Trust Board Meeting: Wednesday 22 January 2014 TB2014.13

Title

Status

History

Board Lead(s)

Key purpose

Trust Board Meeting: Wednesday 22 nd

January 2014

TB2014.13

Review of progress in delivering 2013/14 Trust Business

Plan

For information

The Trust Business Plan for 2013/14 was approved by the Trust

Board on 10 July 2013 (TB2013.85)

Mr Andrew Stevens, Director of Planning and Information

Strategy Assurance Policy Performance

TB2014.13 Review of progress in delivering 2013/14 Trust Business Plan Page 1 of 37

Oxford University Hospitals TB2014.13

Executive Summary

1. This paper summarises the progress against the corporate objectives set out in the

2013/14 Trust Business Plan.

2. The Business Plan contained some short term and long term objectives.

3. Overall good progress has been made.

4. Key areas for more attention in the coming months include:

•

Achievement of performance standards

•

Continued focus on safety, including infection control

•

Reduction of turnover and sickness

•

Achievement of planned CIP when activity levels are higher than commissioned

•

Optimising the configuration of clinical services and the use of the Trust’s estate

•

Improving the response rate for the Friends and Family Test

•

Increasing the screening of patients for dementia

Plans for addressing these areas are included in other Board papers and will be incorporated into the Trust’s Business Plan for 2014/15.

5. Recommendation

The Trust Board is asked to note this report.



ABBREVIATIONS

AGM Acute General Medicine

AHSC Academic Health Science Centre

AHSN Academic Health Science Network

BRC/U Biomedical Research Centre/Unit

CCG Clinical Commissioning Group

CIP Cost Improvement Programme

CQC Care Quality Commission

CQUIN Commissioning for Quality and Innovation

CSW Care Support Worker

ED Emergency Department

EDD Estimated Date of Discharge

EMU Emergency Medical Unit

EoL End of Life

ERAS Enhanced Recovery After Surgery

FT Foundation Trust

GET

GI

Gastroenterology, Endoscopy and Churchill Theatres

Gastrointestinal

GMC General Medical Council

GUM Genitourinary Medicine

HDR High Dose Rate

HDU High Dependency Unit

HGH Horton General Hospital

IM&T Information Management and Technology

IMRT Intensity Modulated Radiotherapy

IOFM Intra Operative Fluid Management

ITU Intensive Therapy Unit

JR

KPI

John Radcliffe

Key Performance Indicator

LiA Listening into Action

MDT Multi-Disciplinary Team

MRI Magnetic Resonance Imaging

MRSA Methicillin-resistant Staphylococcus aureus

MTC Major Trauma Centre

NHSLA National Health Service Litigation Authority

NICE National Institute for Health and Care Excellence

NOC Nuffield Orthopaedic Centre

NSPCC National Society for the Prevention of Cruelty to Children

NTSS Neurosciences, Trauma and Specialist Surgery (now NOTSS - Neurosciences,

Orthopaedics, Trauma and Specialist Surgery)

OBC Outline Business Case

PALS Patient Advice and Liaison Service

PLICS Patient Level Information and Costing System

Q

QA

Quarter

Quality Assurance

QIPP Quality, Innovation, Productivity and Prevention

SHDS Supported Home Discharge Service


Oxford University Hospitals

SLR Service Line Reporting

SOC Strategic Outline Case

SOP Standard Operating Procedure

Surgery & Oncology S&O

TDA

TME

ToR

Trust Development Authority

Trust Management Executive

Terms of Reference

VBI

VTE

Value Based Interviewing

Venous thromboembolism

TB2014.13



Review of progress in delivering 2013/14 Trust Business Plan

TB2014.13

1. Purpose

1.1. This paper provides an update on the delivery of the corporate objectives set out in the Trust’s 2013/14 Trust Business Plan. The plan was approved by the

Trust Board on 10 July 2013 (TB2013.85)

2. Background

2.1. Each objective has been reviewed in conjunction with the director accountable for its delivery. More detail has been added to some of the actions, milestones and measures.

2.2. Progress as at the end of December 2013 is provided in the table below.



Ref Objective Accountable

Director

Key Actions Milestones/Measures Progress year to date as at end of

December

SO1 To be a patient-centred organisation, providing high quality, compassionate care with integrity and respect for patients and staff

– “delivering compassionate excellence”

1.1

Respond to the recommendations of the Public Inquiry into the Mid

Medical Director Agree actions that the

Trust should take in response to the report and implement

•

Agreed action plan

•

Report on implementation

Reports of the Mid-Staffordshire

NHS Foundation Trust Public

Inquiry (Francis 2), Professor Don

Berwick’s review of arrangements

Staffordshire NHS

Foundation Trust (the

Francis Report) for patient safety and Professor Sir

Bruce Keogh’s examination of 14

NHS Trusts with higher than expected mortality have been thoroughly examined by the Trust.

They have been considered by the

Clinical Governance Committee,

Trust management Executive and

Trust Board on a number of occasions. A paper outlining the

Trust’s overarching response was considered and accepted by TME in

August 2013. The paper outlined 21 actions and initiatives that will over time further strengthen systems, processes and culture within the

OUH in response to the issues identified in the wider NHS.

Together, these actions and initiatives represent a blueprint for the Trust. However, it is recognised that the necessary work will need to take place over years and that individual initiatives and



Ref Objective

1.2

Sustain and improve staff engagement and empowerment

Accountable

Director

Chief Nurse

Key Actions

Clarify and refresh reporting of nurse sensitive indicators from

“Ward to Board”

Director of Workforce Create alignment of individual, team and

Trust objectives

Director of Workforce Listening into Action

(LiA) methodology adopted at Divisional, directorate and departmental level

Director of Workforce Complete implementation of value based recruitment, appraisal and customer care training

TB2014.13

Milestones/Measures Progress year to date as at end of

December workstreams should only be commenced if they can be completed. From the initiatives outlined, the Trust prioritised a series of peer review visits and risk summits. These are on-going and progress of each has been, and continues to be, reported to TME and the Trust Board.

