TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION …€¦ · TAMESIDE AND GLOSSOP INTEGRATED...

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Report to Public Trust Board meeting of the 27th April 2017

Agenda Item6b

TitleChief Executive’s Report

Sponsoring Executive DirectorKaren James

Author (s)Tom Neve

PurposeTo discuss and note the various items covered bythis report.

Previously considered bySome items previously considered by the ExecutiveManagement Team

Executive Summary:

Government to extend protections for NHS Whistle-blowers – Consultation

Plans have been published that will prohibit discrimination against whistle-blowers when they

apply for jobs with NHS employers.

Sir Bruce Keogh to step down from NHS England role

Professor Sir Bruce Keogh has announced he will stand down as NHS England medical

director at the end of the year, after 10 years in the role.

NHS England national director to step down next month

New care models director Samantha Jones is to step down next month to spend more time

with her children.

Related Trust Objectives This report relates to all of the trust’scorporate objectives

Risk Assurance – risk impacted uponRelates to all aspects of Board AssuranceFramework and Significant Risk Report.

Legal implications/Regulatoryrequirements

This report impacts on the regulatoryrequirements from NHSI and the CQC

Financial ImplicationsMay have some financial implications

Has a quality impact assessment beenundertaken?

N/A

How does this report affectSustainability?

Some items in the report have a directimpact on the organisation’s sustainability

Action required by the Board

To note and discuss the items contained within the report

Chief Executive’s Report

Government to extend protections for NHS Whistle-blowers – Consultation

Plans have been published that will prohibit discrimination against whistle-blowers

when they apply for jobs with NHS employers.

These changes were a recommendation from Sir Robert Francis’ Freedom to Speak

Up review which found a number of people struggled to find employment in the NHS

after making protracted disclosures about patient safety.

The consultation, Protecting whistle-blowers seeking jobs in the NHS seeks views on

the draft regulations that aim to:

Give the applicant a right to an employment tribunal if they have been

discriminated against because it appears they have previously blown the

whistle

Set out a timeframe in which a complaint to the tribunal must be lodged

Set out the remedies that the tribunal may or must award if a complaint is

upheld

Make a provision as to the amount of compensation that can be awarded

Give the applicant a right to bring a claim in the county court or the High Court

for breach of statutory duty in order to, among other things, restrain or prevent

discriminatory conduct

Treat discrimination of an applicant by a worker or agent of the prospective

employed (NHS body) as if it were discrimination by the NHS body itself.

The consultation on the Department of Health website closes on 12 May 2017.

Sir Bruce Keogh to step down from NHS England role

Professor Sir Bruce Keogh has announced he will stand down as NHS England

medical director at the end of the year, after 10 years in the role.

He will then take up a new role as chair of Birmingham Women’s and Children’s

NHS Foundation Trust.

NHS England national director to step down next month

New care models director Samantha Jones is to step down next month to spend

more time with her children.

Ms Jones was appointed by NHS England in January 2015 to lead the vanguard

programme to set up and test five new models of care outlined in the Five Year

Forward View.

The vanguard programme is in its final year. In 2017-18 the vanguards and national

new care models team will increasingly focus on supporting the rest of the country to

implement new care models.

Louise Watson, currently deputy director for new care models, will take over as

director.

IR35 regulations

The IR35 regulations, which took effect at the beginning of April 2017, force “off-payroll” workers to pay the same level of tax as substantive employees, by makingemployers responsible for paying their tax and national insurance.

This has resulted in locum doctors and other contractors at some trusts demandingsignificant uplifts in their pay, or threats not to come to work.

In relation to this trust, it has resulted in some difficulties in covering the emergencydepartment.


Report to Public Trust Board meeting of the 27th April 2017Agenda Item 7a

Title Integrated Performance Report : March 2017

Sponsoring ExecutiveDirectors

Trish Cavanagh, Director of OperationsBrendan Ryan, Medical DirectorAmanda Bromley, Director of HRClaire Yarwood, Director of FinanceTracey McErlain-Burns, Chief Nurse

Author (s) Peter Nuttall, Director of Performance & Informatics

Purpose To note/receive

Previously considered by This report has not been considered by any othermeeting

Executive SummaryThis Board Report includes an appendix showing the metrics and triggers included in theSOF. Not all metrics are currently measured, but work is being undertaken to ensure that: a.performance data is generated; and b. this report is developed to reflect the new Framework.The Trust reported failure of one of the performance metrics included in the SOF: the four-hour- wait target.

Related Trust Objectives Objective 1 - All patients receive harm-freecare through the delivery of the Trust’sPatient Safety Programme.Objective 2 - To improve the quality ofpatient care through the implementation ofthe Trust’s agreed Quality Strategy.Objective 3 - To improve the patientexperience through a personalised,responsive, compassionate and caringapproach to the delivery of patient care.Objective 7 - To deliver against the requiredlocal and national frameworks in order tomeet all the requirements of the Trust’soperating licence and the commissioners’requirements.

Risk Assurance – risk impacted upon Relates to all aspects of Board AssuranceFramework and Significant Risk Report.


This report indirectly impacts on CQCfundamental Standards of Care and licencerequirements.

Financial Implications Tameside and Glossop CCG may applyfinancial penalties for failing to achievespecific performance targets as detailed inthe Contract.


This is the Medical Director and Chief Nurseview on the impact of any service change


Reflects current risks to the Trust’s businessand strategic objectives

Action required by the Board The Board is asked to review the quality and performancestandards noted in the Integrated Performance Report.

INTEGRATED PERFORMANCE REPORT: April 2017 Board (March 2017 performance)

This page is intentionally blank


Board of Director’s Meeting 27th April 2017

Integrated Performance Report 2016/17

Contents

Introduction 4

List of Acronyms 5

Dashboard March 2016/17 6

Exception Reports

Medical Director/ Director of Operations

Cancer 62-day target 7

Director of Operations

Four-hour wait/ ambulance handover 8

Inpatient discharge summaries) 9

Director of Human Resources

Staff attendance 10

Mandatory Training 11

Thresholds for 2016-17 12

Single Oversight Framework (SOF) metrics and triggers (draft) 13


Integrated Performance Report – March 2017 Performance

IntroductionThis report provides the Trust Board with: an overview of the Trust’s performance across a range of qualityand operational indicators for the month of March 2017; and year-to-date performance, along with a RAGrating, to support the Board in evaluating performance against each indicator.

Exception ReportsAlongside the Quality and Performance Dashboard, the report includes exception reports, which respond tothe performance data and allow the Executive Team and Trust Board to be assured of, and contribute to,plans to rectify performance and quality issues. All serious incidents are reported to Trust Board in Part 2 ofthe meeting for patient confidentiality reasons; therefore, no exception report is provided for this indicator.

March PerformanceThe Trust reported failure of one performance target included in the Single Oversight Framework (SOF):the four-hour- wait standard. This report includes exception reports for the following metrics: four-hour waitand ambulance handovers; Emergency Department and inpatient discharge summaries; staff attendancerate and mandatory training.

Mortality

In the latest Summary Hospital-level Mortality Indicator (SHMI) publication, THFT has a value of 111 for theperiod October 2015 - September 2016. This value means that the SHMI is ‘as expected’. The hospital’sStandardised Mortality Ratio (SMR) for the latest available twelve months (January 16 - December 16) is93.05, which is ‘better than expected’ but not statistically significantly so.

Mixed-Sex Accommodation Breach

The Trust reported its first mixed-sex accommodation breach of 2016-17 in March. The affected patientwas delayed on ICU, over the weekend of the 18th/ 19th March, as a result of the unavailability of suitablecapacity on the medical wards. An assessment of the current escalation process and its application,particularly at weekends, is being undertaken.

Referral-to-Treatment

In March, the Trust met the national Referral-to-Treatment standard (incomplete pathways) withperformance of 92.45% against the threshold of 92%. The Trust reported that no patients had a waiting timeof more than 52 weeks at the end of March.

Outpatient DNA Rate

The outpatient DNA rate for March was 7.94%, which is significantly better than the 9.5% target.

Stroke TargetsThe Trust Board is asked to note the Trust’s banding of ‘b’ for the SSNAP (Sentinel Stroke National AuditProgramme) national stroke audit for the period August- November 2016, where the poorest performingtrusts are classified as ‘e’ and the best as ‘a’. The SSNAP audit includes 44 measures in 10 domains. TheTrust’s banding for the previous period was ‘c’.

Emergency Readmissions within 30 daysThe 30-day readmission rate remains above the local target level of 10%, at 12.3% (year-to-date),although the rate has reduced steadily from around 14% in 2014.

Appraisal

It was not expected that the appraisal rate would reach the 90% target at the end of March, because theAppraisal Window opens on the 1st April and managers were asked to wait until April and use the updatedpaperwork. Monitoring will recommence on the 1st April.


List of Acronyms

ADT Admission, Discharge, TransferC DIFF Clostridium difficileCIP Cost Improvement PlanCQC Care Quality CommissionCT Computerised TomographyCWT Cancer Waiting TimesDNA Did-not-AttendDPH Director of Public HealthDToC Delayed Transfers of CareED Emergency DepartmentENP Emergency Nurse PractitionerESDT Early Supported Discharge TeamETD Education, Training and Development teamFFT Friends & Family TestGM Greater ManchesterGMCCN Greater Manchester & Cheshire Cancer NetworkHSMR Hospital Standardised Mortality RatioHAS Hospital Arrival ScreenIAU Integrated Assessment UnitIR35 Tax legislation relating to workers supplying services to clients via an intermediaryICO Integrated Care OrganisationMRSA Methicillin-resistant staphylococcus aureusMSA Mixed-sex AccommodationNWAS North West Ambulance ServicePTL Patient Tracking ListRAID Rapid Assessment Interface and Discharge (psychiatry liaison service)RCA Root Cause AnalysisREACT Rapid Assessment Emergency Care TeamRIDDOR Reporting of Injuries, Diseases and Dangerous Occurrences RegulationsROSIER Rule Out Stroke In the Emergency RoomRTT Referral-to-TreatmentSAFER Patient Flow Bundle (Senior review; All patients with expected discharge date; Flow of

patients at earliest time; Early discharge; Review of patients with extended lengths-of-stay)SALT Speech and Language TherapySHMI Summary Hospital-level Mortality IndicatorSOP Standard Operating ProcedureSSNAP Sentinel Stroke National Audit ProgrammeSTAR Staff Accident Rate

StEIS Strategic Executive Information SystemTIA Transient Ischaemic AttackTNA Training Needs AnalysisVTE Venous ThromboembolismWTE Whole Time EquivalentYTD Year-to-Date

* Governance indicators, which appear in Monitor's Risk Assessment Framework

Target Actual 4-mth Actual Current 1-mth Staff Health & Safety Target Actual 4-mth Actual Current 1-mth Target Actual 4-mth Actual Current 1-mth16/17 16/17 Trend Month Period F'cast 16/17 16/17 Trend Month Period F'cast 16/17 16/17 Trend Month Period F'cast

Mortality 0 12 1 Waiting times

≤100 93.05 NA NA 155 0 NA NA ≥92% 92.81% 92.45%

SHMI (rolling 12 months- to Sep 16) ≤100 111 NA RTT waits- incompletes (>52 weeks) 0 0 0

Infection Prevention & Control Staff accident rate A&E

0 6 0 (STAR) ≥95% 85.68% 88.24%

C-difficile - actual cases YTD* N/A 63 6 N/A N/A Trolley waits in A&E (>12 hrs) 0 0 0

97 19 0Target Actual 4-mth Actual Current 1-mth

HAS compliance ≥95% 95.41% 96.43%

NHS Safety Thermometer 16/17 16/17 Trend Month period F'cast Notify to Handover (30-60mins) 0 645 73

NA 91.6% 92.2% NA NA Q4: ≥96% 94.71% 94.9% Notify to Handover (>60mins) 0 248 16

≥98.5% 98.4% 97.9% 90% 71.60% 71.6% Cancer

Patient Safety FFT- Staff Survey (quarterly)

≥96% 96.83% 94.38% Recommend Treatment (Jul-Sep 16) ≥80% NA 79%

Recommend Work (Jul-Sep 16) ≥74% NA 74%

Mandatory Training Target Actual 4-mth Actual Current 1-mth

≥90% 96.5% 100% E-learming Info Gov ≥95% NA 73.3% 16/17 16/17 Trend Month Period F'cast

E-learming SG Children ≥95% NA 75.9% ≥90% 87.42% 89.13%

E-learming Infection Control ≥95% NA 85.0% ≤9.5% 9.31% 7.94%

0 0 0 E-learming E-MH ≥95% NA 92.0% ≥90% 87.46% 86.94%

0 54 7 E-learming E &D ≥95% NA 93.1% ≤0.8% 1.20% 0.59%

0 0 0 E-learming SG Adults≥95%

NA 88.6% 0 0 0

0 0 0 E-learming H&S ≥95% NA 88.2% Discharge Summaries

0 2 0 Manual Handling ≥95% NA 86.9% A&E (within 48 hours) ≥95% 84.7% 89.8%

Stroke Resus ≥95% NA 64.9% Inpatients (within 48 hours) ≥95% 80.8% 79.2%

SSNAP DSC Stroke Indicators Fire Safety ≥95% NA 83.6% Outpatients (within 5 days) ≥95% 82.0% 92.6%

Number achieved out of 9 (Aug-Nov 16) ≥95% NA 81.2% Discharge Summary Quality Audit 100% NA 96.0%

SSNAP Grading (Aug-Nov 16) B NA B Delayed Transfers of Care- Days (Feb-17) NA 11,899 717 NA NA

Safer Staffing Target Actual 4-mth Actual Current 1-mth

TBC 93.4% 93.3% NA NA 16/17 16/17 Trend Month Period F'cast Actual 4-mth Actual Current Yr-end

TBC 105.7% 104.4% NA NA 1 3 - NA 3 - 16/17 Trend Month Period F'cast

- - Cum. Net surplus (£'m) -14489 348 14489

Target Actual 4-mth Actual Current 1-mth Cum. CIP (% of plan) 98.8% 72% 99%

16/17 16/17 Trend Month Period F'cast Cum. Capital (£k) 2937 840 - 2937

FFT positive responses (all) NA 89.7% 90.6% NA NA Cum. CQUIN (% of plan) 97% 97% 97%

FFT response rate (A&E/ Inpatients) 20% NA 21.38% strong improvement

Complaints received NA 446 40 NA NA improvement

Complaints responded to within no change

agreed timescale deterioration

Ombudsman cases upheld 0 3 0 strong deterioration

Patient Access

SMR (rolling 12 months- to Dec-16)

MRSA - actual cases YTD*

Actual is upto March unless stated otherwise.

Overall Clinical Quality

<10 0.214-hour wait*

18-week incomplete*Calendar days lost

RIDDOR incidents reported

0.00

Nutrition risk assessment

Harm-free care (new harms)

due to staff accidents

C-difficile - avoidable cases YTD* (Feb-

17)

Harm-free care (all harms)

83.13%on admission (Feb-17)

VTE risk assessments (provisional)

Medicines reconciled ≥95% 85.00%

Staff Attendance

Appraisals - rolling 12 mths

12.28%Outpatient DNA rate

Serious Incidents reported (StEIS)

30 days (Feb 17)13.02%

Failure of safer-surgery process

Emergency re-admissions within

93.57%

RN/RM hrs on shift (% of planned)

Outpatient slot utilisation

Urgent operations cancelled for a second time

HCA hrs on shift (% of planned)

'Duty of Candour' breaches

Regulation 28 reports (inquests)

Never Events reported (StEIS)

Theatre utilisation (capped)

NA NA 7

Cancelled operations- last-minute (provisional)

Q4: ≤ 11%

≥90%

Patient Experience

Single Oversight Framework (Jan-Mar 17)

Good ≤-£17500

The one-month forecast is an informed prediction of the next

month's performance, which may be based on part-month data,

operational intelligence and historical trends.

≥100% of plan

≥70% of plan1-month forecast 4-month trend

CQC Rating* (Jan-Mar 17)

16/17

92%

Cancer- Composite Indicator

Number achieved out of 8 (Feb-17)

Target

Operational Efficiency

Finance

78 NA

People

Regulatory

Mandatory training (Overall)NA NA

QUALITY ACCOUNT: April 2017 Board (March 2017 performance)

THFT QUALITY ACCOUNT 2016/17

Quality DashboardMarch 2017

QUALITY ACCOUNT EXCEPTION REPORTS: Medical Director/ Director of Operations (1/1)

Cancer Services Target CurrentPerformance

4 MonthTrend

PreviousPerformance

Forecast

62-day GP Referral to Treatment-Overall (reporting Period: February 2017) 85% 92.7%

Acute trusts are required to support the NHS England/ Trust DevelopmentAuthority/ Monitor commitment to ‘Improving and Sustaining CancerPerformance’. One action required of trusts is that they report tumour- site-specific performance against the 62-day cancer target to their Board, irrespectiveof performance against the aggregate target.

This report highlights the Trust’s overall and tumour- site- specific performanceagainst the 85% threshold. The period that it relates to is February 2017 and theposition stated has been fully validated, in line with the Greater Manchester- wideReallocation Policy. For the month of February 2017, the aggregate 62-dayposition was 92.7%, which means that the Trust met the national standard for themonth. The reasons for the 4 breaches in February were as follows:

2 x complex / multi- tumour sites / patient comorbidities; 2 x internal diagnostic delays.

‘Near Misses’Acute trusts are also required to include, in the reports provided to their Board,data relating to patients treated within 48 hours of their breach date. Fourpatients were classified as ‘near misses’ in the month of February. The ‘nearmisses’ were the result of:

1 patient fitness review prior to surgery; 1 patient holiday; 2 external treatments (patients referred on/before day 42).

‘Treated after day 104’A full breach analysis, and clinical assessment, must be conducted on patientswith a total wait greater than 104 days. If harm has been caused by the treatmentdelay, a full ‘Serious Incident’ investigation must be undertaken by the treatingTrust. In February two of the Trust’s patients were treated, post day- 104, attertiary hospitals. These delays were the result of: an internal diagnostic delay;and delay at the tertiary provider. Both patients were referred to the tertiaryprovider on/ before day 42 of the pathway.Expected date to meet target NA Signed off by Janet Smart

Signed off by Trish Cavanagh/ Brendan Ryan

QUALITY ACCOUNT EXCEPTION REPORTS: Director of Operations (1/2)

Patient Access-A&E

Target CurrentPerformance

4 MonthTrend

PreviousPerformance

Forecast

4-hour wait (Reporting period: March 2017)

Notify to Handover: 30-60 mins (Reporting period: March 2017)

Notify to Handover: 60+ mins (Reporting period: March 2017)

95%

0

0

88.24%

73

16

ISSUEThe Trust did not meet the four-hour emergency care standard in March:

Bed capacity across the organisation was problematic, causing delayedfirst assessments due to a lack of capacity in the Department;

IAU remained escalated as a bedded area rather than functioning asoriginally planned;

Reduced ambulatory-care service because of staffing shortages; National and local shortages of medical and nursing cover exacerbated

by difficulties with IR35 regulation; Medical bed-pool occupancy was routinely at >96%; Delayed-transfers-of-care occupied 5.7% of the ‘General and Acute’ bed

pool, a reduction from 10% in January; Increased acuity, as measured using the Charlson Comorbidity Index

(43% of patients with a Charlson comorbidity; 34% in 2009-10).ACTIONS

NHSI’s Head of Service Improvement ‘significantly assured’ about theTrust’s response to the challenges relating to emergency flow;

Silver Command, including the deployment of Ward Liaison Officers, inplace during February;

Additional medical staffing resources deployed, especially on days ofexpected increased activity (Monday/Tuesday).

PROPOSED ACTIONS NHSI to offer focused support concerning ED streaming; Pilot streaming for one month (Monday, Tuesday and Friday for four

weeks) commencing 6th March; Visit to Derby Hospital to assess streaming model.

Notify To Handover Time

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17 YTD

30-60mins

47 59 44 42 109 98 49 73 645

60+Mins

2 28 15 9 56 53 23 16 248

Expected date to meet target Quarter 42017-18

Signed off by DebbieDavies

Signed off by Trish Cavanagh

QUALITY ACCOUNT EXCEPTION REPORTS: Director of Operations (2/2)

Operational Efficiency Target CurrentPerformance

4 MonthTrend

PreviousPerformance

Forecast

Discharge Summaries- A&E: (Reporting period: March 2017)

Discharge Summaries- Inpatients: (Reporting period: March 2017)

95%

95%

89.8%

79.2%

ISSUEPerformance was below target for Emergency Department and inpatientdischarge summaries. Performance against the outpatient- clinic letter standardimproved again during February to 93% so that an exception report is notrequired.

80.5% of inpatient discharge summaries were completed within 48 hours inMarch, which is consistent with reporting from the most recent months. 89.8% ofEmergency Department summaries were completed within 48 hours against the95% standard. This performance represents a marginal deterioration from theperformance in February but is a significant improvement upon performance inthe months prior to that, as can be seen in the chart opposite.

ACTIONSReview at the Patient Safety Board and feedback with proposed actions. Meetingwith Director of Performance, Medical Director, Director of Quality andGovernance and CCIO regarding strategy for discharge summaries. Significantimprovements in performance may require increased digitisation: such optionsare being explored by the Health Records Group.

PROPOSED ACTIONS Start development of eCAS card, which will guarantee delivery of a

summary within target; Develop reporting mechanism to directly target missing/ late summaries; Target areas of underperformance, such as General Medicine,

Cardiology, General Surgery, Paediatrics and Trauma and Orthopaedics.ASSESSING IMPROVEMENTUsing the bespoke performance reports.Expected date to meet target Quarter 2-2017/18 Signed off by Geoff

Lavelle

Signed off by Trish Cavanagh

QUALITY ACCOUNT EXCEPTION REPORTS: Director of Human Resources (1/3)

People Target CurrentPerformance

4 MonthTrend

PreviousPerformance

Forecast

Staff Attendance: (Reporting period: March 2017) 96% 94.86%

ISSUEThe staff attendance rate was below the target for March, although there was areduction in sickness (from 5.3% to 5.1%).

PROPOSED ACTIONSThe HR Business Partners are working closely with ‘hotspot areas’ with highlevels of absence and associated costs. Progress is being monitored via themonthly HR Divisional Management Team Meeting. Actions include:

A review of all sickness cases, ensuring management plans are in place. Delivering 1:1, and small- group, training sessions to raise the profile of

return- to- work interviews. A focus will be put on return- to- workcompliance this month, given the recent increase in short- term sickness.

Attendance Management Masterclass sessions were launched inFebruary. The next session is scheduled for June and 22 managers arebooked to attend.

Discussions are underway with Staff Side with regards to theamendments to the Attendance Management Policy. The main change tothe policy is the reduction of the Trust trigger levels.

A full management ‘toolkit’ will be released with the new policy.

ASSESSING IMPROVEMENTExpect to see improved KPI performance, including an improvement inattendance and a decrease in costs associated with sickness absence includingNHSP/Agency/Bank expenditure. Return-to-work interview compliance is also tobe closely monitored.

Expected date to meet target Quarter 1 2017-18 Signed off by NicolaWilkinson

Signed off by Amanda Bromley

QUALITY ACCOUNT EXCEPTION REPORTS: Director of Human Resources (2/2)

QUALITY ACCOUNT EXCEPTION REPORTS: Director of Human Resources (2/2)People Target Current

Performance4 MonthTrend

PreviousPerformance

Forecast

Mandatory Training: (Reporting period: March 2017) 95% 83.3%

ISSUEMandatory Training performance did not meet the target of 95%:

The Porters/ Domestics staff group was largely non-complaint forMandatory Training upon transfer to the Trust (performance is 52.9%, upfrom 22%); this had a significant effect on the organisation’s overall %performance.

Community staff compliance (currently 77.6%, up from 67.8%) alsoreduced overall compliance upon transfer.

Trust compliance, excluding these groups of staff, is 83.3% (see chartopposite).

ACTIONS Close monitoring of, and the development of action plans for, individual

subjects has had a positive impact on mandatory training elements. Thisincludes reviewing what training should be provided on a face- to- facebasis and which can be delivered via e-learning.

Managers in areas with low compliance have been requested to provideaction plans and trajectories for improvement.

The gap analysis, relating to training in the Community services and forPorters and Domestics, continues

Consideration is being given as to what sanctions can be applied to staffwho are not compliant with mandatory training, and a review ofapproaches, taken by other trusts to this issue, is being undertaken.

