee, monitors the Trust’s health and safety arrangements and performance. Following an external audit, recommendations have been implemented. The Care Groups and the Estates and Facilities Directorate have introduced health and safety indicators into their monthly performance report, which is monitored monthly by the Executive Directors.

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8 Assurances

Apart from the health and safety governance route, the Board receives assurances on ‘health and safety topics’ via the following governance routes. • For those that are directly related to the management of staff eg work-related stress, the

working time directive, young workers and pregnant workers, the monitoring and assurance is delivered via the Workforce and Organisational Development Committee.

• For those that are directly related to patient safety eg water management, medical gases and self-harm are primarily monitored and assured via the Quality Governance route – although certain aspects are monitored by the Health and Safety Committee.

Compliance reporting commenced in 2018 for a number of Estates and Facilities health and safety related topics via the monthly Integrated Performance Report.

The Trust designated responsible persons / topic matter experts have provided further assurance summaries in appendix 1.

9 2019 update

Although this report reviews the performance in 2018, the health and safety agenda continues to move on apace in 2019. Policies development and approval • There are 28 trust policies and documents monitored by the Health and Safety Committee.

Since January 2019, seven policies have been approved, with further policies planned to be approved at the March and April Policy Approval Group.

Training • The Trust has been providing health and safety training for a number of years through its

induction and mandatory training days. Compliance reporting on this training will commence in April. Shadow reporting commenced at the end of February, with an initial compliance rate identified as 59%.

• Work is on-going to raise the compliance rate, with a communications program in place to promote the three routes staff can access this training.

Staff Representation • The Trust has a statutory duty to engage with staff on health and safety matters. This is

traditionally complied with through the Trade Unions attending the Health and Safety Committee.

• The Trade Unions did not attend any of the 2018 Health and Safety Committee meetings and has identified that there is only one Trust employee, who is also an accredited safety representative. Trade Union representation was present at the February 2019 Health & Safety Committee

• To engage with staff and improve the staff safety culture, the February Health and Safety Committee approved the development of a ‘Safety Champion Role’ in principle. The purpose of this role was also presented to the Trade Unions in March 2019.

• Development work has commenced for the role’s job description, training and communication program prior to its launch in the first Quarter of 2019/20.

Governance and Assurance • The February Health and Safety Committee reviewed its governance arrangements. The

Committee agreed that waste management reporting should be included, and to strengthen fire compliance assurances, reports are to come directly from the Fire Group to the Health and Safety Committee.

Bariatric Equipment • The Health and Safety Team are reviewing the management arrangements for patient

bariatric equipment. It is envisaged that this work will support a bariatric patient pathway, the storage and use of Trust owned equipment, and reduce the need and cost of hiring equipment. This work also links into the ‘clear the corridors of clutter’ task and finish work

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being led by the Director of Estates.

Active Reporting • The Risk and Safety Team continue to build on their active work to reduce incidents and

accidents in the workplace. As part of this work, they have undertaken 15 inspections and 32 advisory visits in the first two months of 2019. The Team will start to report on these active performance indicators via the Executive Summary Board Report

Newsletter • A Trust Health and Safety Newsletter is proposed to be launched in April 2019. There has

been commitment from the managers of the Occupational Health, Security and Waste Services to provide articles as required.

10 Summary

Improvements in the Health and Safety monitoring and governance arrangements were implemented in 2018. The Risk and Health & Safety Team’s 2019 work plan is to build on these and further develop staff member’s awareness of health and safety.

11 Recommendations

The Board is asked to REVIEW and NOTE the contents of the annual report for information.

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Appendix 1 – Assurances

• Asbestos The Trust Asbestos Management Policy (CG212) was approved in 2018, by the Health and Safety Committee and is to be approved by the Policy Approval Group in 2019. The Asbestos Management Group meets monthly, reporting exceptions to the Estates Management Assurance Group (EMAG). Asbestos assessments are recorded on the Trusts Micad System, and further assessments are undertaken as part of maintenance and project work, with removal as necessary to facilitate this work.

• Body fluid exposures / needle stick incidents

The Trust’s Prevention and Management of Sharps, Needle stick, and Bodily Fluid Exposure Injuries Policy (CG082) is pending approval by the Trust Policy Approval Group. Amendments include the transportation of sharps by community based staff and updating the information provided to source patients when an injury occurs so they can make an informed decision on consent to have their blood tested for blood borne viruses. The out of hours reporting procedure is to be reviewed and will be communicated once the updated policy has been approved. The OH Nurse Manager and Consultant Physician continue to liaise with the Emergency Department Lead Consultants to provide further refresher training in the management of sharps, needle stick and body fluid exposure injuries to staff. 2018 saw a significant improvement in staff completing Datix reports following injuries and this continues to be monitored by Occupational Health when injuries are reported. The Trust Sharps Group which reports into the Health and Safety Committee, met on a number of occasions in 2018, monitoring incidents and sharps related concerns including waste management processes and external audit findings.

• Control of Contractors

The Trust has delegated the control of building and maintenance contractors to its principal estates and maintenance contractor CBRE, reviewing its performance on a monthly basis. An Estates Operational Management Policy has been drafted and is ready to be submitted to the Health and Safety Committee for review. This document is to include arrangements around permit to work, confined spaces, hot works, access control, working at height etc.

• Display Screen Equipment

The Display Screen Equipment Policy (CG207) requires the individual to assess the risks associated with their workspace. These are person specific risk assessments so not monitored or stored centrally. The Occupational Health Department carried out 48-workstation / workplace assessment during 2018, and recommended for 30 new chairs be purchased for staff.

• Dermatitis and Latex

The Prevention & Management of Work Related Skin Disorders in Trust Employees Policy (CG107) is currently under review. Due to the statutory requirement on work, related dermatitis and managing exposure to latex, clinical staff is required to answer health surveillance questions as part of the Trust’s appraisal paperwork. This has resulted in a reduction in the areas using sterile latex gloves. The Occupational Health Department continue to carryout annual skin health surveillance in areas where latex gloves continue to be in used. Work between OH and H&S teams is planned for a review of products used within the Trust to provide assurance that no other statutory health surveillance is required.

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• Electrical HV and LV The Trust has a standalone Electrical Safety Policy (CG449) and an annual external compliance assessment that is recorded on the Micad system. Exceptions are reported through the Estates and Facilities Governance route to the Health and Safety Committee.

• Fire

The Trust Fire Safety Policy (CG105) is in date. The monthly Trust Operational Fire Safety Management Group has representation from the Berkshire Fire and Rescue Service. Exceptions are reported to the Health and Safety Committee. A program of planned inspections by the Fire and Rescue Service commenced in 2018, and are due to continue into 2019. For those completed inspections, the Trust has been assessed as ‘broadly compliant,’ the highest standard from Berkshire Fire and Rescue Service.

• Gas

The Trusts insurance company inspects Natural Gas systems biannually, with the resultant inspection reports recorded on the E&F Micad System. The Trust replaced gas related equipment in 2018.

• Lifting Equipment

The management of Estates owned/managed lifting equipment is to be identified in the draft Estates Operational Management Policy. The Trust’s insurers undertake the statutory biannual inspections that are recorded on the E&F Micad System and sent to the HSE.

• Manual handling / Musculoskeletal

The Trust procedural arrangements for the Management of Moving and Handling (CG079) are in date. The Manual Handling Advisors delivered 220 face-to-face manual handling training sessions, whilst the Trust Occupational Health Staff Physiotherapy service saw over 400 staff with musculoskeletal related symptoms during 2018. The Manual Handling Advisors continue to undertake a workplace inspection program, provide advice, coaching and assist with staff and patient manual handling assessments. The Advisors provided training and support to trust volunteers and Project Search students.

• Medical Equipment

The Health and Safety Committee receives an exception report from the Medical Equipment Management Committee on the equipment management arranges including purchasing, NHS alerts and responses, maintenance, training compliance and documentation.

• Pressure Systems

The Pressure Systems Policy (CG450) is due for review. The management of pressures systems is monitored by (EMAG) with exceptions reported through the Estates and Facilities Governance route to the Health and Safety Committee.

• Radiation

There are a number of enforcement agencies responsible for overseeing the Trust’s management of radioactive materials including the CQC, the HSE, the Police and the Environment Agency. The Environment Agency and the Police undertake annual inspections and in 2018, the Trust was assessed as broadly, with actions implemented in repose to those visits. The relevant policies were updated to address changes in legislation in 2018and 430 staff received training related to ionising and non-ionising radiation.

• Traffic Management

The Health and Safety Team completed and presented a report on traffic and pedestrian routes to the H&S Committee in 2018.

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• Violence and aggression The Trust’s violence and aggression policy was approved in 2018. An organisation’s management arrangements are identified as a key inspection topic for both the HSE and the CQC. The Annual Security Performance Report is to be submitted to the June 2019 Board, which will provide detail and assurance.

Water

The management of water is monitored on a bi-weekly basis through the Operational Water Hygiene Group, with compliance improving over a number of areas including thermal and chemical controls and inspections of thermo-mixer valve. Where a positive legionella / pseudomonas are recorded, immediate action is taken to ensure patient safety and the cause is investigated.

• Windows Management The 2017 assessments are recorded on the E&F Micad System, with Escalates and Facilitates Managers now undertaking inspections are part of their daily routine.