Indicators and reporting

Ward sensitive indicators are being reviewed as part of a review of staffing capacity and capability.

This has been reported to TME and

Trust Board.

Year on year improvement in staff survey results

Demonstrable service and quality improvement from LiA

Staff receiving regular feedback about behaviours and performance

Implementation of new eAppraisal system will provide an enabler supported by management development and HR Business

Partners and consultants

LiA second wave project teams making progress with some LiA events occurring in Divisions with plans to use to support embedding new Divisional structure Q4 and beyond.

Value Based Interviewing (VBI) project is now entering “spread and embed” phase. Divisional leadership briefings workshops commenced in

Q3. To date 200 VBI interviews undertaken including those for

Director of Workforce. 50 individuals



Ref Objective

1.3

Improve Quality

Accountable

Director

Chief Nurse

Chief Nurse

Medical Director &

Chief Nurse

TB2014.13

Key Actions

Identify value based interviewing implications for ward leadership

Align the “6Cs”

1

into

Trust values work

Deliver agreed quality priorities across 3 quality domains


December recruited.

Implications identified VBI methodology being used for senior level recruitment and being

Document indicating alignment piloted for care support workers.

Existing Delivering Compassionate

Excellence programme reflects the

6Cs. This work will be developed as part of a new Nursing Strategy in

2014.

The 6Cs are being incorporated into new Band 5-9 job descriptions.

As per Quality

Account

For 2013/14 local quality priorities were set across the 3 quality domains. Progress in delivering

Divisional priorities is reported to

Divisional Governance forums and monthly to the Clinical Governance

Committee. a) Domain 1: Safety

Minimise Healthcare

Associated Infection

Medical Director

Increase percentage of patients free from harm as assessed by NHS

Safety Thermometer

Chief Nurse

Ensure a Post Infection

Review is carried out for all MRSA infections

Reduce harm from pressure ulcers

1

Care, Compassion, Competence, Communication, Courage, Commitment

TB2014.13 Review of progress in delivering 2013/14 Trust Business Plan

Incidence of MRSA and Clostridium difficile infections

Achieve NHS “Safety

Thermometer” CQUIN

As at the end of November there had been 3 cases of MRSA against a standard of 0 and 37 cases of

Clostridium difficile against a standard maximum of 70 cases for the financial year.

Not currently achieving target reduction due to reporting methodologies in 12/13.

Page 8 of 37



Director

Minimise venous thromboembolism

(VTE)

Medical

Director/Director of

Clinical Services b) Domain 2: Patient Experience

Introduce Friends and Chief Nurse

Family Test

Improve Dementia

Care

Key Actions

Continue to improve VTE assessment


December

Achieve CQUIN Achieved

•

Medical Director

•

Chief Nurse

•

Introduce test for:

-

All inpatients and

ED patients from

Apr 13

-

Women who have used maternity services from

Oct 13

•

Complete procurement for wider patient feedback system

•

Improve screening for dementia

•

Improve referral to specialist services of identified patients

•

Clinical leadership and training

•

Support to carers

Achieve CQUIN

Achieve CQUIN


TB2014.13

Friends and Family test introduced for inpatients and in ED and maternity services. Results analysed and reported through

Divisional structures and to the

Quality Committee.

Overall response rate for Q3 was

16% against a CQUIN target of

20%. Work is in place to increase performance.

•

Although there has been some improvement in the number of patients being screened for dementia, the Trust’s performance is still considerably below target.

Local feedback to areas

(Trauma and AGM) has begun in order to enable local engagement. This will be expanded in Q4.

•

To date 428 staff have been funded to attend dementia training facilitated by Oxford

Brookes University, 18 staff have attended the Dementia

Page 9 of 37


Ref Objective

Improve service to patients requiring a wheelchair

Accountable

Director

Director of Clinical

Services c) Domain 3: Effectiveness and Outcomes

Develop/extend the use of intra-operative fluid management

(IOFM) technologies for patients during and after surgery


Services

Improve medical outreach to older people with complex needs who are patients


Services


TB2014.13

Key Actions

Develop an action plan to improve processes for timely referral and assessment of children requiring wheelchair equipment


December

Meet requirements of

‘Child in a Chair in a

Day’ (specialist wheelchairs) CQUIN prequalification

(5 week wait from referral to assessment)

Leaders programme and 18 staff the ward level programme facilitated by Oxford Health NHS

FT.

•

All new CSWs receive a one hour session on dementia awareness (128 staff since

Apr 13).

•

Dementia café rolled out.

•

Capital project being progressed for Dementia friendly ward.

Q2 performance 94 – 98%. There is no formal target.

Work continuing to review and identify problem areas e.g. home visits.

Q3 performance currently being analysed but verbal feedback of no new issues


CQUIN prequalification (Use

IOFM - 80% for agreed procedures.

Q3 target = 50 per month / total 150)

Achieve CQUIN

On target.

Achieving CQUIN. A Senior House

Officer and Consultant have been employed to focus on this.

Page 10 of 37



Director

Key Actions in surgical areas

Build capacity in the organisation for clients with learning disabilities, dementia and vulnerabilities

Chief Nurse/Director of Clinical Services

Increase neurologist involvement in management of people with learning disabilities who present with seizures

Identify champions

Training


TB2014.13


December

•

Number of Learning

Disability champions who have attended training

•

Achieve CQUIN

•

Improved outcomes for vulnerable patients

CQUIN target met (relates to improved outcomes for patients with

Learning disability who present with seizures).