ASSESSING IMPROVEMENTData is produced and assessed monthly, and sent to senior managers as soonas the data is produced.Expected date to meet target Quarter 1 2017-18 Signed off by L Harmer

Signed off by Amanda Bromley

Indicator Quarter 1 Quarter 2 Quarter 3 Quarter 4

HSMR (amber if not statistically significant) ≤100 ≤100 ≤100 ≤100

SHMI (amber if not statistically significant) ≤100 ≤100 ≤100 ≤100

MRSA - actual cases 0 0 0 0

C. difficile - actual cases 12 24 34 46

Harm-free care (new harms) 98.5% 99% 99% 99%

VTE risk assessments 96% 96% 96% 96%

Medicines reconciled 95% 95% 95% 95%

Nutrition risk assessment 90% 90% 90% 90%

Re-admissions within 30 days 11.0% 11.0% 11.0% 11.0%

Failure of the safer-surgery process 0 0 0 0

Serious Incidents reported 0 0 0 0

Duty of Candour breaches 0 0 0 0

Never Events reported 0 0 0 0

Regulation 28 reports 0 0 0 0

Complaints response time 90% 90% 90% 90%

Ombudsman cases upheld 0 0 0 0

SSNAP Grading B B B B

RIDDOR accidents reported 0 0 0 0

Staff accident rate <10 <10 <10 <10

Staff attendance 95.0% 95.3% 95.7% 96.0%

Appraisals 85% 90% 90% 90%

Mandatory Training 95% 95% 95% 95%

FFT Staff Survey- Recommend Treatment 80% 80% 80% 80%

FFT Staff Survey- Recommned Working 74% 74% 74% 74%

E-Learning Information Governance 95% 95% 95% 95%

E-Learning Safe Guarding Children 95% 95% 95% 95%

E-Learning Infection Control 95% 95% 95% 95%

E-Learning E-MH 95% 95% 95% 95%

E-Learning Equality and Diversity 95% 95% 95% 95%

E-Learning Safe Guarding Adults 95% 95% 95% 95%

E-Learning Health and Safety 95% 95% 95% 95%

Manual Handling 95% 95% 95% 95%

Resus 95% 95% 95% 95%

Fire Safety 95% 95% 95% 95%

18-week incompleted 92% 92% 92% 92%

RTT waits over 52 weeks (incompletes) 0 0 0 0

4-hour wait 95% 95% 95% 95%

Trolley waits in A&E 0 0 0 0

HAS compliance 95% 95% 95% 95%

Notify to Handover -30-60mins 0 0 0 0

Notify to Handover ->60mins 0 0 0 0

Outpatient Slot Utilisation 95% 95% 95% 95%

Outpatient DNA rate 9.5% 9.5% 9.5% 9.5%

Theatre utilisation (capped) 90% 90% 90% 90%

Cancelled Operations (last minute) 0.8% 0.8% 0.8% 0.8%

Urgent ops cancelled for 2nd time 0 0 0 0

Discharge Summaries- A&E 95% 95% 95% 95%

Discharge Summaries- Inpatients 95% 95% 95% 95%

Clinical Letters- Outpatients 95% 95% 95% 95%

1

TAMESIDE & GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST


Agenda Item 7b

Title Safe Staffing Report

Sponsoring Executive Director Tracey McErlain-Burns, Interim Chief Nurse

Author (s) Tracey McErlain-Burns, Interim Chief Nurse


Previously considered by n/a

Executive SummaryIn-line with the ‘Hard Truths Commitments regarding the publishing of Staffing Data’, the TrustBoard are required to review staffing data on a monthly basis. This report has evolved over thepast three months and this month it includes the results of the January 2017 Safer Nursing CareTool analysis considered alongside professional judgement and NICE guidance on safe staffinglevels for adult in-patients. The Board should note that some of the medical wards are under-established and as such an urgent review of the models of care needs to be carried out. Thisreview will be reported to the Board in June 2017.Finally in terms of summary the Board should note that the CQC requirement for having anAdvanced Paediatric Life Support (APLS) trained nurse on each shift on the children’s ward cannow be achieved following completion of band 6 training.

Related Trust Objectives

1. All patients receive harm free care through the Trust’sPatient Safety Programme.

2. To improve the quality of patient care through theimplementation of the Trust’s agreed Quality Strategy.

3. To improve the patient experience through apersonalised, responsive, compassionate and caringapproach to the delivery of patient care.

Risk Assurance – riskimpacted upon

CR734: Nurse vacancies, leadership and nurse staffing/recruitment across medicine and the ability to provide safecare.AF3480: Failure to meet CQC registration requirementsrelating to staffing.AF3482: Failure to ensure adequate staffing levels to ensurepatient safety and quality of services


NHS England monthly requirement to publish and reportStaffing DataThe CQC report published 7th February 2017 states that theTrust must ensure that there are appropriate numbers ofnursing staff deployed to meet the needs of patients (medicalservices).The report also states that the Trust must ensure anadvanced paediatric life support trained nurse is on each shiftin Children’s Services.

Financial ImplicationsThere are no new immediate financial implications albeit thefinancial implications of international recruitment are beingconsidered by the executive team.

Has a quality impactassessment been undertaken?

Yes – where applicable in plans

2


The Trust is required to ensure staffing levels are adequate tomeet patient safety and quality requirements.

Action required by the BoardThe Trust Board is requested to receive this update and note the actions described and theassertive monitoring and management in place.

3

Background

This is a monthly report to the Trust Board following National Quality Board (NQB) guidance issued in

November 2013 to optimise nursing, midwifery and care staffing capacity and capability: “How to

ensure the right people, with the right skills, are in the right place at the right time: A guide to nursing,

midwifery and care staffing capacity and capability”.

The guidance clearly sets out the expectations and requirements of the Trust to meet the ‘HardTruth’s commitments’ (following the Mid Staffordshire report).

In July 2016, the NQB published an updated set of expectations for nursing and midwifery staffing toassist NHS Provider Boards to take local decisions which will deliver high quality care for patientswithin the available staffing resource (Supporting NHS providers to deliver the right staff, with theright skills, in the right place, at the right time – Safe sustainable and Productive Staffing, NQB, July016). This updated guidance incorporates Lord Carter report findings, in setting out the key principlesand tools that provider boards should use to measure and improve their use of staffing resources toensure safe, sustainable and productive services.

As advised in recent months the content of this report is evolving to ensure that the Board has acomplete picture of matters relating to safe nurse staffing. Specifically this report includes a review ofthe Safer Nursing Care Tool data.

Safe Staffing Update – March 2017 Data

Each month the data collection compares the number of nurse staff hours ‘Planned’ against thenumber of nurse staff hours used ‘Actual’. This is collected by ward, by shift, and is reported bycalendar month as a % fill rate by day and by night. Please refer to the Heat map (Appendix 1).

This staffing information is published via NHS Choices. This data is currently available via our publicwebsite in a specific designated section ‘Safe Staffing’: (www.tamesidehospital.nhs.uk/nurse-staffing.htm)

Overall, Registered Nurse (RN) fill-rates remain constant (with minimal change) month on month, butunregistered (Healthcare Support Worker) fill rates fluctuate due to levels of enhanced care required(1:1’s) and additional support for RN shortfalls.

The following graph highlights to the Board that unregistered fill rates for day and night shifts usuallymeet or exceed 100%1 and registered fill rates for night shifts have recently improved to between 97-100%. Senior Nurse leaders review nurse staffing levels (actual against planned) several times a dayand a conscious decision has been taken to increase the levels of fundamental care support byunregistered staff when registered nurses are not available to fill shifts.

The registered nurse fill rate for day shifts is currently running at 89.9% which is marginally reducedin comparison to the rate of 91.1% for the month of February and the details in this report describesome of the actions being taken to address the shortfall. The reasons for the marginal reduction arefirstly the inclusion of the 7 additional beds in the ward 31 establishment for a full month and increasein demand which was associated with the scheduling of annual leave. The latter is an issue that theAssistant Chief Nurses will address through tightened controls over roster sign off.

1Fill rates dipped to 99% in the month of March due to annual leave.

4

Exception Report – March 2017

There were 5 inpatient areas with registered nurse/midwife fill rates <80% in March 2017 (Appendix 1heatmap). Those areas were:

• Ward 40• Ward 42• Ward 44• Ward 45• Ward 46

As reported to the Board last month ward 40 is trialling the inclusion of two registered charteredphysiotherapists in the nursing establishment 6 days a week. Excluding those hours of registeredpractitioner input to care on the ward the fill rate is 79.9%. Inclusive of those hours the fill rate was102%. The Board was advised last month that the Interim Chief Nurse was liaising with NHSEngland to seek clarity on whether the physiotherapy hours should be included in the unify return ornot; making the case that they should because of the model being trialled. A response has nowbeing received from NHS England and the advice is that these hours should not be included in theunify return however, NHS England noted the development of new models of care and will considerthe inclusion again in the future when unify returns are reviewed.

Wards 44, 45 and 46 have featured in this section of the Board report for several months due to fillrates being less than 80%. All three wards have 24 beds and their establishments are set atregistered nurse to patient ratios of 1:8 during the daytime and 1:12 at night. A recent review of theSafer Nursing Care Tool data (expanded in a later section of this report) indicates that theestablishment for wards 44 and 45 matches patient dependencies whereas on ward 46 the ward isunder established to meet patient dependencies and as such new models of care will be explored.

There are currently 4.89 whole time equivalent (wte) Registered Nurse vacancies on ward 44; 3.9wtevacancies on ward 45 and 5.29wte vacancies on ward 46. As such recruitment campaigns are beingdevised for these three areas.

Ward 42 has not featured in the list of wards with less than 80% fill rate in recent months. Theestablished RN to patient ratio is 1:8 on days and 1:10 on nights. There are currently vacancies onthe ward and this ward has a considerable number of new members in the team (new recruits).Ahead of the Board meeting the Interim Chief Nurse and Assistant Chief Nurse will be meeting withthe Ward Sisters of the medical wards to discuss models of care, retention, recruitment, capacity anddemand. A verbal update will be provided at the Board meeting.

85

90

95

100

105

110

115

120

125

%Fi

llR

ate

Average Fill Rates

Registered FillDAY

Registered FillNIGHT

Unregistered FillDAY

Unregistered FillNIGHT

5

Since February 2017 this report has included details of the number and impact of escalation beds. Inthe month of March there was an average of 5 additional beds opened across ambulatory care, theday care unit, surgical unit and the heart care unit2 which required 845 hours of nurse staffing (acombination of registered and unregistered) of which 411 hours were filled via NHS Professionalsand the remaining hours were redeployed from other areas within the Trust.

RequestedHours

Filled /Worked Unfilled

%Filled

Ward 30 H C U 545 288 257 53%

Ambulatory Integrated Assessment Unit 136 61 76 45%

Day Surgery Unit 126 61 65 49%

Surgical Unit 38 34 4 89%

Total 845 411 434 48%

Care Hours per Patient per Day (CHPPD)

In recent months the heatmap attached at appendix 1 has included actual CHPPD; a measure usedby NHS Improvement. This provides a consistent way of measuring the deployment of nurses andhealthcare support workers and it needs to be used alongside acuity and skill mix.

Planned CHPPD by ward and Trust has been added to the heatmap from February 2017 to show thehours required (based on nurse staffing establishments) versus that available. This draws attention tofive wards with actual hours less than planned, which includes ward 41 which was not in the previouslist of wards because it exceeded the 80% fill rate. It also draws attention to areas such as thesurgical unit, critical care, the neonatal unit, children’s unit, Stamford Unit and Shire Hill all of whichexceeded their planned RN hours. This was largely due to reduced occupancy in those areas attimes during the month of March, for example occupancy in the neonatal unit was 52%.

The graph below shows the trend in actual CHPPD, as a total of days and nights, registered andunregistered, since the methodology was introduced. Benchmarking data is not yet available but it isanticipated that this may be available via NHS Improvement imminently.

2A reduction of 7 compared with the month of February 2017

7.5

7.0

7.27.1

7.0 7.0

7.7

7.3

7.5

7.2

7.5

6.76.6

6

6.2

6.4

6.6

6.8

7

7.2

7.4

7.6

7.8CHPPD Trust Total

CHPPD Total Planned

6

Safer Nursing care Tool (SNCT)

In accordance with the NQB / Hard Truths guidance the Trust undertakes a review of nurse staffingestablishments, using appropriate tools at least twice per annum. The latest Safer Nursing Care Tool(adult in-patient) review was conducted throughout January 2017 and the results were presented to agroup of professionals comprising corporate nursing, divisional nursing, HR and finance colleagueson 28 March 2017. Each Ward Sister / Matron participated in the review of the staffingestablishments in their own area.

In summary a small number of areas would appear (based on the use of the SNCT) to be over-established and some appear to be under-established. In a number of areas such as the heart careunit and acute care unit, together comprising the cardiology unit the SNCT does not adequatelycapture acuity and dependency and as such professional judgement is essential. Potentiallyefficiencies within the establishment could be achieved if the HCU and ACU were co-located.

The planned orthopaedic unit and the emergency orthopaedic unit are both over established onSNCT analysis. The Board should note that the results of the January 2017 deployment have notbeen considered in isolation; averages over three deployments of SNCT in January 2016, June 2016and January 2017 have been considered.

The orthopaedic unit is part of the modern facilities and has a high percentage of single roomscubicles which do demand higher staffing numbers for the purposes of observation made easier inmore open wards. It is recommended that benchmarking information would be available from otherTrusts and as such this will be requested by the Assistant Chief Nurse for the Surgical Division aheadof the next SNCT deployment. In the interim the Matron and Ward Sisters have been charged withhaving zero tolerance on the use of bank and agency staff based on establishment.

The Surgical Unit would also appear to be over-established however it is noted that consultation isimminent with the Women’s Health Unit part of which may be co-located with the surgical unit andtherefore the outputs from the SNCT will be considered when finalising the establishment at the endof consultation.

In relation to the medical wards and especially wards 40, 41, and 42 these are not established tomeet a 1:8 ratio on days and some, together with wards 44 and 45 only achieve a 1:12 ratio onnights. Options for these wards need to be explored informed by the pilot on ward 40 and the factthat they are co-located. The simple solution of recommending an increase in RN establishment isnot an adequate proposal given the level of vacancies and the temporary staffing fill rates. Solutionsneed to be identified and shared with the Board no later than June 2017.

Finally in relation to the SNCT the review on 28 March identified that there has never been anyvalidation built into the data collection and therefore this will be developed before the nextdeployment in June 2017. Validation would usually involve someone external to the ward reviewingthe assessed dependencies of groups of patients. Going forward the Trust may chose to deployother Health-roster modules including Safecare which would involve data collection every shift, everyday benefiting not only twice per annum staffing establishment reviews but more importantly shiftdeployment and understanding of acuity and dependency.

Safe Midwifery Staffing

A detailed update on the midwifery staffing establishment was presented to Board in March 2017along with a description of the framework being proposed as a replacement for the statutorysupervision of midwives.

On 07 April 2017 guidance of the A-EQUIP model of clinical midwifery supervision was published andthis is now available of the NHS England website. The guidance describes transition from thestatutory model of midwifery supervision to an employer led model of supervision. Until such time as

7

the Professional Midwifery Advocates (PMA) are prepared through a programme of education, theTrust as a provider of maternity services is required to deliver the non-statutory elements of thesupervisor of midwives role through effective management and governance arrangements. Thosearrangements are being led by the Head of Midwifery working with 11 of the previous (12)supervisors of midwives.

Unlike statutory supervision which required providers to meet a 1:15 ratio of supervisors to midwivesthe PMA model can be flexible based on tasks, standards and the responsibilities of the PMA inorganisations. The published guidance includes the competencies of the PMA and some roledescriptors / profiles. Unlike the previous arrangements, the Head of Midwifery is now responsiblefor the selection of the PMAs.

Now that the guidance has been published the Head of Midwifery, Deputy Chief Nurse, DivisionalDirector for Surgery and Women’s Health, the Clinical Director for Women’s Health and the InterimChief Nurse will meet to recommend a model of clinical midwifery supervision with a view to thatbeing presented to the Board by the Head of Midwifery in June 2017.

Finally for this section of the report the Board is advised that following the dissolution of the LocalSupervising Authority (LSA) NHS England has now appointed a new maternity leadership team.That team will be led by Mr Neil Tomlin and the Trust is in contact to arrange to meet him and histeam.

Community Nursing

The Board has previously been advised of the concerns of the community nursing team regardingcaseloads both in terms of the number of patients on caseloads and the complexity of thosecaseloads.

Regular meetings with the community nursing team leaders are taking place and a communitynursing (adults) action plan is now in place. An important component of that action plan is the caseload review which has commenced together with a specialist review of the community nursing needsof all patients with a diagnosis of diabetes.

Furthermore all patients requiring a continence assessment are now being assessed by thecontinence team rather than the community nursing team and the post of District Nurse Liaison isbeing appointed to.

In March 2017 NHS Improvement released draft guidance on safe staffing management incommunity nursing settings. The guidance includes a literature review of the evidence to inform thesetting of safe community nursing caseloads. Given the complexity and multifaceted nature ofcommunity nursing the literature review concludes that the notion of understanding safety incommunity nursing caseloads is still far from reach. As such a number of operational and strategicprinciples are proposed including the standardisation of data collection, avoidance of duplication,enriching learning and development environments, developing patient reported out-come measuresand using ‘canary markers’ to provide an early warning system, such as missed breaks.

The guidance advocates the use of professional judgement in setting community nursing staffinglevels. Currently all posts within the community nursing establishment are filled albeit there arestaffing gaps due to sickness and other forms of absence. In recent weeks a small internal staffingbank has been established and it is planned for this to grow in the coming months.

The new Assistant Chief Nurse – Medicine has a community nursing background and thereforetogether with the Community Nursing Clinical Pathway Lead the current action plan will be reviewedto timetable a review of the staffing establishment informed by the published guidance. Updates willbe included in future Board reports.

Children and Young People

8

A ‘must do’ action in the Care Quality Commission (CQC) report is to “ensure that there is one nurseon duty on the children’s ward trained and up to date in Advanced Paediatric Life Support (APLS) oneach shift”.

Training of band 6 nurses was completed on 12 April enabling this action to be met. Having devisedmechanisms to capture this on e-roster the Assistant Chief Nurse for Surgery and Women’s andChildren’s Services will be accountable for ensuring that the requirement is met when signing off therosters.

Red Flags

There were a total of 69 incidents with 163 Red Flags recorded via the incident reporting system withregards to Nurse Staffing for March 2017 – this is due to the fact that multiple red flags can bereported on one incident3. The number of red flags recorded can be broken down as follows:-

DepartmentMissedbreaks

A shortfall of morethan 8 hours or25% of RegisteredNurse timeavailablecompared with theactual requirementfor the shift

Intentionalrounding

Delay of 30minutes inprovidingpain relief

Patientvital signsnotassessedorrecordedas outlinedin the careplan

Unplannedomissioninprovidingmedication

Less than2registerednursespresenton a wardduringany shift Total

Ward 31 14 9 8 10 5 2 48

Ward 42 5 6 2 5 4 1 23

IAU 5 3 2 4 2 1 17

DepartmentMissedbreaks

A shortfall of morethan 8 hours or

Intentionalrounding

Delay of 30minutes in

Patientvital signs

Unplannedomission

Less than2 Total

3A three fold increase on February 2017, as predicted.

9

25% of RegisteredNurse timeavailablecompared with theactual requirementfor the shift

providingpain relief

notassessedorrecordedas outlinedin the careplan

inprovidingmedication

registerednursespresenton a wardduringany shift

A&E -Childrens

1 1

ACU 4 3 2 9

DewsnapLane Clinic

1 1 2

Hyde Clinic 1 1 2

MossleyClinic

7 7 1 15

Surgical Unit 1 1 2

Ward 41 16 12 11 2 41

Ward 44 1 1

Total 55 45 25 21 11 6 0 163

The Board should note that there were no shifts with less than two registered nurses on duty duringany shift. This is because the Interim Chief Nurse and the senior nursing team consider any suchevent to be an ‘internal never event’ and as such must be prevented. There were a small number ofoccasions when the potential for only having one registered nurse on duty existed and in order toprevent this redeployment was managed.

Strategies to Address Shortfalls in Nurse & Midwifery Staffing Levels

The Trust has a range of strategies which include recruitment, workforce redesign through thecreation of new roles, retention and flexible staffing solutions. This section of the report provides anupdate on some of those strategies.

Recruitment & Retention

During the month of March 6 Registered Nurses left the organisation; a total of 5.42 wte, and 11Registered Nurses (10.29 wte) commenced employment with the Trust. However at any one timethe Trust continues to experience a minimum of 100 RN vacancies.

At the beginning of April the Executive Management Team (EMT) considered the proposal to investin international recruitment and this has now progressed to the next stage of consideration.

Meetings between colleagues in HR, Communications and the Interim Chief Nurse have taken placeto look at redesigning our advertising and reach campaigns and the next recruitment open day willtake place on a Saturday in June.

Temporary Staffing

The Trust works with NHS Professionals to provide a temporary staffing solution. In March 2017 theoverall temporary staffing fill rate was 78.7%, up slightly on the fill rate in February 2017 and onregional comparative fill rates despite an 11.5% increase in demand. The top booking reasonsremain vacancy, sickness, escalation and 1-1 specialling.

10

Of note whilst the new HMRC rules (IR35) have temporarily impacted on the shift uptake of someprofessional groups the Trust’s Advanced Nurse Practitioners, Advanced Paediatric NursePractitioners and Emergency Nurse Practitioners have stepped up to strengthen rotas.

Trainee Nurse Associates

The Trust is part of the Nurse Associate pilot and had 20 Trainee Nurse Associates in post. The pilotis receiving very positive feedback to date however the number of trainees has now decreased to 18due to the personal circumstances of 2 of the candidates. This will create a deficit in funds receivedfrom Health Education North West impacting on the financing of the Clinical Educator role. Non-recurrently that will be avoided in year from underspends in the corporate nursing budget due tonatural time-lags in recruitment of new personnel. In year a solution to the £1750 cost pressure for2018/19 will be identified.

Preceptorship

The Trust continues to place importance of the preceptorship period of newly registeredprofessionals. Twenty one preceptees joined the Trust on 03 April, 15 of whom are adult nurses.

In March several members of the team led by the Preceptorship Lead attended the Ashton SixthForm College to raise the profile of the Trust as an employer and to discuss career options.Discussions between the corporate nursing team and HR colleagues are taking place to understandif there are opportunities to work with other education establishments more frequently and what thereturn on that resource (time) investment might be.

Summary

Ensuring the correct numbers of suitably skilled Nurses, Midwives and Healthcare Support Workersare in post is essential for the delivery of safe and effective patient centred care.

As described in this report there are a number of daily challenges not least due to vacancies andtemporary staffing fill rates affecting the ability to have adequate numbers of suitably skilled nurses,midwives and HCSW on duty each day.

The Safer Nursing Care data indicates that there are a number of wards under-established and someover-established and this data has been reviewed, for the first time jointly with nursing, HR andfinance. It is clear that alternative models of safe staffing need to be quickly reviewed, informed by

11

the pilot on ward 40 for both the short and longer-term at the same time as exploring internationalrecruitment to RN vacancies.

Recommendations

The Trust Board is asked to note the details of this report and the actions being taken.

