BOARD OF DIRECTORS
MEETING IN PUBLIC
30 April 2014
PAPERS
Board of Directors’ Meeting Part I in Public
30 April 2014
09.00 The Education Centre, Birmingham Children’s Hospital
AGENDA
Item
No.
14.75
14.76
14.77
Apologies for absence
Declarations of interest
Minutes of public Board meeting 27 March, 2014
Note
Note
Approve
14.78
Matters arising from public Board meeting 27 March 2014
Note
14.79
14.80
Chairman’s Report
Chief Executive’s Report
Note
Note
14.81
14.82
14.83
14.84
14.85
Item
Outcome
Strategy
National & Local Staff Survey Outcome 2013 Theresa Note &
Nelson, Chief Officer for Workforce Development.
Approve
Updated People Strategy Theresa Nelson, Chief Officer for Note &
Workforce Development.
Approve
Quality & Resources
Quality Report - Vin Diwakar, Chief Medical Officer and Note &
Michelle McLoughlin, Chief Nurse
Approve
Performance Report - David Melbourne Chief Finance
Officer & Deputy Chief Executive
Resources Report - David Melbourne Chief Finance Officer
& Deputy Chief Executive, Phil Foster, Director of Finance &
Procurement and Theresa Nelson, Chief Officer for
Workforce Development.
Note &
Approve
Note &
Approve
Time
Allocated
time
09.00
09.00
05 mins
Report type
Verbal
Verbal
Enclosure 01
Verbal
09.05
09.10
05 mins
20 mins
Verbal
Verbal
09.30
30 mins
Enclosure 02
10.00
30 mins
Enclosure 03
10.30
10 mins
Enclosure 04
10.40
10 mins
Enclosure 05
10.50
10 mins
Enclosure 06
11.00
05 mins
None
Any other business
14.86
Questions from members of the public
Part II of this meeting of the Board of Directors will be held in private, as the information to be discussed is exempt from
public disclosure under the Freedom of Information Act 2000.
Next meeting of the Board of Directors: 29 May 2014, Education Centre, BCH
UNCONFIRMED
Item 14.77
Enc 01
BOARD OF DIRECTORS MEETING
Minutes of the meeting held in public on 27 March 2014 at 09.00
in the Education Centre, Birmingham Children’s Hospital
Present
Attending
Ref.
14.43
14.44
14.45
14.46
14.47
Keith Lester
Sarah-Jane Marsh
Tim Atack
Vin Diwakar
Jon Glasby
Colin Horwath
Michelle McLoughlin
David Melbourne
Theresa Nelson
Roger Pearce
Elaine Simpson
KL
SJM
TA
VDi
JG
CH
MM
DM
TN
RP
ES
Interim Chairman
Chief Executive Officer
Chief Operating Officer
Chief Medical Officer
Non-Executive Director
Non-Executive Director
Chief Nursing Officer
Deputy CEO and Chief Finance Officer
Chief Officer for Workforce Development
Non-Executive Director
Non-Executive Director
Deborah Bannister
Matthew Boazman
Simon Crooks
Georgina Dean
Phil Foster
DB
MB
SC
GD
PF
Interim Company Secretary
Director of Strategy and Planning
Executive Office Manager (minutes)
Deputy Chief Officer, Contracting and Performance
Director of Finance and Procurement
Item
Apologies
There were no apologies for absence.
Declarations of Interest
None
Minutes of the Board meeting held in public on 27 February 2014
The minutes were agreed as an accurate record.
Matters arising from the Board meeting held in public on 27 February 2014
There were no matters arising not covered by the agenda.
Chairman’s Report
Non-Executive Director
Interviews for the above position would be held on 1st April, 2014.
The Board noted the verbal report
14.48
Chief Executive’s Report
SJM reported verbally as follows:
Professor Malcolm Grant, Chair of NHS England had visited the Trust the previous
Tuesday. He had focused on services NHS England directly commission, particularly the
KIDS and P/C. He was impressed with the enthusiasm of staff and the blend of high-end
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science and family centred care.
A Peer Review of the Burns Service had taken place. The review concluded that the
Trust delivered high quality care, but there was scope for some areas of improvement.
In particular the review had highlighted therapy input.
The Trust had been the subject of recent media activity; Sky News had covered the flu
jab uptake where BCH had achieved the highest rate in the country, whilst the
Birmingham Post had reported on the future of the Hospital looking at the past five
years.
A successful CEO fundraising lunch had been taken place with a particularly helpful
discussion regarding the BCH name and brand. Feedback received suggested we need
to be much better at ‘selling our message’.
The NHS EXPO event in Manchester had been attended, where SJM had presented and
joined a debate on care.data.
The UK Children Alliance meeting had been hosted. It was the most successful meeting
in recent years and agreement had been reached to employ a part – time coordinator
to work on behalf of the Group.
NHS Change Day had taken place at the Trust on Monday 3rd March with hundreds of
staff involved; the ‘Gruffalo’ statue outside the canteen had been well received.
MM had appointed two deputy chief nursing officers, Caron Eyre and Marion Harris.
An open day had been held for Haemoglobinopathy services, attended by the
Children’s character Billy Blood, raising awareness of blood disorders and the impact
this has on children’s lives.
The Board noted the verbal report.
STRATEGY
14.49
Nursing Workforce
MM presented an update of the Trust’s Nursing Workforce and explained the context behind
this, specifically the Francis enquiry and the Governments response to it. A subsequent guide to
nursing and care capacity had promoted ten expectations.
As a result the Trust had reviewed the existing nurse workforce to aid future planning and
manage aspirations. An established process of managed nursing workforce reviews
already existed and complied with the expectations currently recommended in the
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‘Right People, Right Place, Right Time paper.
The process of ensuring safe nursing staffing was based around managing the right skill` mix,
daily management and constant monitoring at ward level. A breakdown of the nursing skills mix
was reviewed which showed nurses in each ward, the nurse patient ratio and the skill mix.
TA asked how this information compared with data at other Children’s hospital, MM advised
that it was comparable with Great Ormond Street, but better that Alder Hay, Manchester and
Bristol. However MM emphasised that it was difficult to draw a comparison due to the skill mix
contained within our figures, including a variety of specialists, researchers and trainee nurses.
A discussion took place as to why staff say there are not enough staff at listening events, when
comparatively there are more than other hospitals.
SJM agreed this was a much heard message but stressed the difference between safe and
enough staff and it is very rare that we hear the message that staffing levels are ‘unsafe’.
Discussion followed on, a) whether a welcome board at the entrance to each ward detailing the
number of nurses on duty backed up by individual photographs. It was noted that this was not
something asked for by parents and, b) the possibility of extending this to a six monthly report
to the Board showing the number and skill mix maintained on each ward and adding it to the
Board Assurance Framework so that nursing levels at each ward were monitored.
The Board received and noted the report.
14.50
Next Generation, Looking back, Moving Forward
SJM presented the above strategy and explained that the term ‘Next Generation’ would be the
brand name for the future development of the Trust, either as part of a joint development in
Edgbaston or the development of the existing site at Steelhouse Lane.
The presentation concentrated initially on the journey since 2009, reviewing how the Trust had
developed and extended the services provided. There had been major improvements in patient
care and significant investment in facilities, staff and workforce development. Income had
increased from £173m in 2009 to £240m and the number of patient visits had increased from
225,000 to 240,000 in the same period, although these figures did not explain the true
complexity of patient treatment.
However problems remained – cancelled operations were still a major concern, waiting times
remained too long in some areas and there remained a daily struggle to manage capacity, in
turn impacting on staff stress and patient experience.
The Next Generation project would cover phase 1, the period of development up until 2022.
Savings of £58m would need to be achieved in the next ten years, simply to breakeven, a
challenge of £5m to £6m a year, but to make our aspirations a reality, we need £9m to £10m a
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year.
Next Generation would be structured around four specific platforms;
Improved patient pathways
Developing people, building team BCH.
Investment in technology
Providing modern facilities for better patient care.
CH acknowledged that the Trust would look significantly different in nine years time, through
what would be a major significant restructuring of facilities.
Finances remained a concern; whilst DM believed the project was possible, the pressures on
meeting CIP targets would become more difficult to achieve.
The Board received and accepted the contents of the report.
14.51
Monitor Operational Plan 2014/15 – 2015/16
DM and MB explained the background to Monitor’s requirements for the submission of the
annual plan for the period leading up to 2016.
This year two submissions were required;
an operational plan for 2014-16 in early April
a strategic plan for the next 10 years in June,
both submissions had to take into account expected demands, in particular demographics and
changes in the market place. Our market share remained strong, fuelled by the demand for
services for more complex patients. However our market share of other services also increased
over the past few years.
The Board discussed the outline return and pressures the Trust faced. The possibility of a Board
away day was raised as an opportunity for a more detailed debate.
The Board approved the outline report and its submission to Monitor.
14.52
QUALITY & RESOURCES
Quality Report 2013-14 – Local Indicators
VD introduced the report and explained that the Quality Report is mandated by Monitor and is
published as a section of the overall Annual Report in May. The Report also required the Trust
to publish a report on a series of indicators and could select a further indicator. The Council of
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Governors had selected for this purpose a review of MRI waiting times.
The Board received and noted the Quality Report and approved the list of Indicators
contained therein.
14.53
Quality Report
VD introduced the report containing a range of issues that had been reviewed and investigated
during the month. Items of note included;
A new approach to reviewing patient data had commenced to ensure we receive a
consistent report.
There had been no Never Events during the month but four new SIRI’s had occurred.
The Duty of Candour as promoted by Jeremy Hunt following the Mid-Staffs Public
Inquiry had led the Trust to review where we currently are with regards to openness.
SJM said that the Trust remained ahead of the standard set by the Secretary of State as
we report all incidents of moderate harm to families and are considering this for low
harm too. The challenge remained how the Trust could stay ahead of this standard.
Safeguarding training at levels 1, 2 and 3 had increased
There had been one new safeguarding complaint.
MM reported that discussions continued on the Children safeguarding service provided by
Birmingham City Council and the potential of the service being removed to another provider. A
Government report on the service was expected today.
The Board noted the report.
14.54
Performance Report
GD presented the report, which had earlier been reviewed by the Finance & Resources
Committee. The following key issues were highlighted and discussed;
Cancelled Operations
February had seen 47 patients or 2.27% of all operations cancelled on the day due to hospital
reasons. This matches the highest monthly total recorded earlier in the year and reverses the
trend seen over the last three months. A further 33 patients had their operation cancelled by
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the hospital the day before the operation. Lack of ward beds and shortage of PICU beds
remained the principal reasons behind the cancellations.
The PWC report into cancelled operations had been received and the recommendations were
being reviewed. RP confirmed that the report had been considered by the Finance & Resources
Committee. The benefits from the recommendations were being reviewed but it was difficult to
predict how successful they would be. Further work had been requested and would be fed back
to the F&R Committee.