A report was presented to the

Dec 13 Quality Committee meeting which identified a range of improvements, including those listed below.

The identification of learning disability champions across the

Trust is on-going, with a particular focus on Emergency Medicine.

Training on the provision of healthcare to patients with learning disabilities is embedded within current training frameworks for

Safeguarding, Equality and

Diversity, the Preceptorship course for nurses, CSW and overseas nurses’ induction.

Specific training is delivered to

CSWs in Neurosciences and individualised training to learning disability champions.

Training for medical staff and Allied

Health Professionals is in the process of being developed.

A learning disability awareness training DVD has been developed.

Page 11 of 37



Director


December

The Trust has an established

Learning Disability Working Group.

Other improvements include:

•

A good range of easy to read information is available throughout the organisation, including procedures and consent, PALS and complaints, treatment options and appointments.

•

An established Trust Tracking and Flagging group which is developing a system to identify people with learning disabilities who use the Trust’s services.

•

Audit by the Learning Disability

Acute Liaison nurse of reasonable adjustments required by and provided to individuals

•

Promotion of the community

Learning Disability Teams to

Trust staff and monitoring of referrals made to them.

1.4

Maintain/deliver national and local performance standards (figures marked with a * represent year to date performance)

Referral to treatment Director of Clinical •

Delivery of theatres

≥ 90% admitted

91.1%* waiting times for nonServices workforce plans patients to start urgent consultant-led treatment within treatment 18 weeks

≥ 95% non-admitted patients to start

96.6%* treatment within

18 weeks




Director

Diagnostic test waiting times


Services

A&E waits and

Ambulance Handovers


Services

TB2014.13

Key Actions

•

Introduce 6 day working in endoscopy

•

Review ultrasound and musculoskeletal

MRI provision

•

Agree and implement action plan to support delivery

•

Respond fully to recommendations of

Emergency Care

Intensive Support

Team

•

Ensure all patient pathways are clearly defined and effective

•

Ensure all Divisions are engaged

•

Establish Therapies

Rapid Response

Service, working with

SHDS to avoid admissions

•

Ensure there is a process in place to escalate potential


December

≥ 92% incomplete pathways within

18 weeks

92.9%*

32 to the end of November No referral to treatment times

>52 weeks

<1% of patients waiting 6 weeks or more for a diagnostic test

≥ 95% patients admitted, transferred or discharged within

4 hours of their arrival in ED

Although the year to date figure is

8.1%, as at the end of December this had been reduced to 1.4%.

94.2%*

No waits over 12 hours Maximum 12 hour trolley wait in ED

Handovers between ambulances and ED

Department within

15 minutes (standard

95%)

Achieve CQUIN

(“Emergency Care

Intensive Support

Team Action Plan”)

81.9%* (performance for November was 89.84%)

Currently on target against action plan. Additional practitioners are in place in the ED.



Ref Objective

Cancer Waits

Accountable

Director


Services

Cancelled operations Director of Clinical

Services

TB2014.13


December breaches to the appropriate level of management

•

Consolidate and develop Children’s

Urgent Care Pathway

•

Introduce 7 day working on linear accelerators

•

Achieve agreement for the Outline Business cases to expand radiotherapy capacity

Review theatre utilisation and list management/planning

93% of patients seen within 2 weeks of an urgent GP referral for suspected cancer

96% of patients receiving 1st definitive treatment within

1 month of cancer diagnosis

85% of patients receiving 1st definitive treatment for cancer within 62 days of an urgent GP referral for suspected cancer

Where subsequent treatment is radiotherapy 94% of patients receiving treatment within

31 days

All patients who have operations cancelled, on or after the day of admission (including the day of surgery),

95.3%*

97.5%*

82.5%*

95.4%*

Although the year-to-date figure as at the end of November was 14.6% not rebooked within 28 days, this figure is likely to be overstated due to incomplete validation of Q1 data.




Director

1.5

Strengthen nursing care (linked to recommendations of

Francis report)

Chief Nurse

TB2014.13

Key Actions

Evaluate and benchmark ward based nurse staffing levels at least annually


December for non-clinical reasons to be offered another binding date within 28 days, or the patient’s treatment to be funded at the time and hospital of their choice

The percentage who had not been rebooked at the end of November was 2.22%.

No patient to be cancelled for a second time for an urgent operation

Evaluation and benchmarking

No patients cancelled a second time.

Agreed Competency framework

Q3 have used Safer Nursing Care tool to determine the levels of staff required in adult ward areas and reported this to Trust Board. This will be done bi-annually to determine safe levels of staff. This incorporates patient acuity and dependency. This data can be benchmarked against the Shelford

Group.

This work in on-going. Progress Modernising

Nursing Careers plan in relation to Band 8 nurses and midwives

Review and relaunch

Band 7 Leadership

Programme

At least 2 cohorts of the programme run

In total 48 staff have now completed the leadership programme (3 cohorts). The next cohort is due to start in February with 18 staff already booked onto it from ward and critical care areas.



Ref Objective

1.6

Optimise

Configuration of

Patient Services

Accountable

Director


Services


Services

Key Actions

Review and expand

Healthcare Assistant

Academy

Consult on future delivery of emergency surgery across the Trust, develop plan and implement

Maximise the use of the

Horton General Hospital to improve services in the north of Oxfordshire


TB2014.13


December

Run monthly programmes

Patient feedback has highly commended the Trust’s CSW training.