12

Inpatient Ward Compliments Complaints

Moderate

Harm +

Incidents

Falls

with

Harm

MRSA C.Diff

PU

(+G2

only)

FFT

Positive

(%)

Registered

Staff

Fill Rate -

Days

% of

Temp

Staff

Used

Registered

Staff

Fill Rate -

Nights

% of

Temp

Staff

Used

Unregistered

Staff

Fill Rate -

Days

% of

Temp

Staff

Used

Unregistered

Staff

Fill Rate -

Nights

% of

Temp

Staff

Used

Planned

Registered

CHPPD

Actual

Registered

CHPPD

Planned

Unregistered

CHPPD

Actual

Unregistered

CHPPD

Actual

CHPPD

TOTAL

Planned Orthopaedic Unit 32 2 0 0 0 0 0 100.0% 95.4% 1.35% 98.6% 21.55% 106.1% 22.99% 154.6% 61.83% 3.45 4.2 2.93 4.3 8.5

Surgical Unit 85 0 1 0 0 1 0 96.5% 94.3% 19.13% 99.2% 25.07% 89.3% 26.33% 109.0% 46.79% 3.12 4.40 2.92 4.30 8.70

Emergency Orthopaedic Unit 18 1 2 0 0 0 4 98.0% 92.3% 3.50% 97.8% 40.75% 116.0% 20.68% 143.1% 37.41% 3.31 3.50 3.00 3.70 7.10

Critical Care 0 1 0 0 0 0 1 100.0% 99.3% 11.28% 90.8% 34.41% 103.2% 13.15% N/A N/A 25.0 33.70 1.33 2.00 35.6

AMU 0 5 0 0 0 0 1 94.4% 100.8% 16.40% 98.0% 44.81% 94.9% 14.11% 97.6% 22.83% 3.85 4.30 4.27 4.60 9.00

Acute Cardiology Unit 15 0 0 0 0 0 1 96.2%

Heart Care Unit 18 1 2 2 0 0 0 100.0%

Ward 31 0 0 3 2 0 1 0 100.0% 84.3% 35.72% 90.7% 76.43% 101.1% 57.86% 100.1% 59.98% 2.40 2.40 3.60 3.60 6.10

Ward 40 40 1 1 0 0 0 0 95.8% 79.9% 6.07% 99.6% 52.07% 81.3% 23.45% 118.5% 34.74% 2.40 2.40 2.79 2.90 5.30

Ward 41 32 0 1 0 0 1 1 0.0% 84.4% 13.81% 97.8% 74.84% 98.4% 12.11% 100.6% 18.31% 2.47 2.40 3.00 3.00 5.40

Ward 42 11 1 2 0 0 1 0 82.4% 72.8% 0.00% 99.3% 45.57% 110.0% 11.33% 114.8% 34.27% 2.80 2.60 3.14 3.20 5.80

Ward 44 7 0 0 0 0 0 2 91.7% 73.7% 25.50% 100.0% 45.21% 146.1% 20.72% 132.2% 48.45% 2.59 2.30 3.31 4.60 6.90

Ward 45 6 1 1 0 0 0 1 100.0% 76.7% 26.29% 98.3% 44.43% 103.1% 22.36% 100.8% 17.70% 2.50 2.40 4.25 4.40 6.80

Ward 46 32 0 0 0 0 0 0 100.0% 73.4% 20.92% 82.4% 38.84% 109.5% 16.93% 182.4% 31.06% 2.81 2.40 2.50 3.50 5.90

Ward 27 (Maternity) 20 1 0 0 0 0 0 91.8% 84.2% 25.41% 91.3% 7.17% 84.8% 9.94% 112.9% 11.79% 2.57 3.60 1.65 2.00 5.60

NICU 52 0 0 0 0 0 0 100.0% 95.6% 12.38% 99.2% 14.87% 100.0% N/A N/A N/A 7.38 14.60 0.66 1.20 15.80

Children's Unit 40 1 0 0 0 0 0 99.0% 95.0% 17.67% 95.7% 12.29% 69.8% 25.41% N/A 11.11% 3.93 8.10 0.99 2.10 10.20

Stamford Unit 1 9 0 1 0 0 0 2 95.4% 10.94% 99.9% 63.28% 91.3% 21.54% 102.3% 62.18% 1.50 2.20 3.75 4.90 7.20

Stamford Unit 2 7 1 2 0 0 0 2 100.6% 5.42% 103.3% 45.22% 94.7% 30.24% 103.9% 40.84% 1.50 2.30 3.75 5.00 7.30

Shire Hill 0 1 0 0 0 0 0 90.0% 100.2% 27.06% 99.7% 22.35% 90.5% 20.25% 91.8% 51.94% 2.33 2.90 3.33 3.50 6.30

Inpatient Totals/Averages 424 17 16 4 0 4 15 98.2% 89.9% N/A 97.7% N/A 99.0% N/A 112.7% N/A 3.5 3.8 3.01 3.7 7.5

100.0%

Heat map - Inpatient Ward Areas - March 2017

84.7% 25.16% 110.5% 46.28% 121.8% 25.78% 102.4% 51.07% 4.65 4.20 2.91 3.10 7.30

KEY

Complaints Moderate Harm + Falls with Harm MRSA CDIFF PU(+G2) Staffing Fill Rates0 - Green 0 - Green 0 - Green 0 - Green 0 - Green 0 - Green > 90% - Green

>1- Amber >1 - Amber >1 - Amber >1 - Red >1- Amber >1 - Amber 80 - 90% - Amber>2 - Red >2 - Red > 2 - Red >2 - Red >2 - Red < 80% - Red

NB: Please note that Inpt FFT Total shown does not include Community areas.

Appendix 1


Report to Public Trust Board meeting of the 27th April 2017Agenda Item 7c

Title Director of Finance Report - Month 12, March 2017)

Sponsoring Executive Director Claire Yarwood, Director of Finance

Author (s) Finance Team

Purpose Discussion and Endorsement

Previously considered by This paper has been reviewed by the Finance andPerformance Committee

Executive Summary:The financial position for the full year as at March 2017 is a £14.5m deficit which is £2.8mbetter than plan. Cash balances are slightly above plan.

Related Trust Objectives6 – To deliver against the required local and nationalregulatory frameworks as part of the GreaterManchester Health and Social Care Devolution,securing the best economy efficiency andeffectiveness in use of resources the Trust spends todeliver services both directly and through partnerorganisations.

Risk Assurance – risk impactedupon

723 – Failure to meet, deliver the Trust’s financialplan


In breach of licence

Financial ImplicationsNone

Has a quality impact assessmentbeen undertaken?

None


Sustainability is subject to the outcome of the systemwide review by the CPT


The Board are asked to discuss the contents of the report, recognise the risk and endorsethe actions required.

Executive Summary

1

Summary of Performance• For the financial period to the 31st March 2017, the Trust is reporting a normalised deficit of £13.3m which is £3.98m better than plan. The position is driven by

the Trust receiving additional Sustainability and Transformation Funding from NHSI, and strong financial control measures implemented throughout the year.• For the full year, the Trust has spent £12.7m on agency staffing, broadly in line with the NHS Improvement ceiling of £12.5m. The Trust has been reliant on

agency usage to support winter pressures, and to cover medical vacancies in several areas where recruitment has been challenging.

Key Risks for 2017/18:• The Trust has still not agreed as control total with NHSI. Failure to do so could

result in additional financial implications not yet included in the 2017/18financial plan.

• As the Trust is planning for a deficit, there is a requirement for a DH loan tofund it. The Trust will be subject to a higher interest rate for borrowing if acontrol total is not agreed.

• At the end of 2016/17, the Trust has loan liability of £54.8m. It is anticipatedthat this will increase to £78.1m in 2017/18. The Trust could be required torepay part of this liability in 2018.

Key I&E issues:• Agency expenditure for the year end forecast is £12.7m so is broadly in

line with the NHSI ceiling of £12.5m. A lot of hard work has beenundertaken to strengthen control of agency usage within the Trust.

• The Trust Efficiency Savings target has been exceeded by £610k. This isan excellent achievement, although continued work is required in2017/18 to increase the value of recurrent savings.

Key Balance Sheet issues:• Cash is c.£1.9m greater than planned. This is due to NHSI releasing STF

earlier than planned.• Better Payment Practice Code is currently below the target of 95%

across all metrics, because the DH will only lend the Trust funding tomeet the deficit plan, not improve the Trust creditor position.

• The annual capital plan of £3m has been delivered in full.

Plan

(£'000)

Actual

(£'000)

Variance

(£'000)

Plan

(£'000)

Actual

(£'000)

Variance

(£'000)

Plan

(£'000)

EBITDA (273) 2,107 2,384 (7,912) (4,811) 3,101 (7,922)

Normalised Surplus/(Deficit) (1,056) 1,364 2,420 (17,300) (13,320) 3,980 (17,300)

Net Deficit after Exceptional Costs (1,056) 844 1,900 (17,300) (13,993) 3,307 (17,300)

Trust Efficiency Savings 764 721 (43) 7,832 8,442 610 7,808

Use of Resources Metric 3 3 3 3 3

Financial Overview - Dashboard

2

Plan

(£'000)

Actual

(£'000)

Variance

(£'000)

Plan

(£'000)

Actual

(£'000)

Variance

(£'000)

Income 17,227 22,384 5,157 202,453 212,355 9,902

Expenditure - Pay 12,277 12,212 65 147,603 148,501 (898)

Expenditure- Non Pay 5,223 8,065 (2,841) 62,762 68,665 (5,903)

EBITDA (273) 2,107 2,380 (7,912) (4,811) 3,101

Financing 782 743 40 9,388 8,509 879

Normalised Surplus/(Deficit) (1,056) 1,364 2,420 (17,300) (13,320) 3,980

Exceptional Costs 0 520 (520) 0 673 (673)

Net Surplus/(Deficit) (1,056) 844 1,900 (17,300) (13,993) 3,307

Deficit (% of Turnover) -6.1% 3.8% -8.5% -6.6%

Trust Efficiency Savings 764 721 (43) 7,832 8,442 610

Capital Expenditure 165 815 650 3,016 2,937 (79)

Cash and Equivalents 1,000 2,945 1,945

Use of Resources Metric 3 3 3 3

Analysis of Income

Elective 2,352 1,914 (438) 24,636 23,398 (1,238)

Non Elective 4,207 4,797 591 51,037 52,816 1,779

Outpatients 2,447 2,310 (137) 27,788 27,398 (390)

Other Clinical Income 7,273 10,465 3,192 87,525 91,369 3,844

Total Clinical Income 16,279 19,486 3,208 190,985 194,981 3,995

Non Clinical Income 948 2,897 1,949 11,467 17,374 5,907

Total Income 17,226 22,384 5,157 202,452 212,355 9,902

Month 12 Full Year

Breakdown of Deficit Improvement

3

£m Notes

Planned 2016/17 Deficit (17.3)

Balance Review (1) Sept 2016 0.4Once indications suggested the Trust would not deliver

the Q3 and Q4 A&E trajectory, mitigations were sought.

Matched STF for Balance Sheet Review (1) 0.4 NHSI 'incentive' for improving the financial position.

Balance Sheet Review (2) January 2017 0.5

Matched STF for Balance Sheet Review (2) 0.5 NHSI 'incentive' for improving the financial position.

GM H&SC Partnership Transformation IM&T Review 0.5 Funding to offset previously incurred expenditure

Matched STF for Transformation Funding 0.5 NHSI 'incentive' for improving the financial position.

Bonus STF 1.0NHSI additional payment for delivering a financial

position better than planned.

Revised Year End Deficit (13.4)

‘Valuing Care’ – Productivity and Efficiency Programme

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

£

Year to Date Performance

Plan

Actual

Recurrent

Key Messages

The 2017/18 savings target has been exceeded by £653k. Thisattributable to the hard work from the operational and financeteams in identifying and delivering savings.• Surgery and W&C: The division broadly delivered the target

for the year.• Corporate: The division overachieved the annual target due

to non recurrent benefits. The division is working towardsidentifying recurrent savings for 2017/18.

• Medicine and CSS; The division exceeded the annual target by£188k. However, the majority of savings are non recurrent,and so work is ongoing to identify recurrent savings.

• Community Services: The savings target for 2016/17 has beenachieved non recurrently.

• Invest to Save – £70k was invested in a creating a new postfor a medical staffing specialist within HR. This post hasachieved the following;

Supported an increase in Direct Engagement from 70%to over 90% resulting in a saving of over £150k.

Supported the procurement of Brookson – predictedannual saving of £200k although this could be offsetby increased costs relating the implications of IR35

Is an integral part of the 2017/18 Medical Staffing TEPand is the lead for the majority of schemes.

Actions for 2017/18:• Development and implementation of 2017/18 schemes.• Working with the local health economy to develop system

wide efficiency schemes.

4

Annual

Plan

(£'000)

Plan

(£'000)

Actual

(£'000)

Variance

(£'000)

Plan

(£'000)

Actual

(£'000)

Variance

(£'000)

Surgery and W&C 2,266 244 268 23 2,266 2,265 (1)

Corporate 2,114 180 198 18 2,114 2,580 465

Medicine and CSS 2,928 299 255 (44) 2,951 3,096 145

Community Services 500 42 0 (41) 500 501 1

Grand Total 7,808 764 721 (43) 7,832 8,442 610

Month 12 Year to Date

Financial Performance to Month Twelve (March 2017)

Pay: is slightly worse than plan for the full year (£898k, 0.6%). Underspends in the Community , Corporate and Surgery and Women and Children’s divisions relating tovacancies are offset by overspends in Medicine and CSS staffing for escalation beds and the premium cost of temporary staff to cover vacancies. In addition,expenditure category changes in reserves are offset by corresponding underspends in non pay.

Drugs: expenditure is overspent by £154k for the full year. Benefits relating to unrequired prior year anticipated expenditure is offset by activity related overspendsacross several areas. £347k of this is offset by income for PbR excluded drugs.

Clinical Supplies: are overspent by £4.7m cumulatively to year end. This predominantly relates to expenditure plan category movements in reserves, which are offsetby underspends on other types of expenditure, and overspends on medical and clinical equipment across all operational divisions.

General Supplies: are overspent by £1.1m for the year to date. Expenditure plan category movements in reserves are offsetting overspends in the commercial sector(156 T&O cases, 30 General Surgery cases and 24 ENT cases- totalling £785k) and radiology private sector expenditure.

Clinical Income: is cumulatively above plan by £3.9m, this includes an additional £2.4m of Sustainability and Transformation funding.

Other Income: is better than plan by £6m, relating to recharges for staff and equipment funded by other organisations. This is predominantly offset by expenditure.

5

-30,000

-25,000

-20,000

-15,000

-10,000

-5,000

0

£'0

00

Cumulative Financial Position

Cumulative Plan

Cumulative Actual

Pay Analysis – Bank and Agency

Key MessagesSpend on bank and agency staff for the year to March 2017 is £19.5m which is c.£3.7m higher than in 2015/16. The Trust is now commissioned toprovide Community Services for Tameside and Glossop, so bank and agency expenditure associated with this service in included in the 2016/17figure.• Bank usage has increased in comparison to the trend at the beginning of the year– this is to support winter pressures. However, agency

expenditure has been steadily decreasing since September 2016.

6

0

200

400

600

800

1,000

1,200

1,400

£'0

00

Tameside Rolling 12 Months Bank and AgencyExpenditure

Agency

Bank

Agency w/o credit

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

1,000,000

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

2014-2015 2015-16 2016-17

Exp

en

dit

ure

£

Trust Agency Usage April 2014 to March 2017

Medical

Nursing

Other

Trust Total Agency Spend• The Trust has been assigned a year end ceiling of £12.5m total agency spend for 2016/17. Planned agency expenditure has been profiled based on

the average of monthly expenditure over the last two years.• The Trust spent £12.7m on agency for the full year, which is broadly on line with the NHSI ceiling.• Overall, the pay budget is slightly above plan, however some of the overspend is offset by income to fund various staff posts. The Trust is also

paying significantly for premium staffing costs due to the difficulties in recruiting certain staff groups.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total

Plan (£'000) 994 908 1,043 1,065 1,106 1,033 1,038 1,123 983 1,053 1,054 1,102 12,499

Medical Actual (£'000) 699 584 509 236 584 753 726 667 472 556 408 514 6,708

Nursing Actual (£'000) 238 229 271 284 364 300 218 223 287 250 259 347 3,268

Other Actual (£'000) 178 259 211 339 201 253 261 185 237 162 182 248 2,716

Total Actual (£'000) 1,115 1,073 991 859 1,148 1,306 1,205 1,075 995 968 848 1,109 12,692

Variance (£'000) (121) (165) 52 206 (43) (273) (167) 48 (12) 85 205 (7) (192)

NHS Improvement Agency Cap

Key Messages

• On the 1st April 2016, the NHS Improvement capped rates were reduced.• The Trust has to report to NHSI on a weekly basis how many agency shifts are being used which exceed the capped rates.• The latest return is shown below;

7

Actions

• A&E and General Medicine middle grade rotas have been redesigned to reduce the reliance on agency staffing. Substantive recruitmentis now in progress, and some posts have been filled.

• Information by specific staff breaching the cap rate is being shared with the Executive Management Team on a weekly basis.• A summary report is presented at the monthly Finance and Performance Committee for review.• A review of medical staff recruitment and the impact on service delivery is ongoing.

Staff Group

Number of Shifts Exceeding the

Price Cap Week Ending 26/03/17

Nursing, Midwifery & Health Visitors 76

Scientific, Therapeutic and Technical 40.1

Medical & Dental 181

Administrative & Estates 0

Total 297

Clinical Income - Contract Analysis

Key Messages:

• Overall, clinical income is above plan by £3.9m. The Trust has a sophisticated block contract with Tameside and Glossop CCG has agreed ayear end settlement.

• The value of over-performance blocked back to contract plan for Tameside and Glossop CCG year to date is £324k. Areas of over-performance in ambulatory care, non elective discharges and excess beddays are offset by underperformances in A&E, electivedischarges and outpatients.

• Tameside MBC has provided funding to support costs incurred relating to delayed transfers of care. This funding offsets expenditureoccurred by the use of spot beds.

• ‘All Other Commissioners’ includes the Sustainability and Transformation funding (STF), of which the Trust is receiving £9.4m.

8

Commissioner Plan (£m) Actual (£m) Variance (£m)

Annual Plan

(£m)

15/16 Outturn

(£m)

Tameside and Glossop CCG 154.7 154.3 (0.3) 154.7 128.4

Oldham CCG 6.3 6.4 0.0 6.3 7.1

Manchester CCG's (All) 6.0 5.9 (0.1) 6.0 5.7

Stockport CCG 1.3 1.2 (0.0) 1.3 1.2

NHS England Specialised Services 5.6 6.3 0.7 5.6 5.1

Secondary Dental - NHS Area Team 1.7 1.6 (0.1) 1.7 1.6

Tameside MBC 5.7 7.2 1.5 5.7 0.0

All Other Commissioners 9.8 12.1 2.3 9.8 2.1

Grand Total 191.0 195.0 4.00 191.0 151.1

Year to Date

Income and Activity - Year to Date

Key Messages:

• Critical Care is under plan by £1m. Adult critical care is worse than plan by(£613k, 321 bed days) and neonatal critical care is worse than plan by(£396k, 639 bed days).

• Elective income is worse than plan by £841k, (494 procedures below plan).Under performances in Cardiology (£176k), General Surgery (£164k),Orthopaedics (£197k) and Gynaecology (£100k) are offset by small overperformances in Breast Surgery, ENT and Paediatrics.

• Day-Case income is worse than plan by £397k (25 procedures below plan).Over performance in General Surgery (£204k, 602 procedures above plan) isoffset by underperformances in Colorectal Surgery (£133k), GeneralMedicine (£166k), Pain Management (£114k) and Plastic Surgery (£90k).

• Non-Elective income is better than plan by £1.7m. Over performance inObstetrics (£334k), Paediatrics (£377k) and Medicine (£654k) is offset byunder performance in General Surgery (£396k) and Trauma andOrthopaedics (£61k). Excess bed-days are above plan by £882k.

• Outpatient income is under performing by £389k, equating to 6,000attendances. Over performances within Cardiology, Dermatology andGynaecology are offset with underperformances in Anti Coagulant, PainManagement, Orthopaedics and Urology.

• Drugs and device income is cumulatively above plan by £347k. This is offsetby corresponding overspends in expenditure.

• Other income additional STF funding of £9.3m and £1.5m additional fundingfrom commissioners in relation to A&E and RTT pressures.

9

-2,000

-1,000

0

1,000

2,000

3,000

4,000

5,000

6,000

£'0

00

Clinical Income Variance by Point ofDelivery

-7,000

-6,000

-5,000

-4,000

-3,000

-2,000

-1,000

0

1,000

2,000

3,000

A&E Critical Care Elective Daycase Non Elective Out-Patients

Act

ivit

y

Activity Variance by Point of Delivery

Pay Analysis

Key Messages:

• Pay expenditure is £898k worse than plan for the year todate. This is largely driven by expenditure categorychanges in reserves. *

• Community Services pay expenditure is underspent by£175k. This underspend has slowed down since thebeginning of the year as teams have worked hard torecruit into vacancies.

• Corporate is underspent by £1.5m relating to vacanciesacross all Directorates The Corporate team have reviewedall budgets to ensure they accurately reflect serviceprovision, and this will be reflected in the 2017/18budgets.

• Surgery and W&C is underspent by £566k. This is due tovacancies relating to several specialties.

• Medicine and CSS is overspent by £914k. This largelyrelates to premium cost temporary staff to cover medicalvacancies, as well as expenditure to staff unfundedescalation beds and additional staffing to support the CQCinspection.

10

-1,000

0

1,000

2,000

3,000

4,000

5,000

6,000

Surgery andW&C

Corporate Medicineand CSS

CommunityServices

£'0

00

In Month Divisional Pay Analysis

Bank

Agency

Payroll

Budget

4,000

9,000

14,000

£'0

00

Tameside Rolling 12 Months Pay Expenditure

Budget

Bank

Agency

Payroll

* As per NHSI, once a budget is set by expenditure type for thefinancial plan, it cannot be changed. For example, whenbusiness cases are finalised in year it may be decided that abudget set for the commercial sector (non pay expenditure) atthe beginning of the year would now be required for payexpenditure to perform the work in house. This category changewould be transacted through reserves so the division has theappropriate budget in the correct expenditure category.

Divisional Performance (EBITDA) – Month Twelve (March 2017)

Key Messages• Surgery and W&C: Contribution is £351k worse than plan for the full year. This is driven by underperformance in clinical income, unfunded

expenditure within the independent sector due to a shortfall in internal capacity and overspends on clinical prosthesis.• Corporate: Full year contribution is £735k better than plan. This is largely driven by under-spends on pay expenditure relating to vacancies is offset

by over-spends on non pay relating to efficiency savings targets.• Medicine and CSS: Contribution is £1m worse than the full year. Minor over-performance on income is offset by overspends on pay relating to the

premium costs covering vacancies, and activity related overspends on non pay.• Community Services: Contribution is £76k better than plan for the full year which is due vacancies throughout the division. A significant number of

these have no been recruited to, so the underspend has reduced in year. This is partially offset with the costs associated with running the StamfordUnit, an element of which are unfunded.

• EBITDA movement to Normalised Deficit position: The total Trust position is supported by a number of underperforming non operatingexpenditure budgets with an annual budget of £9.4m, which are not counted within the EBITDA. This is predominantly PDC payments (£581k betterthan plan), depreciation (£203k better than plan), exceptional costs (£561k worse than plan) and interest payable (£131k worse than plan).

11

Division

Plan

(£'000)

Actual

(£'000)

Variance

(£'000)

Plan

(£'000)

Actual

(£'000)

Variance

(£'000)

Surgery and W&C 1,529 1,569 40 15,588 15,236 (351)

Corporate (3,083) (2,993) 90 (36,811) (36,076) 735

Medicine and CSS 874 (298) (1,172) 8,053 7,047 (1,006)

Community Services (277) (360) (83) (1,767) (1,691) 76

Reserves 683 4,245 3,561 7,024 10,728 3,704

Trust EBITDA (274) 2,163 2,436 (7,913) (4,753) 3,154

Month 12 Year to Date

Cash Flow, Capital Expenditure and Debtor and Creditor Analysis

Key Messages:Cash: The March month end cash balance was £2.9m, above the £1m plan. This is due to the Trustreceiving STF earlier than indicated by NHSI. The overall level of cash is forecast to remain at circa£1m across the next 13 weeks. Peaks in cash balances during this period reflect cash timing ofreceipt of monthly contract payments from NHS commissioners and payment to suppliers.Capital: Cumulatively, £2.9m of capital expenditure has been incurred as planned. Investments in2016/17 included development of the Antenatal Clinic , upgrade of Critical Care and ITdevelopments.Debtors: The majority of the debt relates to NHS debt. This has been reduced significantly in March.Loans: The cash support to the Trust is funded from an Interim Revenue Support Loan (IRSL) of£13.2m. For the remainder of the loan required to fund the deficit, the Trust agreed anuncommitted revenue support loan with DH, up to the value of £6.6m. The uncommitted loan canbe withdrawn and full repayment requested at any time. The total distressed loan liability the Trusthas at year end is £54.8m.Creditors: The creditor balances are predominantly current balances which will be settled in linewith the Trust’s payment terms. This is currently at 60 days due to the low levels of cash theorganisation can maintain whilst operating in a deficit.Public Sector Payment Compliance (Target 95%):

0

100

200

300

400

500

600

700

800

900

Apr

-15

May

-15

Jun-

15

Jul-1

5

Aug

-15

Sep-

15

Oct

-15

Nov

-15

Dec

-15

Jan-

16

Feb-

16

Mar

-16

£'00

0

Capex Expenditure

Capex Budget

Capex Actual

0

5,000

10,000

15,000

20,000

25,000

£'00

013 Week Cash Flow from 13th March 2017

Forecast (£'000)

Target Minimum CashReserve

Category

Balance

(£'000)

0-30 Days

(£'000)

31-90 Days

(£'000)

Over 90 Days

(£'000)

Total Sales Ledger Debtors 5,900 4,187 885 828

Total Aged Creditors 5,510 3,984 422 1,104

Top Five Debtors £m

Tameside MBC Other 1,563 1,493 32 38

NHS Tameside and Glossop CCG NHS 957 828 129 0

NHS England North West (Manchester) NHS 638 501 0 137

NHS England North West (Commissioning Hub) NHS 561 95 466 0

Pennine Care NHS Foundation Trust NHS 297 296 0 1

Top Five Creditors £m

NHS Professionals LTD Other 994 977 17 0

Central Manchester University Hospitals NHS Foundation TrustNHS 869 523 0 346

NHS Tameside and Glossop CCG NHS 404 404 0 0

Tameside MBC Other 350 350 0 0

University Hospital of South Manchester NHS Fooundation TrustNHS 253 127 20 106

12

Total

NHS Value (£'000) 47,402 40,510 85.5% 6,892 14.5%

NHS Number 2,186 572 26.2% 1,614 73.8%

Non NHS Value (£'000) 116,632 77,797 66.7% 34,693 29.7%

Non NHS Number 41,282 18,384 44.5% 22,898 55.5%

30 Days Greater 30 Days

Statement of Financial Position (formerly Balance Sheet)as at 31st March 2017

13

31 Dec 2016

Actual £'000

31 Jan 2017

Actual £'000

28 Feb 2017

Actual £'000

31 Mar 2017

Actual £'000

Feb - Mar

Movement

£'000

Total Non Current Assets 118,234 118,201 118,388 125,415 7,027

Current Assets

Inventories - Stock - Finished Goods 1,619 1,426 1,743 1,430 (313)

Trade & Other Receivables:-

> NHS Trade Receivables 1,952 1,995 1,201 3,665 2,464

> Non NHS Trade Receivables 956 876 746 2,235 1,489

Provision for doubtful debt (559) (559) (545) (594) (49)

> PDC Dividend Receivable

> Other Receivables 871 1,133 685 317 (368)

> Accrued Income 4,348 4,128 5,573 5,844 271

> Prepayments - Non PFI Related 2,926 3,259 1,647 1,287 (360)

Cash 1,247 1,028 1,235 2,945 1,710

Investments

Total Current Assets 13,360 13,286 12,285 17,129 4,844

Current Liabilities

Trade & Other Payables:-

> NHS Trade Creditors (1,459) (1,599) (828) (1,899) (1,071)

> Non NHS Trade Creditors (2,932) (2,836) (2,229) (3,612) (1,382)

> Other Creditors (7,062) (7,199) (6,852) (6,992) (141)

> Capital Creditors (61) (210) (123) (704) (581)

Other Liabilities:-

> Accruals (14,462) (13,157) (12,060) (10,862) 1,198

> Deferred Income (2,619) (3,874) (3,323) (2,342) 981

>PFI Leases (1,282) (1,282) (1,282) (1,336) (54)

>PDC Dividend Creditor

Provisions (179) (174) (337) (149) 188

Total Current Liabilities (30,057) (30,332) (27,035) (27,897) (862)

Net Current Assets/Liabilities (16,697) (17,046) (14,750) (10,768) 3,983

Non Current Liabilities

Other Financial Liabilities:-

> Deferred Income 0

> PFI Leases (53,964) (53,855) (53,757) (53,594) 163

> Interim Revenue Support Loan - DOH (47,175) (48,150) (51,525) (54,801) (3,276)

Provisions (767) (766) (681) (694) (13)

Total Non Current Liabilities (101,906) (102,772) (105,963) (109,089) (3,126)

TOTAL ASSETS EMPLOYED (369) (1,617) (2,325) 5,559 7,884

Financed By Taxpayers Equity

PDC 53,285 53,285 53,285 53,285 0

Revaluation Reserve 29,298 29,298 29,298 35,287 5,989

I&E Reserve (33,588) (33,588) (33,588) (32,538) 1,050

I&E reserve 2014/15 (15,703) (15,703) (15,703) (15,703) 0

I&E reserve 2015/16 (20,779) (20,779) (20,779) (20,779) 0

TOTAL TAXPAYERS EQUITY (368) (1,616) (2,324) 5,559 7,883

of 29



Agenda Item 7d

Title Significant Risk Report

Sponsoring Executive Director Karen James Chief Executive

Author (s) John Fletcher, Acting Director of Quality andGovernance

PurposeFor discussion and agreement of futureactionsFor approvalTo note/receive

Previously considered by Risk Management Group, Service Quality andOperational Governance Group

Executive SummaryThe Significant Risk Report provides details on all identified significant risk exposurethrough the Risk Register and Board Assurance Framework across servicesprovided by the Trust.