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Appendix 2: Policy & Approved Document Tracker

Policy Title Ref Author Review Date Asbestos Management Policy CG212 Andrew Large, Independent Asbestos Advisor Feb 2018 Out of date Due to go to April 2019 Policy

Approval Group (PAG) Asbestos Management Protocol CG350 Andrew Large, Independent Asbestos Advisor Feb 2018 Out of date Electrical Safety at Work Policy CG449 Jeremy Bouedo, Head of Engineering July 2019 In date n/a Fire Safety, Prevention and Compliance Policy CG105 Ailsa Leach, Fire Safety Advisor May 2019 In date n/a Fire Safety & Prevention Protocols Document CG348 Ailsa Leach, Fire Safety Advisor Feb 2020 In date n/a Permit to Work Policy CG563 David Lumley, Assistant Director – Capital Programmes May 2019 In date Extension approved at PAG Management and Control Of Pressure Systems Policy CG450 Ailsa Leach, Estates Risk Manager Oct 2018 Out of date E&F currently reviewing

Replaced with Preventing, Minimising and Managing Aggressive and Violent Behaviour Including Restraint Policy CG669

CG010 Terry Morris, Security Manager Sept 2020 In date n/a

Water Safety Management Policy & Corporate Procedures CG096 Jeremy Bouedo, Head of Engineering July 2019 In date n/a Window Management Policy CG599 Ailsa Leach, Estates Risk Manager Jan 2019 Out of date E&F currently reviewing Display Screen Equipment Policy CG027 Dwayne Gillane, Occupational Health Nurse Manager July 2019 In date n/a Health and Safety Policy CG113 James Brind, Head of Risk Management Jan 2021 In date n/a H & S Policy Management Arrangements for First Aid CG208 James Brind, Head of Risk Management Jan 2021 In date n/a H & S Policy Management Arrangements for Lone Working CG043 James Brind, Head of Risk Management Jan 2021 In date n/a H & S Policy Management Arrangements for Hazardous Substances

CG206 James Brind, Head of Risk Management Jan 2021 In date n/a

H & S Policy Procedural Arrangements for the Management of Moving and Handling

CG079 James Brind, Head of Risk Management Jan 2021 In date n/a

Health and Safety Policy Procedural Arrangements for the Management of Internal and External Pedestrian Routes

CG035 James Brind, Head of Risk Management Aug 2020 In date n/a

Non-Patient Harm RIDDOR Incidents GL1077 James Brind, Head of Risk Management Sept 2019 In date n/a Patient Harm RIDDOR Incidents GL1076 James Brind, Head of Risk Management Sept 2019 In date n/a Medical Equipment Management Policy CG548 Andy Smith, Head of Clinical Engineering Feb 2020 In date n/a Medical Equipment – Clinical Engineering Procedural Guidance

CG558 Andy Smith, Head of Clinical Engineering June 2020 In date n/a

Medical Equipment – Loan Procedural Guidance CG556 Andy Smith, Head of Clinical Engineering June 2020 In date n/a Medical Equipment – Procurement Procedural Guidance CG555 Charlotte Hopgood, Head of Clinical Engineering June 2020 In date n/a Medical Devices: Training - Procedural Guidance CG554 Malcolm McGuirk, Head of Clinical Engineering June 2020 In date n/a Medical Equipment – Clinical Users Procedural Guidance CG557 Andy Smith, Head of Clinical Engineering June 2020 In date n/a Prevention and Management of Sharps, Needlestick, and Bodily Fluid Exposure Injuries Policy

CG082 Dwayne Gillane, Occupational Health Nurse Manager Feb 2021 In date

Policy for the Prevention & Management of Work Related Skin Disorders in Trust Employees

CG107 Dwayne Gillane, Occupational Health Nurse Manager Aug 2018 Out of date Due for submission to the April H&S Committee and then to the April PAG

Radiation Policy CG102 M. Nyekiova and D Putney Feb 2020 In date n/a

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Title: Staff Survey Results Agenda item no: 9 Meeting: Board of Directors Date: 27 March 2019 Presented by: Don Fairley - Director of Workforce Prepared by: Pete Sandham – Employee Engagement and OD Manager Purpose of the Report

To provide a high level overview of the Royal Berkshire NHS Foundation Trust results from the 2018 Staff Survey – highlighting trends in performance and benchmarked position.

Report History n/a


The Committee is asked to note the contents of the report.



Relationship to Risk in BAF: Failure to be a Great Place to Work







1 BACKGROUND

1.1 The full results from the 2018 NHS staff survey were released on the 26 February 2019.

1.2 In 2018, 46.3% of staff responded to the survey - a 3.6% increase from the 2017 response rate (which in itself was a 4.1% improvement since 2016). The Trust 2018 response rate was better than the National Acute Average response rate of 44%.

1.3 In a change in reporting format from previous years, 2018 National findings are presented under the umbrella of 10 key themes.

2 HIGH LEVEL SUMMARY OF FINDINGS

2.1 Trust performance is better than the Acute average in 9 out of 10 themes. Compared to last year, statistically significant improvement is reported in 3 themes and statistically significant deterioration is reported in 1 theme

2.2 Each of the 10 themes - along with a summary of benchmarked performance and Trust trend performance relative to 2017 is provided in the table below:

*Significant relates to statistically significant change

2.3 Performance in each of the 10 themes is simply ranked on a 0-10 scale (with 10 representing best). The score on the scale is derived from the range of relevant survey questions which are computed to form an overarching score.

2.4 Scores per theme, including benchmark relevant to the Acute best, worst and average scores are provided in the table below.

2018 Survey Theme Our performance compared to 2018

Acute trust average

2018 performance compared to 2017

performance

Equality, Diversity and Inclusion Worse No significant change

Health and Wellbeing Better No significant change

Immediate Managers Better No significant change

Morale Better Not measured 2017

Quality of Appraisals Better Significantly Better

Quality of Care Better No significant change

Safe Environment – B&H Better Significantly worse

Safe environment - Violence Better No significant change

Safety Culture Better Significantly better

Staff Engagement Better Significantly better

2.5 Key findings and points of note under each of the themes are presented in the analysis below

3 EQUALITY, DIVERSITY AND INCLUSION

3.1 Increases in staff experiencing discrimination at work from patients (up 1% to 7.6% in 2018), managers and other work colleagues (up 1% to 9.5% in 2018) are reported, with these figures higher than the Acute average. Significant drop in disabled staff believing that adequate adjustments have been made to enable them to carry out their work – but reported position still ‘better’ than average.

4 HEALTH AND WELLBEING

4.1 34.7% report feeling unwell as a result of work related stress (up 3% from 2017), but still favourable to the acute trust average figure of 39%. ‘Best’ Acute Trust reports 29%

4.2 Increase in satisfaction with opportunities for flexible working patterns, but decrease in number of staff believing the organisation takes positive action on Health and Wellbeing (but still ‘better’ than average).

5 IMMEDIATE MANAGERS

5.1 Positive improvement in all questions relating to immediate management – including levels of support; provision of feedback; involvement and being valued at work.

6 MORALE

6.1 This is a new theme with no historic comparison data available. Performance is favourable to the Acute average across the range of component elements such as involvement; respect at work; working relationships and likelihood of leaving

6.2 The finding provides useful insights into retention challenges. 20% of RFBT staff report that they will probably look for a new organisation in the next 12 months. This compares to the acute average of 21% and a best acute trust performer reporting 14%.

7 QUALITY OF APPRAISALS

7.1 The Trust has improved significantly since 2017 in all areas relating to quality of appraisals and is better than average in all aspects.

8 QUALITY OF CARE

8.1 At 83.3%, strong satisfaction with the quality of care staff give to patients. Acute average figure is 80.1%

9 SAFE ENVIRONMENT – BULLYING AND HARASSMENT

9.1 Staff personal experience of Bullying and Harassment or abuse at work - either from patients/relatives; managers or other colleagues - have all increased in a trend consistent with the National picture.

9.2 19.8% of staff report personally experiencing bullying, harassment or abuse at work from colleagues, up from 17% in 2017. The acute trust average for 2018 is 20%.

10 SAFE ENVIRONMENT - VIOLENCE

10.1 Small, positive decrease in staff experiencing physical violence at work from patients/relatives of other members of the public, down 0.6% to 12.5% in 2018 and favourable to the Acute trust average of 14.3%

11 SAFETY CULTURE

11.1 Significant improvements reported in a range of constituent measures, including treating staff involved in errors fairly; taking action to ensure errors do not happen again; given feedback in response to errors.

11.2 Small decrease (down 0.4% to 71%) in terms of staff feeling secure around raising concerns about unsafe clinical practice. Acute average is 69.2%

12 STAFF ENGAGEMENT

12.1 Significant improvement in the headline components of the staff engagement measure, namely:

Staff Engagement Elements RBFT 2018

RBFT 2017

2018 Average

2018 Best Acute Trust

Care of patients is my organisations top priority 84.5% 81% 76.7% 88.3%

Recommend my organisation as a place to work 67% 63.5% 62.6% 81%

If a friend or relative needed treatment, would be happy with the standard of care provided by Trust

79.4% 76.6% 71.3% 87.3%

12.2 Strong reported improvements in the range of other constituent measures of engagement, including staff looking forward to going to work; enthusiasm about job; involvement and influence.

13 KEY AREAS OF CONCERNS

13.1 Although the results provide a broadly positive picture in terms of historic trends and benchmarked performance, there are trends which are of concern which can be summarised as follows:

• Decrease in reported satisfaction with adequate adjustments to enable disabled staff to carry out their work

• Decrease in staff believing organisation takes positive action on health and wellbeing

• Increase in work related stress

• 20% of staff will probably look for a new organisation in the next 12 months

• Increase in personal experience of bullying and harassment at work

14 DEEP DIVE INTO DIRECTORATE/SPECIALITY LEVEL FINDINGS

14.1 Trust level data can mask local trends in performance. In order to address this, a full suite of intellignece has been cascaded through senior leads identifying performance at both directorate and speciality level. The reports identify both trends in performance and benchmark local performance relative to the Trust average.

15 NEXT STEPS 15.1 Trust Level 15.2 A Trust level thematic improvement plan will be developed. 15.3 Improvement priorities will be mapped against and integrated into our What

Matters Phase 4 delivery schedule and People Strategy priorities– enabling concentrated focus on improvement needs, particularly around the themes of inclusion; staff and health and wellbeing ; management development and creating a bullying free culture.