VD referred to a regional PIC review which could suggest designated cardiac as and a possible
direction of travel.
Diagnostic Waiting times
At the end of February 113 patients had been waiting over 6 weeks for an MRI Diagnostic test.
Whilst remaining well above the NHS standard of 1%, the waiting list remained the same and
the number of breaches in February remained in line with forecast.
The forecast now predicted zero breaches by June.
A positive response to the advert for a new radiographer had been received, confirmed by TA
who emphasised how BCH was now seen as an attractive place to work.
CAMHS
We were unable to support ten patients requiring an-inpatient bed during the month,
principally due to regional and national capacity pressures. The outcome of a national review
was awaited, but until then the clinical risk remained with the Trust to manage.
The Board expressed frustration with this issue and the complete lack of system ownership.
SJM concurred and added that if current inpatients could be discharged to social care system, it
would unblock the system but no one was willing to address this.
The Board noted the report.
14.55
Resources Report
PF reported that the Trust’s financial position was improving as the year end approached. The
forecast surplus remained at £8m, reflecting the unexpected CAMH’s payment. Trading
remained strong, benefiting from higher income levels and was reflected in the cash position
which at the end of February now stood at 36.8% above plan. CIP performance remained a
concern, now 35.5% below target.
TN reported on two specific concerns, namely;
Sickness levels had increased to 3.76%, the highest level recorded for two years,
reflecting increases in both long and short term sickness levels, with stress remaining a
concerning factor.
Turnover for the eleven months ending in February had increased and remained above
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the Trusts KPI. Whilst bank staff levels had reduced in February, wte’s were 4.2% higher
than the same period last year.
The recently announced 1% staff pay award and the qualifications on who would receive was
complex in its application and with increased pension contributions from April, would reduce
the net pay for some staff.
The Board noted the report
OTHER
14.56
Questions from the Public
There were no questions from members of the public.
Next Board Meeting: 30 April 2014, The Education Centre, BCH
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Action
Board of Directors
Public Meeting
30 April 2014
Item 14.81
Enc 02
Strategic Objective/ Enabler
The People Strategy
Report Title
Staff Survey 2013
Sponsoring Director
Chief Officer for Workforce Development
Author(s)
Chief Officer for Workforce and Associate Director for
Education and OD
Previously considered by
Trust Leadership Team
Situation
This report, with the attached presentation/report, gives an overview of the
outcomes from our annual National Staff Survey. The National Staff Survey is run by
every NHS organisation and the results are then put into ‘key findings’ by the CQC
for the purposes of their reporting.
Background
The National Staff Survey runs every year between September and December. We
have a choice as to whether we run a sample survey (850 staff chosen at random
by our survey provider) or a census. In 2013 we opted to run a census survey. The
reason for this was to
a) Gain a more robust data set
b) Enable us to include our first ever set of local engagement questions to
establish an initial benchmark
In 2013, we achieved our best ever response rate of 59%, an improvement of 13% on
the previous year.
The National Survey data is taken by the CQC (who commission survey experts) and
analysed, weighted and reported into ‘key findings’. This means that the raw
questions are ‘chunked’ together into categories, including staff engagement,
recommendation, motivation, training and development, wellbeing, and others.
The full report and summary report can be found on our intranet for via
www.nhsstaffsurveys.com
Assessment
The attached presentation/report gives an overview of our improvements and declines in the
survey, along with our local engagement rate, and how we compare to other Specialist Acute
Trusts. It should be noted that we do not believe we are directly comparable to many other
Specialist Acute Trusts, however, this comparator is decided upon by the CQC/NHS
England. As the attached presentation highlights, when compared to other Specialist Acute
Trusts, we do not rank well in the majority of the key findings, however, we have seen a
number of internal improvements in our data.
Our staff engagement score nationally has improved (3.74 to 3.84), as has our score around
motivation, training and recommendation. Our staff are also telling us that they enjoy their
roles and feel more involved in decision making.
We are still seeing a high level of staff reporting stress, pressure, harassment and bullying,
and clearly these need to be of significant focus for the next 12 months to ensure we are
able to ensure our workforce wellbeing is supported, that we are proactive, not reactive, and
are addressing staff concerns. Retention of our workforce, and ongoing attraction of highly
skilled and motivated staff is essential for the future of BCH, especially given our ambitious
Next Generation plans.
Our local engagement score overall shows that 61% are positive about working at BCH, with
23% sitting in the middle (neither agree nor disagree) and 16% giving negative feedback.
We have work to do to
a) Maintain the engagement of those that are positive
b) Encourage our ‘fence-sitters’ to become more positive
c) Work to find out what could help those giving negative feedback feel more positive
From the assessment of the results, we have identified there are 3 key themes that BCH
should focus on for the coming 12 months.
These are:
Staff wellbeing (especially mental health and stress)
Harassment and bullying (especially from patients/families)
Team working
The attached shows the work that is already being undertaken or in development, including
investment in The Big White Wall (an on-line emotional support tool for staff), leadership and
management development, staff support and advocacy, Team Maker programmes and team
development work.
There will need to be some further investment in staff wellbeing resources to enable this
focus to be maintained over the next 12 months and a report is being developed around this.
Moving forward we will be more regularly surveying our staff on our local questions, as well
as the Friends and Family Test for staff which is a national initiative. Plans are being
developed currently around implementation and further detail will be provided.
Recommendations
The Trust Board is asked to discuss the outcomes of the National Staff Survey and give
approval to the key themes for focus.
Key Risks
Risk Description
As per above
Controls
Trust board sub
committees/SWC
Assurances
Regular reports to chief
officers, TLT, SLT, SWC and
the Trust Board.
Standards of compliance
and assessment
Key Impacts
Strategic Objectives
CQC Registration (state
outcome)
NHS Constitution
Other Compliance (e.g.
NHSLA, Information
Governance, Monitor)
Equality, diversity & human
rights
Trust contracts
Other
The People Strategy
Education delivery, employment compliance,
engaged staff who deliver quality care.
This will support how the trust embeds the NHS
constitution and the BCH values
This will ensure that all legislative other requirements
pertaining to employment are met and monitored.
Ensuring we have a productive workforce which aligns
with the financial forecasting outlined in the monitor
plan.
This supports the delivery of the Equality Delivery System
and ensures that we embed inclusion into the core of
everything we do.
Theresa Nelson,
Chief Officer for Workforce Development Trust Board – 30th April 2014
Staff Survey 2013
Introduction
•
This presentation/report provides a summary of the
findings of the 2013 national NHS staff survey conducted
in Birmingham Children's Hospital NHS Foundation Trust.
•
Internally our results present some positive changes.
Despite this, BCH, in comparison to other Acute
Specialist Trusts, does not necessarily rank well.
•
The presentation outlines the key findings that are
produced for the survey reports for CQC. Our raw data
questions do show some areas of improvement.
•
Key Finding 24 “Staff recommendation of the trust as a
place to work or receive treatment” has seen an
improvement from 3.88 to 3.97 (this is not deemed as a
statistically
significant
change).
Despite
this
improvement, we are ranked as Below (worse than)
average in comparison to other Acute Specialist Trusts.
We are now undertaking further analysis to give
directorates and specialities their local outcomes
•
Our best ever response
rate - 59% of our staff
completed the 2013
survey compared to 46%
2012
Staff Engagement has
increased to 3.84 (from
3.74 in 2012)
On the FFT we have seen
an overall 1%
improvement
Where we’ve seen improvement
in the CQC key findings
Staff Engagement
Staff Motivation
Training
• Overall increase in the key
finding from 3.74 to 3.84
• Increase in key finding that
staff feel more motivated
(3.73 to 3.83)
• H&S training up (65% to 76%)
• Equality training up (45% to
66%)
Other Local
Improvements
Staff know how
to raise concerns
Staff feel safe to
raise concerns
Staff are
enthusiastic
about jobs
Staff feel they
have ability to
use initiative
Staff feel more
Involved
Staff feel comms
with senior
managers is
better
Staff feel there is
better
management
Support
Staff feel we take
positive action
on wellbeing
The organisational context and how this has that impacted on results?
Context
Results Impact
•
•
•
•
•
•
•
•
•
•
•
•
Staffing Shortages/bed closures
Increased patient acuity and complexity
The shadow of Francis
Increased scrutiny and bureaucracy
Change (process, terms and conditions)
Increased activity
Sickness absence
Increased pressure
CIP
Family expectations
The general pressures of working in the
NHS
•
•
•
•
•
High numbers of staff reporting stress and
pressure
Less positive perception of team work
Increase in staff witnessing errors
Reduced satisfaction in the level of care
able to deliver
High numbers of staff experiencing
bullying, harassment and abuse from
patients and families
Experience of bullying from
colleagues/managers
The key themes for focus
Staff Wellbeing,
specifically mental
health/stress
related
Work to reduce
harassment and
bullying from
patients/families
Continued focus
on improving team
working
National Positives - Top Five Ranking Scores
Training, communication and contribution
KF14. Percentage of staff reporting errors, near misses or incidents witnessed in the last month
KF22. Percentage of staff able to contribute towards improvements at work
KF6. Percentage of staff receiving job-relevant training, learning or development in last
12 months
National Positives Continued - Top Five Ranking Scores
KF21. Percentage of staff reporting good communication between senior management and staff
KF26. Percentage of staff having equality and diversity training in last 12 months
National Areas For Improvement - Bottom Five Ranking Scores
Team working, stress and pressure
KF4. Effective team working
KF11. Percentage of staff suffering work-related stress in last 12 months
KF13. Percentage of staff witnessing potentially harmful errors, near misses or incidents in last month
National Areas For Improvement Continued - Bottom Ranking Scores
KF3. Work pressure felt by staff
KF20. Percentage of staff feeling pressure in last 3 months to attend work when feeling unwell
56% of staff survey
respondents have undertaken
training on how to deliver
good patient/service user
experience compared to 42%
in 2012
80% of staff survey respondents
strongly agree that the organisation
acts on concerns raised by patients
and service users
BCH Engagement Questions
The 2013 Staff Survey included some BCH engagement questions that have provided us
with a solid foundation to build upon.
The questions were:
-
At BCH I feel I am motivated to do a great job
‘I regularly get feedback and feel appreciated for what I do’
‘I understand how what I do contributes to achieving BCH objectives and priorities’
‘I feel encouraged and able to put forward ideas that help improve quality and safety’
‘The team I work with make my working life enjoyable’
‘My manager shows genuine care about my health and wellbeing’
‘I feel I am shown respect by everyone I work with’
Based upon respondents to the survey:
61% of our staff feel actively engaged
16% are disengaged
23% are ‘fence sitters’ – we can push them either way!
Boorman (2009) Report on Wellbeing in the NHS
BCH has gone some way to implementing the recommendations from the Boorman report.