Related Trust Objectives Impacts on all Trust Objectives

Risk Assurance – risk impacted upon Impacts on all BAF and Risk Registers


Referred to if necessary in the paper

Financial ImplicationsReferred to if necessary in the paper

Has a quality impact assessment beenundertaken? Referred to if necessary in the paper

How does this report affectSustainability? Reflects current risks to the Trust’s

business and strategic objectives

Action required by the GroupMembers are asked to discuss and consider the current position in relation tosignificant risks and the proposed changes to reporting and Trust Risk Strategy

of 29

April 2017 – Significant Risk and BAF Report

1.0 Summary Narrative of April Significant Risk and BAF Paper

This paper provides members with a report on the significant risk exposure through

the Risk Register and Board Assurance Framework across services provided by the

Trust. The recently revised format places more emphasis on the target risk score

and timescales for achieving the target score and focusses attention on the gap

between the current and target risk scores. A review of target risk scores is

progressing to ensure achievement of the target is realistic and possible.

Alongside the changes there will be focussed organisational development sessions

to support the review of the risks in the context of the changes and the revision of the

Risk Management Strategy Policy and Guidance.

The risks included in this report have been subject to review by the Quality and

Governance Unit following discussion with responsible Directors. The risks have

been consistently and systematically reviewed in light of the regulatory requirements

and mapped against the Trust’s Strategic plans and responses to regulatory

oversight which contain specific actions against identified risks. The Treatment Plans

for these risks have been reviewed by responsible Directors and leads to ensure

reflection of the assertive improvement work and current mitigations. Horizon

scanning for future risks to ensure foresight and insight is continually taking place

with systematic examination of information to identify potential threats, and

vulnerabilities, and detect opportunities and options to reduce existing risks. Where

applicable, necessary third party assurances are referred to.

1.1The Trust has identified a range of significant risks to its strategic objectives, which

are currently being mitigated, the impact of which could have a direct bearing on

compliance with NHS Improvement Provider Licence, CQC registration or the

achievement of corporate objectives, should the mitigation plans be ineffective.

Currently, the significant risks relate to the following areas:

Discharge processes and the management of the Urgent CarePathway across the whole health economy

Health economy capacity to manage patient flow and Urgent Careimpacting on Emergency Department pressures

Finance (Cost control, TEP delivery and liquidity) Information technology Medicines management Recruitment and Staffing Third party decisions /Transition to Integration Environmental monitoring Results Governance

of 29

The main controls and action plans for each significant risk have been reviewed and

collated in the Trust’s Risk Register. Our Risk management programme has

incorporated the Corporate Risks (CR) and aligned them to the Board Assurance

Framework (BAF). Updates against the BAF and Risk register significant risks are

summarised in the analysis table in Appendix 1 and detailed risk information

provided in Appendix 2.

1.2Detailed updates against the BAF significant risks are included in this report. The

Board have informed the principal risks described.

The report reflects the revision of the BAF to include consideration of the potential

impact of Greater Manchester Health and Social Care Devolution and external

reconfiguration and the iterative development of Models of Care between acute,

community, primary and social care providers. We continue to keep a line of sight on

these and emergent risks through the Care Together Programme.

The risks associated with Healthier Together implementation, Greater Manchester

Health and Social Care Partnerships and the Care Together programmes are

aligned through the Board as they emerge and are identified.

The Director of Operations is currently overseeing the development of the risk

assessments related to the five Neighbourhoods for inclusion in the risk register from

April 2017.

The BAF is being aligned to the 2017/18 Corporate Objectives and updated through

a schedule of reviews by the Executive Directors, prior to next Trust Board.

1.3 New Significant Risks

The following risks have been included within the report since the previous Trust

Board meeting

CR4302 Introduction of IR35 tax regulations on the 6th April 2017 may increase

existing issues relating to medical and nursing staff. The risk has emerged

following assessment of the impact of HMRC enforcement of Tax Law IR35 which

relates to medical and nursing staff who are employed via an agency and being paid

by a limited company which are now subject to normal PAYE and National

Insurance. This has impacted specifically on medical staffing rotas and the ability to

maintain medical staffing levels. The impact has the potential to impact on the

consistency of supervision to trainee doctors. This is currently scoring 16 with a

target score of 8.

CR 4212 Delay/inability to obtain microbiology results

This risk is concerned with the risk of inappropriately treating a significant infection

due to delay/inability to obtain microbiology results. The risk has arisen out of delays

in samples being transported to the Laboratories at Manchester, and delays in these

being processed for cultures/microscopy. These are contributing to delays in results

of 29

being received from the Manchester Laboratory. The risk has been presented at Risk

Management Group and is currently scoring 16 with a target score of 4 and a gap

score of 12. Mitigations are in place to reduce the clinical risk, but there is impact on

clinical time.

1.4 Reduction in Risk ScoresNone to report

1.5 Increased Risk ScoresNone to report

1.6 Other Notable Changes / Update

Following the last Risk Management Group meeting divisions are focussing on

revisiting the risk target scores and ensuring target scores are realistic and gap

scores are aligned with the organisations risk appetite. Divisions will be supported by

the Quality and Governance Unit in the new format and requirements.

There will be a schedule of reviews by the Executive Directors supported by the

Quality and Governance Unit to review the BAF in the context of the new corporate

objectives for 2017/18. There will also be emphasis on reviewing the target score,

gap score and risk appetite.

2.0 Recommendations

Members are requested to note current significant risks, current controls and

mitigations within the report.

of 29

Appendix 1 Summary of risks and analysis

Sub-Committee Key:

AC: Audit Committee SQOGG: Service Quality & Operational Governance GroupCoG: Council of Governors IPCG: Infection Prevention & Control GroupQGC: Quality & Governance Committee ISB: Internal Safeguarding Board

FPC: Finance & Performance Committee IMTG: IM&T GroupEMT: Executive Management Team IG: Information Governance Group

Risk Lead Key: BS: Board Secretary

CEO: Chief Executive DoHR: Director of Human Resources

MD: Medical Director DoE: Director of Estates

CN: Chief Nurse DoP: Director of Performance & Informatics

DoO: Director of Operations DoSP: Director of Strategy & Partnership

DoF: Director of Finance DoQG: Director of Quality & Governance

Risk MatrixConsequence

Likelihood Insignificant Minor Moderate Major Catastrophic

Rare 1 2 3 4 5

Low/Unlikely 2 4 6 8 10

Possible 3 6 9 12 15

High/Likely 4 8 12 16 20

Almost ccertain 5 10 15 20 25

Gap Score Matrix (Difference between Target Score andCurrent score)

Gap score ≤0 Risk target achieved

Gap score 1 - 5 Tolerable

Gap score 6 - 9 Close monitoring

Gap score 10 Concern

Gap score > 10 Serious

Direction of travel - Change since previous review

Escalated

De escalated

Unchanged

Target achieved

of 29

BAF Ref/ RiskRef

Description Analysis of RiskSubCommittee

ExecutiveLead

CurrentRiskScore

RiskTarget

RiskTargetGap

RiskAppetiteGuide

Risk AF

1.24

(3483)

If demands increase beyond predicted

levels and outside current capacity, and

the management of the urgent care

pathway across the Health Economy is

not undertaken in a cohesive and

standardised way, this could result in

delay, increased clinical risk and a

reduced positive patient experience.

The risk score remains in excess of the target score and

continues to be closely monitored, The achievement of

the target score is dependent on the transformation of

services and pathways across the Health Economy. The

Trust continues to engage with other service providers

and to progress models of care to improve capacity and

patient flow.

QGC DoO

DoSP

20 10 10 Moderate

AF 1.23

(3482)

Medical Staffing - The ability to recruit

to Consultant and Middle Grade posts

due to national shortages in certain

specialties i.e. Radiology, Medicine and

A&E. This may impact on patient

experience and the ability to provide

safe care

This risk remains at 20 and continues to be challenging.

The risk is influenced by the national picture and

availability of workforce. There still remains a significant

operational risk profile against the BAF risk as the

organisation continues to meet challenges in relation to

medical staffing particularly speciality medical staff.

International recruitment and alternative staffing models

are being reviewed in difficult to recruit specialities.

SQOGG DoHR

MD

20 10 10 Moderate

AF 1.23

(734)

Nursing Staff The ability to

consistently sustain and maintain safe

nurse staffing levels is compromised as

a result of operational demand, use of

escalation and additional capacity beds

third party decisions and actions and

continuous readmission challenges

This risk remains at 20 and continues to be challenging.

The risk is influenced by the national picture and

availability of workforce. The Trust has been actively

addressing staffing and has been utilizing a number of

strategies to maintain consistent staffing levels, which

include recruitment fast track events, skilling up of staff,

and the recognition and certification of Health Care

Workers. There still remains a significant operational

risk profile against this BAF risk as the organisation

continues to meet challenges around staffing

particularly for registered nurses.

International recruitment and alternative staffing models

are being reviewed in difficult to recruit specialities.

SQOGG DoHR

CN

20 10 10 Moderate

AF2.2

(3485)

Failure to deliver financial plans in line

with National guidance from NHS

Improvement

This risk has remained static and links with other

financial risks within the BAF. There are a number of

monitoring processes in place and regular reporting to

Trust Board.

FPC DoF

20 10 10 Moderate

CR3618

linkedIf demands on the service outstrip

capacity this may result in inability to

Related closely to AF1.24 this risk score remains in

excess of the target score and continues to be closely

OG DoO 20 5 15 Moderate

of 29

BAF Ref/ RiskRef


ExecutiveLead

CurrentRiskScore

RiskTarget

RiskTargetGap

RiskAppetiteGuide

with

AF3489

deliver the 4 hour Emergency Access

Standard.monitored, The achievement of the target score is

dependent on the transformation of services across the

health economy. The Trust continues to engage with

other service providers and to progress models of care

DoSP

AF2.8

(3526)

Failure to achieve VFM services andfinancial sustainability.

This risk score has remained at 20 throughout the

financial year and was reviewed at Audit Committee in

February 2017. The risk continues to be closely

monitored and assurance of the position provided

through performance and financial reporting

AC DoP

20 10 10 Low

AF2.9

(3527)

Cash Management and Capital

Investment

Failure to achieve :

a) cash/ liquidity targets,

b) Capital Investment within planned

resources

c) Capital Absorption rate targets

This risk was recently updated to reflect current

terminology. The risk score reduced in Q1 2016/17 from

25 to 20 and has remained stable at 20 since this time.

This BAF risk links closely with AF2.8 and AF2.9. There

are a number of controls and assurance processes in

place in relation to this risk which include internal audit.

AC DoF

20 10 10 Low

AF5.1

(4059)

Failure to deliver Trust efficiency

programme

This risk emerged following the decision to separate a

previous risk made following discussion at the Finance

and Performance Committee in Q2 2016/17 the risk

score remains at 20

FPCDoF

20 10 10 Low

CR4201 Healthier Together

Risk that the Trust will be in breach of

its financial control limit due to the

significant stranded costs caused by

the reconfiguration of emergency and

elective (cancer) general surgery as

part of the Healthier Together

Programme across Greater

Manchester.

This risk was identified in Quarter 3 2016/17 and is

being monitored closely. The risk score will be adjusted

accordingly as mitigations and controls take effect. The

Trust is continuing to engage with the Healthier

Together clinical Advisory Group and the Trust

Executives are being informed of any significant

financial and/or clinical implications

SQOGG

DoO

20 10 10 Low

CR4183 There is a risk of delayed patient

diagnosis and/or treatment as a result

of lack of availability of

radiologists/radiology staff in the

service.

This risk emerged in Quarter 4 2016/17 and is being

monitored closely. The risk score will be adjusted

accordingly as mitigations and controls take effect.

SQOGG

DoO 20 12 8 Low

of 29

BAF Ref/ RiskRef


ExecutiveLead

CurrentRiskScore

RiskTarget

RiskTargetGap

RiskAppetiteGuide

CR4012 Banking Trojans now using Locky

ransomware resulting in potential data

loss due to encryption

This risk score saw an increase following the realisation

of a ransomware occurrence. The risk is expected to be

decreased following implementation of anti-ransomware

software being procured

IM&T Group DoP&I

20 10 10 Moderate

CR4147 Ability to consistently sustain and

maintain a workforce with capability andcapacity to deliver community nursing

services

This risk was identified following the transfer of the

Community Services. The Division is reviewing options

for alternative service delivery and staff skill

requirements to further mitigate the risk. This risk was

reviewed and reworded in March 2017 by the DoO and

controls updated.

OG DoO

16 12 4 Moderate

CR3472 The ability to consistently apply, sustain

and maintain processes relating to themanagement of medicines

This risk score has remained the same in Q1 and Q2 of

2016/17. Assertive work is being undertaken to

understand and address the risks. Assurances are

being scrutinised and challenged through the

governance processes. This risk is currently being

reworded and refocussed to more accurately reflect the

specific areas of risk

QGC, OG MD

16 12 4 Moderate

CR4219 Radiology requests on Lorenzo for in

patients and out patients are being

recorded as cancelled by the Radiology

department without reference to the

requesting clinician.

This risk emerged in March 2017 and is undergoing

further validation of information and evidence to support

the score.

SQOGG DoO

16 4 12 Moderate

CR4302 Introduction of IR35 Tax Regulations

on the 6th April 2017 may increase

existing issues relating to medical and

nursing staff.

This is a new risk and ongoing rota monitoring is in

place to ensure mitigations are in place and to minimise

the clinical risk. The risk is a National risk arising from a

change in UK Tax Law this is impacting on the

availability of Locum doctors. This also have a potential

to impact on the nursing service and the supervision of

doctors in training.

RMG MD/DoO

16 8 8 Moderate

of 29

BAF Ref/ RiskRef


ExecutiveLead

CurrentRiskScore

RiskTarget

RiskTargetGap

RiskAppetiteGuide

CR4212Delay / inability to obtainmicrobiology results

Risk of missing a significant infection

due to delay/ antibiotics which may

result in morbidity or inability to obtain

microbiology results and therefore risk

of mis-treating a patient with an

inappropriate death.

This is a new risk arising in Quarter 1 2017/18 from the

Division of Surgery Women and Children which has a

specific area of focus within the Paediatric speciality.

Mitigations are in place which is expected to reduce the

risk these include active follow up of results.

SQOGG MD

16 4 12 High

AF4.2

(3488)

Failure to ensure on-going compliancewith terms of NHS Improvement

Provider Licence requirements

This risk reduced from 25 to 15 in Quarter 4 2016/17 as

a result of positive assurances. There are no gaps in

controls or assurances identified at this time.

AC DoF15 10 5 Low

AF4.8

(3491)

Failure to have in place an IM&T

infrastructure and service supporting

the organisational objectives

This risk score remains at 15 and has been static at 15

throughout this financial year to date. Although the risk

score remains that same further assurances are being

sought in relation to the integration of Community

Services

IMTG DoP

15 10 5 Moderate

CR3997 Inconsistent room temperatures in

NICUThis risk has remained static and following discussions

at Risk Management Group in April 2017 assertive

action has been requested by the Risk Management

Group to resolve this issue via the Estates Department.

SQOGG DoO

15 3 12 Moderate

CR4158 Transfer of microbiology laboratory to

Manchester Royal Infirmary andrelates to IT issues with Telepath and

ICNet connectivity.

This risk emerged with the transfer of microbiology

services, manual systems for ensuring effective

communication have been implemented to mitigate the

risk and the risk is being closely monitored on an

ongoing basis.

SQOGG CN

15 9 6 Moderate

Direction of travel - Change since previous review

Escalated Residual Risk Score (Current Risk)

De escalated (Target Risk / Risk Appetite Threshold)

Unchanged * New Risk Score

Target achieved

of 29

Appendix 2 Detailed Risk Tables

Strategic Priority (Objective)

Corporate Objective 1, Corporate Objective 3, Corporate Objective 4, Corporate Objective 5, Corporate

Objective 6,

BAF Ref:

AF1.24

Risk ID number:

AF 3483

Risk Description: If demands increase beyond predicted levels and outside current capacity, and the

management of the urgent care pathway across the Health Economy is not undertaken in a cohesive and

standardised way, this could result in delay, increased clinical risk and a reduced positive patient experience.

Potentially this could lead to;

Delays in treating 95% of patients within the 4 hour standard

Increased levels of cancellations for elective surgery

Increased financial cost of escalation areas

Longer length of stay and associated complications.

Executive Director Lead


Assurance Committee

Quality & Governance Committee

Current Risk Score (L x C)

4 x 5 = 20

Risk Direction

Unchanged

Date of last review:

April 2017

Target Risk Rating

2 x 5 = 10

Target Gap Score

10 Concern

Date of next review:

May 2017

Graph of Risk over time Risk Appetite

None

low

Moderate

High

Significant

Rationale for current score:

The Trust is not willing to risk the

ability of the organisation to

delivery safe effective care or

compliance with regulatory

requirements

Date When Target Risk score expected to be achieved

Unable to quantify currently. Multiagency and Multi-organisational Agenda and transformation programme

Rational for Risk appetite

Current Reported performance information and impact on patient flow

Controls:

Working in partnership with external agencies to improve discharge process

Care Together models of Care Work

Patient flow list reviewed twice weekly to determine actions required for each patient

A&E Delivery Group monitoring of recovery plan established across the health economy and monitored

through the Finance and Performance, Operational Board and Executive Management Team meetings

Internal escalation plans in place to maintain safe and effective care during periods of increased pressure

Partnership working with other providers to ensure a long term strategy is in place regarding

sustainability and service provision

Community Care Model being extended to support existing structures

Assurance: (how do we know if the things we are doing are having an impact)

Daily monitoring of bed capacity and ED Waiting times

Waiting List Steering Group

Activity Planning

Monthly contract performance reporting to Executive Management Team & Board

Monthly finance and activity reporting to Board

MIAA audits

Monthly submission of DTOC data

Trust/Social Services Director level interface meetings

A&E Delivery Group

Mitigating actions: (what more should we do?)

Development of integration strategy and further models with key partners

Implementation of Recovery Plan by all partners

Gaps in assurance and actions not being actioned

Third party action by other parties and stakeholders has impact upon organisation. Delays in

delivery due to funding

Risk source

Third party review and internal monitoring, incidents, complaints and claims and Operational performance

Anticipated effect of controls

(Expected /risk score reduced) Reported at Board meeting aligned to performance trajectory and

performance report

0

5

10

15

20

25

Target score

Risk score

of 29

Strategic Priority (Objective) Corporate Objective 1, Corporate Objective 3, BAF Ref:

AF1.23

Risk ID number:

AF 3482 linked to CR1549

Risk Description: Medical Staffing - The ability to recruit to Consultant and Middle Grade posts due to national

shortages in certain specialties i.e. Radiology, Medicine and A&E. This may impact on patient experience and

the ability to provide safe care.


Director of Human Resources

Medical Director

Assurance Committee



4 x 5 = 20

Risk Direction

Unchanged


April 2017

Target Risk Rating

2 x 5 = 10

Target Gap Score

10 Concern


May 2017


None

low

Moderate

High

Significant


There is a national shortage of

Consultant and Middle Grade

doctors in some specialties

therefore there is additional

reliance on Locum and Agency

staffing to provide full staff

compliment


Unable to quantify currently despite mitigations. Local and National agendas and changes influence the

Trust’s ability to achieve this target


The Trust is not willing to risk the ability of the organisation to delivery safe effective care or

compliance with regulatory requirements

Controls:

Workforce strategy

Sickness Policy and monitoring

Use of Agency and Locum staff to bridge the gap

Temporary staff management monitoring

Senior Managers receive daily staffing report summaries

Capacity & Demand being reviewed through job planning process

Robust job planning process

Staffing monitoring via Quality Account dashboard and HR metrics.

International recruitment

Assurance: (how do we know if the things we are doing are having an impact and can we validate

or evidence e.g.: Inspections; Committees; Working Groups; Reports; Monitoring Returns etc.?):

Improvement Plan

HENW Review Action Plan monitored by Educational Governance and SQOGG

Reports to

Medical Staffing Group

HR & OD Workforce Group

Medical Staffing Expenditure Review Group (MSERG)


Reports to Board and Executive Team

Continuous recruitment in to the vacant posts is underway and to continue under monitoring

Weekly monitoring of KPI’s

Stronger links to the annual Trust planning process

Lack of workforce availability at an operational level leading to difficulty in recruitment

Gaps in assurance and actions not being actioned (what additional assurances should we seek?)

No gaps in assurance identified however implementation of real time operational management

requires consistent application of agreed systems and processes by all staff at all levels across all

divisions

Risk source

Operational performance

Anticipated effect of controls (when is a reduction in risk trajectory expected /risk score reduced)

Reported at Board meeting aligned to performance trajectory/ performance report

05

10152025

Target score

Risk score

of 29

Strategic Priority (Objective) Corporate Objective 1, Corporate Objective 2, Corporate Objective 3, BAF Ref: AF1.23 Risk ID number: CR734 Linked to

CR 3909 and AF1.23 (3482)

Risk Description : Nurse Staffing -The ability to consistently sustain and maintain safe nurse staffing levels is

compromised as a result of operational demand, use of escalation and additional capacity beds, third party

decisions and actions are continuous as admissions challenges


Chief Nurse

Assurance Committee



4 x 5 = 20

Risk Direction

Unchanged


April 2017

Target Risk Rating

2 x 5 = 10

Target Gap Score

10 Concern


May 2017


None

low

Moderate

High

Significant


Current operational processes

and daily staffing reviews


Unable to quantify as local and National agendas and changes influence the Trust’s ability to achieve this.

Rational for Risk appetite; The Trust is not willing to risk the ability of the organisation to

delivery safe effective care or compliance with regulatory requirements

Controls:

Workforce Strategy

Recruitment open days

Monitor safer staffing analysis/submission and oversight with Acuity and dependence reviews

Nurse staffing are informed by National Guidance

Continuous monitoring at each operational bed meeting.