15.4 Further granular analysis will be undertaken on a question level basis, both to celebrate and share good practice and performance at the local level and also to highlight, challenge and redress local performance indicating a sub optimal staff experience

15.5 Local Level 15.6 The key vehicle for continuous improvement will need to be local development

plans developed and delivered by local leaders and managers through engagement with their staff on the key areas ‘that matter’.

15.7 Care Group, Service and Directorate level Staff Survey Results have been

circulated through senior leadership channels to enable localised responses to trends in services/directorates.

15.8 Senior Leaders have been charged to:

• Review and digest findings to understand Directorate and Speciality Level Performance

• Cascade through senior teams and then share and discuss findings with staff • Complete the development of 2019 action plans by the end of April 2019 • For all areas identified as ‘poor’ performing, improvement plans will be required to

be tabled at EMC for assurance by the end of April/early May 2019. • Areas identified as ‘below par’ will be reviewed through the Performance meetings

schedule.

16 RECOMMENDATIONS

16.1 The Committee is asked to note the contents of the report.

Agenda Item 10a

Finance and Investment Committee Monday 21 January 2019 10.05 – 12.55 Boardroom, Level 4, Royal Berkshire Hospital Members Mrs. Sue Hunt (Non-Executive Director) (Chair) Ms. Caroline Ainslie (Director of Nursing) (up to minute 11/19) Mr. Brian Hendon (Non-Executive Director) Mrs. Nicky Lloyd (Chief Finance Officer) Mr. Steve McManus (Chief Executive) Mr. John Petitt (Non-Executive Director) Ms. Mary Sherry (Chief Operating Officer) Mr. Graham Sims (Chair of the Trust) In Attendance Mr. Craig Anderson (Director of Finance) Mr. Mike Clements (Deputy Director of Finance – Central Finance) Dr. Janet Lippett (Care Group Director, Networked Care) Mrs. Caroline Lynch (Trust Secretary) Mr. Andrew Statham (Director of Strategy) (for minutes 08/19 and 09/19) Apologies 01/19 Declarations of Interest There were no declarations of interest. 02/19 Minutes: 19 December 2018 & Matters Arising Schedule

The minutes of the meeting held on 19 December 2018 were approved as a correct record and signed by the Chair.

The Committee received the matters arising schedule. [Section exempt under s43]. The Director of Finance advised that the higher use of cardiac devices during November

2018 had been discussed at the Care Group performance meeting. [Section exempt under s43]. However, the review had identified an increase in activity and a change in the mix of patients; therefore, there had been a higher usage of devices.

The Director of Finance advised that the QiPP tracker had also been discussed at the Care

Group performance meeting. Further work was required to ensure QiPP savings were identified in the accounts. The Director of Finance advised that work was on-going to test the reconciliation. However, the Executive team remained concerned in this area. The Committee noted that the QiPP tracker was due to be reviewed with the Chief Operating Officer and Chief Finance Officer at the meeting with Planned Care later in the week. The Committee considered that assurance was required in relation to this issue.

Minutes

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Finance & Investment Committee January 2019

Action: N Lloyd 03/19 December Finance Update The Deputy Director of Finance introduced the report and advised that the December

position was in line with the adjusted NHSI Improvement (NHSI) control total. Prior to the adjustment financial performance was £4.3m adverse to the control total. December performance was a £2.13m variance predominantly in Care Groups split between pay and non-pay.

The Committee discussed the QiPP target for the year and noted that phasing of QiPPs had been incremental as the year progressed. The Chair highlighted that QiPP had been £1.3m off target in the month and queried the detail in relation to this variance. The Committee noted that there had been higher variances in relation to nursing and medical pay. In relation to nursing, this was related to QiPP delivery and medical pay spend was higher than planned. The Chief Operating Officer advised that there were some higher medical pay costs in Planned Care that related to high cost rate sessions in relation to delivery of cancer performance. The Committee queried whether these costs would continue in some specialties. The Care Group Director, Networked Care, advised that additional sessions were an area of focus by the Care Group due to the high cost. However, there had been some progress achieved in reducing the cost of sessions. The Chief Operating Officer highlighted that the QiPP target for 2018/19 had been discussed at the outset of the year as well the challenge to deliver this target. This challenge had continued. The Director of Finance confirmed that the QiPP target had been reset when the Quarter 1 and Quarter 2 forecast had been discussed and central reserves had been used. The Committee noted that Care Group underperformance was circa £700k and all of this related to non-pay and included an element of QiPP. The Deputy Director of Finance advised that Care Groups were marginally better on pay in December versus the Quarter 2 Forecast. Nursing spend was underspent versus Quarter 2 Forecast. However, this position was not sustainable due to Winter pressures. Medical pay was slightly higher than Quarter 2 Forecast. The Committee noted that further information would be available in the full finance report for the month. The Committee requested that, where possible, the full finance report should be made available for future meetings. Action: N Lloyd The Deputy Director of Finance gave an overview of items that had contributed to meeting the control total. This included release of accruals for purchase orders receipted more than six months ago, recover of VAT through quarterly review, release of income positions and variation to risk share within the Berkshire West contract. The Director of Finance advised that Provider Sustainability Funds (PSF) had been recognised as the Trust had achieved the year to date trajectory for A&E. The Committee discussed the review of VAT recovery. It was agreed that the Chief Finance Officer would review timing of processes in relation to this to ascertain if this could be undertaken on a more regular basis. Action: N Lloyd

04/19 Quarter 2 Forecast The Chief Finance Officer advised that a number of actions were on-going. This included

regular meetings with Care Groups as well as reviews with corporate areas. The Director of Finance advised that the latest view that included forecast amendments

submitted by Care Groups was a £6.12m deficit. As discussed with the Committee in November 2018 there was a £2m to £4m risk at that time. Following a review of November results, particularly in Care Groups, the position had worsened by £840k. This would result in a £7m to £9m deficit based on November results. The Committee noted actions

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to close the potential gap to the financial control total totalled £5.79m, £3.99m of which had been recognised in December results. The Director of Finance advised that, in relation to actions on the NHSI checklist, a number had been implemented already as business as usual, some were being implemented and other that had not been implemented would be considered during 2019/20.

The Director of Finance advised that the recommendation was not to submit a formal re-

forecast to NHSI at this time. However, a degree of risk remained and opportunities to improve the position would still be pursued. The Director of Nursing highlighted that there had been higher nursing costs as all areas had been escalated to. Whilst costs for the Acute Medical Unit (AMU) had been included in the forecast, there had been a requirement for additional beds in the Intensive Care Unit (ICU), the cost of which had not been included in the forecast. The Director of Finance advised that whilst activity was below contract a discussion could be held with commissioners in relation to the additional costs for ICU beds as these were above contract. The Director of Finance recommended that ICS partners and NHSI should be updated regularly with the residual risk and the extent to which it was crystallising or not.

The Committee agreed that a recommendation should be submitted to the Board that a

formal re-forecast was not required at this time. Action: N Lloyd 05/19 QiPPs Update The Committee noted that the transformation team risk assessment was currently £13.7m

against a target of £16.5m. The Committee noted that £9.7m of savings had been delivered year to date against a budgeted savings figures of £10.4m.

06/19 Procurement Programme The Chief Operating Officer highlighted the comprehensiveness of the report and

suggested that the interim Head of Procurement should be invited to attend a future meeting to present the report as well as providing an overview of plans for 2019/20.

Action: N Lloyd

The Committee noted that the programme was currently £700k behind target although there was an improving position. The Chief Operating Officer highlighted the engagement of both operational and clinical teams into the procurement process.

The Chief Operating Officer advised that where significant engagement was required in

areas this was resource intensive. The Director of Nursing highlighted that the CQC Use of Resources exercise as well as the accreditation process for departments would prove useful in clinical engagement. The Chief Operating Officer advised that challenges in the procurement team had impacted on delivery of the programme. The Committee noted that the Trust had established good links at national level in relation to procurement. The Committee queried how much of the savings in the programme related to rebates. The Chief Finance Officer agreed to confirm this. Action: N Lloyd

07/19 Model Hospital Programme The Care Group Director, Networked Care, introduced the report and advised that data in

the Model Hospital related to 2016/17. However, there had been recent updates in December 2018 and additional data was also being included in Model Hospital. The Care Group Director, Networked Care, advised that the data related to standard benchmarking that differed to services provided by the Trust. The Committee noted that ‘Getting It Right First Time; (GIRFT) reviews were extremely helpful and action plans were developed following reviews. The Care Group Director, Networked Care, highlighted that areas within

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the Model Hospital were already being considered by the various teams. 08/19 Operating Plan 2019/20 The Director of Strategy introduced the report that set out progress in relation to the

Operating Plan for 2019/20 and initial returns in relation to activity and efficiency. The Committee noted that detailed planning guidance and control totals for 2019/20 had not been issued by NHSI.

The Director of Strategy highlighted NHSI had clarified that narrative at Integrated Care

System (ICS) level rather than at Trust level was required. The Director of Strategy advised that a draft Operating Plan was due for submission to NHSI on 12 February 2019. It was agreed that an additional Board meeting would be scheduled to review and approve the draft Operating Plan prior to submission. Action: C Lynch

The Director of Strategy advised that an initial analysis of the control total for 2019/20 had

been undertaken and was in line with expectations. The challenge remained in relation to the underlying run rate. The Chief Executive confirmed that the control total assumed a £4m deficit for the Trust at the end of 2018/19. The Committee noted that budget discussions had started with five areas within the Trust the previous week and discussions with commissioners had also started. The Director of Strategy advised that activity was broadly flat but costs had increased. The Committee agreed the need to be able to demonstrate the level of acuity of patients and how this impacted on costs as this was not currently visible. The Chief Finance Officer suggested that patient level costing could be reviewed to identify this.

It was agreed that letter from NHSI in relation to the control total would be circulated to the Board once this had been reviewed at the Chief Executive’s team meeting.