This report, along with others, showed a clear relationship between staff wellbeing,
organisational performance and patient satisfaction.
Boorman Recommendation
Trust Status
Leaders are equipped to recognise the links between
wellbeing, performance and patient satisfaction and are
contributing to, not undermining wellbeing
Some development specific to wellbeing has taken place
Still a lot more to do to support managers to be more
effective in this important area
Any programme should aim to tackle key health and
lifestyle issues:
Our interventions have targeted all
We need to have a more robust and integrated
programme which is communicated well and supported
at all levels
Implementation of NICE guidance
We have undertaken self-assessment and have
implemented some of the guidance.
Our key gaps are:
Need a wider range of support for stress/mental health
Provision of fast-track services for mental health and
musculo-skeletal issues
Better communication
More targeted approaches to tackle specific health
issues
The Business Case for Improving Engagement and Wellbeing
There is extensive research around the importance of organisations supporting their employees
and the positive impact that this can have on the ‘customer’ experience.
London’s Business Case for Employee Health & Wellbeing outlines the financial benefits as:
 Reduction in overtime, temporary staffing
 Reduction in recruitment costs
 Reduction in insurance/claims
 Reduction in management time costs
Investors in People states that employees who are engaged and healthy will:
 Be more resilient and cope better with pressure, uncertainty and change
 Be more supportive to colleagues
 Have reduced absenteeism and presenteeism
Internal exit work in PICU has demonstrated a
clear link between resilience and turnover
The World Economic Fund found globally
that firms that promoted wellbeing were
2.5 times more likely to be seen as best
performers by employees and staff are 8x
more likely to be engaged
The National Nursing Research Unit found that a
positive and supportive working environment
impacted on the experience and care of the patient
Royal Mail introduced a wellbeing/mental
health programme and saw a reduction in
sickness absence of 3% and saved £230m
(over a 4 year period)
Knapp et al estimate that a firm of 1000
employees where NICE guidance on
mental wellbeing is implemented will see a
saving of £250,607
Some of Our Current Actions and Plans
Improving Staff
Wellbeing and
Engagement
Reducing Bullying and
Harassment
Improving and
growing Team
Working
Management training, development of competencies and toolkits
InTent to listen events
Introduction of Supervision /
Resilience Training
Re-tender for support contract
Conflict Resolution Scheme
Building Team BCH
Review of ‘keeping people safe’
policy, violence and aggression
policy and dignity at work policy
Team Maker Tips
Team Maker Programme
Developing Business Case for
resources and funding
Improve awareness and
communication
In Their Shoes/Paired Learning
Engagement Tool-kit
Raising concerns process review and
advocate role
Local surveys / FFT
Big White Wall
Developing the ‘BCH Way’
Revise appraisal to improve
understanding of team objectives
Supporting Team Development Days
Our Survey Plans for the Future
Quarter 1
Friends & Family
Test for Staff
FFT(S)
(sample)
Quarter 2
Local staff survey
questions and
FFT(S)
(full)
Quarter 3
National Staff
Survey
(sample)
Quarter 4
Local staff survey
questions and
FFT(S)
(full)
Conclusion and Recommendations
• BCH is clearly seen as a positive, motivating and engaging place to work but our
staff are reporting high levels of pressure and harassment which will impact on
our ability to retain them.
• It is recommended that the Trust places a significant focus on improving
wellbeing for the BCH workforce, and the Board are asked to support this
recommendation and to support the future business case for improved
resources and funding for staff wellbeing.
• We know that improving wellbeing will further improve engagement and will
therefore improve our patient experience and outcomes.
The Trust Board are asked to:
• Note the results of the staff survey for 2013
• Support the recommendation for focus/action over the next 12 months
Board of Directors
Public Meeting
30 April 2014
Item 14.82
Enc 03
Strategic Objective/ Enabler
The People Strategy
Report Title
The People Strategy Refresh 2014
Sponsoring Director
Chief Officer for Workforce Development
Author(s)
Chief Officer for Workforce and Associate Director for
Education and OD
Previously considered by
Finance and Resources Committee
Situation
BCH faces significant operational and financial challenges over the next three to
five years. We know that there will be less junior medics available, that we have
nursing supply shortages, issues with retention, and that the funding position will
mean that we need a more productive workforce.
The requirement to redesign the way we deliver care to improve quality, is even
more important. All of this together with ensuring our staff feel valued and involved in
the decisions that influence them at work, will make BCH a great place to work. We
also have to ensure we are prepared for Next Generation, and only through a strong
complementary people strategy, will these aims be achieved.
Our staff are our most important resource and this refreshed people strategy brings
together the key components of the scale of the workforce challenges ahead and
provides a strategic steer to improve organisational performance through our
people. We have simplified our strategy to ensure our priorities have the right focus,
and have clear outcome measures.
Background
Our recent staff survey results, show that BCH has a very committed and engaged
workforce, but a workforce that need more support to ensure we retain them. We
have a range of specialist and highly skilled people, with a reputation for delivering
strong performance and experience of delivering great financial results, and we
must ensure our strategy ensures we are able to retain this talent, and attract future
talent. The changes in funding for the trust and our plans for the estate strategy,
however, mean that we will need to reduce the expenditure on our staff.
This strategy has been informed by what our staff have told us of their experience of
working at the Trust is, what the internal and external drivers are for the Trust are over
the next three years, with a key focus on workforce redesign and culture
improvement.
Assessment
The refreshed strategy shows that culture development is core. The enablers, are in
3 areas, each with 2 robust priority statements.
Developing our people
Caring for our people
Managing our people
The delivery of these components will be monitored through the board committee
structure and updates on key strategic decisions will be presented to the board in
line with the annual timetable.
The following strategic workforce risks will be mitigated through the delivery of this
strategy.
The organisation fails to identify and develop the right numbers of staff with
the right skills to meet future service requirements, to deliver a high quality
and safe service.
The organisation fails to improve the workforce productivity and efficiency, in
order to meet the current and future financial challenges.
The organisation fails to embed the OD priorities and shift the culture to one of
high staff engagement and high performance.
Recommendations
The Trust Board is asked to discuss and approve the People Strategy.
Key Risks
Risk Description
As per above
Controls
Trust board sub
committees
Assurances
Regular reports to chief
officers, TLT, SLT, SWC and
the Trust Board.
Standards of compliance
and assessment
Key Impacts
Strategic Objectives
The People Strategy
CQC Registration (state
outcome)
NHS Constitution
Other Compliance (e.g.
NHSLA, Information
Governance, Monitor)
Equality, diversity & human
rights
Trust contracts
Other
Education delivery, employment compliance,
engaged staff who deliver quality care.
This will support how the trust embeds the NHS
constitution and the BCH values
This will ensure that all legislative other requirements
pertaining to employment are met and monitored.
Ensuring we have a productive workforce which aligns with
the financial forecasting outlined in the monitor plan.
This supports the delivery of the Equality Delivery System
and ensures that we embed inclusion into the core of
everything we do.
The People Strategy: Improving Team BCH Today,
Securing The Workforce For The Next Generation
Contents
1. Introduction
2. The People Priorities
3. Looking Forward
4. Where are we now
5. Success Measures
6. Conclusion
2
1. Introduction
2. The People Priorities
3. Looking Forward
4. Where are we now
5. Success Measures
6. Conclusion
3
Introduction
As one of the UK‟s leading paediatric centres we go to great lengths to target, teach, nurture and develop the skills of our present
and future workforce, to enable access to training and education and to foster life-long learning. Our aim is to ensure that all staff
are appropriately equipped and qualified for the work they do and continue to learn and develop in their time with us. We
continually examine our practice and look at ways to innovate and improve the service we all deliver so that our children, young
people and families receive a first-class service.
The issues we are facing with increasing high demand for our services means we have to continue to grow our capacity at a rapid
pace, not just by building new facilities, but also by organising ourselves differently to improve our patient pathways. We need to
redesign our workforce to use our skilled professionals in new ways and invest in technology to enable change. If we look ahead to
the next five years, our local population is expected to grow significantly, and we will see thousands more children every year, with
even more complex conditions.
The Trust's strategy is based on our mission, which is “to provide outstanding care and treatment to all children and young people
who choose and need to use our services, and to share and spread new knowledge and practice, so we are always at the forefront
of what is possible.”
This is supported by a clear set of strategic goals and our vision of being the leading provider of healthcare to children and young
people in the UK, whatever their condition and wherever they need our expertise
This refresh of the 2012 People Strategy has taken into account a range of national, regional and local workforce priorities and
identified a number of key priorities that can be effectively measured. Implicit in this strategy is that it is through the delivery of
these priorities that our organisational culture will develop. There is not an individual strand called ‘culture’ it is a fundamental part
of the whole rather than a definitive piece of work. It is very much how we are rather than what we do.
This paper also addresses how the trust board deploys responsibility for monitoring the people strategy through SWC to a new
board committee.
1. Introduction
2. The People Priorities
3. Looking Forward
4. Where are we now
5. Success Measures
6. Conclusion
5
Our Strategic Workforce Priorities
The following 6 high level priorities have been determined from a range of indicators including our medium and long term goals, the
quality and safety agenda, the feedback from our staff and managers, the external environment and workforce supply issues.
LEADERSHIP CULTURE &
DEVELOPMENT
Enabling our leaders to develop
compassionate leadership styles, to
improve staff engagement
wellbeing, and organisational
culture, including how we manage
our ‘talent’ and ensure staff are
valued for their contribution
WELLBEING
Development of support & self-care
packages for staff health & wellbeing
to reduce stress and build resilience
& further investment in wellbeing,
including on-line and e-learning
PEOPLE SYSTEMS
Improving our people management
systems & processes through better
use of IT and further enhance the
workforce planning process.
Improved managers induction and
tools to support them in their roles
WORKFORCE REDESIGN
Development of the clinical
workforce for the future, growing
new and innovative roles, to
support excellence in clinical care,
as well as development of new
ways of learning
REWARD & RECOGNITION
Ensuring that individual performance
is clearly aligned to reward and there
are opportunities for staff to develop
through clear career frameworks.
Development of clear individual and
team objectives linked to Trust
priorities
1:1 SUPPORT & GUIDANCE
Further growth & development of
clinical supervision, clinical team
de-briefing, coaching and
mentoring, to improve evidence
based practice and promote
resilience
The Context for our People Strategy - Our Revised Priorities for
2013 – 2016
We will strengthen Birmingham Children’s
Hospital’s position as a provider of Specialised
and Highly Specialised services, so that we
become the leading provider of healthcare in
the UK.
Every member of staff working at Birmingham
Children’s Hospital will be a champion for
children and young people.
We will continue to develop Birmingham
Children’s Hospital as a provider of
outstanding local services: ‘a hospital without
walls’, working in close partnership with other
organisations
• To develop and promote our strategy for
rare diseases
• To be more ambitious in our delivery of
specialised mental health services, ensuring
children and young people receive the best
care in the best environment.