Monitoring of KPI’s Ward level dashboards.

Roster approval signed off by Ward Manager and Matron through e-rostering standards. Processes for

authorisation to backfill in place

Incident reporting systems analysis of variance


or evidence e.g.: Inspections; Committees; Working Groups; Reports; Monitoring Returns etc?):

NHSP monthly contract monitoring meetings

E Rostering

Reports to:

Executive Management Team



Continuous recruitment in to the vacant posts is undertaken and continually monitored.

Monitoring of KPIs.

Utilisation of a partnership model and secondment opportunities from other trusts.

Recruitment from abroad

Return to Nursing and Pre nursing care Support Worker programme

Weekly recruitment tracker to EMT

Monthly Staffing Board Report to Trust Board informs this risk score.


Decision of other parties

Ability and availability of temporary staffing to meet demands

Use of escalation areas and operational demand drawing from wider compliment of

Trust resources.

Risk source

Operational performance, incidents and complaints


Reported at Board meeting aligned to performance trajectory and performance

0

5

10

15

20

25

Target score

Risk score

of 29

Strategic Priority (Objective) Corporate Objective 6 BAF Ref: AF2.2 Risk ID number:AF3485

Risk Description : Failure to deliver financial plans in line with FT (Provider Licence) compliance framework Executive Director Lead

Director of Finance

Assurance Committee

Finance & Performance Committee


4 x 5 = 20

Risk Direction

Unchanged


April 2017

Target Risk Rating

2 x 5 = 10

Target Gap Score

10 Concern


May 2017


None

low

Moderate

High

Significant


Current financial performance.

Service model for financial

sustainability being implemented


The delivery of the financial plan for 2017/18 should be achieved by April 2018 however this should be

assessed in the context of the longer term financial plan


The Trust not willing to risk the ability of the organisation to achieve NHS Improvement

requirements and financial sustainability

Controls:

Continued use of appropriate NHS Reference Costs information led by the Finance Department to

ensure control and rigor of TEP delivery

Finance Team work with budget holders to drive down costs and increase income and contribution

margin and, with clinical teams, to exploit opportunities and repatriate activity and develop new

markets

Established Governance structure

Ensure Divisional teams work with finance to review income, expenditure and TEP variances and to

identify root cause analysis and where appropriate update systems and controls.

Improvements to clinical coding team

Standing Financial instructions


or evidence

Weekly EMT

Performance and financial reports to Board

Review of assurance and management structure/ meetings for TEP delivery

Ensure PIDs and QIA are completed for each scheme

Establish a recovery plan for all schemes not achieving targets

Ensure Divisional infrastructure regularly review TEP Schemes, complete recovery plan

and identify new schemes either in mitigation or for next financial year

TEP programme alongside Improvement Plan to ensure they complement each other

2017/18 programme outline developed.

Contractor meetings with the single Commissioner

MIAA Audit


Revised programme of financial management

Certify that all material non-recurrent TEP's have also been subject to a rigorous QIA

Fully develop schemes to deliver the TEP target on a recurrent basis.

Develop and submit to regulators milestones and financial modelling

Review of clinical coding and impact on income.


Level of recording of non-recurrent TEP versus recurrent TEP.

Timely planning of TEP programme to ensure future delivery

Risk source Strategic Insight and Foresight Anticipated effect of controls Reported at Board meeting aligned to performance trajectory and

performance report

05

10152025

Target score

Risk score

of 29


Corporate Objective 2 Corporate Objective 6

BAF Ref:

AF 1.1, 1.24

Risk ID number:

CR3618 linked with AF3489

Risk Description : If demands on the service outstrip capacity this may result in inability to deliver the 4 hour

Emergency Access Standard



Assurance Committee

Operational Group


4 x 5 = 20

Risk Direction

Unchanged


April 2017

Target Risk Rating

1 x 5 = 5

Target Gap Score

15 Serious


May 2017


None

low

Moderate

High

Significant


Current Reported performance

information and impact on

patient flow


Reduction of risk score is dependent on sustained proven performance and ability to influence external

partners


The Trust is not willing to risk the ability of the organisation to delivery safe effective care

Controls:

Additional ED Management Support and Infrastructure.

Extended out of hours management presence.

Bed meetings.

Additional staffing (all services)

Breach analysis and system resilience work.



Emergency Department daily performance report

Bed meeting reports

Executive Team reports

Board reports

Divisional action plans and analysis of information

Improvement Board Actions

Detailed Improvement Plan and system resilience work.


Daily management oversight on a patient by patient basis.

On site management support overnight.

In-reach from medical consultants to ED

Trust wide focussed work regarding patient flow

System resilience work


Impact of Third party action and third party decision – e.g. impact of Primary care and

Local Authority

Risk source

Strategic Insight and Foresight


Reported at Board meeting aligned to performance trajectory and performance report

05

10152025

Target score

Risk score

of 29


Corporate Objective 6,

BAF Ref:

AF2.8

Risk ID number:

AF3526

Risk Description : Failure to achieve Value For Money (VFM) services and financial sustainability Executive Director Lead

Director of Finance

Executive Team

Assurance Committee

Finance & Performance

Committee


4 x 5 = 20

Risk Direction

Unchanged


April 2017

Target Risk Rating

2 x 5 = 10

Target Gap Score

10 Concern


May 2017


None

low

Moderate

High

Significant


The Trust is currently working to

a deficit plan, therefore is not

currently financially sustainable


Unable to quantify currently. The achievement of this for all services will only be realised with the

achievement of a fully Integrated Care System


The Trust is not willing to risk the ability of the organisation to achieve NHS Improvement


Controls:

Standing Financial Instructions (SFI’s) in place

Routine monthly service and financial meetings

Regular monthly reporting to Executive Team and Board

Monthly TEP reporting to Executive Team /Board

Contract performance meetings

Planned process

Scheme of Delegation. Budgetary Systems and Procedures

Appropriate insurance protection established

Activity Planning income and activity



Strategic plan in place to work with other organisations to ensure sustainability going

forward

Audit Committee

Finance and Performance Committee

Trust Board Report.

Internal and External Audit Reports to Audit Committee

Annual (External) Audit. Annual Report to Trust Board on Financial Plans and Budgets

for the new year


Divisional action plans and recovery plans where required

Implementation of CPT plan and formation of an integrated Care organisation


No gaps in assurance identified

Risk source




05

10152025

Target score

Risk score

of 29

Strategic Priority (Objective) Corporate Objective 6 BAF Ref: AF2.9 Risk ID number: AF3527

Risk Description : Failure to achieve:

a) Cash/ liquidity targets,

b) Capital Investment within planned resources

c) Capital Absorption rate targets


Director of Finance

Assurance Committee


Committee


4 x 5 = 20

Risk Direction

Unchanged


April 2017

Target Risk Rating

2 x 5 = 10

Target Gap Score

10 Concern


May 2017


None

low

Moderate

High

Significant


The Trust requires financial

support to achieve liquidity

targets and deliver the Trusts

Efficiency Programme


The delivery of the financial plan for 2016/17 should be achieved by April 2017 however this should be

assessed in the context of the longer term financial plan


The Trust is not willing to risk the ability of the organisation to achieve NHS Improvement


Controls:

SFIs and Scheme of Delegation. Budgetary Systems and Procedures

Capital Budget Monitoring. Cash Flow monitoring and forecast against monthly profile over a two

year forward look

Treasury Management Policy

Business case development controls.

Monthly Board reports



Monthly finance reports to Finance and Performance Committee and Board

Audit Committee reports (shadow investment committee)

External Audit opinion on Accounts

MIAA Audit


Divisional action plans and recovery plans where required

Implementation of CPT plan and formation of an Integrated Care Organisation


No gaps in assurance identified

Risk source




05

10152025

Target score

Risk score

of 29



BAF Ref:

AF5.1

Risk ID number:

AF4059

Risk Description : Failure to deliver Trust Efficiency Programme Executive Director Lead

Director of Finance

Assurance Committee


Committee


4 x 5 = 20

Risk Direction

Unchanged


April 2017

Target Risk Rating

2 x 5 = 10

Target Gap Score

10 Concern


May 2017


None

low

Moderate

High

Significant


To be confirmed following Board

development session


Currently being reviewed to be reported at the next Board meeting aligned to performance trajectory


To be confirmed following Board development session

Controls:

Benchmarking with other organisations to ensure challenge and appropriateness of TEP

Review of Lord Carter Report to ensure TEP reflects outputs of reports

Ensuring valuing care efficiency programme is communicated effectively across the organisation

Divisional structures performance manage delivery of TEP



TEP Assurance Meeting

Operations Board

Finance and Performance Committee

Trust Board

Divisional Performance Groups

Internal Audit VFM work covers arrangements in place to deliver TEP


Revised programme of financial management

Certify that all material non-recurrent TEP's have also been subject to a rigorous QIA

Fully develop schemes to deliver the TEP target on a recurrent basis.

Develop and submit to regulators milestones and financial modelling

Review of clinical coding and impact on income.


Level of recording of non-recurrent TEP versus recurrent TEP.

Timely planning of TEP programme to ensure future delivery.

Risk source




0

5

10

15

20

25

Target score

Risk score

of 29


Corporate Objective 1, Corporate Objective 4, Corporate Objective 5, Corporate Objective 6.

BAF Ref:

AF2.6, AF2.8

Risk ID number:

CR 4201

Risk Description : Healthier Together

Risk that the Trust will be in breach of its financial control limit due to the significant stranded costs caused by

the reconfiguration of emergency and elective (cancer) general surgery as part of the Healthier Together

Programme across Greater Manchester.

Unless recurrent transformational funding is agreed the loss of income to the Trust would be far greater than

the levels of costs which could be safely extracted.

Currently GM is proposing to fund 2 years non recurrent stranded costs which would leave the organisation in

serous financial deficit



Assurance Committee

SQOGG


4 x 5 = 20

Risk Direction

Unchanged


April 2017

Target Risk Rating

2 x 5 = 10

Target Gap Score

10 Concern


May 2017


None

low

Moderate

High

Significant


Reconfiguration across Greater

Manchester effecting services

and financial income


Unable to assess at this time


The Trust is not willing to accept risk with the preference being for maintaining financial stability

Controls: (what are we currently doing about the risk?)

Continue to engage with the Healthier Together Clinical Advisory Group and inform the Trust Executives

of any significant financial and/or clinical implications.

Ensure identified actions are worked through and completed



Monitoring of data and financial position.

Executive Management Team Board Reports


Continue to attend HT clinical advisory group

Input into key work streams, finance, human resources, cancer MDT.

Contribute to and complete the outline business case and identification of stranded costs vs costs

which can be influenced

Completion of detailed bottom up analysis of stranded costs vs costs to be extracted.


Ultimately the controls are third party reliant.

Risk source

Operational performance and finance

Anticipated effect of controls (when is a reduction in risk trajectory expected /risk score

reduced)

Continued transformation and financial awareness.

05

10152025

Target score

Risk score

of 29


Corporate Objective 1, Corporate Objective 3

BAF Ref: AF1.23 & CR3482 Risk ID number:

CR 4183

Risk Description

There is a risk of delayed patient diagnosis and/or treatment as a result of lack of availability of

radiologists/radiology staff in the service. This is related to risk CR770, reduced sustainability of Radiology

Services.

This risk is multifaceted and impacts on activity and the ability of the department to undertake investigations

within timescales, particularly to support the cancer pathways

• report investigations within timescales

• quality of service provided

• delivery of key objectives

• budgetary control

• reduction of backlogs (see risk no. 1880)

• Workload pressures - stress on the current workforce due to long working hours/complexity of work



Assurance Committee

SQOGG


5 x 4 = 20

Risk Direction

Unchanged


April 2017

Target Risk Rating

3 x 4 = 12

Target Gap Score

8 Close monitoring


May 2017


None

low

Moderate

High

Significant


Current reported performance

information


July 2017

Rational for Risk appetite The Trust is not willing to accept risk with the preference being for

maintaining service stability


use of locum and agency radiologist reporting and direct clinical sessions EG ultrasound scanning and

Breast interventions

Radiographer reporting

advanced practice

Consultant Radiographer in post

planned development of additional radiographer advanced practice

outsourcing of CT and MR scanning and reporting

use of WLI and ECP’s



Reports to

Divisional Governance meeting

SQOGG


submission of Radiology staffing paper to Executive Team in early 2017

Scoping exercise to identify possibility of support from local organisations across GM.

Review of options to widen scope of practice/skill set of radiographer staff in the mid to longer term


Locum cover not sustainable in the long term due to high cost implication

locum availability

heavy reliance on very small substantive Consultant Team

Risk source Risk register, and Operational performance Anticipated effect of controls To be monitored closely to ensure impact is minimised

05

10152025

Target score

Risk score

of 29

Strategic Priority (Objective) Corporate Objective 4, Corporate Objective 6 BAF Ref: AF4.8 Risk ID number: CR 4012

Risk Description : Banking Trojans now using Locky Ransomware and potential for data to be unavailable due

to encryption of files


Director of Performance & Informatics

Assurance Committee

IM&T


4 x 5 = 20

Risk Direction

Unchanged


April 2017

Target Risk Rating

2 x 5 = 10

Target Gap Score

10 Concern


May 2017


None

low

Moderate

High

Significant


Current IM&T infrastructure and

local intelligence


Currently being reviewed to be reported at the next Board meeting aligned to performance trajectory


The Trust is not willing to accept risk with the preference being for maintaining delivery systems


ITIL (Information Technology Infrastructure Library) change Control process in place.

IM&T Group structure.

Risk Assessment in place with plans to mitigate.

Strengthened structure to support service flow and ownership within IT.



Monitoring of data/incidents.


Exception Reports

Audit – Internal & External


All user communication

Propose to block macro’s at point of entry into the Trust for all email communications

Review options to enforce disablement of Macros within Office or quarantine emails with macros

from none trusted sites

User Training – Information Security as part of mandatory training

Review options to block the downloading of documents with macros enabled – This would require

significant investigation due to risk of impact.

Purchase of software to reduce the risk further


Ultimately the solution is operator reliant.

Knowledge and Skills Gaps

Risk source



reduced)

Continued stability and prevention of incidents.

Embedding of best practice re user responsibility.

Improved understanding, communication and visibility

05

10152025

Target score

Risk score

of 29


Corporate Objective 1, Corporate Objective 2, Corporate Objective 3

BAF Ref:

AF1.23 AF1.24 & AF4.6

Risk ID number:

CR 4147

Risk Description : Ability to consistently sustain and maintain a workforce with capability and capacity to

deliver community nursing services


Divisional Directors and Head of Adult Services / Head of

Children, Young People & their Families Services

Assurance Committee

Operational Group


4 x 4 = 16

Risk Direction

Unchanged


April 2017

Target Risk Rating

3 x 4 = 12

Target Gap Score

4 Tolerable


May 2017


None

low

Moderate

High

Significant



local intelligence


Unable to quantify at this time


The Trust does not have any risk appetite for tolerating risk to quality of service


Continue to encourage self-management at all visits, particularly for administration of injections

Review of existing workforce provision and exploration of options for transformation of services.

Daily scoping of work across the whole service to try to minimise the mismatch between demand

and capacity



CRIG

Service Quality and Operational Governance group and sub groups reporting to Quality

and Governance Committee

Regulatory compliance monitoring


Engagement from finance and HR to support timely recruitment to current vacancies

Review of resources and services to obtain a robust baseline and align existing skills and

competencies with service requirements.

Leadership model review

Assess the need for further workforce development ensuring services are sufficiently resourced to

meet service requirements

Identify DN representation for each of the neighbourhoods and links with all GP practices. Continue

to engage in and influence the development of integrated neighbourhoods and identify

opportunities for new care models that transformation will enable


No gaps identified

Risk source

Incidents, Complaints and Operational performance


reduced)

Unable to quantify at the current time.

05

10152025

Target score

Risk score

of 29



BAF Ref:

AF1.12

Risk ID number:

CR3472 linked with Risk CR656

Risk Description : The ability to consistently apply, sustain and maintain processes relating to the

management of medicines is compromised due to inappropriate prescribing of drugs/ineffective medicines

management and/or theft/ loss of drugs


Medical Director, Director of Operations

Assurance Committee

Quality and governance

Committee, Operational Group


4 x 4 = 16

Risk Direction

Unchanged


April 2017

Target Risk Rating

3 x 4 = 12

Target Gap Score

4 Tolerable


May 2017


None

low

Moderate

High

Significant



local intelligence


It is expected that this risk score will reduce by Quarter 4 following assertive focus on medicines safety


The Trust does not have any risk appetite for tolerating medicines regulatory risks


Medicines Management Committee

Compliance with CAS Alerts for medicines

Drugs and Therapeutic Group and Medicines Safety Work Stream

Joint working arrangements with CCG re antibiotic prescribing

Antimicrobial management Team

Pharmacy stock control systems and procedures.

Ward stock control systems and procedures.

Review of Trust Medicines Policy

Assurance:

Drug and Therapeutic Committee

Service Quality and Operational Governance Group and sub groups reporting to Quality

and Governance Committee which has the Chief Pharmacist as a member

Safety Walk rounds

Periodic progress reports to Safety Programme Board

Audit Committee and Clinical Audit reports

Internal Audit reviews regularly undertaken

Pharmacy Dept. undertakes quarterly audits of compliance against Medicines Policy

and Safety Thermometer monitoring against metrics.

Regulatory compliance monitoring


Medicines management Patient Safety Work Stream and programme

CQC assurance plan and agreed action

Recommendations and actions following the MIAA Audit Report and the Review of Service to be

completed.


No gaps identified

Risk source

Incidents, Complaints and Operational performance

Anticipated effect of controls Recommendations and actions following the MIAA Audit Report

and the Review of Service will reduce the risk

0

5

10

15

20

25

Target score

Risk score

of 29



BAF Ref: AF1.12 Risk ID number: CR4219

Risk Description : Radiology requests on Lorenzo for in patients and out patients are being cancelled by the

Radiology department without reference to the requesting clinician


Medical Director, Director of Operations,

Assurance Committee

Service Quality and Operational

Governance Group


4 x 4 = 16

Risk Direction


April 2017

Target Risk Rating

1 x 4 = 4

Target Gap Score

12 Serious


May 2017


None

low

Moderate

High

Significant


Current incident information and

local intelligence

Date When Target Risk score expected to be achieved Rational for Risk appetite

The Trust does not have any risk appetite for tolerating clinical risks of this nature



Patients that are cancelled are re-booked and letter sent to the Radiology department.

Assurance:



Periodic progress reports to local Quality and Safety Board


Speak with and write to the management team in Radiology requesting immediate action.

Radiology department are looking to invest in a system to solve the stated issue

All Trust consultants to be emailed informing them of the risk and potential compromise this may

have to their practice


Radiology department are aware of the issue. Radiology state that they have a system

in place to notify the relevant clinician. Clinicians are not aware of this system and have

not received emails.

Risk source

Incidents, and Operational performance

Anticipated effect of controls Recommendations and actions following and the review of system

will reduce the risk

05

10152025

Target score

Risk score

of 29



BAF Ref: AF1.12 Risk ID number: CR4302

Risk Description: Introduction of IR35 tax regulations on the 6th April 2017 may increase existing issues

relating to medical and nursing staff.


Medical Director, Director of Operations,

Assurance Committee


Governance Group


4 x 4 = 16

Risk Direction

NEW*


April 2017

Target Risk Rating

2 x 4 = 8

Target Gap Score

8 Close monitoring


May 2017


None

low

Moderate

High

Significant


Current staffing information and

local intelligence


This risk is still under assessment in relation to achievement of the target risk score


The Trust does not have any risk appetite for tolerating clinical risks of this nature


Daily discussions with medical staffing team to optimise rotas.

Substantive recruitment continues, including international recruitment

Internal bank rates increased to try and mitigate financial impact on clinicians and encourage rota

fill.

Communication with clinicians to try and understand and mitigate their concerns/issues.

Assurance:


and Governance Committee and Trust Board


Ongoing monitoring and oversight by Senior Managers and Clinicians


None identified

Risk source


Anticipated effect of controls Reduction in clinical risk and impact on services

05

10152025

Target score

Risk score

of 29

Strategic Priority (Objective)Corporate Objective 1, Corporate Objective 6

BAF Ref: Risk ID number: 4212

Risk Description : Delays/inability to obtain microbiology results

Risk of missing a significant infection due to delay/inability to obtain microbiology results andtherefore risk of mis-treating a patient with an inappropriate antibiotics which may result inmorbidity or death.

Doctors time taken to chase results is a risk of less clinical time (more so at weekends/nights) toprovide clinical care. Risk of delay in clinical decisions and prolonged hospital stay due tomicrobiology samples being delayed in being transported to Manchester, delay in being put forcultures and direct microscopy and delay in results being received from the Manchester Laboratory.

Executive / Divisional LeadMedical Director Divisional Director

Assurance CommitteeDivisional Governance Meeting

Current Risk Score (L x C)4 x 4 = 16

Risk DirectionNEW*

Date of last review:April 2017

Target Risk Rating1 x 4 = 4

Target Gap Score12 Serious

Date of next review:May 2017

Graph of Risk over time Risk AppetiteNonelow

ModerateHigh

Significant

Rationale for current score:Incidents

Date When Target Risk score expected to be achieved Rationale for Risk appetiteInappropriate prescribing of Anti-biotics.


Active chasing up of results.

Emails to laboratory regarding risks of delay in samples being sent and viewed.

Assurance: (how do we know if the things we are doing are having an impact)

SQOGG

Divisional Safety & Quality Group

Mitigating actions: (what more should we do?) Directorate Manager for Diagnostic Services/Associate Divisional Director for Scheduled Care to

liaise with CMFT regarding concerns.

Gaps in assurance and actions not being actioned

Risk sourceClinical Risk

Anticipated effect of controls (when reduction is risk trajectory expected /risk scorereduced)To be agreed in line with Trust approach

0

5

10

15

20

25

Target score

Risk score

of 29



BAF Ref:

AF4.2

Risk ID number:

AF3488

Risk Description : Failure to ensure on-going compliance with NHS Improvement Provider Licence requirement Executive Director Lead

Company Secretary with Executive Team

Assurance Committee

Trust Board


4 x 5 = 15

Risk Direction

Unchanged


April 2017

Target Risk Rating

2 x 5 = 10

Target Gap Score

5 Tolerable


May 2017


None

low

Moderate

High

Significant



local intelligence


To be achieved and sustained on a continual basis


The organisation is not prepared to accept risks to the ability of the Trust to maintain compliance

with the Provider licence


Board reporting in line with FT provider licence requirements

Board Financial reporting procedures fit for purpose

FT metric performance framework

Regular contact with Monitor and Board reporting re actions taken to maintain authorisation

Assurance:

Regular contact with NHS Improvement and Board reporting re actions taken to

maintain authorisation

Trust Board seminars

Board Reports

Financial governance infrastructure

MIAA Audit – review of Annual Report


Continuous implementation of required actions by all staff at levels required

Implementation of action plan re TEP identification and implementation of Trust Improvement

Programme and Agreed Monitoring action


No gaps in control identified

Risk source

NHS Improvement Provider licence requirements and Regulatory Monitoring


It is anticipated that current controls and mitigations will align performance to ensure compliance

05

10152025

Target score

Risk score

of 29



BAF Ref: AF4.8 Risk ID number: AF3491 linked to

CR3511 and 3604

Risk Description: Failure to have in place an IM&T infrastructure and Service supporting the organisational

objectives. (Linked to AF 4.8)


Director of Performance & Informatics

Assurance Committee



3 x 5 = 15

Risk Direction

Unchanged


April 2017

Target Risk Rating

2 x 5 = 10

Target Gap Score

5 Tolerable


May 2017


None

low

Moderate

High

Significant



local intelligence


Unable to quantify as assessment is still being undertaken in respect of additional IM&T risks transferred or

arising out of the integration of services


The Trust is not prepared to accept risks to the achievement of acceptable outcomes


Director of Performance and Informatics Leadership.

ITIL (Information Technology Infrastructure Library) change Control process in place.

IM&T Group structure.

Risk Register in place with plans to mitigate.

Strengthened support service flow and ownership within IT

Assurance:

Significant reduction in number of unscheduled outages impacting Trust services.


Exception Reports

Audit – Internal & External (MIAA)

Third party reviews and feedback


Production of a detailed 1-3 year roadmap with 4-5 at a holistic level.

Review of roadmap at key junctions, changes in business strategy or 6-monthly.

Alignment of resource structure to meet the business model.

Identification and mitigation plans reported via the risk board.

IM&T Group in place to support developments across the Trust.

Single points of failure to be identified and mitigated against.

Departmental business plans in place in the event of an IT outage.

Skills gaps to be addressed through training matrix.

Funding for some elements of disaster recovery requirements


Lack in business understanding of the infrastructure supporting key services.

Financial constraints.

Technical refresh programme supporting the business strategy.

Business strategy is not in place.

Business leads not engaging with IT through Change Control and Service Desk.