The Academy is a pilot site for the

NSPCC project supporting the introduction of VBI. Initial anecdotal feedback clearly demonstrates the value of this recruitment system and the team has noted how these values are being exhibited within the

Induction programme.

A programme of education of existing support workers is due to commence in Jan 14 following consultation over the summer with senior nurses and CSWs.

A pilot project to support a small cohort of Young Apprentices was launched in September 2012.

6 Young Apprentices were successfully recruited into geratology as well as microbiology, business development and OUH

IM&T Services.

This has been delayed due to CCG wishing to undertake a broader public engagement exercise to cover a wider service strategy, rather than a single focus on the

Horton. Undertake public consultation with CCG on the future of the

Horton General

Page 16 of 37



Director


Services


Services

Key Actions

Resolve mixed sex accommodation issues

•

Relocate respiratory inpatients and Cystic

Fibrosis service to the

JR site

•

Relocate and reorganise respiratory day case and outpatient service on

Churchill site


December

Hospital

Mixed sex accommodation breaches

•

Agreement of business case

(Summer 2013)

•

Relocation by end of March 2014

There have been 4 breaches as at the end of Q3.

Delayed as alternative proposals for the reconfiguration of services between the JR and Churchill sites are under consideration.


Services


Services

Relocate Clinical

Genetics to NOC site

Review outpatient capacity on the Churchill site with objective of vacating old estate

Agreement of business case

(Summer 2013)

•

•

Identify clinic requirements

Relocate services

Aim to relocate service in Q4.

Exercise to establish clinic requirement completed. Options now being considered for service locations.

SO2 To be a well-governed organisation with high standards of assurance, responsive to members and stakeholders in transforming

2.1

services to meet future needs – “ a well-governed and adaptable organisation”

Achieve NHS Director of Planning Progress application •

Submit updated

Foundation Trust and Information Integrated

Status Business Plan and

All milestones met in line with timetable agreed with TDA.

(Timescale paused nationally pending development of new CQC Long Term

Financial Model

•

TDA support

•

Monitor assessment inspection regime). New timetable for next phase of application agreed.




Director

Key Actions

TB2014.13


December

2.2

Continue to improve Governance and Assurance systems a) b)

Implement changes from the review of the

Trust’s governance framework as part of the development of the application for

Foundation Trust status

Ensure the continued provision of a legal

Director of

Assurance

Director of

Assurance

Revised Committee arrangements designed and implemented

Implement the changes from the reviews of committee effectiveness

Support the development of effective paperwork for the Board and subcommittees

Undertake a review of the legal services

SOPs in place and published / communicated to relevant staff (Aug 13)

SOPs embedded and used effectively

(March 2014)

Implement and communicate new suite of templates to support meeting effectiveness

(Sept 13)

Cycles of business revised for Board and sub-committees

(Sept 13)

Review ToR for the

TME and subcommittees

(Jan 2014)

Guidance written and issued

(Sept 2013)

Training sessions held for key report authors

(Mar 14)

Review to be completed by

Completed –Committee Handbook published on Trust intranet, Aug 13.

In progress . Timescales being monitored and exceptions addressed or escalated as required.

Completed – Report template issued and published on the intranet. Feedback being used to enhance templates as and when received, Sept 13.

Completed – All cycles of business revised, Sept 13.

Completed. Review of ToR for TME and sub-committees completed and due to be reported to TME on

23 Jan 14.

Completed – Guide to writing and presenting an effective Board paper published on the intranet, Sept 13.

In progress - External provider identified and budget being negotiated.

Training for Directors to be scheduled.

In progress / behind schedule –

Field work including interviews with



Ref Objective services department which meets the needs of the Trust

Accountable

Director c) Review and implement changes to the policy management framework

Director of

Assurance d) Continue to implement and embed the Assurance and Risk

Management

Strategies

Director of

Assurance

TB2014.13

Key Actions department

Present a proposal to

TME on proposed changes

Implement changes as identified through the review

Use LiA methodology to support the review

Seek approval from the

Trust Board to implement changes

Convene Policy

Coordination Group


December

31 Dec 13 key stakeholders completed.

Review to be completed Jan 14.

In progress - Report to be Results of review reported to TME where necessary

(Jan 14)

All changes to be implemented by

1 Apr 14 produced Jan 14.

Not started – Any necessary changes will be made following the review of the formal report.

Completed – LiA events held in

Jul and Aug 13.

LiA event to be held in

July 2013

Trust committee to consider revised approach Nov 13

Group in place by

Nov 13

Completed by end

Jan 14

Completed agreed by TME Dec 13.

Completed

– Revised approach

– Corporate Policy

Coordinators identified and group convened, Nov 13.

In progress – Due to be completed by 31 Jan 14

Review all Corporate

Policies to check all corporate policies are current, and compliant

Review achievement of initial Implementation

Plans for both strategies

Further embed the Risk and Assurance

Strategies into the Trust

Review of strategies and presentation of results to Trust Board by Nov 13

Update risk training and run across the

Trust (March 14)

Completed – Risk Management

Strategy implementation plan formally reviewed and presented to the Board Sept 13. Assurance

Strategy implementation plan reviewed and results presented to

Trust Board Nov 13.

In Progress – Risk Management training updated and currently being delivered



Ref Objective e) Continue to implement action plans to ensure continued compliance with CQC outcomes and other regulations

2.3

Continue to realise

Accountable

Director

Director of

Assurance

Director of Planning

TB2014.13

Key Actions at:

•

Divisional level and,

•

Corporate directorate level

Develop and implement phase 3 HealthAssure action plan


December

Develop assurance map process

(March 14)

In Progress – Data quality assurance map presented to Quality

Committee Dec 14, further developments in progress.