• To further develop our position as an
advocate and provider of public health
advice, improve the lives of our patients,
and all the children and young people across
Birmingham.
• To further strengthen the voice of children
and young people in how our services are
run and how we promote healthy lifestyles.
• To promote the quality of end of life care
• To improve the life chances for young
people with a learning disability by
developing a range of employment
opportunities.
• To continue to develop, with our partners, a
Birmingham Children’s Network, that
enables high quality, high value healthcare
for children and young people across
Birmingham
• To work with primary care partners to
examine how we might come together to
best provide first line care for children and
young people.
• To examine, with partners, how we best
provide community mental health services
for children and young people, given the
budget restrictions expected from
commissioners.
Every child and young person requiring access
to care at Birmingham Children’s Hospital will
be admitted in a timely way, with no
unnecessary waiting along their pathway.
Every child and young person cared for by
Birmingham Children’s Hospital will be
provided with safe, high quality care and a
fantastic patient experience.
Every member of staff working at Birmingham
Children’s Hospital will be looking for, and
delivering better ways of providing care, at
better value.
• To ensure that no child or young person has
their appointment or operation cancelled,
unless there is unforeseen urgent clinical
priority.
• To provide high quality consistent
emergency medical and surgical care by
improving the patient journey and removing
all unnecessary delays.
• To further develop our approaches to
gaining feedback from staff, children, young
people and families to ensure that their
voice is heard at every level of the
organisation.
• To further innovate our systems to promote
and enhance patient safety and reduce
avoidable harm.
• To introduce technology to improve the
service safety, quality and experience.
• To build an organisation of high performing
teams, focussing on quality.
• To review whether we have the right
people, with the right skills, undertaking key
roles to ensure we can provide high quality
services within the resources available.
• To support and develop innovation in the
delivery of care by redesigning a range of
clinical pathways.
• To explore how we can work with partners,
to improve our commercial offer in order to
further support NHS services.
1. Introduction
2. The People Priorities
3. Looking Forward
4. Where are we now
5. Success Measures
6. Conclusion
8
Looking Forward ……
There are a number of strategic workforce challenges facing us as we refresh the people strategy, some are
definitive, i.e. staff shortages and finances and some will be based on feedback from staff and our managers:
One year on post the Francis publication we must continually check our culture for raising patient safety & quality concerns and
supporting staff through this. In addition the Berwick and Keogh review s build on the safety culture & Governance systems required
including our board focus on nursing skill mix and how we publish this information.
The workforce supply – is no longer available in some key professions following a national reduction in training commissions, eg: less
nurses and a shift to health visiting and a 6% year on year reduction in junior doctors
The Next Generation programme will recommend new and improved patient pathways, new IT systems and new estate which will
require different skill sets and role redesign
Our staff have told us that they are struggling to cope with the increased acuity of our patients with increased expectations from
families and the impact this has on them personally
The medium term estates strategy will require us to design new ways of working to meet the workforce demand for new theatres etc.
Our expectations of leaders and managers to create the right environment and culture for staff to deliver higher quality care at
reduced costs , requires us to invest in their development
The Financial challenge – Based on recent reports the NHS is going to face unprecedented financial pressures which will mean most
organisations will have to meet an approximate 9% reduction in the pay bill.
Predicted supply and demand model for nurses
(based on 80:20 currently, but modelling a different skill mix)
We know that workforce supply will continue to be problematic. The workforce modelling example below shows the supply
issues for nursing. Redesigning the workforce is the only way we can address the supply gap we have and meet the financial
challenge. We have already begun the journey but there is still a long way to go. Any work done on skill mix changes will need
to take account of patient acuity and will not be a one size fits all model.
Year
2015
Demand
Predicted leavers
- all based on
12.85%
Demand year on
year
Supply
Difference
(est. supply gap)
2016
2017
2018
2019
1228.47
1233.79
1238.64
1238.64
1260.84
158
159
159
159
162
218
164
164
159
184
c108
c108
c108
c108
c108
-110
-56
-56
-51
-76
=72:28
=70:30
Skills mix scenario model: 10% shift in ratio implemented over 5 years
Ratio change
Supply gap (est)
=78:22
(43 less)
=76:24
- 67 (75 less)
=74:26
+19 (105 less)
+49 (136 less)
+85 (164 less)
+88
(44 less)
-7 (39 less)
-37
+19 (75 less)
+19 (75 less)
+ 24 (70 less)
-6
Ratio change scenarios: impact on qualified nurse (demand) and supply +/78:22
(43 less)
-67
76:24
(74 less)
-36 (75 less)
74:26
(104 less)
-6 (104 less)
+48 (105 less)
+49 (105 less)
+ 54 (102 less)
+26
72:28
(135 less)
+25 (136 less)
+80 (136 less)
+80
+85
+57
(45 less)
-11
(44 less)
-12
(136 less)
(133 less)
Redesigning the workforce is a priority for the People Strategy here is why ……
Our Workforce are our largest cost. One way to address the affordability gap is to have a different workforce model that still delivers high
quality patient care, but reduces the overall pay bill costs. If we are to be ready for the Next Generation, we have to do things differently,
we have already begun to re model certain areas such as PICU and General Surgery, this has resulted in a staffing model which is not only
provides more resilience in the services but is also lower in cost. Our business planning for 2014/15 has integrated the workforce plans for
the next 5 years and a process for tracking and monitoring against this will be developed through the resources report.
Impact of cost inflation / Income deflation on Trust I&E 10 years
262.3
262.0
252.0
Affordability
gap
242.0
£m
Income
231.0
232.0
222.0
Expenditure
226.4
213.6
212.0
13/14 14/15 15/16 16/17 17/18 18/19 19/20 20/21 21/22 22/23 23/24
Year
1. Introduction
2. The People Priorities
3. Looking Forward
4. Where are we now
5. Success Measures
6. Conclusion
12
Looking back… the journey since 2011
2011
InTent - Developed Mission, Vision,
Values and Strategic Goals
2012
June - Launch of the first People Strategy
 InTent – 150 year celebration and staff ‘Thank you’
2014
 January – team Builder and New
Leadership development
Programmes launched
 February – Staff survey results at
directorate level
 March – InTent2Listen events
ongoing to highlight where else we
can improve our staff’s experience
 Launch of the ‘Next Generation’
April 2014
Refresh of The People Strategy
2013
 March – Refresh of the People Priorities with a
greater focus on engagement, workforce
productivity, leadership and culture
 June – Staff ‘Together We Can’ listening events
told us where we needed to focus
 InTent – ‘Building Team BCH’ and roll-out of
supporting initiatives
 November – Review of the Education & Learning
functions
 December - Full census staff survey with BCH
local questions – highest ever return rate
Achievements since the launch of The People Strategy in 2012
The following list is not exhaustive and demonstrates where the trust has made significant progress to secure the right organisational
culture and a pipeline of clinical and non clinical workforce.
Organisational Development
Developing the Workforce
Caring for the Workforce
Managing the Workforce
Best ever response to staff
survey
New programme for newly
qualified practitioners and
Clinical Support Workers to
improve retention
Positive feedback from the NICE
audit on workforce wellbeing
and better than average
sickness levels
Improved HR support and
information for managers
through the introduction of
managers brief
3% increase in staff engagement
scores with positive shifts in
culture measurements
Significant improvement in
junior doctors induction and
training
A range of staff health and
wellbeing initiatives delivered
impacting staff perception of
the trust
Fully compliant junior doctors
rotas and increased role
satisfaction and reputation as an
educational provider
Local engagement measures
agreed and system for Staff
Friends and Family in place
Innovative workforce solutions
to address supply issues, e.g.
ANP’s, PA’s, CSP’s
Conflict Resolution Scheme
developed
Embedded workforce planning
processes
New leadership and Team
Maker programmes focused on
Team BCH receiving excellent
feedback
Improved quality assurance
processes providing deanery
and HEE greater confidence
More local and Trust wide staff
recognition schemes
Highly commended deanery
reviews
Intent, Intent to Listen, Team
Development
A full review of the Education
Service, new governance
structures
Stress audits embedded and
improvement plans in place
Improved recruitment process
leading to reduction in time to
hire
Youth Academy – traineeships,
apprenticeships, new and
improved intern programme
Introduction of Future Fit
programme resulting in range of
workforce improvements
Clinical Impact of New Roles
The trust has had much success with the introduction of a range of new clinical roles. This has built resilience in our clinical workforce and
supported the development of the wider clinical workforce. We recognise the internal challenges to this in that we are fishing from the
same workforce pool so we do not want to fill the advanced roles whilst compromising the professional resilience at different levels.
There is also the financial challenge and we need to ensure that these new roles are replacement roles and not additional.
Number
New Role
Impact on Clinical Services
Physician Associate
4
Support daytime service delivery, improved continuity of care. Offers stability to the tier 1 (SHO) medical workforce with
potential to support out of hours tier 1 rotas. Potential to develop new roles e.g. trauma coordinator. Current limitations:
prescribing capability. Potential growth area of non medical and non nursing workforce. Horizontal career pathway.
Advanced Nurse Practitioners
3 medicine
2 cardiology
11 PICU
Longstanding ANP programme offering variety of different local support. In PICU 6 ANPs on the middle grade rota with 5 more in
training. New initiative in progress to develop ANP’s with experience across different departments, currently training in
medicine and cardiology. Potential to support tier 1 (SHO) out of hours rotas with further potential to support middle grade
rotas in some areas. Potential to develop sustainable middle tier workforce in vulnerable areas e.g. haem / onc. Takes at least 2
years to train.
Advanced Clinical
Practitioners
2
Microbiology - in hours and out of hours cover at senior registrar level. ? Potential in other areas
International Doctors (UHB)
2
Service delivery and support junior doctors rotas. Ongoing work to address the challenge of matching desire of where applicants
want to train with vacancies / areas of need. Links with UHB programme facilitate recruitment, pre employment and induction
processes.
BCH International Fellows
1
Support daytime service delivery, stability to medical rota and filling gaps in areas hard to fill e.g. Hepatology, Oncology. Raising
profile of BCH internationally and potential to develop an ‘ international fellowship programme‘ with links to specific
departments. Variable experience of International doctors. Potential growth area.
Clinical Site Practitioners
? how many
wte increase
for DSS
weekends
CSP proven robust, sustainable workforce solution, have been part of H@N since 2007. Under NWOW CSP assist with weekend
workload in cardiology and hepatology. Have necessary training and experience to support tier 1 (SHO level) out of hours rotas
trust wide. Some have prescribing skills, potential to extend, flexibility to be despatched to areas of need across trust. Potential
clinical career progression for BCH nursing staff, but needs back fill of ward nursing gaps.
Pharmacy
In local areas prescribing pharmacists have made an impact. Potential for development.
Trainee Physician Associates
Ensuring we have a supply of PA’s and building our reputation as a provider of excellent education for new roles.