Action: S McManus 09/19 MSK Update [The Director of Finance declared a conflict of interest due to the work he would be

undertaking once he had left the Trust in February 2018. The Committee agreed that the Director of Finance was not required to leave the meeting for the item under discussion]

The Director of Strategy advised that, following the pause in October 2018 in relation to

affordability, a working group formed of representatives from Berkshire Healthcare Foundation Trust, GP Alliance, Berkshire West CCG and the Trust had developed a light solution for MSK services. This included a secondary clinical review of referrals with physiotherapy provided in a primary care setting. The light solution had been developed and discussed at the ICS. The current solution would be an interim solution and it had been agreed that this would be progressed to business case development. A further update would be provided to the March meeting of the Committee.

Action: A Statham 10/19 Insurance The Committee noted the report that set out details of the NHS Resolution, (formerly NHS

Litigation Authority), contribution for 2019/20. The Committee noted that contributions had reduced by 1.9%. The full year cost was £19.47m. The Director of Finance confirmed that a review had been undertaken two years previously to seek alternative insurance provision. However, there was no suitable alternative provider available.

The Committee agreed that a recommendation should be submitted to the Board to approve the payment of the contributions for NHS Resolution. Action: N Lloyd

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11/19 Procurement for the Provision of Ophthalmology Supply

[Section exempt under s43]. The Committee agreed that a recommendation should be submitted to the Board to approve the contract, subject to confirmation of the risk in relation to not being able to receive VAT exemption and clarification of the indemnity clause in the contract. Action: N Lloyd

12/19 Procurement for the Provision of Orthopaedic – Trauma Products

[Section exempt under s43]. The Committee noted that the one key supplier would be appointed and supply would continue with two other suppliers at circa 20% each. The Committee agreed that a recommendation should be submitted to the Board to approve the contract, subject to confirmation of the split between suppliers. Action: N Lloyd

13/19 Estates Programme Committee Update The Chief Executive advised that the first meeting of the newly established Estates

Programme Committee had taken place in December 2018. A patient representative would be invited to join the Committee. During 2019/20 the Committee would be reviewing the use of capital for major estates work. The Chief Executive confirmed that the Trust had been unsuccessful in its WAVE 4 bid in relation to Bracknell Healthspace. This would be reviewed as part of the Trust’s capital programme. The Committee noted post project appraisals would also be reviewed by the Estates Programme Committee.

14/19 Work Plan Review The Committee discussed the work plan and the frequency of updates on the IT strategy.

The Chief Operating Officer advised that a business case for the next Digital roadmap was being developed. Going forward, the Digital Hospital Committee would include all areas of IT. A digital strategy would be developed. It was agreed that the Chief Operating Officer would discuss and agreed the timescale for the digital strategy with the Director of IM&T and an outline plan would be submitted to the March meeting. Action: M Sherry/H Allan

15/19 DXC Update The Director of Finance confirmed that a report was currently being prepared for the

January Board. 16/19 Key Messages for the Board

Key issues to draw to the attention of the Board included:-

• December finance performance discussed in detail • Quarter 2 Forecast reviewed • Detailed review of Procurement and Model Hospital QiPP programmes • Operating Plan 2019/20 development update received • MSK update received • Recommendation to the Board to approve the contribution to NHS Resolution • Recommendation to the Board to approve the contract for ophthalmology subject to

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clarification of queries raised by the Committee • Recommendation to the Board to approve the contract for orthopaedic trauma

products subject to clarification of queries raised by the Committee • Minutes of the Estates Programme Committee received

17/19 Date of Next Meeting

It was agreed that the next meeting would be held on Monday 18 February 2019 at 10.00am.

SIGNED: DATE:

6

Agenda Item 10a

Finance and Investment Committee Monday 18 February 2019 10.05 – 13.35 Boardroom, Level 4, Royal Berkshire Hospital Members Mrs. Sue Hunt (Non-Executive Director) (Chair) Dr. Lindsey Barker (Medical Director) Mr. Brian Hendon (Non-Executive Director) (by conference call) Mrs. Nicky Lloyd (Chief Finance Officer) Mr. Steve McManus (Chief Executive) Mr. John Petitt (Non-Executive Director) Ms. Mary Sherry (Chief Operating Officer) Mr. Graham Sims (Chair of the Trust) In Attendance Mr. Craig Anderson (Director of Finance) Mrs. Mandy Claridge (Director of Operations, Urgent Care) (for minute 27/19 Mr. Mike Clements (Deputy Director of Finance – Central Finance) Mrs. Caroline Lynch (Trust Secretary) Mrs. Tracey Middleton (Director of Estates & Facilities) (for minutes 27/19 and 28/19) Mr. Richard Jenkins (Deputy Director of Finance – Contracts) Apologies 18/19 Declarations of Interest There were no declarations of interest. 19/19 Minutes: 21 January 2019 & Matters Arising Schedule

The minutes of the meeting held on 21January 2019 were approved as a correct record and signed by the Chair. The Committee received the matters arising schedule. Minute 02/19 (154/18): Matters Arising Schedule: November Finance Update/Quarter 2 Forecast: The Chief Finance Officer advised that accruals for Berkshire Surrey Pathology Services (BSPS) would be matched on a monthly basis going forward. The Committee discussed the increase in the costs for BSPS. The Chief Finance Officer advised that additional costs related to tests referred to other organisations. The Medical Director advised that BSPS were reviewing these tests as to whether they could be carried out in-house. However, due to the clinical pathways some tests would still need to be referred to another organisation. The Committee whether this would impact on benefits realisation for BSPS. The Committee noted that an annual review of BSPS was submitted to the Board in July each year. The Medical Director confirmed that the original business case for BSPS included these tests being referred to other organisations. The Chief Finance Officer advised that controls, counter-party invoicing and approval processes were currently being reviewed and an update would be provided at the next meeting. Action: N Lloyd

Minutes

1

Finance & Investment Committee February 2019

Minute 06/19: Procurement Programme: The Chief Finance Officer confirmed that the interim Head of Procurement would attend the March meeting to present a review of the Procurement Programme in addition to an overview of plans for 2019/20. Action: N Lloyd Minute 14/19: Work Plan Review. The Chief Operating Officer advised that an outline plan of the digital strategy would be submitted to the Board seminar in April.

Action: M Sherry

20/19 January Finance Update The Chief Finance Officer advised that January financial performance was £700k behind

Quarter 2 Forecast and £1m behind the adjusted control total. Discussions with commissioners in relation to year end income position were on-going. Overall, the risk to delivery of year end was £1.4m. The Committee noted that whilst a number of controls had been put in place to address spend there were two key areas of challenge. This included control of agency spend, particularly short term agency at a high premium. In addition, Care Groups had assumed a reduced run rate of cost in the Quarter 2 Forecast. Savings programmes were being monitored to ensure these were delivering efficiencies. The Chief Operating Officer advised that dialogue with all Care Groups ware on-going for all areas of performance, including finance. A specific meeting with Care Groups had been arranged later that day to specifically focus on non-pay QiPP programmes.

The Chief Finance Officer advised that there was a need to accurately forecast spend and

advised that a number of work streams were on-going to support this. The payroll team were reviewing completion of variation and termination forms to ensure these were completed in a timely manner. A contract central database would also be established to identify clearly when contracts were due for renewal. The single tenders process would also be reviewed. The purchase requisitions process was also being reviewed to ensure these were raised in advance where possible.

The Committee discussed the possibility of whether the control total would be met at year

end. The Chief Executive highlighted that January had been a challenge in relation to capacity and costs. Additional resource had been put in place but external funding had been negotiated therefore this would not present an issue in February. The Chief Finance Officer advised that pay cost variances in the month included additional sessions for doctors in obstetrics and gynaecology as well as Professionals Allied to Medicine (PAMs) due to a high level of vacancies in radiology and ultrasound.

The Chief Finance Officer advised that the format of the monthly finance report was being

reviewed to order to provide higher visibility of the balance sheet position as well as liquidity. There would be a focus on specific areas each month as well on run rate of spend.

The Committee discussed maternity and noted that the lower birth rate had resulted in

lower spend on nursing. The budget had been reset as a result but in other areas where there had been a lower level of activity the budget had not yet been reset. The Chief Executive highlighted that the Board would need to understand the impact of the year end position in relation to the starting position for 2019/20 as part of the Board seminar discussion. The Committee recommended that the financial bridge should be made available at Trust level as well as Care Group and corporate level. Action: N Lloyd

The Committee discussed risk appetite in relation to financial performance and delivery and

quality and access standards. The Committee considered that service provision would need to be considered in relation to financial performance as well as the need to undertake

2


transformation work to reduce costs. The Chair queried which specialties presented the biggest challenge in relation to financial performance. The Committee noted that, during the year, this had included maternity but this had been now been resolved. Other areas included A&E, paediatrics and Intensive Care Unit (ICU). The Committee discussed the need to better understand the acuity of patients and how this impacted on costs.

It was agreed that the Chief Finance Officer would identify those areas that had larger

variances and set out examples for the Board discussion in February. Action: N Lloyd The Committee discussed capital spend of £16m against a target of £34m. The Committee

noted that the majority of capital schemes were based on compliance and equipment replacement. It was noted that the resource within the estates team had impacted on delivery. It was agreed that the Chief Finance Officer would provide an update on predicted capital spend for 2018/19 for the Board discussion in February. This would include the reasons for not progressing projects. Action: N Lloyd

21/19 QiPPs Update The Committee noted that as at 11 February the in-year risk assessed total was £13.9m

against a target of £16.08m. This position would be discussed further at the Board seminar as part of the Operating Plan discussion. The Committee noted that in-year delivery of QiPPs would continue into 2019/20.