Ensure evidence is populated on Health

Assure at clinical service level

Quality assess the evidence and make recommendations for improvements

Phase 3 Plan developed (July 13)

Risk register reporting developed (Nov 13)

Quality review of risk registers

(March 2014)

All evidence sets to be populated (Sept 13)

Completed – Plan developed

July 13

Completed –Reporting developed and updated user guide completed

Dec 13

In progress – Due to be completed by 31 Mar 14

Completed - CQCAssure in place and running across the Trust. All assessments completed Sept 13.

Implement internal peer review process

Assist with the Trust

NHSLA accreditation processes

Agree future

QA process to be 80% completed by

31 Jan 14

Full review of each division to be completed by

Mar 14

Develop an on-going programme of Peer

Review (Mar 14)

In line with inspection timeframes

•

Agree future roll-

In progress – initial reports to TME

Sept 13 and Quality Committee

Oct 13, on-going reports from

Jan 14 (80% of QA on track for completion by due date)

In progress –Review of all divisions to be completed end of Feb 14

In progress by 31 Mar 14

Completed

– Due to be completed

– Maternity NHSLA

Level 2 assessment completed

Nov 13.

•

Maternity relaunch successfully



Ref Objective the benefits of the introduction of the

Electronic Patient

Record

2.4

Develop and support

OUH leadership community to deliver

2.5

Carry out Trust’s legal obligations with regard to Medical

Revalidation

Accountable

Director and Information

Key Actions development path

TB2014.13


December out plan

•

Agree reprocurement approach

•

• implemented

Roll-out plan agreed at

November Trust Board meeting

Reprocurement approach agreed at May Trust Board meeting. Reprocurement timetable remains on target.

Strategy and Plan developed

Draft Plan tabled at the last 2

Workforce Committees – scheduled for January Board

Director of Workforce Create a Leadership

Strategy (Framework) and Plan which supports the on-going development of leaders

Director of Workforce Introduce a 360º feedback process into appraisals to support personal development planning

360º feedback mechanism in place

Director of Workforce Commence a training needs analysis of leaders on a phased basis

Medical Director Ensure each doctor has a quality-assured annual appraisal.

Training needs analysis completed for ward sisters and other priority groups

All doctors have quality-assured annual appraisal

Integrated into leadership strategy – new NHS Leadership 360º tool to be launched in Feb 2014 – Initial introduction to the new model made at the OUH leaders Conference in

Dec 13

Integrated into the leadership development strategy

The medical appraisal window runs from 1st Oct 13 to

31st Mar 14. At the end of Q3 all doctors with a prescribed connection for medical revalidation had been assigned an appraiser, advice had been updated and circulated and a small number of completed appraisals had been received by the Medical Director’s




Director

Key Actions

For those doctors who have revalidation dates within 2013/14 make revalidation recommendation


December

Revalidation recommendations made for the 20% of doctors with revalidation dates

Apr 13-Mar14

Office. Every doctor is being tracked individually and each appraisal received is checked against basic quality standards to enable full compliance to be reported.

All revalidation recommendations due to date have been made on time and in accordance with GMC guidelines.

SO3 To meet the challenges of the current economic climate and changes in the NHS by providing efficient and cost-effective services and better value healthcare – “delivering better value healthcare”

3.1

Increase productivity and delivery of CIPs year on year in line with the agreed financial strategy and within the agreed performance framework/compacts

Director of Finance and Procurement supported by Director of Clinical Services

Deliver agreed Financial

Plan

Deliver Cost

Improvement

Programme

Financial plan

Cost Improvement

Programme

The Trust is on plan to generate the agreed break even surplus after the first eight months of the year.

The Trust forecasts it will deliver

£42.7m in savings in 2013/14, with the high levels of activity making the delivery of savings through ward closures not currently possible and with some slippage on the workforce initiatives.

3.2

Maximise the utilisation of resources through


Services

Downsize commensurate with commissioner QIPP delivery

Business case for

23 hour day surgery unit

QIPP delivery The delivery of savings through ward closures is not considered possible. Commissioned activity is ahead of plan and delayed transfers of care are also above target.

Business case in development




Director

Key Actions

TB2014.13


December

3.3

extending hours and increasing 6 and 7 day working

Develop workforce plans that respond flexibly to activity levels within the affordable financial envelope whilst maintaining quality standards


Services/Director of

Workforce


Services/ Director of

Workforce

Develop weekend gynaecology scanning and Saturday theatre sessions

Pilot 7 day radiotherapy service

Review scope to extend working hours in theatres

Improve workforce and capacity business planning capability to reduce reliance on temporary workers during peak periods of activity

•

Align job plans, shift arrangements and rotas to service requirements

•

Improve staff retention and reduce turnover and sickness absence

Director of Workforce Improve the effectiveness of the recruitment process to avoid pressures

Workforce expenditure in line with agreed budgets

Achieve agreed turnover, sickness absence and recruitment KPIs

Weekend scanning on-going.

Saturday theatre sessions have been run when justified by demand.

Pilot has commenced

Extended hours are in operation in some theatres, with plans to extend this further.

Expenditure is above agreed budget levels due to continued use of agency and higher than forecast activity levels for specialised commissioners.

Turnover and sickness absence

KPIs were above the agreed standard as at the end of Nov 13

(11.35% and 3.24% respectively)

Retention plan to be agreed with

TME in Feb 14.

“First care” being rolled out across the Trust, will be fully utilised from

1 Apr 14

Recruitment process has been reviewed using Lean methodology.