Trainee ANPs
3 ED
3 PICU
2 Cardiac
2 Gen Paeds
1 Haem Onc
Ensuring we have a continued supply of clinical professionals to sustain the revised models of care delivery.
What have our staff told us they need to improve their experience
at work?
“people are finding it more
difficult to cope”
“as a manager, I need systems
that are easy to use and
access so I can concentrate on
supporting staff, not spending
ages in front of a computer”
Recognition of the growth of
complexity of patients – skills of
workforce to meet these needs
A ‘safer’ culture where staff feel able
to raise concerns and challenge poor
behaviours
Supporting our workforce to
become more resilient and cope
with the pressures they face
“you get treated differently
based on the colour of
your uniform”
“there are some areas
that you walk into that
have a good feel, there
are others that are very
different, you don’t feel
welcome”
The need to shape roles and
responsibilities differently and give
greater clarity around objectives
and aims
Development for our managers and
leaders to enable them to be more
compassionate
Smoother and simpler processes and
systems
Help to grow team working across the
organisation
Help to deal with the behaviours of our
patients and their families, and of our
staff
“we just need recognition
that things are much more
difficult now”
Underpinning everything in the People Strategy is the need to improve
organisational culture. We have to have the right culture to deliver sustainable
and meaningful change that will ensure we can deliver the
Next Generation
1. Introduction
2. The People Priorities
3. Looking Forward
4. Where are we now
5. Success Measures
6. Conclusion
17
How will we know we’ve improved? – Success Measures
Caring for our staff ….
Our priority
Inputs
Output Measures
Enabling our leaders to develop
compassionate leadership styles, to improve
staff engagement wellbeing, and
organisational culture, including how we
manage our ‘talent’ and ensure staff are
valued for their contribution
Leadership programmes
E-learning modules
Masterclasses
Engagement measures/surveys
OD interventions
Appraisal review
Talent management system
Improved survey outcomes in areas around
management support, wellbeing,
engagement, team work and raising
concerns
Improved retention
Pipeline for future
Development of support & self-care
packages for staff health & wellbeing to
reduce stress and build resilience & further
investment in wellbeing, including on-line
and e-learning
Improved staff support contract
Big White Wall
E-Resilience module and resources
Mindfulness and other ‘training’
Physical activities
Physiotherapy access
Reduction in sickness absence specifically
for MSK and stress related absences
Improved response in surveys re focus of
wellbeing and supported by organisation
and stress levels
Reduction in behaviour and attitude related
complaints
Improved retention
How will we know we’ve improved? – Success measures
Managing our staff ……
Our priority
Inputs
Output Measures
Improving our people management systems
& processes through better use of IT and
further enhance the workforce planning
process.
Improved managers induction and tools to
support them in their roles
Introduction of e-forms where possible
Improvement to policy/processes
Improved recruitment processes
Tool-kit that guides managers on the what,
when, how and why of people management
processes
Clear performance management processes
Workforce dashboard
Junior Doctors Streamlining Project
Values based recruitment
Less pay/other errors
Improved customer feedback
Improved attraction and retention
Ensuring that individual performance is
clearly aligned to reward and there are
opportunities for staff to develop through a
clear career framework.
Through Future Fit deliver improvements in
productivity by maximising the freedoms
within national employment contracts.
Introducing Total Reward
Pensions Advisory Service
Pay flexibilities
Enhanced salary sacrifice / exchange
scheme options
Development of local reward package
Improved survey outcomes in areas around
reward, engagement
Improved pension awareness and
understanding
Increased access and participation in salary
sacrifice / exchange schemes
Improved attraction and retention figures
How will we know we’ve improved? - Success measures
Developing our staff ….
Our priority
Inputs
Output Measures
Development of the workforce for the
future, growing new and innovative roles, to
support excellence in clinical care, as well as
development of new ways of learning
Workforce planning and modelling tools
Project groups
Commissioning of education
Growth of e learning/simulation/curriculum
design
More individuals in new/different roles
Changing workforce ‘Christmas tree’
Reduced ‘time out’ for training
Improved education evaluation
Improved compliance
Further growth & development of clinical
supervision, clinical team de-briefing,
coaching and mentoring, to improve
evidence based practice and promote
resilience
Easy access to clinical supervision, de-brief,
mentoring, coaching
Growth of pool of supervisors/mentors
Introduction of formal models of team debrief
Talent/potential management tool
embedded at senior management level
Potential management tool embedded in all
appraisals
Clear succession plan for senior/high risk
roles with gap analysis and strategy in place
Survey feedback re quality of appraisal
Numbers accessing 1:1 interventions
Survey feedback around wellbeing
New Governance Structure for delivering - The People Strategy
The Audit Committee has approved in principle the creation of the Trust Board People Committee to oversee the delivery of
the People Strategy and the management of strategic workforce risks. The Board will assure itself through the People
Committee that the strategic workforce agenda is being delivered.
The Trust Board
The Finance and Resources
Committee
Reports to FRC will be related
to how the workforce agenda
meet the financial challenges
The Board People
Committee
Audit Committee
Quality Committee
Strategic Workforce
Committee
The focus for SWC will change in line
with the new leadership structure
Reports to quality committee
will be related to how the
workforce challenges are
impacting the quality agenda.
What does the People Strategy mean for our Staff?
• Clarity on how what you
do helps achieve the
Trust’s priorities
• Improved access to
advice & support for your
own health & wellbeing
• Working as part of a
supportive team with
shared goals
• A supportive approach to
keep you well at home
and at work
• A manager who listens &
supports your
development
• Various activities to
support health and
lifestyle
• A regular conversation
about your progress and
potential through the
appraisal process
• Meeting your differing
needs
• An environment where
you feel comfortable to
raise concerns
• Clear plans for career
progression
What we need from you!
• Development
opportunities
• Team work & support for
colleagues
• Good quality appraisal
• Role-specific training
• Focus on your own health &
wellbeing and access support
when required
• Flexible ways to meet
CPD & mandatory
training
• Always put patients at the
heart of what you do
• Improved systems to
remind you of your
required development
• Behaviours in line with our
values
• Innovative ways to
develop yourself i.e.
e-learning & bedside
teaching
• Maintain professional
development requirements
including Statutory &
Mandatory & that of your staff
• Commitment to team
• Support junior healthcare
colleagues to give them a great
training experience
• Provide regular feedback for
the Trust on your work
experience and areas that
could be improved
What the People Strategy means for our Managers
• Access to Managers’ Toolkit,
a collection of guidelines &
processes to aid every day
decision-making
• Support in identifying
vulnerable staff and
develop strategies to
support them
• Greater understanding of
• Improve workforce
dashboard so that you have
up-to-date information on
workforce statistics
• Improved access to
Occupational Health
services
• Access to evidence-based
& validated training
opportunities for yourself
& your teams
• Access to master classes to
improve your capability
• Clear workforce planning
tools to support you to
redesign skill mix of your
teams
• Support to develop team
working and setting
priorities & objectives to
provide clarity for your staff
• Professional support to deal
with people / teams in
difficulty
• Access to specialised
mental health support
provided by an external
provider
• Access to tools & support
that prevent staff going off
sick and if they do,
provision of support
• Clear processes to escalate
areas of concern or staff /
teams in difficulty
the development
opportunities linked to
specific career framework
• Access to tools to develop
your talent management
& succession planning
process
• Access to leadership
development to build
effective teams
• Opportunity to influence
the Trust training priorities
to meet your service
needs.
Expectations of our
Managers
• Develop team working,
acting as a role model
• Create a culture where
staff feel comfortable to
raise concerns
• Create a culture where
staff innovate to improve
patient experience
• Listen to staff & create
opportunities to reflect on
‘How we are doing’
• Comply with people
management processes
within required timelines
• Commit to developing
your leadership skills
• Support staff through
change processes to
improve engagement
1. Introduction
2. The People Priorities
3. Looking Forward
4. Where are we now
5. Success Measures
6. Conclusion
24
Conclusion
This report has outlined the People Priorities for the Trust and this is the first
opportunity for the Finance & Resources Committee to discuss the content of the
priorities and ensure that the range of actions identified sufficiently enables the Trust
to meet our strategic goals and supports our aim to be the employer of choice.
Board of Directors
Public Meeting
30th April 2014
Item 14.83
Report Title
Sponsoring Directors
Contributors
Previously considered by
Enc 04
Quality Report
Dr Vin Diwakar, Chief Medical Officer & Michelle McLoughlin,
Chief Nursing Officer
Governance Services, Corporate Nursing, Education, Infection
Prevention and Control, PICU & Cardiac Services
Clinical Risk & Quality Assurance Committee, SLT
Situation
The enclosed report provides an update on key clinical safety and quality topics.
Background
The report is collated from a number of information sources and provides assurance that key
risks are being escalated and monitored until sufficient action has been taken to address the
concerns.
The report includes information on key risks, serious incidents, mortality data, cardiac arrest,
respiratory arrest, other acute life threatening events, infection control data, Safety
Thermometer data, Net Promoter Question results, and data from the PED database.
Information on Never Events and other safety information is included by exception.
The report now aligns information against Trust priorities and measures.
Assessment
Please see the enclosed report for a discussion of the key risks.
Recommendations
Review the enclosed report
Key Risks
Risk Description
Failure to correctly identify the
greatest risks to the quality of care
and safety of our patients.
Controls
Directorate Governance
systems
Board Assurance
Framework
Risk Register
Safety Strategy
Safety Dashboard
Assurances
Monthly Board Safety Report
Mortality Review
Monitoring of incident trends
Monitoring of complaints
trends
Key Impacts
Strategic Objective
Strategic Priorities
CQC Registration
NHS Constitution
Other Compliance
Equality, diversity & human
rights
Every child and young person cared for by Birmingham Children’s
Hospital will be provided with safe, high quality care, and a
fantastic patient and family experience
3. Further develop our approaches to gaining feedback from staff,
children, young people and families to ensure that their voice is
heard at every level of the organisation.
4. Further innovate our systems to promote and enhance patient
safety and reduce avoidable harm.
Standard 16 - Assessing & monitoring the quality of service
provision could be affected by a failure to manage risks
highlighted by the report. Risks to compliance with other
standards may be highlighted by the reports.
Patient Rights
• Quality of Care and Environment
•
Treatments, Drugs
•
Respect
•
Consent and Confidentiality
•
Informed Choices
•
Complaint and Redress
The report supports compliance with NHSLA and Monitor
requirements
Right to life
Quality Report:
Safety & Patient Experience
April 2014
Vin Diwakar, Chief Medical Officer
Michelle McLoughlin, Chief Nurse
Item 14.83
Enc 04
1
The BCH Vision of Quality
Strategic Objectives which reflect our commitment to Quality, Safety and a fantastic patient Experience.