The Committee requested that future reports should identify whether savings were recurrent or non-recurrent. Action: M Sherry

22/19 Draft Budget 2019/20 The Chief Finance Officer confirmed that work was on-going in relation to the draft budget

as part of the Operating Plan for 2019/20. 23/19 Acute Contract Update [Section exempt under s43]. The Committee noted that discussions with Berkshire East CCG were on-going. The

Deputy Director of Finance (Contracts) gave an overview of current challenges in relation to this.

The Committee agreed that a recommendation should be submitted to the Board to

approve the revised contract. Action: N Lloyd 24/19 Procurement for the Provision of Spinal Products [Section exempt under s43].

The Chief Finance Officer confirmed that savings had been based on the current year’s activity levels. The Committee agreed that a recommendation should be submitted to the Board to approve the contract subject to confirmation of the activity levels for 2018/19 and the anticipated activity for 2019/20. Action: N Lloyd

25/19 Draft Capital Plan 2019/20 The Deputy Director of Finance (Central Finance) advised that a deadline of 22 February

had been set for all areas to submit their capital bids. The value of the capital plan for 2019/20 was in line with the Long Term Financial Model (LTFM). The Chief Finance Officer

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confirmed that replacement or enhancement would be captured as part of the work to prioritise capital bids for 2019/20.

26/19 Board Assurance Framework/Corporate Risk Register: Finance Item The Chief Finance Officer advised that further work would be undertaken on the finance

section of the Board Assurance Framework (BAF). An updated version would be submitted to the March meeting. Action: N Lloyd

27/19 Dingley Relocation Update

[Section exempt under s43].

The Director of Operations, Urgent Care, advised that Dingley services were part of a block contract therefore the contribution would decrease due to the increase in rental costs. This element had been considered by the Committee when it had originally approved the business case. The Committee noted that costs for a dedicated project manager for 6 months had also been included due to the timescale to move into the building and to have the service running was a short timeframe. The Director of Estates & Facilities confirmed that due diligence had been undertaken in relation to all companies that had tendered for the works.

The Committee noted the length of lease was proposed at 20 years with a break clause at

15 years. The Committee suggested that an improved position could be negotiated. The Chief Finance Officer confirmed that this could be raised as part of contract discussions with commissioners.

[Section exempt under s43]. 28/19 Pathology Project The Director of Estates & Facilities gave an updated on Phase 1 of the new laboratory. An

updated estimate had been received for completion of costs which was significantly above the approved amount. Therefore, a decision had been made to pause the project. Staff had been made aware that there was a potential of the project being paused. The Committee requested that the figure approved for the original business case be confirmed.

Action: C Lynch

The Director of Estates & Facilities outlined work currently on-going that included a design and health planning review, a cost review and an electromechanically review. A peer review would also be undertaken. It was anticipated that these reviews would be completed within the next four weeks.

[Section exempt under s43]. A further update would be provided to the Board the following week.

Action: N Lloyd 29/19 Brexit The Chief Finance Officer advised that an internal briefing had been undertaken and ICS

communications were being prepared. 30/19 Work Plan Review The Committee noted the work plan. 31/19 Key Messages for the Board 4


Key issues to draw to the attention of the Board included:-

• January finance performance discussed in detail • Recommendation to the Board to approve the acute contract with Oxfordshire CCG • Recommendation to the Board to approve the provision of spinal products contract • Recommendation to the Board to approve the revised building costs for Dingley • Pathology Project update received

The Committee expressed its thanks to Craig Anderson for his contribution to the work of

the Committee. 32/19 Date of Next Meeting

It was agreed that the next meeting would be held on Monday 18 March 2019 at 10.00am.

SIGNED: DATE:

5

Agenda Item 10b

Quality Committee Tuesday 12 February 2019 14.00 – 16.05 Boardroom, Level 4, Royal Berkshire Hospital Members Mrs. Helen Mackenzie (Non-Executive Director) (Chair) Ms. Caroline Ainslie (Director of Nursing) Dr. Lindsey Barker (Medical Director) Mr. Julian Dixon (Non-Executive Director) Mr. Steve McManus (Chief Executive) (from minute 03/19 to 09/19) Mr. John Petitt (Non-Executive Director) Mr. Graham Sims (Chair of the Trust) In Attendance Dr Bal Bahia (Non-Executive Director designate) Ms. Katie Egginton (Associate Director of Nursing for Children and Young People) (for minute 04/19) Dr. Janet Lippett (Care Group Director, Networked Care) (for minute 06/19) Mrs. Tracey Middleton (Director of Estates and Facilities) (for minute 09/19) Mrs. Caroline Lynch (Trust Secretary) Ms. Sue Timperley (Matron, Paediatrics & Neonates, Urgent Care) (for minute 04/19) Mrs. Hannah Travers (Deputy Trust Secretary) Apologies Ms. Mary Sherry (Chief Operating Officer) The Committee welcomed Helen Mackenzie as Chair of the Quality Committee. 01/19 Declarations of Interest There were no declarations of interest.

02/19 Minutes: 4 December 2018 and Matters Arising Schedule

The minutes of the meeting held on 4 December 2018 were approved as a correct record and signed by the Chair.

The Committee noted the matters arising schedule. Minute 73/18: Inquest – Regulation 28: The Medical Director advised that a response had

been submitted to the Coroner. The response included that additional staff were rostered overnight including three trainee doctors, a clinical outreach nurse and some additional ED consultant time. In addition, during the evening, there were four additional trainees and extra acute medical consultant time. More recently, there had been changes in working practices to assess patients in a timely manner during the day that had reduced the night workload.

Minutes

1

Quality Committee February 2019

The Trust had shared the Regulation 28 response with Health Education England (HEE) and the Oxford Deanery in respect of additional registrars being available at night as the number of training posts for the Trust was set nationally. The Medical Director would circulate a copy of the response to the Committee. Action: L Barker Minute 79/18: Quality Accounts Update: The Medical Director confirmed that avoidable cardiac arrest calls can be provided as a baseline

03/19 Board Assurance Framework: Quality Section The Committee received the Board Assurance Framework (BAF). The Committee recommended that the BAF should be simplified to read across the

framework and advised that dates for completion of actions needed to be updated. In addition, it was suggested that, for assurance, the gaps in controls and improvement actions be expanded upon to enable the Committee to review detailed actions that were being taken to mitigate against the risks. The Committee recommended that further work be undertaken to update the Quality section of the BAF and an update be provided at the next meeting. Action: C Ainslie / L Barker

04/19 Children & Young People Update The Associate Director of Nursing for Children and Young People (ChYp) advised the ChYp

services was one area still to be reviewed by the Care Quality Commission (CQC). The services had previously been rated as ‘good’ by the CQC in 2014 and the teams had been carrying out benchmarking and audits to review current services. There had been minimal complaints received and the Friends and Family test feedback rated ChYp services at 100%.

The Committee noted that ChYp accounted for 81,000 outpatient attendances to the Trust

in 2017/18. 78% of the attendees had been seen in departments outside of paediatrics including head and neck, trauma and orthopaedics. These areas had been reviewed and the Associate Director of Nursing for ChYp highlighted that the environment in outpatient waiting areas such as Ophthalmology needed to be adapted to be more child friendly.

The Associate Director of Nursing for ChYp highlighted the vacancy rate for paediatric

nursing was at 29% and this was a challenge nationally. Work was ongoing to strengthen the nursing leadership and resilience in paediatrics. A ChYp forum had been establiahsed and this would need to be further developed. The Committee noted that the team were seeking to appoint a practice educator and recruitment initiatives would be launched to increase recruitment of paediatric nurses. Skills and training for non-paediatric areas was also a priority as well as increasing the ‘play team’ due to the amount of ChYp being seen outside of the paediatrics department.

The Associate Director of Nursing for ChYp advised that initiatives adopted on Buscot ward

included avoiding term admissions into neonatal units (ATAIN). Buscot ward had also adopted the initiative of red hats for babies at risk of hypoglycaemia to mitigate against the risk of specific monitoring being overlooked.

The Committee noted that the Babies in Buscot Support (BIBS) (charity had funded a

breast feeding counsellor post as well as funding improvements for the Neonatal ward. In addition, the ward was applying for BLISS baby charter accreditation that endorsed the ward had a high quality approach to family-centred care. A Children and Adolescent Mental Health Service (CAMHS) practitioner had been funded 6 days a week to reduce the length of stay for patients and to improve service and patient experience.

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The Associate Director of Nursing for ChYp highlighted the issue of mental health patients

admitted to paediatric wards due to lack of placements. However, lack of placements was a national issue. The Committee noted that Special Education Needs and Disability (SEND) patients were a priority at the Integrated Care Service (ICS) level and the Trust was looking to appoint a transition nurse to support this work.

The committee noted that the ChYp directorate had a number of areas that they wanted to

improve however these would be constrained by resources available. 05/19 Mortality Audit Report The Committee received the Mortality Audit report. The Medical Director advised the

report had highlighted positive key findings. These included triage forms being completed with sufficient detail to understand the key points of the case and conclusions that had been reached. Three of the case reports reviewed highlighted positive learning points that detailed clear communication between all parties involved in a patient’s care and timely administration of medication. The Mortality Surveillance Group (MSG) had been observed by auditors and the report highlighted that clear conclusions were made following discussion and learning points were developed from the case records discussed.

The Committee noted that two medium and one low risk finding had been issued following

the review. These included that the lack of formal mechanism for family concerns to be raised to initiate a mortality review. In addition, some mortality reviews had been undertaken by the consultant in charge of a patients care. The review had also identified no evidence of shared learning following every MSG meeting.

The Medical Director advised a Medical Examiner was due to start in April 2019. The next of kin of a deceased patient would be routinely contacted and any clinical concerns raised would trigger a full mortality review to be undertaken. Information to raise concerns was available on patient leaflets. However, these would be reviewed by the Medical Examiner. In addition, a mortality lead nurse had been established and the post holder would assist to develop ways to share learning across the Trust. The committee queried whether the Learning from Deaths national leaflets were used by the Trust. The Medical Director agreed to confirm whether this was the case.