“TRAC” candidate tracking system has been introduced. Time to hire



Ref Objective

3.4

Improve utilisation of

Trust’s estate

Accountable

Director

Key Actions

Director of

Development and the

Estate associated with high vacancy rates

Reconfigure theatre and critical care facilities across sites, refurbishing facilities where required

TB2014.13


December has been reduced.

•

Feasibility paper for JR theatre and critical care facilities to be presented to Trust Management

Executive in January 2014.

•

Project underway for refurbishment of Women’s

Centre theatres.

•

6 Facet survey expected completion 31 Dec 13.

•

Proposals for configuration of clinical services across sites discussed at Board Seminar

8 Jan 14.

•

Latter two documents will inform development of detailed Estates strategy

3.5

Use IM&T to improve quality and efficiency

Reduce unnecessary face-to-face contact between patients and healthcare professionals by incorporating technology into these interactions


Services

Work with Oxford

Health NHS FT and

Oxfordshire Social

Services to increase the use of telemedicine


Services

Project to reduce antenatal visits for gestational diabetics

Project to improve physical outcomes post myocardial infarction

Agree plan for use of telehealth/telecare to support more accurate assessment of patients who have become


“Digital First” CQUIN prequalification


“3millionlives” CQUIN prequalification

Target was for 50 women to participate in satisfaction survey. 49 out of 52 women participated.

Recruited to all posts except one in

December.

Information governance and procurement issues have led to a delay in the project.



Ref Objective

3.6

3.7

Develop initiatives to reduce length of stay

To change OUH from an expenditure-led

Accountable

Director to provide whole system care delivery close to home

Extend ICE on-line ordering to radiology requesting/reporting

Prepare for paperless referrals in NHS (target date March 2015)

Director of Planning and Information



Services

Director of Finance and Procurement

TB2014.13


December acutely unwell in community settings

Roll out ICE to radiology requesting/ reporting

Strengthen underpinning

IT infrastructure

Extend Enhanced

Recovery After Surgery

(ERAS)

Extend use of minimally invasive surgery

Improve provision of specialist support for medicine patients with GI bleeds

Promote the use of

Patient Level Information


“Digital First” CQUIN prequalification

Update clinic templates to support

Directly Bookable

Services

•

SLR and Reference costs used in

Milestone achieved/CQUIN target met

•

Direct booking implemented on

NOC site

•

Project plan for clinical profiling agreed

•

Project on track

Extension of ERAS underway for additional elective clinical pathways and emergency clinical pathways.

Recruitment problems to physiotherapy aide post has caused delay to this project.

Widening of skill base and application of minimally invasive robot assisted surgical procedures in progress. First cystectomy completed in 13/14. Extension to colorectal surgery planned for 14/15 to enable participation in national clinical trial.

Initial discussions and scoping of a service model improving 7/7 provision of GI bleed service between GET Directorate and

Medicine completed.

Clinical Costing Advisory

Development Group established.



Ref Objective service line reporting organisation to an income-led Service

Line Management organisation with a focus on positive contribution

Accountable

Director

TB2014.13

Key Actions and Costing System

(PLICS) and Service

Line Reporting (SLR) information throughout the organisation, allowing the Divisions to more effectively manage services and costs

Encourage Divisions to improve accuracy of clinical coding and optimise clinical productivity, including job planning

Undertake specific work with NTSS and S&O

Divisions to analyse factors driving


December

Divisional

Performance reviews

•

SLR analysis included in evidence within business case submissions and improvements in

SLR performance included in criteria for approving change

SLR analysis must now be included in the evidence within business case submissions and improvements in SLR performance are to be included in the criteria for considering and approving change.

The patient level costing system

(PLICS) is used to support the negotiations with Commissioners for non-tariff service areas.

The Trust has established the

Information Governance & Data

Quality Group which receives regular reports relating to data quality improvements including benchmarking, external audits and

Divisional data audits.

Job Planning Guidance has been issued and a review of medical on call rotas is also in progress. The

PLICS and SLR models are updated with the up to date consultant job plans when they are made available.

NTSS Division, supported by the central Costing Team, has used a

“drill down” approach within the

PLICS system to identify,




Director

3.8

Introduce internal trading for Radiology and Pathology


Services

Key Actions performance with objective of making recommendations for reducing costs and improving financial performance


TB2014.13


December

•

Implement

1st Apr 13

•

Monthly data distributed

•

Quarterly review meetings in place for all Divisions investigate and address adverse cost variances.

The S & O Division has undertaken in depth case studies for each of the

4 directorates, and in Surgery,

Renal and Gastroenterology

Operational Service Managers have been reviewing the costs attributed to their services within the model and improving and amending the activities used to allocate direct costs to patients.

Radiology internal trading was put in place as of Month 3 with a backdate to 1st Apr 13. The data has been validated with the clinical divisions. There has been an over performance across all Divisions. A full review was undertaken after Q1 and the feedback from the clinical divisions was very positive. Regular on-going meetings have taken place at directorate level and queries have been dealt with as they have arisen.

Pathology internal trading has taken longer to implement due to the volume of data that has required validation. This is now completed and monitoring has been in place since Month 9. Again there has been an over performance across all Divisions.

Page 27 of 37



Director


December

SO4 To provide high quality general acute healthcare to the people of Oxfordshire including more joined-up care across local health

4.1

and social care services – “delivering integrated local healthcare”

Work with partners to Director of Clinical

•

Expand Supported reduce the number of system wide delayed transfers of care

(DTOCs)

Services Home Discharge

Service (SHDS)

•

Roll out joint pilot between Therapies team and SHDS in ED to help reduce admissions

•

Develop a night care service to reduce

•

75% of patients to have an ‘estimated date of discharge’

(EDD) documented within 36 hours of admission

•

Meet Local CQUIN payment criteria

Audit demonstrated 100% compliance with EDD 36 hour target.