Every child and
young person
requiring access to
care at Birmingham
Children’s Hospital
will be admitted in a
timely way, with no
unnecessary waiting
along their pathway
Every child and
young person cared
for by Birmingham
Children’s Hospital
will be provided
with safe, high
quality care, and a
fantastic patient and
family experience
Every member
of staff working
at Birmingham
Children’s
Hospital will be
looking for, and
delivering better
ways of
providing care,
at better value
Clinical Quality is our organising principle. It has always
been our mission to provide outstanding care and
treatment to all children and young people who choose
and need to use our services, and to share and spread new
knowledge and practice, so we are always at the forefront
of what is possible. Our vision is to be the leading provider
of healthcare for children and young people, giving them
care and support – whatever treatment they need – in a
hospital without walls
The physical capacity of the estate is the biggest challenge
to this vision. Thus, our clinical quality strategy is founded
on capital investment in our estate, modernisation of care
pathways, equipping our staff with the skills to use our
existing resources more safely, effectively and efficiently,
and partnership working to deliver healthcare for children
and young people closer to their home wherever possible.
Birmingham Children’s
Hospital’s leaders will
work hard to strengthen
its position as a provider
of Specialised and Highly
Specialised Services, so
that it becomes the
national provider of
Children’s Healthcare
Services in the UK
Birmingham
Children’s
Hospital will
continue to
develop as ‘a
hospital without
walls’, working in
close partnership
with other
organisations
Birmingham
Children’s
Hospital will be
a champion for
children and
young people.
We have built in a relentless focus on the experiences of our children,
young people and families at every level.
We want to be a place where safety is everyone’s top priority and have
set the following 3 year objectives to reflect this:
• Continue development of tools to prevent predictable and
preventable cardiac and respiratory arrests, reduce extravasation
injuries and medication incidents, improve time from decision to
administration of antibiotics, and prevent Grade 2 pressure sores
• Reduce risks in the handover of patients between services and
caregivers during their inpatient stay
• Develop a Trust wide quality outcomes dashboard
• Introduce new methods of collecting and responding to the
experience of our patients and families in real time using all
appropriate means
• Ensure that Patient Experience feedback is used to inform the strategy
for ensuring that we continue to demonstrate our Core Values.
2
The April Report at a glance
New Events & Concerns
Past harm
•New SIRIs
•New Complaints
•New PED Need to Improve Comments
•Aggregated Patient Experience Analysis (March)
•Aggregated Patient Experience Analysis (2013/14)
4
4
4
5
6-8
•Zero new Never Events for 12 months
•‘Routine ‘ Quality Surveillance Group rating
•Low numbers of absolute deaths and deaths/1000 admissions
Lowlights
Learning from Experience
Integration & Learning
•Closed SIRIs
•Closed Complaints
•Quality Surveillance Groups Update
Highlights
9
9
10
•4 new SIRIs
•7 new complaints
Themed Analysis
Sensitivity to Operations
•Complaints & PALS Quarter 4 and 2013/14 Analysis
•Monthly Patient Experience Feedback Analysis
11-16
17
Monitoring & Review
Mortality
Reliability & Sensitivity to Operations
•Friends & family test
•Feedback App
•Infection Control
•Arrests, ALTEs and Unplanned Admissions to PICU
•Safeguarding
•Safety Thermometer
•SCAN
We continue to align existing data to the 5 domains of patient
safety identified by the Health Foundation.
We also continue to align data to the Trust priorities wherever
possible.
18
19
20
21
22
23
24
Past harm
•Absolute number & deaths /1000 admissions
•SMR Run chart
•SMR Funnel Plot & Bar Chart
•PICU Cusum
•Cardiac Cusum & VLAD
•Liver Cusum
25
26
27
28
29
30
3
New Events & Concerns
Past Harm
There have been no new Never Events (None since 15/4/13)
Complaints Overview 2013/14
There have been 4 new SIRIs
96
13/14:82 Hospital transmission of H1N1 and parainfluenza A to two patients in our medical high dependency unit. Both
patients have recovered well and their treatment was not affected. Another similar incident is also under investigation as
a SIRI (13/14:79), in that case a patient who had been exposed to H1N1 was transferred to BCH without us being notified.
13/14:83 A PICU handover sheet was found off-site in a public location by a member of BCH staff. This sheet contained
patient confidential information. The confidentiality breach has been reported to the Information Commissioner.
13/14:87 A patient was transferred to BCH from a DGH for line insertion. The patient was known to BCH because of his
underlying skin condition. The patient unexpected suffered from a cardiac arrest and passed away. The initial review of the
case did not highlight any care management or service delivery failures, however, some potential concerns were identified
through the subsequent mortality review process and so we have reclassified this case as a SIRI.
13/14:80 A neurosurgical patient has experienced delays with outpatient review and surveillance of their condition. This
may have resulted in a potentially preventable deterioration to their spinal pathology.
105
Waiting, delays, cancellations and access to services
Staff Attitude
Quality of Treatment
Communication
Other
Need to Improve Comments March
2014
21
Mother raised concerns surrounding the personal information about
her own mental health, that was shared between the Consultant
Plastic Surgeon, Cleft Nurses and Psychologist.
Mother has raised concerns surrounding the waiting time for her son's outpatient appointment with Consultant
Orthopaedic Surgeon. Mother has stated that there was lack of information surrounding the delay of her
appointment and due to parking and work commitments she had to leave the hospital before her son was seen.
Joint Complaint with UHCW who are leading.
The primary concern with UHCW ENT and quality of
care provided by them as no diagnosis is yet
available. However, BCH concerns relate to
attendance in ED and level of care provided as the
child was not seen by specialist and discharged
despite bleeding from the ears.
Mother has raised concerns surrounding the
quality of care received whilst her daughter was
an inpatient on PICU. She feels that a number of
these contributed to her daughter's planned
overnight stay lasting 6 weeks. Care in PICU was
thought to be very inconsistent, and they felt
like they had to stay with their child all the time
and monitor her care.
58
67
There have been 7 new Formal Complaints
Mother has raised concerns surrounding the lack
of follow up for her daughter, resulting in a delay
in providing her daughter with a hearing test.
15
11
53
12
7
Facilities
Play & activities
Waiting times
Staff in general
Food
Parents have raised concerns surrounding the attitude of
Consultant General Paediatrician. Parents are unhappy
with the attitude presented in a clinic appointment and
have raised concerns surrounding the clinic letter and the
information detailed within it. Parents feel that the
Consultant did not listen to their concerns and requests.
Concerns and questions raised following surgery – why did their daughter come back from Theatre with breathing
problems.? How was the pleural nerve damaged? Were recordings incorrectly interpreted? The parents have
stated that explanations provided to date have all been very technical.
New Events & Concerns
Past Harm
Themed Analysis - Pooling our Patient Experience Data – March14
This is a new approach to presenting an aggregated picture of information
An Annual aggregated analysis appears
received via a number of feedback sources, complaints, Patient Advice &
on the next pages
Liaison contacts, SIRIs and the Patient Experience Database (PED) – Need to
Improve comments only (NTIs). The Venn diagrams illustrate the areas where
Complaint
these sources of feedback overlap.
SIRIs
Complaint
NTI
2
SIRIs
7
SIRIS
1
0
0
Complaint
1
PALS
8
0
Waiting, delays &
cancellations
Staff
Attitude
PALS
PALS
Quality of
treatment
52
21
9
3
FacilitiesNTI
NTI
PALS
NTI
SIRIs
3
39
Complaint
14
2
Complaint
1
SIRIs
Complaint
SIRIs
0
1
NTI
0
11
Food
Communication
PALS
PALS
0
20
Complaint
SIRIs
NTI
0
0
9
PALS
0
Play &
Activities
NTI
12
5
New Events & Concerns
Past Harm
Themed Analysis – – Annual Review 2013/14
Pooling our Patient Experience Data
Complaint
58
NTI
220
Waiting, delays
& cancellations
PALS
306
SIRIS
1
56 Formal Complaints specifically related to the Quality of Medical
Care and 23 to nursing care. A analysis of of complaints appears
later in this report. However, both Cardiac Services and the
Emergency Department received 10 complaints about the quality of
care provided.
The 13 SIRIs which concluded that there had been deficiencies in the
Quality of Care identified issues such as, competence and
supervision, equipment problems, capacity/demand, poorly
designed tasks, suitability/access to guidelines, clarity of role.
Staffing issues were raised 51 times by way of Need to Improve (NTI)
comments. Quality of Nursing Care was questioned on 46 NTIs and
there were 77 Infection Control NTIs. A common thread between
SIRIs and NTIs is a lack of or failure to follow protocol which was a
factor in 8 SIRIs and was raised via 25 times via NTIs.
This is a consistently identified, previously reported theme (see Dec &
March reports).
A high proportion of these issues relate to cancelled procedures or
appointments in areas such as:
•ENT
•Neurology
•Neurosurgery
•Fracture Clinic
•Cardiac Surgery
•Paediatric Surgery
The SIRI involved a patient who experienced delays with outpatient
review and surveillance of their condition which may have resulted in
avoidable harm.
PALS
Complaint
89
105
Quality of
treatment
SIRIs
NTI
354
13
6
New Events & Concerns
Past Harm
Themed Analysis – – Annual Review
Pooling our Patient Experience Data
We align complaints to Trust
Values on a quarterly basis.
An analysis of complaints
involving Staff Attitude is
included later in this report.
However, those areas which
received 3 or more concerns
in 2013/14 were:
PICU (3)
Neurology Medics (3)
General Paeds (4)
Gastroeterology (4)
Emergency Department (10)
Within this analysis, we rarely
see individual names
repeated.
3
Complaint
67
SIRIs
31
0
PALS
Staff
Attitude
47
NTI
44
211
54
84
It’s important to contextualise
that there were 2010 positive
comments about staff attitude in
the same period
0
10
20
The most common cause for concern relating to communication as
raised by families through PALS, Formal Complaints and NTIs relates to
the quality of the information that they have been given verbally and
whether important information has been shared with them at all.
We also see communication recognised as a contributory factor or root
cause through our SIRI investigations.
Common themes within SIRIs include:
•A failure to write down what was done
•Not sharing important information or being in a position to share such
information within the team.
30
40
50
60
Complaint
96
SIRIs
6
Communication
NTI
185
PALS
202
7
New Events & Concerns
Past Harm
Themed Analysis – – Annual Review
Pooling our Patient Experience Data
Complaint
SIRIs
Complaint
NTI
4
SIRIs
0
Issues are generally raised in
these 3 categories via Patient
Experience feedback and not so
readily reflected in the other
more proactive sources of
feedback. This suggests that
while these issues are clearly
important to patients and
families, there is a level of
acceptance which exists and
individuals are not compelled to
complain even when
dissatisfied.