Skills Gaps.

IM&T Group

Risk source


Anticipated effect of controls Continued stability as experienced over the last twelve months.

Embedding of best practice utilising the ITIL model.

Improved understanding, communication and visibility

05

10152025

Target score

Risk score

of 29



BAF Ref: Risk ID number:

CR3997

Risk Description : Inconsistent temperatures in NICU

Clinical risk to babies dropping temperatures and nurses are giving, what could be considered as, conflicting

advice to parents about wrapping babies. This is due to dropping temperatures in breastfeeding room and

room 2 on NICU, due to fluctuating environmental temperature, especially at night and on cold days. This has

the potential to lead to babies needing to be swaddled and/or put back into incubators.



Assurance Committee


Governance Group


5 x 3 = 15

Risk Direction


April 2017

Target Risk Rating

1 x 3 = 3

Target Gap Score

12 Serious


May 2017


None

low

Moderate

High

Significant


Incident occurrence


It is expected that this risk score will reduce by Quarter 4 following assertive focus on medicines safety


The Trust does not have risk appetite for tolerating incidents of this nature



Breastfeeding room: doors are kept closed. Wall thermometers in situ; temperature monitoring is

ongoing.

Staff are advised to keep the door closed, when this is safe and feasible.

Wall thermometers in situ; temperature monitoring is ongoing.

Estates Manager continues to lead on the management of this risk; plan of action to fully rectify this

issue remains outstanding. New vents installed to regulate temperature.

Assurance:



Safety Walk rounds

Periodic progress reports to local Quality and Safety Board


Interim Head of Estates will review the building management system for anomalies. Director of

Estates and Facilities has oversight of the NICU risk assessment to ensure awareness and for

reflected risk assessment on estates to ensure cohesive team work to mitigate the risk.


No gaps identified

Risk source

Incidents,

Anticipated effect of controls Monitoring is initially demonstrating controls may be stabilising

the issue, it is expected the risk should be reducing once controls are demonstrating consistent

compliance

05

10152025

Target score

Risk score

of 29



BAF Ref: Risk ID number:

CR4158

Risk Description: Transfer of the Microbiology laboratory Services to Manchester Royal Infirmary to begin

earlier than anticipated, commencing October 2016, and relates to IT issues with Telepath and ICNet

connectivity (IP Electronic Surveillance System). No ICNet connection for a period of 27 days whilst remedial

works to solve the connectivity Issues takes place


Chief Nurse

Assurance Committee

SQOGG


3 x 5 = 15

Risk Direction

Unchanged


April 2017

Target Risk Rating

3 x 3 = 9

Target Gap Score

6 Close monitoring


May 2017

Graph of Risk over time

Risk Appetite

None

low

Moderate

High

Significant



local intelligence


To be reviewed once the connectivity issues is resolved


The Trust is not willing to accept risk of disruption brought about by business contingency and

maintains an overall preference for safe delivery options


Notification by email (NHS.net accounts) on a daily basis plus additional phone call with urgent

results

Manual opening of cases into ICNet and inputting of results.

Assurance:

Provision of manual systems

Daily monitoring of communication


Business continuity plans in place


External pressure and decisions influence the ability of the Trust to limit action

Risk source

Restructuring of service delivery of Microbiology to Manchester Royal Infirmary


With proposed actions implemented the Risk will reduce from a Major to a Moderate in Severity

although will remain as a "red" risk

05

10152025

Target score

Risk score


Report to Public Trust Board meeting of the 27 April 2017

Agenda Item 7e

Title Sealed Documents – Quarter 4 2016/17

Sponsoring Executive Director Tom Neve

Author (s) Tom Neve

Purpose To notify the Board of the documents to which theTrust seal has been applied in Quarter 4

Previously considered by This report has not been considered by any othermeeting

Executive SummaryThe Trust’s Seal has been applied on three occasions during Quarter 4 of the 2016/17financial year

Related Trust Objectives Objective 6To deliver against the required local/nationalregulatory frameworks and standards, inaddition to securing the most effective andefficient use of resources to deliver servicesthat we provide directly or indirectly throughout partner organisations

Risk Assurance – risk impacted uponN/A


Complies with the Trust’s Standing Orders

Financial ImplicationsN/A


N/A


N/A

Action required by the BoardTo note that the trust’s seal has been used on three occasions during Q4 of the 2016/17financial year

Sealed Documents – Quarter 4 of 2016/17

The Trust’s Standing Orders require a report to the Trust Board identifying alldocuments to which the Common Seal has been applied during the precedingquarter. These documents were secured and sealed under “Tameside and GlossopIntegrated Care NHS Foundation Trust”.

The Trust’s seal was applied on the following occasions during quarter 4 of the2016/17 financial year:

1. Lease for Stamford Unit from L and M

2. Deed of novation – Consort Healthcare

3. Lease for Stamford Unit (replacement documents)



Agenda Item 8a

TitleQuality and Governance CommitteeAggregated learning summary report –attached

Sponsoring Non-ExecutiveDirector

Ms T Kalloo

Author (s) John Fletcher, Director of Quality and Governance


Previously considered by Not applicable

Executive Summary

Summary aggregated learning report

Related Trust Objectives Relates to all Corporate objectives

Risk Assurance – risk impacted upon Relates to all areas of risk


None identified

Financial Implications None


Not applicable


Not applicable


The Board is asked to receive and note the Summary notes of the walkrounds undertakenand the Summary Aggregated Learning Report.

of 7

Quality and Governance Committee

The Quality and Governance meeting took the form of assurance walk rounds. Walkround teamswere convened with Non-executive Directors and Executive Directors supported by Quality andGovernance Unit. The walkround process was unannounced to the areas visited.

Real time assurances were sought and received on the implementation of work previouslyreported through the Governance processes to the Committee and Trust board. Members fedback that the process had provided assurance of implementation of the reported workprogrammes and the progress made to improve and ensure Quality and Safety of serviceprovision. The reports from these walkrounds including any inconsistencies identified will befeedback to the Clinical and service leads to inform further improvement.

The specific areas of focus in the walkrounds were to seek assurance that the actions identifiedfrom the CQC assurance plan had been implemented, to seek assurance on the pilot projectscommenced and production of discharge letters in some medical areas were delivering theanticipated benefits and to speak to Porters and domestic staff following the transfer to an inhouse service.

The areas visited were Maternity Ward 27, Neonatal Intensive Care unit (NICU), Medical Wards31, 40, 41, 42, 46 the Whitehouse and a number of Domestics and Porters who were available.For each area the context of the review was identified and aligned to issues and previousassurance reports to the Committee with potential lines of enquiry being identified in relation toObservation, conversations with patients, relatives and staff as appropriate.

The visit to the Maternity ward and the NICU are both located in the Charlesworth Building, thegeneral fabric of the Charlesworth building was noted as a concern which would require furtherattention and assessment, and be considered in the estates strategy. However the contrast of thispart of estate in the context of the newly upgraded Antenatal suite was noted. Despite this thefeedback received from Patient and family members spoken to in both areas very positive aboutthe care, treatment and services received.

In the maternity ward the visitors were assured that the actions planned following the CQCinspection had been taken relating to replacement of furniture and fridge temperature monitoringappeared to be consistently monitored. The impact of the new ward manager was also noted.However, it was proposed that the ward environment could be further improved and declutteredwith further actions agreed. Consideration was also discussed for what further work on the wardcould take place to upgrade the facilities.

Within the NICU unit it was noted that whilst most CQC actions were completed, some action werestill being progressed, and improved ward communications were being refined and acommunications book to be implemented. The issue of temperature control in one area was still aconcern. Work to monitor this with Estates and Facilities had been progressed and changes made,however the issue had not been resolved, and was currently on the Risk register. It was agreedthat the executives would escalate and review further with the Estates team to understand.

In the medical wards the review team split to cover a greater number of areas. On ward 31 it wasnoted that there was a new ward manager on the ward and band 6 nurse being recruited to furtherstrengthen the ward leadership. It was noted that the area was a specific focus of the Chief Nursewho was overseeing a weekly meeting and improvement work being undertaken which hadcommenced. This included staff recording feedback on what the shift had been like to work on adaily basis on the ward.

of 7

The ward felt calm and well organised, the CQC specific action re fridge temperature monitoringwas taking place consistently, and positive feedback was again received from the patients spokento. However, it was noted that recruitment of permanent staff continued to be an issues and theuse of temporary and locum staff a cause for concern which was monitored several times dailyand reported and escalated through the bed meetings to ensure safe staffing levels weremaintained throughout the whole site.

On Ward 40 the Respiratory ward a pilot project using Physiotherapists to support staffingresources appeared to be working very well and had been well received by the team membersspoken to, and was providing addition support and training for ward staff to enhances their skillswith the therapies offered on the ward. Whilst it was acknowledged that further nurse recruitmentwas required and being progressed, it was noted that pilot had developed good team workingacross disciplines. Assurance was noted on the other CQC actions and the feedback from patientwas overwhelmingly positive.

On ward 41 and 46 again the environment was reported to appear calm and well managed calmand well managed, assurance was noted that the CQC actions appeared to be consistentlyimplemented and the new resuscitation trollies were noted to be in place and being monitored,again the patient feedback was positive. On ward 41 the area of the ward assigned to dementiacare included a memories room used which the review team were impressed with.

On Ward 42 Staff interaction with the patients was excellent, and the feedback again was positive,however there were some inconsistencies in the completion of some of the actions required noted,and the ward environment felt less well organised and cluttered. The issues identified werediscussed with the Ward Manager and matron of the ward to identify support needed some delaysin provision of discharge letter production had been identified and is being managed by thedivisional management team.

The improvement work achieved in the Whitehouse over 12 months ag was noted to have beenmaintained, and the staff spoken to were overwhelming ley positive about the continuesachievement of the turnaround times for the discharge letters transcription undertaken. No delayswere identified. It was noted that the Whitehouse building could do with some externalmaintenance which may benefit the internal state of the building. Of particular note was the staffnotice board at the entrance which identified current information and the teams’ position with allmandatory training updates all staff talked positively about being up to date with all mandatorytraining and appraisals.

The engagement with porters and domestics included two Porters who were new and had onlybeen here four months and the other only two weeks. Both were very positive with no negativeword to say. They had undertaken local induction and training. However the four domestics whilsthappy with their working environment and the equipment available provided feedback that nothinghad changed and was a lack of communication of what was taking place in the Trust. Theyidentified that they met their supervisor regularly but had not had regular team meetings, howeverthey had been notified that monthly team meetings were to commence, and hoped that this wouldimprove communications.

The issue was raised around the buffing of floors; Domestics informed the team that they are notallowed to buff as patients with dementia may think the shiny floor is water, however they did notbelieve they could remove all the marks on the floor without the buffers, and they were concernedthat this may reflect on the perceived cleanliness of the Trust. This was agreed to be escalatedwith the management team. It was noted that the Domestic’s and Porters spoken to were a creditto the service they all went and helped the patients, their attitude and demeanour was first class.

of 7

The committee noted the feedback and assurance provided. Specific feedback will be provided tothe areas visited and issues identified escalated on the day of the visit or with the managementteams

Trish KallooApril 2017

of 7

Summary Aggregated Learning information –

Initial Data for March 2017 **still being validated

Incidents reported March 2017 **

New incidents (reported in month- includes delayed reports) 938

Reported with Moderate harm 20

Reported with Major harm 2

Reported with Catastrophic harm 1

Never Event 0

RIDDOR reported incidents 1

Complaints and PALS issues

New Complaints 40

New MP enquiry 0

New External complaint 0

New Enquiry 2

New PALS issues 154

Total issues received 199

Re opened Complaints 4

Issues /cases responded to 203

Complaints %age closed in agreed timescale 92%

Average time to close issues/cases (working days) 12

Number issues on-going @ time of monthly report 105

Ombudsman Cases upheld 0

Other Indicators

Mortality reviews required 51

Initial Mortality reviews undertaken at time of report within 14 days 51

Inquests with TGH involvement closed /heard 7

Coroner-Prevention of Future Death report (Regulation 28) 0

Potential claims received in month 18

StEIS reports - Internal issue 7

StEIS reports - Never events 0

Safeguarding Adult cases - Allegation on hospital care 14

Safeguarding Adult cases - Allegation on other care 4

DOLS - Cases reported to Supervisory Body 10

PREVENT - Cases reported 0

Compliments 891

of 7

Aggregated Dashboard – December 2016 – February 17 dashboard

Incidents reported December 16 January 17 February 174 month

avg trend12 monthavg trend

New incidents (reported in month- includes delayed reports) 940 982 858

Reported with Moderate harm 10 15 19

Reported with Major harm 0 1 0

Reported with Catastrophic harm 1 0 1

Never Event 0 0 0

RIDDOR reported incidents 1 1 1

Complaints and Concerns December 16 January 17 February 174 month


New Complaints 26 43 38

New MP enquiry 1 0 0

New External complaint 0 0 0

New Enquiry 3 0 0

New Concerns (PALS) issues 115 159 148

Total issues received 150 205 192

Re opened Complaints 7 5 8

Issues /cases responded to 158 176 188

Complaints %age closed in agreed timescale 96% 96% 97%

Average time to close issues/cases (days) 7 6 13

Ombudsman Cases upheld 0 1 0

Complaints & Concerns by Month by Directorate

Top Incident Causes reported withModerate harm and above

February 2017

Slips/Trips/Falls

Pressure Ulcers

Specimen Error

Medication

Failure To Follow Procedures

Staffing Issues

Top issues reported in February 2017 related to

Clinical Treatment

Communications

Prescribing

Admissions & Discharges (Excl Delayed Discharge)

Privacy, Dignity And Wellbeing

Patient Care

of 7

Top issues reported in February 2017 related to

Communications

Appointments

Clinical Treatment

Values And Behaviours (Staff)

Other

Admissions & Discharges (Excl Delayed Discharge)

Indicators December 16 January 17 February 174 month


Mortality reviews required 97 111 77

Mortality initial reviews undertaken (@time of reporting) 97 111 77

Inquests with TGH involvement closed /heard 8 11 8

Coroner-Prevention of Future Death report (Rule 43 ) 1 0 0

Potential claims received in month 14 8 10

Themes reported

Morality – themed feedback to Division for learning from reviews Consistent use of NEWS

Record keeping standards

DNAR

Re-assessment and of patients

Inquest and Coroner n/a

Indicators December 16 January 17 February 174 month avg

trend12 monthavg trend

StEIS reports – Internal issue 4 4 9

StEIS reports – Never events 0 0 0

Safeguarding Adult cases – Allegation on hospital care 14 6 15

Safeguarding Adult cases – Allegation on other care 12 9 10

DOLS - Cases reported to Supervisory Body 11 9 22

PREVENT – Cases reported to Supervisory Body 0 1 0

Compliments 1032 867 877

Themes reported

StEIS Related to Infection control and patients admitted with Pressure ulcers

Care related issues as above

Adult Safeguarding allegations/issues relate to Pressure Ulcers

General Care

Physical Abuse

Self-Neglect

1



Agenda Item 8b

Title Minutes of the Audit Committee held on 21ST

February 2017

Sponsoring Executive Director Claire Yarwood - Director of Finance

Author (s) Claire Yarwood - Director of Finance

PurposeTo inform the Board of the discussions held by theAudit Committee at its meeting in April

Previously considered by Not previously considered.

Executive Summary :

The attached reflect the minutes of the Audit Committee which met in April

Related Trust ObjectivesTo deliver against the required local andnational frameworks in order to meet all therequirements of the Trust’s operating licenceand the commissioners’ requirements

Risk Assurance – risk impacted upon 723 – Failure to ensure on-going compliancewith the terms of FT Authorisation


In breach of Licence

Financial ImplicationsNone


No


Not Applicable


The Board is asked to note the minutes from the Audit Committee.

2

AGENDAITEM 3

AUDIT COMMITTEE

Date of Meeting: 21st February 2017 Time: 9.00 am Location: Silver Springs Meeting Room

Present Position InitialMrs A Dray Non-Executive Director (Chairperson) ADMr M Taylor Non-Executive Director MT

In AttendanceMs C Yarwood Director of Finance CYMs L Hulme Assistant Director of Finance, Financial Services LHMr T Neve Trust Board Secretary TNMr J Fletcher Head of Assurance & Governance JFMrs D Chamberlain KPMG DCMr M Holden Partner Governor MHMrs J Bowles Porter Public Governor JBPMr M Husaini Public Governor MHMr N McQueen Mersey Internal Audit Agency Anti-Fraud Manager NMMr Steve Connor Mersey Internal Audit Agency SCMs S Dowbekin Mersey Internal Audit Agency SD

ApologiesMs Karen James Chief Executive KJMr P Connellan Chairman PCMrs T Kalloo Non-Executive Director TKMr P Weller Director Quality and Governance PW

Item NoDescription Action

01/2017 Apologies

As above.

02/2017 Declaration of Interests

None declared

03/2017 Minutes of the meeting held on 8th December 2017

The minutes were approved subject to the following amendments:

57/2016 – the sentence ‘SD confirmed that the following Management requests havebeen finalised; Consultant Job Plans, Medical Locums and Well Led Self-AssessmentWorkshops’ is to be corrected to read ‘SD confirmed that the Management requestre Consultant Job Plans has been finalised. Those for Medical Locums and Well Led

3

Self-Assessment Workshops are outstanding’

04/2017 Action Log

The action log has been updated as per the discussion and is attached.

05/2017 Internal Audit

5.1 - Progress Report

SD provided an update on the latest Internal Audit Progress Report and outlined thefollowing key points.

Work has been completed on follow ups and a management request for medicallocums. As previous discussed at the Committee, management requests will bepresented by management at a later date.

The follow up report has two purposes, one to review the internal processes formanaging internal audit recommendations and also to undertake an independentassessment of the position of the Internal Audit recommendations.

It has been determined that the Trust has a robust process for monitoringrecommendations and the independent assessment reconciles to what the Trust isstating.

There are a number of pieces of work in progress and the overall plan is on schedulefor completion by the end of the financial year.

CY advised the Follow Up report has been presented to the Executive Team meeting.The outstanding items were discussed and it was stressed and acknowledged that anychanges to the recommendations are documented to provide evidence for scrutiny.

5.2 - Audit Committee Update

The report was provided for information. SD highlighted the upcoming events forawareness.

5.3 - Assurance Framework Benchmarking Report

The report was provided for information and consideration. SD highlighted the keypoints for information. The review focussed purely on Assurance Frameworks and nosignificant issues have been identified within the process.

AD enquired if having a high number of risks is positive or negative, SD confirmed thatit is not a negative sign as the risks are organisationally specific and reflects how theBoard Assurance Framework is used. SC explained it is more about what works forthe Trust and the average number is around fifteen and no judgement calls are beingmade in terms of what is right or wrong. CY advised that given where theorganisation has come from in terms of being a Keogh Trust and the previous lack of

4

reporting around risks and issues the report is helpful to the Board around quality andsafety as well as the financial position. JF added the report reflects the progress theorganisation has made and confirmed high numbers are expected due to theintegration and transformation work being undertaken.

MT acknowledged the report endorses the fact that the Trust embraces risk cultureand actions are undertaken to address the issues.

5.4 - External Quality Assessment

SC presented the report and explained there is a mandatory requirement for allInternal Audit Providers to have an independent assessment against the standards.As a result MIAA have been assessed as being fully compliant with the standards, withsome areas for enhancements being identified.

06/2017 Anti-Fraud

6.1 - Progress Report

NM presented the report and outlined the items of interest.

The national fraud initiative has highlighted that the Trust had just under 500duplicate matches in total and work is ongoing to resolve the issues.

The Register of Interest is being reviewed and NM and SD have attended a DivisionalOperational Board to provide information on conflicts of interests, register of interestand general fraud awareness training. NM has attended a Cardiology Business Groupto provide a presentation of fraud awareness which included information on conflictand registers of interest and which interests need to be reported to the Trust.

The local proactive protection exercise into Supplies and Stores is ongoing and theresults are being written up and will be reported to the next meeting.

MT asked if the exercise has highlighted any serious concerns. CY acknowledgedthere are some issues regarding protocols to work on but there are no serious issuesfrom fraud perspective. It has been concluded that this exercise should have beenconducted by Internal Audit rather than the Fraud Investigator.

MT enquired if there is a material issue with regards to finance. CY advised she is notaware of any issues at this stage.

There is one ongoing investigation from 2015/16 which has now been passed to theCPS to consider prosecution.

The second investigation is in the initial enquiry stage.

6.2 - Self Review Toolkit

5

NM presented the draft version and highlighted the changes to the report and askedfor approval to submit to NHS Protect.

AD highlighted the item which states that effectiveness is monitored by the fraudSurvey and enquired whether a high number of responses have been received. NMreplied that the responses have not been high. CY suggested exploring the options tointroduce another method to collect the information.

AD asked if conflict of interest has been rated as Green due the amount of work beingundertaken to ensure the information is presented to groups of staff. NM confirmedhis continued attendance at Divisional meetings (Medicine and Surgery) and advisedthat he is also presenting at meetings with Community staff.

AD enquired how the national framework agreement related to the agency cap. CYadvised that a national review of Agencies has been undertaken and a nationalagreement has been obtained to keep the prices under the cap. This is a way ofnationally controlling the Agency prices. If Agencies meet the nationally setframework they can apply to be added to the Framework. If Agencies not on theFramework are used a report has to be submitted to NHSI.

MT requested information regarding the internal challenge process which informed theoutcome of the self-review. NH stated that NHS Protect challenge the submissionshould an inspection take place. CY acknowledged there are currently no internalforums to investigate issues around fraud and the options on how counter fraud willbe utilised across the Acute and Community services are to be explored. CY outlinedthe benefits of the Anonymous telephone contact number. SC explained an internalQuality Assurance review across a number of clients has been undertaken whichincluded calibration across the piece and advised this would provide some degree ofassurance in terms of how the Trust stands against others and the consistency interms of the way actions are undertaken.

6.3 - Fraud Investigations Benchmarking

Following the benchmarking exercise it has been determined that the Trust’s policiesand procedures provide the necessary information regarding reporting of any potentialfraudulent issues.

NM confirmed the Trust is comparable with other Trusts regarding the types of fraudreported.

07/2017 External Audit

7.1 - Audit Plan and Fees

DC presented the report and outlined the key points.

Materiality levels are £3.25m which has increased from last year and this is torecognise the increase in income following the transfer of the Community services.This means working towards a performance materiality of £2.4m and audit differences

6

over £160k will be reported.

NHS income and NHS receivables is a new significant risk which recognises theuncertainty around Sustainability and Transformation funding and also the incentivesfor Commissioners and Providers to hit the control total and how this may impact onto agree of balance for the process at year end.

Valuation of property plans and equipment was also considered a significant risk lastyear, due to the high value and potential for material misstatement. It has beenrecognised that the Trust has had a valuation in year and a paper is to be presentedto a future meeting and will be reflected appropriately in the Accounts.

Fraud risk from the management over ride controls and fraud risk from revenuerecognition are the significant risks required by the Auditing Standards and all theaudit processes are tailored to ensure they are covered throughout the audit.

The next responsibility is reaching the value for money conclusion which is describedin the report and the arrangements in place to achieve the outcomes are reviewed.

The first initial risk assessment for the BFM value for money risks is the Managementof the Trust’s cash position and the second risk is the delivery of the Trust EfficiencyProgramme which is similar to the previous year and is around achieving the financialposition and ensuring the correct arrangements are in place.

The integration of Community services has been assessed as a risk which recognisesthere has been a significant transaction in-year as a new area of business has beentaken on.

The content of the Quality Account is reviewed to ensure it matches requirements andalso to ensure this aligns to other information available. Two mandated and one localindicator (chosen by the Governors) are also reviewed to check the data quality toensure this is reported appropriately.

AD asked for clarity around the requirements for the Quality Account. JF replied thatthe work required for the Quality Account continues throughout the year, and therequirements for the Quality Account have not changed substantively. Therefore, theinformation received via the Quality and Governance Committee will support the vastmajority of the metrics which are required to be reported through the QualityAccounts. Metrics which are not submitted to the Quality and Governance Committeeare presented to Trust Board or Finance and Performance Committee as theinformation in the Quality Account also includes financial and performanceinformation.

AD enquired if any issues had been identified with outstanding debts with other NHSorganisations. CY confirmed there are currently no issues to report.

7

7.2 - Technical Update

DC highlighted two items for which actions should be considered, Publication of thenational tariff and also the very Senior Manager Guidance.

CY provided an update and advised that the new HRG 4 tariff has been implementedand the contract has been adjusted accordingly. As the contract has moved to ablock contract there will be no impact in-year. The Senior Manager guidance hasbeen adhered to in relation to the appointment of an Interim Chief Nurse.

08/2017 Charitable Funds Minutes 15th November

The minutes were noted.

09/2017 Agreement of Final Accounts Timetable 2016/17

LH provided an overview of the timetable and advised the report highlights keysubmission dates for the Committee and includes the Audit Committee dates for Apriland May. A report is to be provided to Finance and Performance Committee prior tosign off and the new Non-Executive Directors are to be invited to attend.