All actions required for CQUIN payment completed.

Two audits undertaken jointly with

Oxford Health FT demonstrate OUH compliance with agreed KPIs.

However, system-wide delays at the end of Q3 show a year to date

• admissions

Expand service provided to Abingdon average of 142 delayed discharges.

Community Hospital

•

Joint audit with Oxford

Health FT to identify how urgent care is used (April-June)

•

Develop single point

4.2

4.3

Develop relationships with local GPs, both as commissioners through CCG and its localities and as providers

Continue implementation of



Services of access (availability of advice from expert nurse)

•

Agree joint Work

Programme

•

Individual workstreams agree objectives and deliverables

Develop model for

Emergency Medical Unit

Agreed business case

•

•

Joint work programme agreed

Individual objectives and deliverables in process of being finalised

EMUs at JR and Horton are joint developments with Oxford Health



Ref Objective review of Acute and

General Medicine

4.4

Continue to improve psychiatric liaison and access to psychological support for the

Trust’s patients

4.5

Prepare

Genitourinary

Medicine (GUM) services for a tender

Accountable

Director


Services


Services

TB2014.13

Key Actions

(EMU)/Acute Ambulatory

Multidisciplinary Unit at the JR and Horton sites

Increase availability of intensive observation, treatment and nursing facilities within Trust

•

Establishment and full integration of the new

•

Psychological

Medicine Service in

Acute General

Medicine and

Geratology

•

Consider the future requirements for psychological input into specialist services in line with NHS

England draft service specifications

Review costs and provision of existing service


December

NHS FT and will be fully operational in Jan 14.

Develop business case for a Medical

HDU on JR site

Meet CQUIN payment criteria

Feasibility study for the replacement of JRII theatres and integrated ITU and HDU considered by the TME in

Jan14. Further work being undertaken and an update will be submitted to the TME in Mar 14.

CQUIN requirements fully met.

Psychiatric input is in place for medicine and old age (including

Horton and weekends).

A joint medicine/Women’s services psychiatric post will be advertised shortly. There is also psychiatric input in place for Children’s services and extension of this is being examined.

Business cases are being developed for further psychiatric input into Cancer, Palliative Care and Neurology services.

Work is underway to scope the need for psychology/psychiatric input in Transplant and Renal (some input already in place for donor assessment), ITU, Trauma and Pain services.

Tender submitted and OUH awarded contract for combined service which incorporates sexual health and contraception advice.



Ref Objective exercise for all GUM services under the new commissioning regime within the local authority

4.6

Improve the care of

Diabetes patients

4.7

Improve the care of

Stroke patients

Accountable

Director


Services


Services

TB2014.13

Key Actions

•

Consider how to propose future service provision

•

Submit tender return

(Aug 13)

Develop multidisciplinary foot protection team and

Diabetic Footcare

Pathway

Improve care of inpatients with diabetes


December

Meet criteria for local

CQUIN payments

Criteria met

•

Reduced length of stay for inpatients with diabetes

•

Compliance with

NICE guidance

•

Benchmarked performance in

Diabetes inpatient audit

A risk summit was held in Oct 13 to examine processes and outcomes in relation to the care of adult inpatients with diabetes. The summit was attended by approximately 50 members of staff, along with representatives of both patients and commissioners with a follow up in Nov 13. A number of workstreams have been defined.

Criteria met Improve support for young adults (16 -25 year olds) with diabetes

Meet criteria for local

CQUIN payments

80% spend 90% of stay on a Stroke Unit

85% of patients have direct admission to the Hyperacute

Stroke Unit / Acute

Stroke Unit within

4 hours of hospital arrival

90% (year to date)

Nov 13 – 100% at both the HGH and JR




Director

4.8

Provide enhanced community-based palliative care service for Oxfordshire, in collaboration with

Katharine House

Hospice and

Sue Ryder


Services

4.9

Develop the Trust’s role in preventing, as

Chief Nurse

TB2014.13

Key Actions

•

Establish “hospice at home” and a community respite/step down facility

•

Agree model for retention of in-patient services, including widening of End of

Life Care to nononcology interventions

Participate in Maternity services pilot


December

100% of patients are scanned within

24 hours of arrival at hospital when judged clinically appropriate


95% screened for swallow problems

Assessment by the multi-disciplinary team within 72 hours of admission

Nov 13 – 100% at the HGH and

96.67% at the JR

Nov 13 – 100% at the HGH and

98.25% at the JR

Percentage of patients who have

MDT Rehabilitation goals agreed within

5 days


Initial meetings with Sobell House

Hospice Trustees to establish common vision and strategy to develop step down facility.

In discussion with CCG colleagues about Hospice at Home, though this has stalled following PCT/CCG reconfiguration.

Inpatient service model for specialist palliative care confirmed but future model for EoL care provision included in outcomes based commissioning framework. Details not known.

•

First ‘Train the Trainer’ session has taken place



Ref Objective well as treating, ill health in accordance with the “Every

Contact Counts” initiative

Accountable

Director


December

•

Presently sourcing digital images for the posters

•

Meeting had been organised but needs to be re-scheduled due to sickness

SO5 To develop extended clinical networks that benefit our partners and the people they serve. This will support the delivery of safe and sustainable services throughout the network of care that we are part of and our provision of high quality specialist care for

5.1

the people of Oxfordshire and beyond – “excellent secondary and specialist care through sustainable clinical networks”

Continue Director of Clinical •

Develop outline

•

Trust Board and the TDA have implementation of Services business case for approved the SOCs for satellite radiotherapy increased radiotherapy units. The first modernisation plan, including potential radiotherapy capacity

•

Expand use of IMRT

OBC will be considered by the

Trust Board at its January for satellite radiotherapy facilities in line with agreed business case

•

Implement prostate meeting.