223
Food
PALS
3
SIRIs
0
PALS
0
Complaint
2
2
0
Facilities
PALS
15
NTI
660
Largest subcategories
•Patient facilities (décor etc) - 330
•Parent facilities & accommodation -109
•Cleanliness – 77
•Parking – 70
Play &
NTI
Activities 337
8
Learning from Experience
Integration & Learning
There were zero closed SIRIs in March
There were 7 Closed Complaints in March
Summary
Key Actions
The RCA team could not identify a cause for the rapid
deterioration nor could they find any contributory factors.
Plans have since been put in place to have a Clinical
Support Worker to work in the waiting room, regularly
assessing children after they have been triaged but
before they are called into the department.
Mother raised concerns about the quality of care her son received under the care of the MDT Meeting Arranged
general paediatricians, ED and neurosurgery at BCH
Detailed explanation of care provided to the satisfaction of
Mum feels that she has not been listened to when she indicated something was seriously the family.
wrong with her son and she feels a scan was not performed when it should have been
which would have identified that her son had a bleed on the brain requiring surgery.
Assistance provided in relation to funding application for
Mother has raised concerns that she has been waiting over 6 months for her son's
treatment.
application for Neurosurgery with the use of Bone Morphogenic Protein (BMP) to be
A liver patient re-attended ED after being reviewed and discharged earlier that day. The
patient suffered an arrest in the waiting area and could not be resuscitated. Mother
believed that her daughter was not given help that would have avoided her death. This
case was investigated as a SIRI (12/13:56).
submitted.
Parents feel that CPR was administered incorrectly to their son by a Radiographer.
Further investigation has discovered that CPR was given by a Cardiologist.
PICU to develop a best practice guideline for
communicating significant events in a timely manner to
parents.
Detailed explanation of care provided to the satisfaction
of the family.
Father believed that his son needlessly had keyhole surgery 4 years ago .
Father wants to know why parents are not given the option to choose whether to have a
test procedure to ascertain it is worth putting the child through distressing, intrusive
surgical procedures.
Parents raised concerns that they felt the Consultant had not been honest with them in Explanation provided to family of treatment and
relation to her actions and information had been withheld. The family were concerned safeguarding process followed.
about the level of care provided to their son.
Mother states that she did not receive a change of appointment letter. She waited 2 and Apology given.
half hours to see Consultant and was told that he had no notes or information about the Electrical socket protectors purchased and in use.
visit. Mother then went to Pharmacy and her son was injured by a sharp object which was
in a power socket. Mother would like the health & safety aspect responded to.
9
Learning from Experience
Integration & Learning
Quality Surveillance Groups
(QSGs)
Since April 2013, a network QSGs has been established to bring
together organisations from across the health economy to share
information and intelligence on the quality of care being provided to
their communities.
The aim of QSGs is to identify risks to quality by proactively sharing
information and intelligence between commissioners, regulators and
those with a system oversight role. Having identified any potential
risks or concerns, the QSG should ensure that action is taken to
mitigate these risks and drive improvement in quality in an aligned
and coordinated way and to resolve issues locally where possible.
The National Quality Board publication ‘How to Establish a Quality
Surveillance Group – guidance to the new health system’ (January
2013) confirmed that QSGs do not have statutory powers and that
the actions that can be taken as a result of discussion at QSG are
limited to the remits of their member organisations. These actions
include:
•Actions and investigations conducted by member organisations
•Triggering Risk Summits
•Keeping providers under review at each meeting
•Collecting information about a provider for further consideration.
A risk surveillance rating system was established for the Birmingham,
Solihull and the Black Country QSG, with each provider considered
then assigned a surveillance rating. These rating have now been
refined and a system of narrative risk surveillance ratings are used
throughout the Midlands and East region.
The ratings used by the
QSG are described below:
Routine
Further
information
required
Enhanced
Risk Summit
No specific concerns identified, schedule for
routine discussion as part of QSG business
cycle
Potential concerns identified, further
information required for consideration at
scheduled future QSG.
Quality concerns identified, schedule for
further consideration at each QSG until
concerns are adequately addressed.
Serious quality concerns or failures triggering
QSG request for a risk summit.
BCH Rated as ‘Routine’.
A letter to the CEA dated 31st March 2014 confirmed
that at the most recent review Birmingham Children’s
Hospital NHS Foundation Trust was maintained at
‘Routine’.
Following each QSG, if there is a change to the agreed
surveillance rating, a letter will be issued to Chief
Executives of provider trusts which will highlight
particular issues of concern.
10
Themed Analysis
Sensitivity to Operations
Complaints Quarter 4 2013/14
•36 Formal Complaints in Q4
•125 individual issues were identified within the 36 complaints received in Q4
•In Q4, there was 1 referral to the Ombudsman
•73 Formal Complaints Received in 2012/13
•110 Formal Complaints Received in 2013/14
40
Frequency of Complaints
30
20
10
0
20
15
10
5
0
Complaints
Complaints per 1000 Admissions
Complaints According to Theme Q4
3
25
Waiting, delays, cancellations and
access to services
45
19
28
Admission,Discharge &
Transfer
4
11
Access to Services
5
1
4
Staff Attitude
Breach DofH Target
Waiting & Delays inpatient
Quality of treatment
1 1 1
5
Communication
AHP
Discrimination
Medical
Pattern since Q4 2010/11
11
Other
50
Other
Appropriateness of Treatment
Waiting, delays &
cancellations
40
Staff Attitude
30
Nursing
1 1 11
9
14
1
Medication Errors
AHP
Medical
Nursing
20
Quality of
Treatment
10
Communication
0
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
1011 1112 1112 1112 1112 1213 1213 1213 1213 1314 1314 1314 1314
Other
Overal Service
Staffing Issues
12
2 12
28
Complaints
Handling
Confidentiality
Not Listening
Oral
Written
Complaints 2013/14 Analysis
Communication
70
60
50
40
30
20
10
0
Waiting, delays, cancellations and access to services
Staff Attitude
Quality of Treatment
Communication
Other
15
64
30
58
95
25
Staff Attitude
25
Oral
4
Written Other
23
20
55
2
Not
Listened
to
26
15
10
104
6
5
0
Medical
Areas with 4 or more concerns
Ward 7
Plastic Surgery
Paediatric Assessment Unit
Neurosurgery Medics
Neurology Medics
Haemoglobinopathy
ENT
Endocrinology
Cardiac Services (General)
Nursing
Other
Areas with 3 or more concerns
Quality of Treatment
60
56
50
0
1
2
3
4
5
6
7
8
Areas with 4 or more concerns
40
30
Ward 2
PICU
Paediatric Surgery
Neurosurgery Medics
General Paediatrics
ENT
Emergency Department
Cardiac Services (General)
20
PICU
3
Neurology Medics
3
General Paediatrics
4
Gastroenterology
4
22
11
14
Emergency
Department
10
10
0
Medical Nursing Overall
0
5
10
15
Other
0
5
10
15
Some Complaints Issues
Quality of Care
Waiting, delays, cancellations & access to services
•Concerns with the fact that this baby had been seen at ED following a
respiratory arrest, and was then discharged home. Arrested again at
home and had to return to ED
• Mother unhappy with waiting time to see orthopaedic surgeon, she
had to leave the hospital without the patient being seen
•Family felt there was a lack of urgency with treatment and a failure to
closely monitor persistent ear infections
•Cancellation of surgery on day of operation.
Communication
Attitude
•Personal comments made in patient’s medical records.
•Family felt the consultant was incredibly dismissive and bordering on
rude
•Wrong information provided to the family due to anaesthetist reading
the wrong medical notes.
•Family believe the attitude of some professionals involved in the
patient’s care has been “horrific”
Actions Arising from Complaints
4
3
2
1
0
An Example of how we classify
Complaints
• 22 Recommendations in Q4
• 7 Complete – 15 Remain open
A family’s concerns are summarised
below:
CAMHS
CSS
DSS
Family are concerned about the way the
Consultant spoke to the patient
MD
SD
how he discussed the condition in
front of the patient
Corp
All actions arising from complaints are followed up on a Quarterly basis. The Investigating Manager is
asked for confirmation that each action has been completed and, where it has not proven possible to do
so, provide details of alternative actions taken.
The family felt
they had not been
listened to
PALS Contacts – Q4
80
70
60
50
40
30
20
10
0
Waiting, delays & cancellations
60
50
40
30
20
10
3
2
1
0
Medical Nursing Other
Other
Oral Communication
e.g. lack of information
about delays, treatment,
procedure and conflicting
information between medics
Waiting & Delays outpatient
AHP
0
Waiting & Delays inpatient
35
30
25
20
15
10
5
0
14
12
10
8
6
4
2
0
Quality of Medical Care
e.g. concerns about
treatment received to
include misdiagnosis
Communication
Access to Services
14
12
10
8
6
4
2
0
Staff Attitude
Admission,Discharge &
Transfer
Quality of Treatment
Outpatient/Inpatient delays and
cancellations
e.g. delays and cancellations of
appointments, cancellations of
surgery and difficulties in
obtaining surgery date
PALS 2013/14 analysis
Communication
140
120
100
80
60
40
20
0
Waiting, delays, cancellations and access to services
55
Staff Attitude
Quality of Treatment
Communication
306
202
Other
119
68
89
Waiting, delays &
cancellations
250
206
84
200
12
Oral
Written
150
Other
100
Areas with 10 or more issues raised
General Paediatrics
Gastroenterology
Fracture Clinic
General Paediatrics
Eye Department
Gastroenterology
ENT
Cardiac Services (General)
Emergency Department
0
Cardiac Services
0
10
20
10
20
30
40
Waiting & Delays - outpatient
Neurosurgery Medics
Waiting & Delays - inpatient
Neurology Medics
Access to Services
Neurosurgery Medics
Paediatric Surgery
Neurology Medics
30
0
Trauma & Orthopaedics
Paediatric Surgery
Respiratory Medicine
41
Urology Medics
Plastic Surgery
Urology Medics
27
Admission,Discharge & Transfer
Areas with 8 or more issues raised
50
Themed Analysis
Sensitivity to Operations
Patient Experience Database
Positive Comments March 2014
What parents liked during their stay
Need to Improve Comments March 2014
Friends & Family Questionnaire
What parents think needs to be improved
17
Friends and family
•This month the Friends and Family Test data was moved onto Vesper.
•Data from ED will be reported on a monthly basis.
•We have developed a creative way to obtain Friends and Family data from young people in ED by designing an
activity book which also educates the reader about Emergency services and has the question on the last page
January
2014
Trust NET Score
Total Discharged
Promoters
Passive
Detractors
February
2014
March
2014
85.1
1183
207
32
77.8
1085
215
43
85
1140
350
61
2
8
1
Neither likely nor unlikely
2
7
0
Unlikely
Extremely unlikely
0
0
1
0
1
0
CQUIN requirements :
•Continue to ask 15% of parents/ carers throughout Q1 - Q4 
Introduce a question with a comparable format and response rate for 8
year upwards and by Q4 be achieving a 15% response rate. 