Action: L Barker 06/19 Dermatology Update The Care Group Director, Networked Care, introduced the report that provided an update

on recent developments in the Dermatology service, actions planned for the short term and the proposed model for a sustainable service in the long term.

The Committee noted that two week wait referrals were at 93.5% for January 2019. The Trust was working with the Oxford Deanery to provide consultant supervision to the Speciality Registrars currently at the Trust. The Trust had also approached Oxford University Hospital NHS Foundation Trust (OUH) to discuss advertising further posts in partnership with the Trust. Job plans for the post had been drafted and would soon be advertised. OUH had agreed, in the short term, to provide a consultant to cover the dermatology service at Townlands Memorial Hospital from 1 March 2019 and final details of the agreement were being finalised. In addition, a nurse consultant post was due to be advertised. The post holder would carry out a range of tasks independently including diagnostics and minor surgery.

3


The Care Group Director, Networked Care, advised that a sustainable dermatology service

for the Trust and the Berkshire West Integrated Care Service (ICS) continued to be a preferred option going forward. However, a different service model would be required to enable the delivery of a sustainable service. A service model had been developed by the Dermatology Steering Group (DSG) that would manage varying dermatology complexities. The model also had a stronger primary care element delivered through GP Alliances as the DSG had identified that 14% of total referrals could be managed within Primary Care.

The Committee discussed the impact of on local partners as a result of the change in

service provided by the Trust. The Care Group Director, Networked Care highlighted that referral patterns for local partners had been reviewed and Basingstoke Hospital and the Great Western Hospital in Swindon had received an increase in referrals compared to other local trusts. However, the Trust had not received an increase in complaints and an improved communication between the Trust and GPs regarding appropriate referrals for two week wait referrals had been identified.

The committee thanked the Care Group Director, Networked Care for the report and agreed

that as an interim measure patient harm and risk was being managed within the system. 07/19 Patient Relations Quarterly Update The Committee received the Patient Relations Quarterly update and complimented the

Director of Nursing on report content. The Trust had received 73 complaints during Quarter 2 (Q2) 2018/19. 15 complaints received in Q2 had been re-opened and these had been closely monitored through Care Group performance and local clinical governance reviews.

The Director of Nursing advised that although no increase in complaints had been received relating to elderly care wards there had been an increase in pressure ulcers which was being reviewed. This would highlight any additional training and education required due to staffing capacity pressures in these areas. The Committee discussed key themes highlighted across Care Groups that included clinical care and communication. The Medical Director advised that as complaints were split into specific categories any related to diagnosis of a medical condition were categorised as clinical care complaints. In addition, as most complaints related to end of life care it was recognised that this theme would be higher compared to other categories. The committee sought assurance that the complaint about sexual behaviour and attitude had been appropriately investigated. The Director of Nursing confirmed that the complaint had led to a safeguarding investigation. The Director of Nursing highlighted that meetings with complainants were routinely arranged to enable concerns to be discussed and learning from these to be disseminated across the Trust. In addition, complaints were logged on the Datix system that enabled the Trust to identify any recurring complaints in relation to departments or individual staff members.

The Committee noted that 181 compliments had been received by the Patient Relations

team in Q2. Positive feedback was also received regularly via the NHS Choices website. However, the Committee agreed this did not accurately reflect the number of compliments received as some were sent directly to clinicians, wards or departments.

08/19 Quality Assurance & Learning Committee Exception Report

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The Director of Nursing provided a detailed update on Never Events. Three Never Events (NE) had related to unintentional connection of a patient to an air flowmeter. Actions had been taken to mitigate against this included medical air outlets being capped in all ward areas with the exception of respiratory wards.

The Tissue Viability team were supporting staff in the elderly wards through a programme of education as there had been an increase in Grade 3 and 4 pressure ulcers during the Winter period.

The Medical Director highlighted the risk of the Trust not achieving the enhanced support CQUIN. Discussions were taking place with NHS England (NHSE) as it had not been clearly defined what information would be required to meet the CQUIN target. This had been highlighted as a risk in the Quarter 2 Forecast and the Trust would continue to negotiate with NHSE. The Committee noted that there had been an issue with flu point of care testing in the Emergency Department (ED) as the system had been recording false positives on the system (20%). Additional training and support had been provided to ED staff. However, as Public Health England were still reporting low levels of flu b positive nationally compared to the Trust a decision had been made to remove the device from service and the laboratory service provided by BSPS was reinstated. The Committee discussed how learning could be embedded in the Trust following the repeat NE’s that had occurred. The Medical Director advised that a majority of these related to incidents that had occurred in a non-theatre situation. Therefore, there was a need to educate staff on the use of the WHO checklist in an emergency situation. The Director of Nursing highlighted that learning from NE’s and Serious Incidents could be considered as a Quality Account priority for 2019/20. The Committee noted hat the Director of Communications & Engagement had also been reviewing methods of communication that could be used by the Trust to share peer learning as well as learning from NE’s. The Committee discussed the open claims and queried how these were monitored by the Trust. The Director of Nursing advised that claims were input on Datix and were reviewed by the legal team. However, learning from Serious Incidents and NEs were included in peer self-assessments carried out by clinical areas as part of their Get It Right First Time (GIRFT) work. The Director of Nursing highlighted the Trust had recently changed legal advisors and the role of Head of Legal services was currently being advertised. A further update in relation to claims would be provided to the Committee in October 2019. Action: C Ainslie

09/19 Quality Account Dashboard

The Committee received the Quality Account update. The Director of Nursing advised that reduction of hospital-acquired, avoidable pressure ulcers had been rated as amber following the recent increase in grade 3 and 4 pressure ulcers. The Committee that a program of education on pressure ulcer prevention and management was currently on-going by the Tissue Viability team. The Director of Estates and Facilities provided an update on car parking. A data line had recently been installed and discussions were taking place with contractors regarding installation of the Automatic Number Plate Recognition system (ANPR). It was anticipated that the installation would take place in Spring 2019. However, installation would need be

5


considered carefully to minimise disruption to patients and staff using the car park. In addition, the North Block car park had been reviewed and it had been recommended that 12 additional parking spaces could be made available. The Trust was also in discussion with Reading Borough Council in relation to parking in the surrounding area. The Committee discussed the current car parking charges at the Trust. It was agreed that the cost of parking should be reviewed once the ANPR system had been put in place. Action: T Middleton

10/19 Work Plan Review The Committee noted the work plan. 11/19 Key Messages for the Board It was agreed that key issues to draw to the attention of the Board included:

• Children & Young People update received • Dermatology update received • Mortality Audit Report update received.


It was agreed the next meeting would be held on Tuesday 9 April 2019 at 14.00. SIGNED: DATE:

6

Agenda Item 10d

Charity Committee Wednesday 23 January 2019 10.00 – 11.15 Room 3, Level 4, Royal Berkshire Hospital Present Mr. Graham Sims (Chair of the Trust) (Chair) Mr. Jonathan Barker (Public Governor, Reading) Mrs. Nicky Lloyd (Chief Finance Officer) Dr. Sunila Lobo (Public Governor, Reading) Mr. Steve McManus (Chief Executive) (from minute 02/19) Ms. Aneta Saunders (Interim Charity Director) In attendance Mr. Craig Anderson (Director of Finance) (from minute 04/19 to 06/19) Mrs. Caroline Lynch (Trust Secretary) Mrs. Victoria Parker (Director of Communications and Engagement) Mrs. Hannah Travers (Deputy Trust Secretary) Apologies 01/19 Declarations of Interests

There were no declarations of interests. 02/19 Minutes for Approval: 18 December 2018 and Matters Arising Schedule

The minutes of the meeting held on 18 December 2018 were approved as a correct record and signed by the Chair subject to the following amendment:- 19/18 Terms of Reference: The last sentence of the paragraph would be amended to read ‘However, the terms of reference would be reviewed once the new Charity Director was in post’. The Committee received the matters arising schedule. The Chair recommended that an update be provided to confirm if the Charity was on the trajectory to achieve the target operating costs as set out in the Charity Strategy. Action: A Saunders

03/19 Charity Director’s Report

The interim Charity Director introduced the report that provided an update on the financial position of the Charity, strategic priorities and the Knowledge and Development fund. The Committee noted that outstanding recharges were being updated on the system. Therefore, it appeared that charitable funding was currently under budget. In addition,

Minutes

1

Minutes of the Charity Committee 23 January 2019

operating costs were high in comparison to income received at £218k. However it was anticipated this would decrease following the outstanding recharges. The Committee recommended that donations should be reviewed to confirm whether donations received from Jacobs the Jewellers had been included on the voluntary income and, in addition, whether these funds were restricted or unrestricted. In addition, it was suggested that going forward a narrative should be included when large donations were received to identify where the funds had been received from and whether the funds were restricted or unrestricted. Action: A Saunders The interim Charity Director gave an overview of the proposed Knowledge and Development Fund process and recommended that the fund should be piloted for two years and then reviewed by the Committee. The interim Charity Director recommended that an application process would be put into place and successful applicants selected by a panel. Funds would be appointed from the unrestricted funds. The Committee discussed use of charity monies for ideas that would bring added value to the Trust from staff that exceed the Trust values. The Committee had recommended that £300k be made available for the two year pilot. and agreed funds would be capped at £150k per year for each of the two years, in line with the previous approval. The interim Charity Director agreed to provide an update in relation to the preferred process, purpose and governance arrangements for the Knowledge and Development Fund for approval at the next Committee. Action: A Saunders

The Director of Communications and Engagement highlighted that job descriptions had been updated to give the team a greater sense of purpose in their role. A substantive Charity Director was due to be appointed. The successful candidate had a finance background and had previously worked at a charity. The Chief Executive suggested that communications be disseminated to staff to advise of the appointment once the Charity Director was in post. Action: V Parker The Committee discussed governance of the Charity. It was recommended the terms of reference and governance should be reviewed by the end of January 2019 to ensure they were both robust and aligned with the Charity Commission requirements. Action: A Saunders

The Committee received an update on events planned during 2019. It was highlighted that the Soapbox race would be postponed until 2020 as funds raised in 2018 were less than expected in part due to other external factors. However, the Charity would look at external sponsorship for the following year. The interim Charity Director recommended that a staff fun day take place at Englefield Park to celebrate the 180th anniversary of the Royal Berkshire Hospital. It was suggested that the interim Charity Director should liaise with the Director of Estates to discuss whether funds could be used towards estates development as this would align with the Clinical Services Strategy and Vision 2025. It was recommended that the interim Charity Director could attend the Estates Programme Committee to review potential opportunities. Action: A Saunders The Committee discussed the issue of encouraging fund managers to spend charitable funds. The Chief Finance Officer advised that a letter would be circulated to all fund managers to request that they develop a plan to spend fund monies. The fund managers could liaise with the fund manager at the Charity to ensure they had a clear plan that demonstrated what the funds would be used for.