•

The local developments (IMRT, brachytherapy, stereotactic

• brachytherapy

Implement radiotherapy and HDR) have all been implemented. stereotactic body and brain radiotherapy

•

Develop business case for High Dose

Rate radiotherapy

5.2

Expand satellite haemodialysis provision


Services

Agree business case for

Swindon

Implemented

5.3

Continue to deliver specific network service development initiatives:

Complete the Director of Clinical

•

Completion of expansion of neonatal Services services construction

•

Commission building

•

Expanded service operational

Completed and operational



Ref Objective

Progress the plan for the regional provision of Vascular Surgery

Accountable

Director


Services

Continue to develop

Oxford’s role as Major

Trauma Centre (MTC)


Services

Continue to develop

South of England

Strategic Children’s partnership for paediatric cardiac surgery, paediatric neurosurgery and paediatric critical care in association particularly with

University Hospital


Services


TB2014.13

Key Actions

•

Agreement of protocols and guidelines

•

Discuss proposals for development of

Oxford as interventional radiology centre of excellence with neighbouring trusts and prepare business case

•

Review implementation of

MTC business case

•

Establish integrated

Rehabilitation pathway

•

Improve interventional radiology provision

Implementation of a

Health Information

Exchange


December

On-going

Fully operational

Fully functioning paediatric network between OUH and University

Hospitals Southampton FT covering neurosurgery and cardiac services

Page 33 of 37



Director

Southampton FT

Continue to develop relationships with surrounding Trusts, particularly through joint clinical appointments and the delivery of care locally

Review the service specifications published by NHS

England and prioritise investment in response

Develop

Transplantation

Service


Services


Services


Services

TB2014.13

Key Actions

•

Appoint to agreed

Urology and lung clinical oncology posts

•

Develop business cases for further joint posts


December

Posts appointed to

Complete

Review intestinal failure service provision


Services

•

Develop business case for Renal

Medicine and

Transplant Centre

•

Consider extension of transplantation portfolio, (including proposals for islet autotransplantation and liver transplantation)

•

Await outcome of national assessment process

•

Develop full business case for future provision of service

•

Complete Full

Business Cases

•

Implement if agreed


•

Renal SOC due to be submitted to Mar 14 Trust Board meeting.

•

Have not progressed designation for liver transplantation.

Peer review process successfully completed.

Page 34 of 37



Director


December

SO6 To lead the development of durable partnerships with academic, health and social care partners and the life sciences industry to

6.1

facilitate discovery and implement its benefits – “delivering the benefits of research and innovation to patients”

Establish the Oxford Chief Executive Advertise and appoint a

•

Advertisement in Chief Executive and Chief

Academic Health

Science Network

(AHSN) as an entity

(interim accountable officer and deputy chairman) qualified Chief Executive to direct the actions of the AHSN

Mar/Apr 13

•

Interview May 13

•

Appointment

Operating Officer appointed independent of the Jun 13

Oxford University

Hospitals. The AHSN is currently hosted by

OUH

6.2

Publish an

‘innovation scorecard’ to show compliance with NICE guidance on new drugs and treatments or explain why there is a delay

6.3

Pre-qualification High

Impact Innovation for

CQUIN under

International & commercial activity

Chief Executive

(interim accountable officer and deputy chairman)

Chief Executive

(interim accountable officer and deputy chairman)

Compile composite innovation scorecard of all NHS AHSN members regarding NICE compliance.

Publish local formulary

Demonstrate that clear plans are in place to exploit the value of commercial intellectual property – either standalone or in collaboration with

Academic Health

•

Confirm NHS membership of

AHSN

•

Agree standards for monitoring

NICE compliance and returns and publication of local formularies

•

Assure that clear plans are in place

•

Publish

International &

Commercial

Activity strategy either as a Trust or

AHSN joint strategy

•

Agree standardised

Intellectual

The AHSN is now established as an independent entity with its own

Business Plan and objectives.




Director

Key Actions

TB2014.13


December

Property and

Clinical Trials policy across NHS

AHSN members

31st May 2013 AHSC status awarded

Joint working agreement signed

6.4

Apply for Academic

Health Science

Centre status

6.5

Progress the shared agenda with the

University of Oxford and Oxford Brookes

University

6.6

Progress the strategies set out in the successful renewal bids for the

Biomedical Research

Centre and Unit

(BRC/U)

Chief Executive

Chief Executive

Medical Director

Submission of prequalifying questionnaire

Make progress in strategic development of

BRC, establishing appropriate priorities

2 yearly review of all themes and working groups

BRC work programme being progressed.



3. Conclusion

3.1. Overall good progress has been made. Areas for more attention in coming months include:

•

Achievement of performance standards

•

Continued focus on safety, including infection control

•

Reduction of turnover and sickness

•

Achievement of planned CIP when activity levels are higher than commissioned

•

Optimising the configuration of clinical services and the use of the Trust’s estate

•

Improving the response rate for the Friends and Family Test

•

Increasing the screening of patients for dementia

3.2. Plans for addressing these issues are included in other Board papers and will be incorporated into the Trust’s Business Plan for 2014/15.

4. Recommendation

4.1. The Board is asked to note this report.

Mr Andrew Stevens

Director of Planning and Information

Report Prepared By:

Ailsa White

Corporate Planning Manager

January 2014


Trust Board Meeting: Wednesday 22 January 2014 TB2014.13

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