The Committee approved the timetable.

10/2017 Losses and Special Payments Quarter 3

LH advised that the total losses and special payments as at December is at £22k withthirteen new cases being reported.

MT asked if the Pharmacy losses relate to medication which has gone over the expirydate. LH confirmed this is correct and advised that the high number stated forOctober was due to a manual input error which has since been corrected in the report.

11/2017 Update on work plan for Annual Governance Statement

JF advised the work plan has been developed to provide context around how theQuality Governance Framework is routinely monitored and assessed throughout theyear. The framework within the paper articulates the requirements and provides acommentary on how the requirements are being fulfilled. The point of note since theprevious report is the provision of Community Services.

CY reiterated this piece of work is not a requirement but is an example of really goodpractice which provides assurance that the work is being undertaken all year roundand commended JF/PW and the Governance Team for the quality of the workproduced.

AD asked if issues are incremented each time. JF confirmed it is an incrementaldocument and advised a lot of information will be iterative from year to year and thesystems in place will identify assurance in-year that systems have been reproduced orrecycled.

8

AD cited the statement that review work is taking place to support two or three areasand asked if there is an end point of the review to support the final version. JFadvised a comprehensive Community Service review has been undertaken whichinvolved over sixty staff and fifty visits. The review also included an MIAA audit and areport is to be published around the learning disability element and the results willinform the Community Services provision, provide assurance and highlight actionswhich may need to be taken around the requirements for CQC domains.

JF advised no significant concerns were raised. The issues highlighted were aroundstrengthening leadership structures within Community and these are currently beingrealigned within the organisation. It is anticipated that before the end of March areport will be available for distribution to Divisional Teams to provide anunderstanding of what actions are required.

12/2017 Review of the Risk register BAF recommendations

JF highlighted the proposed changes to the Risk Management process and reportingarrangements and advised the proposal has been submitted to Risk ManagementCommittee and is to be presented to Quality and Governance Committee and TrustBoard.

A review of the Risk Management processes and systems has been undertaken andadvised that one of the concerns which has been identified is that focus is given tohow the risks are graded and it is proposed to introduce the concept of a target riskgap score to refocus the organisation’s view on which risks need to take priority.

A change to the way the symbols are used to provide additional clarity has beensuggested and the risk appetite has been rationalised. This will ensure the target riskrating will be vigorously assessed and the target scores set appropriately. This willalso allow the opportunity for the Board and other elements of the organisation toapply a different rigour to the implementation and mitigation actions to achieve realistexpectations of risk reduction. The other element to be included within future reportsis the concept of heat mapping.

The Committee were asked to adopt the revisions and recommendations tosignificantly strengthen the risk assessment process.

AD enquired as to where the initiative came from. JF advised the motivation camefrom the need to reduce the risk exposure and highlight the opportunities for riskreduction. If the target risk is aligned correctly the appetite for managing the riskscan be determined.

DC advised that organisations are starting to look at risk appetite and is recognised asgood practice.

DC suggested a trajectory for the risk over time is included. JF confirmed that theanticipated target achievement date is to be added to the report.

9

MT commended the paper and observed the revisions provide more granularity andstated the gap scoring matrix is a good idea. MT also suggested working out thecosts of managing this type of model. JF replied that if the focus is directed to theright place and people ask the right questions it should cost less overall.

MT commented in relation to Trust Board risk target score metric that he felt it isunusual to see a gap score of 10 being the maximum score as all others have a range.JF explained the logic for the score given the maximum risk score is 25. Howeveragreed that it should probably indicate greater than 10. A gap score of this magnitudescores would indicated that significant mitigation is possible but not yet achieved if thegap score is realistic.

MT stated his approval of the addition of the graph of risk over time within the mainpapers.

MT asked who sets the risk appetite and how is it agreed. JF explained Trust Boardwould set the this for the BAF risks and in terms of reviewing the Board AssuranceFramework on an annual basis is one of the calibrations that if the report is acceptedwould be imposed by adopting the process.

AD enquired how it will be determined that the changes are correct as there will notbe a baseline of the movements of the risks. JF explained that the heat map analysiswill be undertaken quarterly for the Board Assurance Framework risks. JF advised oneof the solutions is to have a pre-mitigation risk and a post mitigation. CY suggestedhaving a post project evaluation.

The final document will be presented to a Trust Board development session fordiscussion and final approval.

JF

13/2017 Outcome of Consultation of Managing Conflicts of Interest in the NHS

TN provided a verbal update and advised NHSE have produced new guidance and thelink will be distributed to all the Non-Executive Directors. The link is also to be addedto the intranet and the policy is to be amended to include the revisions.

Staff awareness sessions are to be arranged, along with including the informationwithin payslips.

TN

14/2017 Governance of the Care Together Programme

AD explained a significant amount of work is being undertaken strategically aroundchanges to the organisation going forward and expressed concerns around theunderstanding of how the Care Together governance arrangements mapped into theTrust’s governance arrangements in order to be sighted on risks, opportunities andcosts etc.

CY highlighted an issue with the timing for approval of the Care Together ProgrammeBoard minutes. A meeting is to be arranged between AD and CY to discuss the issuesin more detail.

AD/CY

10

15/2017 Asset valuation and Impairment

LH stated that the valuation of the assets has been identified as a significant risk andthe paper details the actions undertaken to value land, buildings and equipment.

The District Valuer has been on site and completed the valuation. Within thecalculation a gross internal area has been used to calculate the valuation and this haschanged from previous years and this is due to estates undertaking a more thoroughcalculation on the estates software system. Each change has been reviewed byEstates, finance and the District Valuer.

The element of the building which is through the PFI has not previously been valuedexclusive of VAT and as a result has reduced this element of the building value.

The figures are indicative as they are calculated on the indices and when the valuationwas performed it is showing that the valuation of the land and buildings haveincreased by around £6m.

The valuation of Equipment has to ensure the assets are still in existence and in useand also that there are no indictors that the asset has impaired. A paper has beenpresented to the Executive Team meeting and Operational Board which outlines theresponsibility for staff to manage the assets and communicate to Finance anyindications of any potential impairing event.

A list of the assets has been sent to each responsible Department Manager todetermine whether the equipment is still in existence and in use.

CY reiterated the issues around the gross internal area as this is a material changeand advised that the organisation did not have any mapping software prior to therecent purchase of MICAD. A robust assessment has been undertaken and is nowvalued appropriately.

AD asked how this cross references to the work which External Audit undertakes. DCadvised it is recommended a paper to be brought to Audit Committee to provide theinformation and assurance and explained as part of the work the information will betaken and discussed with the District Valuer to separately gain assurance. The issuearound the VAT on the PFI buildings will also be discussed.

CY advised that Trusts are only required to complete a full valuation every five yearsand desk tops valuations can be undertaken in between.

AD asked what impact will the £6m increase have on the Trust. CY confirmed this willincrease the value on the balance sheet. LH explained it could also increase thedepreciation charge which will have an impact on the I&E account. Once the indiceshave been completed the changes will be reflected within the accounts and the impactwill be forecast.

LH explained that the reduction in the PFI is classified as an impairment and this will

11

technically increase the deficit, but does not affect our control total as we aremonitored against the deficit before technical adjustments.

MT asked if this will create any issues with any of the External bodies. CY confirmedthis is not the case.

MT asked for assurance that the equipment audit has a robust process in place. LHexplained the process and advised responses are being chased weekly and assistancehas been offered to all departments. CY stated that this exercise will highlight anysignificant issues and actions can then be put in place to address these movingforward.

The Committee approved the content of the report.

16/2017 Review of Audit Committee Work plan 2017

The workplan was amended as per discussion.

17/2017 Effectiveness of the Committee

AD and LH to liaise to discuss and agree the process. AD/LH

18/2017 Internal Audit procurement

MIAA representatives left the meeting for this agenda item.

CY advised that the contract with MIAA is due to expire at the end of May andexplained a procurement exercise for the internal audit function would normally beundertaken.

However, on a Greater Manchester basis through the GM Health and Social CarePartnership a number of back office functions are being reviewed to establish if theycan be provided more economically across Greater Manchester. Greater Manchesterhas been awarded Path Finder status which is a DoH and NHSI process which putsscrutiny, review and funding to evaluate whether systems should bring together backoffice functions.

One of the assets in Greater Manchester is perceived to be Mersey Internal AuditAgency who work for a significant number of organisations across the North West.

The proposal is for MIAA to become hosted by Greater Manchester and have anagreed plan over a three year period.

The recommendation from the GMHSCP is for any Trust due to go out to the marketfor Internal Audit services over the next year to put this on hold until the process isput into place.

The paper provided articulates the options available in terms of procurementmethodology and provides a recommendation for option C to be undertaken. Option

12

C is to procure under the framework for one year with the possibility of extending fora further year if necessary.

The paper has been presented to the Executive Team meeting and option C wasrecommended. The Audit Committee were asked to agree the recommendation.

MT agreed to the recommendation in principle and asked if it is considered that MIAAprovide value for money for the service they currently provide to the Trust and askedif they are challenging enough. CY stated in her opinion MIAA do provide value formoney as the added element is the benchmarking across other organisations in theNorth West, development events are also available often at no charge to the Trustwhich also provide a network opportunity.

TN agreed that the Trust gets value for money and added they can be challengingwhen necessary.

DC confirmed that in her experience MIAA are providing good and challenging reports.

The Committee endorsed undertaking Option C.

19/2017 Attendance Matrix

The matrix was noted.

20/2017 Care Together Programme Board Minutes

These were discussed under item 14/2017

21/2017 Any other business

There was no other business.

22/2017 Summary of points to escalate to Board

Annual governance statement Review of the Risk Register and BAF Conflict of interest policy Asset valuation and impairment Internal audit procurement

23/2017 Date of Next Meeting: 25th April 9.00am – Silver Springs Board Room

24/2017 Private Discussions with Internal and External Auditors

1



Agenda Item 8c

TitleMinutes of the Finance & Performance Committee held on16th February

Sponsoring Executive Director Claire Yarwood - Director of Finance

Author (s) Claire Yarwood - Director of Finance

PurposeTo inform the Board of the discussions held by the Finance& Performance Committee at its meeting in February

Previously considered by Not previously considered

Executive Summary :The attached reflect the minutes of the Finance and Performance Committee which met inFebruary

Related Trust Objectives 5 – Develop a strategic plan to secure clinical andfinancial sustainability for the Trust in conjunctionwith the Trust’s strategic partners and keystakeholders

7 – to deliver against local and national frameworksin order to meet all the requirements of the Trust’soperating licence and the commissioners’requirements.

Risk Assurance – risk impacted upon 723 – Failure to meet, deliver Trust’s financial planLegal implications/Regulatoryrequirements

In breach of Licence

Financial Implications NoneHas a quality impact assessment beenundertaken?

No


Review financial sustainability of organisation

Action required by the BoardThe Board is asked to note the minutes from the Finance & Performance Committee.

2

FINANCE AND PERFORMANCE COMMITTEEAgenda item 2

Date of Meeting: 16th February 2017 Time: 2.00 pm Location: Board Room, Silver Springs

Present Position Initial

Mr M Taylor Non-Executive Director (Chair) MTMrs A Dray Non-Executive Director ADMrs A Higgins Non-Executive Director AHMrs C Yarwood Director of Finance CYMrs P Cavanagh Director of Operations TCMr P Nuttall Director of Performance and Informatics PN

In attendance

Mr P Connellan Chairman PCMrs K James Chief Executive KJMs A Bracegirdle Associate Director of Finance ABMs J McShane Divisional Director of Operations (Surgery - W&C) JMMs A Bromley Director of Human Resources (part meeting) ABr

Additional attendees

Ms W Brelsford Public Member – Council of Governors WB

Item No Description Action

15/2017 Apologies

Ms S Derbyshire, Mrs G Parker

16/2017 Minutes of the previous meeting 19th January 2017

Minutes of the meeting were approved as an accurate record.

17/2017 Action log

Action log has been updated as per discussion and is attached.

18/2017 Trust Efficiency Programme

4.1 Month 10 report

AB provided an update and advised £6.4m savings have been identified which is slightlybetter than plan. £1.9m of this are in year recurrent and it is forecast that the £7.8m willbe delivered of which the fill year effect is for £4.3m recurrent savings.All the teams are still being encouraged to identify further recurrent savings and accelerate

3

2017/18 saving schemes where possible.

AD asked if there is a formal process to deal with schemes which are not delivering. ABexplained that all schemes are within the tracker and if it is forecast that the scheme willnot deliver the Division will still have the same target to achieve so therefore areplacement scheme will have to be identified. CY advised if an investment had beenagreed this would cease if it was decided the scheme would not deliver the savings.

4.2 2016/17 TEP – Lessons Learned

CY stated that as part of the Audit report on the Efficiency Programme there was arecommendation which suggested a formal lessons learned exercise was undertaken andthe to-date lessons learned has been useful to help shape the programme for 2017/18.

AH asked if the budget holders will use the savings monitoring tool, AB confirmed that it isplanned for this to be available on the Trust intranet.

AB advised there is also a section for the Local Health Economy (LHE) to add the datafrom their savings schemes in order to provide a LHE savings position.

A discussion took place regarding providing the report via the intranet for NEDs to view.PN provided an update on the work being undertaken to enable external access to theintranet from non Trust devices.

PC asked where the 25% of savings (Small change/big difference schemes) which havebeen returned to Departments has been spent on. CY explained a number of departmentshave offered the funds to be used towards their efficiency target.

MT stated that the development of the TEP programme and presentation format has gonewell in 2016/17 and was positive about the enhancements being put in place for next yearand acknowledged that lessons have been learned.

4.3 Improvement in Theatre Utilisation

JM provided an overview of the presentation and advised a target for saving of a full yeareffect of £140k TEP was agreed. A number of service improvements have beenundertaken to improve start times and utilisation.

Ensure all staff are aware of the schedule for the day. Working towards a 50 week elective programme. Early bed meeting arranged – to ensure Theatres start on time. Theatre timetable has been realigned. Pre-op scheme Processes have been put in place for cancellations. Team Leaders have been assigned to each theatre corridor. A review of equipment was undertaken. The ‘Golden Patient’ process was rolled out.

Following a recommendation from an internal audit of theatres, a company called FourEyes to support the improvement journey. A significant amount of work has taken placeand theatre utilisation has increased.

4

JM advised that the Theatre Team have been shortlisted for an HSJ award andacknowledged the commitment of the team to continue to improve the service. Four Eyeshave agreed to sponsor the table at the event in order for members of the team to attend.

AD asked whether the early finishes have improved over the past few months. JMconfirmed that there are still issues with cancellations due to bed pressures which have animpact on the early finishes.

4.4 2017/18 Medical Staffing Efficiency

JM provided an update on medical staffing and advised the target of £620k has beenincreased by £60k as the Medical Staffing Business Partner was employed on a ‘spend tosave’ basis.

The forecast of the current schemes has identified a gap of around £400k. Five coreschemes have been identified to deliver the target going forward. A further £328k hasbeen identified for cost avoidance. Overall £1m recurrent savings are anticipated at year-end.

The schemes have been broken down into two categories, avoidance and efficiencies.There are two schemes in avoiding expenditure, increasing direct engagement and reviewand reduce payments above the cap and it is anticipated this will deliver around £328k.

A tender exercise is being undertaken for a employing medical agency staff and thesavings will come from the reduced commission fees. A £200k recurrent cost saving isanticipated.

Discussions are being held with JLNC regarding part of the funding for Clinical ExcellenceAwards being put towards the TEP scheme and a decision as to whether or not to offer theawards is yet to be made.

Job plans and on-call arrangements are being reviewed and £200k has been set as atarget for this scheme. The scheme has been Red risk rated as some of the work isbehind schedule. The challenge is to get the final job plans in place by the end of April atthe latest. A test case has been completed within A&E and a system and process for on-call remuneration has been agreed with the BMA.

CY explained the learning from the previous years’ experience is assisting with this year’sprocess with a realistic and achievable target being agreed. KJ acknowledged that robustsystems are now in place to facilitate the challenge with regards to job plans.

19/2017 Operational Performance

5.1 Performance Report

PN highlighted the key points in the report.

2017/18 Activity Plans

2017/18 activity levels have been agreed at a high level and are now being split byspecialty.

5

Outpatients

AD asked if there have been any specific actions undertaken to reduce the DNA rates. TCexplained that this work has been part of one of the service improvement projects andthere has been a number of initiatives around text reminder system, more notice given topatients and moving to agreeing appointments over the telephone. A focused piece ofwork has been undertaken in Paediatrics which has reduced the rate significantly. Followup rates have also been reviewed and telephone assessments have been introduced forsome of the services. An advice and guidance service for patients who do not need aface-to-face appointment is also being introduced.

Single Oversight Framework

The framework is included within the report and around 90% of the metrics are nowincluded. The remaining metrics will be included as soon as the information is available.The format of the report is to be reviewed to ensure the appropriate measures areincluded.

Community Service KPIs

The Information and Governance teams are undertaking a piece of work to agree theCommunity Service KPIs and develop a system in order to measure the KPIs.

AH asked for a breakdown of the process undertaken to set the standards for next year interms of performance targets. PN advised that most of the standards are set nationallyand local target setting come through varies different areas for example the efficiencyprogramme. AH enquired if there are any contractual issues from the Commissionerswhich are driving the standards. PN confirmed the contract KPIs are predominantly thesame as the national standards.

5.2 Financial Performance Month 10 Summary Review

AB provided a summary of the financial performance and advised that the Trust has adeficit of £14.1m at the end of January 2017 which is slightly better than plan. The Trustis now forecasting a year end deficit of £15.5m, which is better than the £17.3m deficitplan.

As it was assumed that the STF funding would not be received due to the Q3 and Q4 A&Etarget not being achieved, mitigation was but in place though a balance sheet reviewwhich identified £400k which could be used to benefit the position. In January it wasannounced by NHSI that if the financial position was improved they would match theimprovement by additional STF funding. As the position was improved by £400k anadditional £400k was allocated. A balance sheet review is undertaken on a regular basisand an additional £500k has been identified which means further matched funding will begiven from NHSI which results in the year-end deficit of £15.5m. In addition, the Trust isappealing the Q3 and Q4 STF funding related to delivery of A&E due to increased numberof patients compared to the plan. Indications have suggested this appeal will besuccessful.

Agency spend is £10.7m and it is forecast that the £12.5m NHSI target will be achieved.

6

A £17.3m loan has been agreed for this year due to the timing of the STF funding. TheDH has advised the Trust will require two different types of loan – a revenue support loanfor £13.2m (interest of 1.5%). This is repayable in 2020. The remainder of the £17.3m isan uncommitted loan (value of £4.1m) for which the Trust can be asked to repay in full atany time.

Capital expenditure is at £1.3m below the plan of £2.5m, but the forecast is to spend thefull £3m as planned.

CY advised a letter has been received from NHSI stating that the Trust is below the targetspend and a return has been submitted to provide assurance that the funding will be spentby the end of the year.

MT stated there is a risk around the independent sector expenditure. JM confirmed thatno further expenditure is planned for the remainder of the year.

PC emphasised that as the whole of Tameside and Glossop health economy will meet itstargets for this year is good news in terms of the overall credibility.

5.3 NHS Improvement Agency Cap Report

ABr provided an update and advised there is currently a reduction in agency expenditureabove the capped rates, particularly within medical staffing and there is steady decline innursing agency spend, although there has been a slight increase in early February due tosickness rates in some areas.

There has been a marked reduction in medical agency usage above the capped rate sincethe HR Business Partner for Medical Staffing commenced in post and there is now aproactive stance around recruitment. The first of the three ED consultants havecommenced in post and the other two consultants will be in post by the beginning of April.

Work is continuing with Management Teams to review the vacancy gaps and ensurerecruitment takes place in a timely way.

There are still issues with recruiting to Band 5 nursing staff. A positive interview eventtook place at the end of January and twenty four posts were recruited to. Five of the staffcan start immedicably and the rest will start later in the year.

There has been an increase in short term sickness on some of the ward areas which hashad an impact in early February and alternative options for recruitment are beingconsidered. Discussions regarding international recruitment are taking place.

There are currently seven WTE gaps within Theatres and the options to recruit to theseposts are being explored.

PC enquired if analysis is completed by day of the week and if there are any lessons to belearnt particularly in relation to sickness. ABr explained that there is a tendency forweekend shifts to experience more sickness and explained this is largely due to agencystaff picking up weekend shifts due to the additional enhancement.

AD asked what actions are being undertaken around retention. ABr advised there is aspecific Recruitment and Retention plan which is discussed at the Executive Meeting each

7

week and an action plan has been put in place. A member of the HR team is contactingstaff who have handed in their notice to ascertain what actions could have been taken forthem to remain in post and the Exit Strategy is being reviewed to ensure exit interviewsare undertaken effectively.

A pilot is being undertaken to look at self-rostering and amending shift patterns toestablish if this makes recruitment to nursing posts more attractive. A PreceptorshipNurse is o also working with newly qualified staff and the new starters to provide supportand identify any issues.

AH highlighted the high number of applications for the Clinic Fellow and Trust GradeDoctors. ABr confirmed that only the applicants who meet the person specification will beshortlisted. JM advised a rotation has been offered which has resulted in the high levels ofapplications. AB explained that the HR Medical Staffing team have been working with theDivisions and Operational Managers to look at different ways to attract applicants. Ascoping exercise is being undertaken with the Clinical Skills Facilitators to undergo atraining needs analysis to develop a training programme for nursing staff.

AD asked if the cap level is likely to change on the 1st April, AB advised there has been nonotification received that the cap will change, but there will be an impact following thechanges to the IR35 and meetings are being arranged to go through the implications toagency staff and agree actions.

MT cited the section in the report which states it is projected there will be a cost of £13magainst the cap of £12.5m, and in the Finance paper it is stated the target will be met. CYconfirmed this anomaly is due to the timings of the report the agency report contains datawhich is a month behind the finance report.

5.4 Month 10 Contract Performance

CY advised the paper outlines information on the performance against the variouscommissioner contracts.

The Trust has over performed by £275k as at Month 10 which is predominantly from theother Commissioners other than Tameside and Glossop CCG. There is currently a blockcontract with T&G CCG which has been balanced back to zero variance.

Concerns have been raised about the increased income relating to the Acute CardiologyUnit (ACU) as increased significantly from month 8. The coding of the activity on the ACUis being reviewed. MT requested an update report is provided to the next meeting.

A year-end position has been agreed with Tameside and Glossop CCG which assumesthere would not be an over performance on the contract. However, an additional £1.5mof income from Tameside Council in relation to delivery of performance targets has beenagreed.

CY provided an update following the contract meeting and advised the contract will befully signed by the end of March 2017.

JM

8

20/2017 Board Assurance Framework Risk Reporting

CY advised the report details risks and the current scores. Each risk was reviewed and thescores amended accordingly. An explanation as to how the score is agreed is to beincluded within future reports.

AF 2.1 = It was agreed to reduce the score to 8


AF 2.8 = It was agreed the score remains at 20


AF 5.1 = It was agreed to score remains at 12

TC enquired if achieving a deficit which is better than prediction is a risk to the Trustagainst agreeing the financial plan for next year. CY advised this would not be the case asthe improvement is due to one off balance sheet items and funding allocations for the STFfrom NHSI. This issue has been raised with NHSI who have indicated this will not impacton the control total issued for 2017/18.

AB

21/2017 Effectiveness of Finance and Performance Committee Review

AB explained questionnaires are to be distributed for completion before the deadline andthe results will be presented at the next Committee meeting.

22/2017 Transformation Savings Plan

Item deferred to next meeting.

23/2017Capital and Revenue Investment Group Minutes (January 2017)

The minutes have been provided for information.

24/2017 Workplan

The work plan was amended as per discussion.

25/2017 Summary of points to escalate to Board

Agency Cap report TEP Improvement in Theatre Utilisation Medical Staffing Efficiency

26/2017 Any Other Business

There was no other business

27/2017 Date of Next Meeting: 23rd March 2017 at 2pm Silver Springs Board Room



Agenda Item 9a

Title Corporate Objectives 2017/18

Sponsoring Executive Director Karen James

Author (s) Executive Team

PurposeTo request endorsement of the Corporate Objectivesfor the 2017/18 financial year

Previously considered by Discussed at Executive Management Team

Executive Summary:The attached Corporate Objectives develop the key themes from the previous year whilstincorporating challenging success criteria to allow us to demonstrate the next phase of thetrust’s continuing improvement and integration journey

Related Trust Objectives All



The successful achievement of the trust’scorporate objectives will ensure theorganisation complies with the legal andregulatory requirements of all its regulators

Financial ImplicationsThe corporate objectives have a materialimpact on the financial sustainability of thetrust.


N/A


The achievement of the CorporateObjectives directly impacts on the trust’sfuture sustainability

Action required by the BoardTo endorse the 2017/18 Corporate Objectives

2

Corporate Objectives 2017/18

Objective Draft 2017/18 Corporate Objectives Success Criteria

1.