Minutes of the Charity Committee – 23 January 2019 2


04/19 Charity Risk Register

The Committee received the Charity Risk Register. The Chief Finance Officer highlighted the application process for receiving charitable funds was being reviewed to ensure these were from a ‘fit and proper’ source. This would minimise any potential risk of money laundering that could cause reputational damage to both the Charity and the Trust. The Director of Finance advised that, to date, no charity funds had been received from abroad. The interim Charity Director highlighted that internal processes were being reviewed for designated, restricted and unrestricted funds. This would provide the Charity team with greater clarity on the best use of the funds. It was agreed that the target score for ‘inappropriate spending of charitable funds’ risk would be amended to 8. Action: A Saunders

05/19 Management Accounts

The Director of Finance introduced the report that provided an overview of the accounts. Charity income received this financial year was £879k. The Director of Finance confirmed this was similar to the income that had been received at the same point in the previous financial year. The Committee noted that operating costs as a total percentage of income was 32%. Operating costs as a total percentage excluding legacies was 44%. The Committee discussed the increased resource that had been made available for the Charity. It had been anticipated the extra resource would result in an increased income being received through donations and legacies. The Committee recommended that an update be provided on the percentage costs of income versus the costs associated with running the charity that had been agreed. The Trust Secretary would confirm the percentage costs that had been agreed in Spring 2018 as part of the Charity Strategy discussion Action: C Lynch

The Committee queried gift aid received as the value was currently at £0. The Chief Finance Officer would confirm this. Action: N Lloyd

06/19 Charity Accounts 2017/18

The Director of Finance provided an update on the Charity Accounts for 2017/18 that were due to be submitted to the Charity Commission in January 2019. Following the merger of the Royal Berks Charity with Reading & District Hospitals Charity (RDHC) evidence to confirm restricted funds from the trustees of RDHC had been required. A due diligence exercise had been undertaken in relation to the cash and property of RDHC following the merger. However, evidence of which funds were restricted had been requested by Deloitte. The Trust had contacted the trustees of RDHC and an update was awaited. The Director of Finance agreed that an executive summary from external auditors would be provided at the next meeting. Action: N Lloyd The Committee approved the submission of the accounts subject to the confirmation of restricted funds being received from the trustees at RDHC.



07/19 Charity Committee Work Plan

The Committee noted the work plan and agreed the knowledge and development fund should be included on the work plan. It was agreed that the Trust Secretary would liaise with the relevant leads to further review and update the work plan. Action: C Lynch

The Committee discussed whether an internal audit of the Charity in 2019/20 would be practicable to ensure that the Charity was compliant with governance requirements set out by the Charity Commission. The interim Charity Director would liaise with the executive leads to discuss this proposal further Action: A Saunders


It was agreed that the next meeting would be held on Wednesday 13 March 2019 at 10.00am.

SIGNED:

DATE:


Agenda Item 10e

Workforce Committee Monday 18 February 2019 14.00 – 16.00 Boardroom, Level 4, Royal Berkshire Hospital Members Mr. Julian Dixon (Non-Executive Director) (Chair) Ms. Caroline Ainslie (Director of Nursing) Dr. Lindsey Barker (Medical Director) Mr. Don Fairley (Director of Workforce) Mrs. Sue Hunt (Non-Executive Director) Mrs. Helen Mackenzie (Non Executive Director) Mr. Steve McManus (Chief Executive) Mr. Graham Sims (Chair of the Trust) In Attendance Ms. Cindy Kouris (Workforce Information Manager) Mrs. Caroline Lynch (Trust Secretary) Ms. Rosalind Penny (Deputy Director of Organisation Development) Mrs. Moyra Pugh (Professional Occupational Therapy Lead) (for minute 06/19) Mrs. Hannah Travers (Deputy Trust Secretary) Mrs. Gill Valentine (Director of Midwifery) (for minute 07/19) Apologies Mrs. Nicky Lloyd (Chief Finance Officer) Ms. Mary Sherry (Chief Operating Officer) 01/19 Declarations of Interest

There were no declarations of interest. 02/19 Minutes: 29 October 2018 and Matters Arising Schedule

The minutes of the meeting held on 29 October 2018 were approved as a correct record and signed by the Chair. Minute 39/18 (31/18): Minutes 30 July 2018 and Matters Arising Schedule: Gender Equality at the RBFT: The Medical Director highlighted that applications for the CEA awards had now closed. Applications would be reviewed to confirm if they were proportional to the number of female staff in the Trust. The Director of Workforce highlighted the Trust had received one response from another Trust that had expressed interest in benchmarking retention of maternity leave returners. Feedback from this trust was awaited. In addition, benchmarking data across the Buckinghamshire, Oxfordshire and Berkshire West Sustainability and Transformation Partnership (BOB STP) would also be considered going forward.

Minutes

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Workforce Committee 18 February 2019

Minute 42/18: Workforce Key Performance Indicators (KPIs): The Director of Workforce advised work was ongoing with the Finance team to clarify staff groups and vacancies within departments. The Committee recommended that further information was required in relation to how QIPPs were removed from budgets in relation to staffing establishments. Action: N Lloyd Minute 48/18: Skill Mix Review: The Director of Nursing confirmed that the report in relation to a test ward that included Physician Associates on the ward would be submitted to the Committee in May 2019.

03/19 Director of Workforce Update

The Director of Workforce introduced the report and advised that a national programme to develop an NHS workforce implementation plan was in progress. Work-streams included future medical and dental workforce, clinical workforce and making the NHS a best place to work. In addition, leadership, development and talent management, technology skills and enablement workstreams were also being progressed. HR Directors within the BOB STP were continuing to develop a workforce strategy. The workforce Strategy would align with the NHS Long Term Plan. Initiatives for 2019/20 would be agreed with partner organisations in the STP and the local Integrated Care System (ICS). The Deputy Director of Organisation Development advised that £70k funding had been received from Health Education England to support the production and implementation of the BOB STP workforce Strategy. The Director of Workforce provided an update on the Kark review which was commissioned to evaluate the scope, operation and purpose of the Fit and Proper Person Test (FPPT). The Secretary of State for Health and Social Care had accepted two of the actions following the review. These included directors meeting specified standards of competence to sit on the board of any health providing organisation and a central database being created that would hold relevant information related to qualifications and history of each director. The Chair of NHS Improvement had been asked to consider five other recommendations from the review. The Committee noted that the pay progression system would come into effect from 1 April 2019. This would include staff being required to complete all mandatory training and appraisals prior to receiving pay increments. Training sessions would be provided to managers in relation to the appraisal system and the talent management framework going forward. In addition, all directors and very senior managers had received a pay uplift in line with the 2018/19 pay award. The Director of Workforce highlighted the pensions lifetime allowance limit would be increased from April 2019 to £1,055,000 in line with the consumer price index. However, some senior staff members were retiring early or removing their pension benefits earlier due to the cap on the pensions lifetime allowance limit. The Director of Workforce highlighted that EU nationals continued to be recruited. 23 nurses had recently been recruited from Spain and further planned activities were taking place. The Director of Workforce advised that recruitment initiatives were developed at Trust level. However, a collaborative approach could be considered at both the BOB STP and ICS level. The Committee requested that an update on recruitment should be provided at the next meeting.

Action: D Fairley

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04/19 Workforce Key Performance Indicators (KPIs) The Director of Workforce introduced the report that provided an overview of the appraisal and

mandatory and statutory training (MAST) compliance. MAST training was at 88.3%, the highest compliance that the Trust had recorded. Appraisal rate compliance was 87.1% and work was on going with the top 10 areas that were underperforming to seek feedback as to why appraisals were non-compliant. The Director of Workforce advised that compliance targets were due to be reviewed for the next financial year.

The Committee noted the turnover rate was 14.8% in December 2018. The highest staff

turnover related to unqualified clinical support roles and Allied Health Professionals (AHPs). The Workforce team were analysing staff turnover and length of service figures to ascertain any emerging themes.

The Committee received an update in relation to agency spend including NHS Professionals

(NHSP), overtime and additional hours. There had been a reduction in agency costs, in part, due to increased scrutiny of the approval process for backfill of admin and management posts.

The Committee reviewed the QIPP programmes that included a pay element and suggested that

further detail be provided including departments where savings had been achieved for admin and management posts. Acton: D Fairley

05/19 Staff Survey Results The Director of Workforce provided an overview of the staff survey results. The Trust ranked 10th

out of 43 acute providers surveyed by Picker. The survey included ten key themes. The Trust performed above average in 9 of these areas. However, the survey had identified that the Trust performed worse in one area that related to equality, diversity and inclusion. An improvement plan would be developed following the full publication of the survey and managers would be encouraged to engage with staff on key themes. Action: D Fairley

The Committee discussed the work undertaken to improve engagement with staff and

recommended that further actions should be identified to improve staff experience of working at the Trust prior to the next staff survey being launched in 2019. Action: D Fairley

06/19 Retention and Recruitment Update: Therapies Case Study The Occupational Therapy Lead provided an overview of the Therapies Service approach to

recruitment and retention. A number of initiatives had been launched that included targeted recruitment at career fairs and universities, financial incentives and a social media campaign to promote the work of therapies. In addition, the team had focussed on celebrating staff excellence through an in-house therapies newsletter and therapies award ceremony. The team had reduced agency spend from £228,498 in 2017 to £82,692 in 2018 due to the investment in recruitment and retention.

Turnover of staff would remain high in Therapies as training and development equipped staff with

skills to work in the local community. Secondment opportunities were also available to different areas including the community re-enablement team that supported reduced delayed transfers of care at the Trust.

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07/19 Maternity Staff Retention Update The Director of Midwifery provided an overview of retention following the implementation of the

maternity staff retention framework in April 2018. The team had implemented a staff ideas board with new ideas being discussed at team meetings. Ward and department blogs had also been developed and retention leads had been established in all clinical areas. In addition, the Freedom to Speak Up role had been publicised and promoted to all staff to enable any concerns to be raised.

The Directory of Midwifery highlighted the turnover of midwifes had reduced from 28% in April

2018 to approximately 17% in November 2018. There had been a slight increase in turnover during November 2018 and retention leads were reviewing reasons for this increase.

Actions from the 2018 staff survey results had been developed and retention leads were continuing to collect feedback from staff groups to implement improvements going forward. The Safety Culture Survey had also identified actions and retentions leads had engaged with staff to establish key topics to be reviewed. These included work progression for Health Care Assistants and Maternity Support Workers and reviewing shift patterns for midwifery and support staff. In addition, staff had recommended reviewing and re-launching the appraisal process and this was due to be implemented in April 2019. The Committee discussed the role of the retention lead as this had made an impact in identifying changes that had helped increase staff retention. It was recommended that this could be tested in other areas where there was a high turnover of staff. Action: D Fairley / C Ainslie

08/19 NHS Health & Wellbeing Update The Director of Workforce provided an update on health and wellbeing (H&W) activity during

2018/19. A number of initiatives including smoking cessation and massage therapy were offered to staff. 12 H&W champion roles had been introduced to disseminate H&W messages to staff and act as a source of information on support services available. The Trust would continue to recruit H&W champions during 2019.

The physiotherapy service pilot for staff had received approximately 400 referrals during 2018/19 and this was now a permanent service within occupational health. In addition, following the change of provider for the Employee Assistance Programme there had been an increase in the number of staff using this service.

The Trust H&W Strategy was being reviewed to include the NHS H&W framework, Vision 2025

and the People Strategy. In addition, the Trust was also reviewing internal communications to increase staff knowledge of the H&W services available.

09/19 Guardian of Safe Working Update The Committee discussed the progress made in relation to the ENT surgery as one exception

report had been submitted in Q3 compared to 16 in Q2. The Medical Director advised that there had been an increase in junior doctors attending the junior doctors’ forum that would continue to develop during 2019.

The Medical Director highlighted the Guardian of Safe Working had been in post for two years and it had been agreed that a new Guardian of Safe Working would be appointed during every 2 to 3 years. The Committee expressed their thanks to the Guardian of Safe working for his excellent work during his time in the role.

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10/19 Occupational Health Report The Director of Workforce provided an overview of occupational health (OH) performance during

2018/19. There had been a 6.7% increase in demand year on year for management and self-referrals. The increase had resulted in KPI’s not being achieved for either the OH Nurse appointments within two weeks or the OH consultant physician appointments within three weeks. The Committee noted that a review of the appointment structure was planned for 2019/20 as the team were currently working at capacity.

A Health and Wellbeing Strategy was due to be developed following the publication of the health and wellbeing (H&W) framework by NHS improvement. The Committee recommended the draft strategy should be submitted to the next meeting. Action: D Fairley The Workforce Information Manager advised that reporting of sickness associated with stress and mental health were low when compared to figures reported in the staff survey. The staff roster system had been reviewed and updates undertaken to increase improved reporting of staff sickness related to stress and mental health. The Committee noted the health & wellbeing awareness campaigns promoted by the OH team and recommended that additional work should be undertaken in relation to mental health wellbeing. In addition, the Committee highlighted that the current structure did not include staff experienced as mental health practitioners. Action: D Fairley

11/19 Workforce Race Equality Standard (WRES) Update The Director of Workforce introduced the report that provided an overview of the National WRES

data report and NHS WRES leadership strategy. The Trust benchmarked well on 6 of the 9 key metrics. This included BAME staff more likely to access non-mandatory and statutory training and less likely to enter the disciplinary process. The Trust performed worse on three key metrics when compared to the national average. These included no BAME representation on the Board and no increase in BAME senior staff. In addition, BAME staff views of fairness of equal opportunities and career progression were also worse than the national average.

The Committee recommended that an update should be provided on disability equality at the next meeting. Action: D Fairley

12/19 Lesbian, Gay, Bisexual & Transgender (LGBT) Workforce Equality Update

The Director of Workforce provided an overview of LGBT data at the Trust and proposed actions in relation to any equality challenges. The Committee noted that only a small number of staff had self-reported that sexual orientation as LGBT and 23% of staff had not disclosed their sexual orientation. Recruitment activity had been reviewed during 2017/18 and this had highlighted that 3.8% of applicants were from LGBT applicants compared to 86.8% of heterosexual applicants. The Trust would look to target recruitment activity to increase the number of LGBT applicants with a focus on developing visibility and profile of LGBT inclusivity on recruitment materials as well as other external communications. In addition, the Trust would also engage with Stonewall to review support that could be offered to increase LGBT equality at the Trust. The Director of Workforce advised that work would continue to increase inclusion of all staff groups at the Trust. Programmes including the talent management and recruitment initiatives

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would also improve how the Trust interacted with staff to ensure that everyone was treated equally.

13/19 Gender Pay Gap Review The Committee received an update on the gender pay gap. The Trust reported a mean gender

pay gap of 25.7% and a median pay gap of 12.63% during 2018 compared to 24.85% and 13.04% in 2017. Recent data had indicated progress in closing the median pay gap with accelerated growth in the number of females in the top two pay quartiles compared to males in these quartiles. However, analysis of the top hourly rates had identified the prevalence of females decreased significantly relative to the increases in hourly rates.

The report highlighted that areas of key focus included identifying, developing and retaining female consultant talent in the organisation and encouraging more female consultants to apply for the CEA awards. In addition, following the recent net growth in the number of female consultants this would need to be sustained and improved upon.

14/19 What Matters The Director of Workforce provided an update on the What Matters Programme and advised key

areas had been identified as a focus for phase 4. These included developing middle managers and the delivery of talent management through the recognising individuals success and excellence (RISE) process.

Inclusion was also a key focus and work would continue to develop BAME, Disability and LGBT equality in the Trust. The Deputy Director of Organisation Development advised that an LGBT network was due to launch in April 2019. In addition, a training platform on neurodiversity was now available and the workforce team were considering implementation of this as mandatory training for managers.

15/19 Board Assurance Framework / Corporate Risk Register: Workforce

The Committee recommended that further work would be undertaken on the workforce section of the Board Assurance Framework (BAF), this included dates against improvement actions. An updated version would be submitted to the next meeting. Action: D Fairley

16/19 Work Plan Review

The Committee reviewed the work plan.

17/19 Key Messages for the Board

The Committee reviewed the key issues to draw to the attention of the Board, that included:- • Update received on the progression of workforce initiatives at the BOB STP system level • Update on KPI’s and review of top ten departments with outstanding appraisals received • Detailed update on Therapies and Maternity Staff retention and recruitment initiatives

received • NHS Wellbeing and Occupational Therapy Report update received • Guardian of Safe Working update received • Phase 4 of the What Matters programme received.

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18/19 Date of Next Meeting It was agreed that the next meeting would be held on Monday 15 April 2019 at 13.30

Chair: Date:

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Agenda Item 11

Focus Item Lead Freq Jan-19 Mar-19 May-19 Jul-19 Sep-19 Nov-19Chief Executive Report SM EveryCorporate Risk Register CAi QuarterlyBoard Assurance Framework CL Bi-annualIntegrated Performance Report Exec EveryIPR Metrics Review MS AnnuallyAnnual Report and Accounts and Quality Account

CL Annually

NHSI Annual Self-Certification CA/CL AnnuallyFreedom to Speak Up Annual Report JP AnnuallyWell Led Framework Action Plan Update SM Bi-AnnuallyN&R Committee Update CL QuarterlyStanding Orders Review CL AnnuallyHealth & Safety Annual Report CA AnnuallyReview of the meeting GS EveryBoard Work Plan CL EveryQuality Strategy CAi AnnuallySkill Mix Review CAi AnnuallyWinter Plan MS AnnuallyPathology LB/CAn OnceSeven Day Services Self-Assessment LB OnceHealth & Safety Balanced Strategy Scorecard AS Twice

Staff Survey Results DF Annually

Annual Revalidation Report LB AnnuallyDirector of Finance Report CAn EveryFinance Strategy Can onceQuarterly Forecast CAn Quarterly2019/20 Contract CAn Once2019/20 Budget CAn Once2019/20 Capital Plan CAn OnceOperating Plan AS TwiceCQC Use of Resources CAi OnceStanding Financial Instructions Review CA Annually

ICS Update AS Every

Achieve Long-Term Financial

Sustainability

Drive the Development of

I t t d S i

Board Work Plan

Other / Governance

Provide the Highest Quality Care

Invest in our Staff and live out our

Values

Focus Item Lead Freq Jan-19 Mar-19 May-19 Jul-19 Sep-19 Nov-19

Transformation Strategy MS once

Integrated Services

Cultive Innovation and Transformation

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