To ensure our patients and users receive harm free care byimproving the quality and safety of our services through thedelivery of our Quality and Safety programme.

We will maintain compliance with the CQC FundamentalStandards of Care

We will maintain our overall CQC ratings at good andaspire to gain outstanding ratings in future serviceinspections

We will maintain and or increase our incident reportingrate per 1000 bed days and aim to be in the top 25% ofTrusts

We will minimize levels of severe and catastrophic harmand be below the national average of 1%

We will ensure our patient safety programme workstreams uses metrics for anticipating and predictingpotential future harm in at least five of the work streamsfor 2017/18

We will achieve the identified CQUIN metric related topatient safety

We will maintain or improve the completed eligible VTErisk assessment at an 98% or above

We will continue to seek improvement of the Trust’smortality indices (HSMR and SHMI) and maintain them inthe ‘as expected’ or “better than expected” bandings

We will continue to ensure learning from Deaths is part ofthe organisational learning and reported in line with thenational requirements

We will achieve the Single Oversight Framework metricrelated to emergency re-admissions within 30 days

2.To improve our patient and service user experience through thedelivery of a personalised, responsive, integrated, caring andcompassionate approach to the delivery of care.

We will further reduce the number of KO41 complaintsper 1000 patient contacts to below 1 complaint per 1,000patient contacts

3


We seek to increase the number of recorded complimentsand improve the Compliments to KO41 Complaints ratioby a further 20% to 40% from the Q4 2015/16 baseline.

(PROMS) Patient reported outcomes continue to bereported on for a range of conditions. We will improve ourparticipation rates for Hip and Knee procedures forquestionnaires issued by the Trust from the March 2017baseline and aspire to be better than the nationalaverage.

We will improve our organisational PLACE Scoresreported in 2017 to be at or above the 2016 nationalaverage reported scores: Cleanliness 97.57, Food andHydration 88.49, Privacy, Dignity and Wellbeing 86.03,Condition, Appearance and Maintenance 90.11 anddementia 74.51

The 2017/18 annual improvement measures for Patientand Service User Experience described in the Strategyare:

Friends and Family Testo All in-patient areas to achieve a 30% response

rate.o Maternity to achieve a 30% response rate.o ED to sustain the 25% response rate.o Adult community services to achieve a 95%

response rate.o Children’s community services to achieve a

95% response rate.o Out-patients to achieve a 20% response rate.o All areas to achieve 95% positive response

rating.NHS Survey

o Reduction in disturbance from noise in the in-patient environment.

o Improved levels of support at mealtime.

4

Objective Draft 2017/18 Corporate Objectives Success Criteriao Improved involvement in decision making

Active Patient Pathwayso A minimum of 70 patients / service users on active

pathways have been spoken to and their feedbackis being presented to the PEG.

3.

To continue to recruit and retain talented individuals.

To develop our staff and future workforce to support theintegration and transformation of our services.

We will achieve the identified CQUIN metrics related tostaff welfare.

We will deliver organisational development sessionsacross the whole system to underpin delivery ofintegration.

We will roll out a Trust wide apprenticeship programmemaximising the benefits of the apprenticeship levy; we willemploy 85 plus apprentices during 2017/18.

We will develop the current workforce within theNeighbourhood teams using the Health EducationEngland (HEE) Workforce Repository and Planning Tool(WRaPT) to review current capacity and roles andconsider alternative roles.

We will work with Neighbourhood teams and Adult SocialCare teams to further transform services within theCommunity and Primary Care.

With the Chief Nurse and Medical Director we will developrecruitment strategies and plans to enable recruitmentand retention of key roles.

We will develop engagement and communicationmechanisms and strategies to communicate with hard toreach groups to further enhance staff engagement withinthese areas

4.

To continue to align and redesign our hospital, community, socialcare, primary care, mental health and voluntary/community sectorservices in order to facilitate our integrated neighbourhoodapproach.

We will establish a senior managers forum across healthand social to understand services and opportunities andco-dependencies

We will establish new structures and governanceframeworks to support the neighbourhoods, with leadsfrom both health and social care.

We will align existing health and social care serviceswhich provide short term interventions to our patient and

5

Objective Draft 2017/18 Corporate Objectives Success Criteriaprovide a link between acute care and neighbourhoodservices into an intermediate tier.

Co-locate the intermediate tier into a single location withina community setting to facilitate integrated working.

We will simplify access to our services and ensureeffective use of resources through;

o The introduction of a single point of contact for allintermediate tier services.

o The delivery of the national e-referral programmefor all outpatient appointments.

Introduce GP streaming within our ED department toensure patients requiring access to urgent care aretreated in a timely manner by services most appropriatefor their needs.

Provide a due diligence report to the Trust Board on thetransfer of Social Care services and Commissioner ledservices which facilitates a decision on the potentialtransfer of services from the Local Authority and SingleCommissioner.

5.

To develop and support our five primary care neighbourhood hubsand key partners to enable them to deliver new integrated servicemodels in order to improve user patient outcomes throughsupporting people:

to prevent ill-health and live healthy, independent liveswherever possible;

to manage any ongoing health conditions more effectivelyin their own homes and communities;

to get easy access to joined-up services in the mostappropriate location.

We will introduce and embed person centred careapproaches and support planning and Patient Activationfor people with long term conditions;

We will systems are fully in place to support people toaccess ‘more than medicine’ services through socialprescribing within every neighbourhood.

We will co-locate neighbourhood teams into a singlelocation within each neighbourhood.

We will continue to work with the public sector partnersto develop community hubs which provide easier accessto joined up services within their communities.

We will continue to work with health, mental health andsocial care partners to deliver a core service offer anddevelop new service models to meet the specific needsof the communities they service.

We will ensure that everyone with a long term conditionwho would benefit has a person centred care andsupport plan.

6


We will commence the rollout of the Patient ActivationMeasure to 12,500 people with long term conditions.

6.

To deliver against the required local/national regulatoryframeworks and standards, in addition to securing the mosteffective and efficient use of resources to deliver services that weprovide directly or indirectly through out partner organisations.

We will achieve the identified CQUIN metrics We will maintain compliance with the CQC Fundamental

Standards of Care and maintain our overall CQC ratingsat good and aspire to gain outstanding ratings in futureservice inspections

We will continue to ensure learning from Deaths is part ofthe organisational learning and reported in line with thenational requirements.

We will ensure financial and Trust Efficiency saving plansare delivered against agreed improvement trajectories

We will ensure key performance metrics/standards aredelivered in accordance with national requirements

Achieve the Trust financial plan for revenue, capital andcash.

Delivery of audited annual accounts submitted withinrequired timescales.



Agenda Item9b

TitleNext Steps on the Five Year Forward View

SponsorKaren James

Author (s)Tom Neve

PurposeTo brief board members of the next steps on the NHSFive Year Forward view document (FYFVNS for thepurposes of this briefing)

Previously considered byThe FYFVNS has previously been considered by theExecutive Management Team and delivered to OpenHouse Forum

Executive Summary: The following is a summary of the key points contained within theFYFVNS document which was drafted by both NHS Improvement and NHS England.

Related Trust Objectives This report relates to all of the trust’scorporate objectives



This report impacts on the regulatoryrequirements from NHSI and the CQC

Financial ImplicationsThe FYFVNS will have financial implicationsfor the trust.


N/A


Directly impacts upon the organisationssustainability

Action required by the BoardTo note and discuss the summary briefing on the next steps of the five year forward view.

NHS 5 Year Forward View

Next year the NHS turns 70. New treatments for a growing and aging population mean that

pressures on the service are greater than they have ever been. But treatment outcomes are

far better - and public satisfaction higher - than ten or twenty years ago.

NHS England recently published an update on their NHS 5 Year Forward View and the

following summary serves as an update on each of their focus areas.

Urgent and Emergency Care

The key item to note here is the adjustment to the 95% A&E standard which we will be

required to meet. This is in line with what was announced in the Government’s 2017/18

mandate to the NHS.

These changes are:

• before September 2017 over 90% of emergency patients are treated, admitted or

transferred within 4 hours (up from 85% currently being delivered)

• the majority of trusts will have to meet the 95% standard in March 2018

By October 2017:

• Every hospital must have “comprehensive front-door clinical streaming”.

• Every hospital and its local health and social care partners must have “adopted good

practice to enable appropriate patient flow”. This includes better hand-offs between

A&E and acute physicians, ‘discharge to assess’, ‘trusted assessor’ arrangements,

streamlined continuing healthcare processes, and seven day service (7DS)

discharge capabilities.

By March 2018:

• Trusts should work with local councils to ensure that the extra £1 billion provided in

the March 2017 budget for adult social care is used in part to reduce delayed

transfers of care (DTOC), thereby helping to free up 2000-3000 acute hospital beds.

Progress against this figure “will be regularly published” - the document does not say

by whom or how frequently.

• ensure that 85% of all assessments for continuing health care funding take place out

of hospital in the community setting,

• Implement the “High Impact Change Model” for reducing DTOCs.

It also notes a range of actions that the national bodies will undertake:

• Roll-out by spring 2018 of 150 standardised new ‘Urgent Treatment Centres’ which

will open 12 hours a day, seven days a week, integrated with local urgent care

services.

• Implement the recommendations of the Ambulance Response Programme by

October 2017, putting an end to long waits not covered by response targets.

It also notes a range of actions that the national bodies will undertake regarding NHS 111

and primary care:

• Enhance NHS 111 by increasing from the proportion of 111 calls receiving clinical

assessment by March 2018,

• By 2019, NHS 111 will be able to book people into urgent face to face appointments

• Roll out evening and weekend GP appointments, to 50% of the public by March 2018

and 100% by March 2019.

To support these changes, the FVFVNS outlines the following support measures:

£100m in capital funding, as announced in the budget, to support modifications to

A&Es to enable clinical streaming by October 2017.

Referral to Treatment Waiting Times

The document makes reference to the referral to treatment time 18 week 92% target. It says:

“Looking out over the next two years we expect to continue to increase the number of NHS-

funded elective operations. However given multiple calls on the constrained NHS funding

growth over the next couple of years, elective volumes are likely to expand at a slower rate

than implied by a 92% RTT incomplete pathway target. While the median wait for routine

care may move marginally, this still represents strong performance compared both to the

NHS’ history and comparable other countries.”

Integrated Care

The Five Year Forward View (Next Steps) document has a chapter dedicated to integrating

care. This provides two main functions:

1. Outlining key areas of clarification for STPs (now referred to in the document as

Sustainability and Transformation Partnerships), accountable care system and

accountable care organisation integration models

2. Outlining new policy changes associated with these models

Other areas of interest…

1. Free up 2000 to 3000 hospital beds

• Using the extra £1bn awarded to adult social care in the last budget hospital trusts

“must now work with their local authorities, primary and community services to

reduce delayed transfers of care.”

2. Further clamp down on temporary staffing costs and improve productivity

• Trusts are set a target of cutting £150m in medical locum expenditure in 2017/18.

NHSI will require public reporting of any locum costing over £150,000 per annum.

3. Use the NHS’ procurement clout

• All trusts will be required to participate in the Carter Nationally Contracted Products

programme, by submitting and sticking to their required volumes and using the

procurement price comparison tool.

4. Get best value out of medicines and pharmacy

• NHSI support trusts to save £250m from medicines spend in 2017/18 by publishing

the uptake of a list of the top ten medicines savings opportunities, and work with

providers to consolidate pharmacy infrastructure

5. Reduce avoidable demand and meet demand more appropriately

• NHS provider trusts will have to screen, deliver brief advice and refer patients who

smoke and/or have high alcohol consumption in order to qualify for applicable CQUIN

payments in 2017/18 and 2018/19.

6. Reduce unwarranted variation in clinical quality and efficiency

• Trusts to improve theatre productivity in line with Get it right first time (GIRFT)

benchmarks and implement STP proposals to split ‘hot’ emergency and urgent care

from ‘cold’ planned surgery clinical facilities for efficient use of beds.

7. Estates, infrastructure, capital, and clinical support services

• The NHS and Department of Health are aiming to dispose of £2bn of surplus assets

this parliament, following recommendations from the forthcoming Naylor review.

8. Cut the costs of corporate services and administration

• NHSI is targeting savings of over £100m in 2017/18, from trusts consolidating these

services, where appropriate across STP areas. NHSI is also establishing a set of

national benchmarks.

Mental Health

• Expand the mental health workforce – 800 mental health therapists embedded in

primary care by March 2018, rising to over 1500 by March 2019.

• Reform of mental health commissioning so that local mental health providers control

specialist referrals and redirect around £350m of funding.

Clear performance goals for CCGs and mental health providers, matched by unprecedented

transparency using the new mental health dashboard

Cancer

What still needs to be achieved?

• Introduction of a new bowel cancer screening test for over 4m people from April

2018.

• Introduce primary HPV testing for cervical screening from April 2019 to benefit 3m

women per year.

• Expand diagnostic capacity so that England is meeting all 8 of the cancer waiting

standards.

• Performance incentives to trusts for achievement of the cancer 62-day waiting

standard will be applied to extra funding available to our cancer alliances.

• 23 hospitals have received new or upgraded radiotherapy equipment in early 2017,

and over 50 new radiotherapy machines in at least 34 hospitals will be rolled out over

the next 18 months.

Workforce

• A new nurse retention collaborative run by NHSI and NHS Employers will support 30

trusts with the highest turnover.

• A consultation will be launched on creating a Nurse First route to nursing, similar to

the Teach First programme.

• NHSI will publish guidance on effective electronic rostering.

Undergraduate medical school places will grow by 25% adding an extra 1500 places,

starting with 500 extra places in 2018 and a further 1000 from 2019.

Technology

• By summer of 2017 GPs will be able electronically to seek advice and guidance from

a hospital specialist without the patient needing an outpatient appointment.

• In the summer 2017 an updated online patient appointment system will be launched,

providing patients with the ability to book their first outpatient appointment with

access to waiting time information on a smartphone, tablet or computer.

• The NHS e-Referral Service is currently used by patients to arrange just over half of

all referrals into consultant-led first outpatient appointments. By October 2018 all

referrals will be made via this route, improving patients’ experience and offering real

financial and efficiency benefit.

• By December 2018 there will be a clear system in place across all STPs for booking

appointments at particular GP practices and accessing records from NHS 111, A&Es

and UTCs

TAMESIDE & GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST

Report to Public Trust Board meeting of the 27th April 2017Agenda Item 9c

Title Care Together Implementation Plan

Sponsoring Executive Director Trish Cavanagh

Author (s) Stephanie Sloan

Purpose To provide the Trust Board with an overview of the CareTogether programme implementation plan

Previously considered by NA

Executive Summary: The paper provides the Trust Board with a high level implementationplan for the next two years for the schemes led by the ICFT within the Tameside andGlossop Care Together transformation programme

Related Trust Objectives This report relates to:Objective 4 –The development of the CommunityIntegration Plans to support the systems integrationstrategy.Objective 5 – to work with our local communities,partners and stakeholders to develop a new modelof integrated care, central to our five yearsustainability and transformation plan.Objective 6 – To deliver against the required localand national frameworks, as part of GreaterManchester Health and Social Care Devolution.

Risk Assurance – risk impacted upon AF3.3(3532)Failure to identify and/or deal with externalopportunities and threats, particularly in the contextof choice and not maintaining and securing place inthe market


This report imparts on the Trust complying with theterms of its Provider license

Financial Implications None


NA


NA

Action required by the BoardThe Board is asked to discuss the update on the models of care and progress to date.

Care Together Implementation Plan

1. Introduction

1.1. This paper provides the Trust Board with a high level implementation plan for the projects

included within the Tameside and Glossop transformational programme, Care Together

which the ICFT has responsibility for delivery of.

1.2. The implementation plan is underpinned by a governance and assurance structure including;

Detailed project documentation for each individual project included in the programme,

including project plans, risks, financial modelling, quality impact assessments and key

performance metrics to monitor impact and benefit realisation.

An overarching implementation plan to map interdependencies and critical path.

A programme risk register to monitor the risks of the programme to the Trust.

An oversight group to monitor progress of the schemes within the programme chaired

by the Executive Director of Operations.

1.3. The implementation plan is a live document and will be monitored and updated on a

monthly basis to assure progress against plan.

2. Implementation Plan

2.1. The implementation plan is provided at appendix one.

3. Recommendation

The Trust Board is asked to note and discuss the Care Together implementation Plan

T&G Integrated Care FT - CARE TOGETHER PROGRAMME IMPLEMENTATION PLAN Appendix 1

PROJECT /MILESTONE

2016/17 2017/18 2018/19

Q1APRIL – JUNE 17

Q2JULY – SEPT 17

Q3OCT – DEC 17

Q4JAN – MAR 18

Q1APRIL – JUNE 18

Q2JULY – SEPT 18

Q3OCT – DEC 18

Q4JAN – MAR 19

DIGITAL HEALTH Advanced Nurse Practitionercommenced

Digital Health Pilot launched in 4care homes & Stamford Unit6/3/17

32 contacts in first 4 weeks (12ED attendances & 8 GP call outsavoided)

Digital Health rolled out toCommunity Response Service1/4/17

New Digital Health staffcommence 8/5/17

Digital Health Service hoursextended 8am – 8pm

Roll out of digital health to all T&G care homes BENEFITS DELIVERYReduction in EDattendances from carehomes.

Reduction inemergency admissionsfrom care homes.

Reduction in GP callouts from Care Homes

Develop Digital Health phase twoReview opportunities to link tocommunity Telehealth / serviceexpansion to other economies /infrastructure use for Advice &Guidance

Roll out Digital Health PhaseTwo

HOME FIRST Home First pilot launched July2016 (wards 41 & POU) rolled outto all wards by January 2017

July 16 – Mar 17 423 patientsreferred for Home Firstassessment & 758 bed dayssaved.

BENEFITS DELIVEREDTrust reduced Delayed TransfersOf Care (DTOC) bed days by33,6% between July 2016 and Feb2017

Additional Health and Social carestaff commence in post toincrease Home First Capacity

Embed Home First model across Acute, community and social care services BENEFITS DELIVERY

Reduction in DTOCs from Acute beds for patients awaiting assessment.

Reduction in emergency admissions through step up services and homefirst in-reach to ED

FLEXIBLECOMMUNITY BEDS

1st Floor of Stamford Unitoperational for Winter Capacity.

Notice Served to Grange View forClosure of Intermediate care beds

Grange View Service Closes 30th

June 2017 (40 Beds).

ICFT to provide all flexiblecommunity beds from Shire Hill(36 beds) and Darnton House (64beds).

BENEFITS DELIVERYclosure of 8 communityBeds 1/7/17 fromGrange View.

Embed flexible community bed model in allcommunity beds.

BENEFITS DELIVERY

Reduction in DTOCs from Acute beds for patients awaiting communitybeds.

Step up capacity available in flexible community beds

GP STREAMING INACCIDENT ANDEMERGENCY

Submit Bid for capital funding tosupport estate works toreconfigure space to delivery GPstreaming in A&E

Activity analysis to map demandfor ED streaming

Development of proposal for A&EStreaming.

Draft Proposal for A&E Streamingpresented at A&E Delivery boardand JMT for discussion andapproval (May 17)

Approval of proposal for A&EStreaming (June 17)

Estate & IT works toenable GP streaming atA&E

Communications acrossall Stakeholders

Commencement of GPstreaming in A&E in linewith national timetable(Oct 17)

SOCIAL CARETRANSFER

Development of Strategic Outlinecase for the transfer of Adultsocial care to ICFT

Adult Social Care Transformationgroup established, led by the

Submission of Strategic OutlineCase for transfer of social careservices to Trust Board / NHSI /SCF for approval (May 2017)

Development of social caretransfer implementation plan

Submission of OutlineBusiness Case fortransfer of social careservices to Trust Board /NHSI / SCF for approval(Aug 2017)

Submission of FullBusiness Case fortransfer of social careservices to Trust Board/ NHSI / SCF forapproval (Dec 2017)

Public & Staffengagement

Implementation of theSocial care transferplan.

Transfer of Socialcare services toICFT complete(April 18)

Director of People at TMBC. including staff and publicengagement Due Diligence Due Diligence

Due Diligence

T&G Integrated Care FT - CARE TOGETHER PROGRAMME IMPLEMENTATION PLAN

PROJECT /MILESTONE

2016/17 2017/18 2018/19

Q1APRIL – JUNE 17

Q2JULY – SEPT 17

Q3OCT – DEC 17

Q4JAN – MAR 18

Q1APRIL – JUNE 18

Q2JULY – SEPT 18

Q3OCT – DEC 18

Q4JAN – MAR 19

INTEGRATEDNEIGHBOURHOODSInfrastructure

5 Integrated Neighbourhoodsidentified.

Structures and governanceframework agreed.

Intermediate Tier of servicesbrought together into a singlestructure to supportneighbourhoods

Core offer and Transformationalfunding prioritised for theNeighbourhood programmeagreed.

Co – location of Intermediate tierservices into Cricket’s lane30/6/17

Glossop Neighbourhood teamcollocated in Glossop PrimaryCare Centre (May 17)

East/Stalybridge, Mossley &Dukinfield Neighbourhood team(health and Social care) co-located into Stalybridge Civic Hall(May 17)

North/AshtonNeighbourhood team(Health and Social care)co-located into AshtonPrimary Care Centre

West/ Droylsden,Denton & AudenshawNeighbourhood team(Health & Social Care)co-located into DentonFestival Hall

South / Hyde, Mottram,Hattersley &LongendaleNeighbourhood Team(Health and Social Care)co-located

Development of an Intermediate Tier SinglePoint of Contact (SPOC) including call centretechnology, admin and clinical triage.

Single Point ofContract (SPOC)for intermediatetier servicesoperational(Sept 18)

INTEGRATEDNEIGHBOURHOODSExtensivists

Extensivist service model, criteriaand standard operatingprocedures approved

2 GP Extensivists in post (1 April& 1 May).

Extensivist service cohortidentified and review undertaken.

Extensivist service pilot May –July 17

Extensivist service fullyoperational (30 Sept 17)

BENEFITS DELIVERY

Reduction in ED attendances for Extensivist cohort.

Reduction in emergency admissions for Extensivist cohort

INTEGRATEDNEIGHBOURHOOSCommunity IVTherapy

Recruitment of IV therapy posts.

Agree referral and treatmentpathways and protocols

Primary care and acuteengagement

Commence communityIV therapy 7 day service

BENEFITS DELIVERY

Reduction in admissions to acute beds for patients requiring IV therapy treatment.

Reduction in length of stay for patients requiring IV therapy regime.

INTEGRATEDNEIGHBOURHOODSAdvice & Guidance

Pilot Advice and Guidanceservices in Cardiology &Paediatrics

BENEFITS DELIVEREDReduction in outpatientattendances for patients usingA&G services

Develop service model, pathways and protocols forcommunity based Paediatric MDT Advice and Guidance(A&G) clinics

Roll out community based Paediatric MDT A&Gclinics

Develop A&G phase twoReview opportunities to use Digital Health infrastructure for A&G,opportunities to roll out A&G across other services

INTEGRATEDNEIGHBOURHOODSSelf Care

Patient activation Measures(PAM) pilot launched

Workforce educationalprogramme for self-carelaunched

Glossop ‘More than Medicine’social prescribing servicelaunched (April 17)

Tameside Social prescribingprovider appointed (June 17)

Tameside & Glossop asset basedprovider appointed

Tameside SocialPrescribing serviceoperational

Asset based grantsawarded

Self care Socialmarketing and social

BENEFITS DELIVERY

Reduction in Acute growth

movement strategylaunched

T&G Integrated Care FT - CARE TOGETHER PROGRAMME IMPLEMENTATION PLAN

PROJECT /MILESTONE

2016/17 2017/18 2018/19

Q1APRIL – JUNE 17

Q2JULY – SEPT 17

Q3OCT – DEC 17

Q4JAN – MAR 18

Q1APRIL – JUNE 18

Q2JULY – SEPT 18

Q3OCT – DEC 18

Q4JAN – MAR 19

COMMUNITY ITSYSTEM

Phased Implementation of community EMIS (complete June 17)

WORKFORCE 3 neighbourhood managersrecruited and in post &5Neighbourhood GP leads in placeas part of the ICFT leadershipteam

Developed a senior managersforum across health and socialcare

Established baseline staffing inintermediate tier andneighbourhoods.

Undertake Organisational development programmeincluding;

Whole system scenario workshops supported byRothwell Douglas

Neighbourhood workforce

Undertaken Workforce analysis review including;

data compilation and analysis using the WRaPT tool andanalysing each to determine skills/capacity,

Analysis of activity data in line with initial modellingsuggestions and assessment alignment between activityand WF.

Mapping patient journeys across the current services toidentify areas of duplication and waste

Develop Neighbourhood Workforce Development Planbased on clinical models and WRaPT assessment

Support Neighbourhood teams to review roles, activities, task and competencies to develop the role requirements for theintegrated neighbourhood workforce.

TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION …€¦ · TAMESIDE AND GLOSSOP INTEGRATED...

Documents

Transcript of TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION …€¦ · TAMESIDE AND GLOSSOP INTEGRATED...