•By Q4 we will have introduced a process into ED for both parents/carers
and children and young people.

Emergency Department Responses
Directorate
Age
Target Tot Total Need %+ Target Tot Total Need %+ve
(15%) al Positi to
ve (15%) al Positi to
ve Impro
ve Impro
ve
ve
A&E Observations
8
Adult
Young Person
0
0
6
2
75
6
2
75
0
0
Na
N
8
0
0
6
2
75
6
2
75
0
0
NaN
Very clean and tidy, staff
very friendly
The toilets were dirty in
the ED Waiting area
Excellent service, Friendly
doctors, very compassionate.
Keep up the good work
I don’t think its private when registering a
patient, other people can hear what your
saying and its not confidential
18
Monitoring & Review
Reliability & Sensitivity to Operations
Feedback App & Social Media
During March we received 53 App comments.
There was a ratio of approx 75/25 positive v need to improve
and is comparable with PED and Friends & Family ratios.
My 4 year old daughter is having sleeping issues as TVs and lights are on till
10.30pm. She is usually in bed for 7pm and I can understand in a hospital it may be
later... but because of the noise and nurses coming to do obs at 10.30/11 she is
having far less sleep :( cut off point needs to be earlier!
Finalist
Thank you for looking after me when I had an operation in my brain. All the doctors are
cool and friendly - Dr Bob is funny and Mr Solanki and Mr Rodriguez are kind and cool.
Alesha in the playroom was funny too. Karen makes me laugh! Ward 10 rocks! Hi 5 :)
Facebook and Twitter:
The past year has seen an increase of the use of social
media by staff. Social media and the app can support
our ambition to be open and transparent and
encourage frank conversations as well as a great
opportunity to interact directly with children, young
people and parents. The app and social media provide
an opportunity for parents, children and young people
to let us know about their experience, both positive and
not so good, in real time and for staff to respond
directly in real time too.
In March we received 111 comments via the
Birmingham Children's Hospital Facebook page and
Twitter account @Bham_Children's
19
Monitoring Infection control
March 2014
Infection
No.
MRSA Bloodstream Infections (BSI)
0
MSSA BSI (pre 48 hour)
2
MSSA BSI (post 48 hour)
2
E. Coli bacteraemia (pre 48 hour)
0
E. Coli bacteraemia (post 48 hour)
0
Glycopeptide-resistant enterococci
0
C. Difficile
0
MSSA - pre 48 hours
2011/12
2012/13
MSSA - post 48 hours
2013/14
2011/12
2012/13
2013/14
5
6
4
4
3
2
2
1
0
0
April
May
June
July
Aug
E-Coli - pre 48 hours
Sept
Oct
Nov
2011/12
Dec
Jan
2012/13
April
Feb March
2013/14
4
3
6
May
June
July
Aug
Sept
Oct
Nov
2011/12
E-Coli - post 48 hours
Dec
Jan
2012/13
Feb March
2013/14
4
2
2
1
0
0
April
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb March
April
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
March
20
Monitoring & Review
Reliability & Sensitivity to Operations
Respiratory Arrests, ALTEs and Unplanned Admissions to PICU
Explanation of Data
Unplanned admissions to PICU are a
measure of how well we are
monitoring patients on the wards.
Good monitoring on the wards means
that we will pick up deteriorating
patients more quickly, allowing us to
admit them to PICU when required. A
combination of high levels of
unplanned admissions and low levels
of cardiac arrests, respiratory arrests
and acute life threatening events
(ALTEs) means that we are monitoring
and escalating clinical deterioration in
a timely manner.
Details of Cardiac Arrests
In March there was 1 cardiac
arrests outside PICU (Out of
hospital ED). There were 6
cardiac arrests on PICU.
None have been classified as
predictable or preventable.
Number of Emergency Events
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
No of Cardiac Arrests (ex PIC)
No of Cardiac Arrests (PICU)
No of Respiratory Arrests
No of ALTEs
21
Monitoring & Review
Reliability & Sensitivity to Operations
Safeguarding
Key Figures
Child Protection Training
Level 1
98.7%
Level 2
77.0%
Level 3
88.3%
There has been 0 Safeguarding SIRI
There has been 0 new Safeguarding Complaint
There has been 0 “Position of Trust’ cases
There have been no new recommendations from Serious Case Reviews
100% of BSCB Meetings attended by BCH Executive lead or representative
90% of cases which require peer review /clinical supervision have had this
There has been 0 child deaths related to suspected physical abuse/neglect
New government measures to end Female Genital Mutilation
It will be mandatory for all NHS Acute hospitals to provide information on
patients who have suffered Female Genital Mutilation (FGM).
From April NHS hospitals will be required to record:
•if a patient has experienced FGM;
•if there is a family history of FGM;
•if an FGM-related procedure has been carried out on a woman.
By September all acute hospitals must report this data centrally to the
Department of Health on a monthly basis.
Serious Case Review:
Adverse Media Attention
KB, a 22 month old child, was admitted to Birmingham
Children’s Hospital on the 19th June 2011 with significant life
threatening injuries. He died on 23rd of June 2011.
He was previously known to BCH. His mother and partner were
convicted on 4th April 2014 and both received custodial
sentences .
The Media have subsequently criticised BCH for failing to
provide adequate medical care to KB during his previous
attendances in May 2011.
A Serious Case Review is currently being undertaken by BSCB .
BCH will fully participate In this process.
Birmingham Safeguarding Children Board:
17th March 2014 – 9th April 2014:
Ofsted is undertaking a full Inspection of the Local
Authority (and its partner’s) arrangements for Children in
need of help and protection, Children Looked After and
Care Leavers and Review of LSCB’s.
Monitoring & Review
Reliability & Sensitivity to Operations
Safety Thermometer
The percentage of harm free care is 99.6%.
There was 1 grade 2 pressure ulcer. The increase in
prevalence was due the additional data collection area of
complex care. This is a ward area and it seems due to the
nature of the patient cohort at an increased risk of pressure
ulcers. The tissue viability team are working with the ward
to identify if any improvements can be made..
Monitoring & Review
Reliability & Sensitivity to Operations
SCAN Safer Children’s Audit No Harm
The co-production of the national Paediatric Safety Thermometer has now begun with our partner Haelo. Their data analysists have
reviewed the pilot data and are refining the measurements for rapid testing in April.
The harms currently remain Deteriorations, Extravasations but testing will include all devices rather than a focus on peripheral cannula,
pain, skin integrity with the addition of medicines omissions
The number of PEWS Scores which were not escalated and should
have been
Harms due to Pressure Ulcers
Pain Harms
Members of the Corporate
Nursing team will form part of
both the expert reference
group and project steering
group. The intention is to have
a ‘New Generation Paediatric
Thermometer’ ready for roll
out by April 2015 and we will
work on a CQUIN in 2014
which reflects this work and
which will be reported in the
Quality Report.
Harms due to Moisture Lesions
Mortality
Past Harm
Mortality data is presented in a number of ways, and
an overall picture can only be gained by using a
number of indicators. These are:
•Absolute number of deaths per time period.
•Number of deaths per time period per 1000
admissions.
•Standardised mortality ratio (See next slide)
•Cumulative sum (CUSUM) charts.
•Review of individual deaths.
Inpatient deaths per 1000 admissions
This is a simple calculation to overcome any
variations in admission numbers over time (e.g.
the hospital may have more admissions in the
winter months) or between hospitals of different
sizes.
Data can be compared between
organisations by this method as it allows for
different admission numbers but it is limited as a
tool for comparison as there is no modification
for case mix. The graph on the right shows the
number of inpatient deaths per 1000 inpatient
admissions at BCH since June 2012. Please note
that the data does not include deaths which
occurred in the Emergency Department.
Absolute Number of Deaths
The simplest way to represent mortality is as an
absolute number of deaths in a particular time period;
however it does not take into consideration either the
number of admissions to the hospital or the case mix of
patients. It is useful only as a sense guide to other data
as it has not been modified in any way. Data cannot be
compared between organisations in this format.
16
14
Deaths
Deaths per 1000 Admissions
12
10
8
6
4
2
0
25
Standardised Mortality Ratio (SMR)
In order to account for differences in case mix for different organisations the idea of standardised
mortality ratios has been developed. This attempts to account for differences in patients, such as
diagnosis, age and pre-existing medical problems, and allows for comparisons between hospitals.
A standardised mortality ratio (SMR) is the ratio of the actual number of deaths in a hospital within a
given time period, to the number that might be expected if the hospital had the same death rates as a
larger reference population (e.g. all English Hospitals). The SMR scores can be presented in a number of
ways.
Run Chart
This shows how the standardised
mortality rate of a hospital changes
over time. If there are a small
number of deaths in each time
period then the month to month
variation can be quite wide (as is the
case with BCH where there are on
average 4-12 deaths a month).
26
Bar chart presenting data comparing a number
of hospitals:
This shows the position of an individual hospital in comparison
with its peer group. It is easy to understand but does not give
much information about whether our outcomes are unusual. The
graph presented below shows 6 months’ worth of data rather
than 12 as previously presented.
Our SMR has risen from 163.48 to 164.31
No Movement in last month
Funnel plot
This shows the standardised mortality ratio on the Y axis, and the
number of expected deaths on the X axis. Control limits can be
applied, so that it is possible to see how likely that the variation
from a score of 100 is by chance only. In the example below an
amber dot occurs if there is between a 0.3% (1 in 330) and 5% (1 in
20) likelihood that the score is different from 100 by chance and a
red dot if there is less than a 0.3% likelihood that the score is
different from 100 by chance. Such warnings should be investigated
as to cause. The funnel plot below is presented using 6 months’
worth of data.
We are in the red section of the funnel plot.
27
Deaths in the Paediatric Intensive Care Unit
(PICU)
CUSUM Charts
Another way of representing outcome
data is by cumulative sum charts.
These can be used where there is a
score available to give a risk of
mortality for each individual patient.
Currently this method is in use at BCH
for intensive care.
The charts use data from all patients,
not just deaths, so are more powerful
than SMR in detecting problems.
For BCH, the PICU CUSUM is a good
reflection of overall hospital mortality
as over 70% of deaths at the hospital
occur on PICU. There is no evidence of
systemic care failures which could have
contributed to deaths on PICU.
28
Deaths in Cardiac Services
CUSUM Chart
One of the Trust’s highest risk specialties is Cardiac Services. The nature of the activity means that proportionally
more of our mortality is related to that specialty than others. The team carefully monitors clinical outcomes to
ensure that that we are providing high quality care.
An upward movement in
the chart means that the
outcome for a specific
patient was better than
expected. A large
increase means that the
outcome was significantly
better
The CUSUM chart is a graphical representation of the outcome data
for the specific procedures which are nationally monitored (70-80% of
our patients fall into this group).
In addition, the team also monitors overall mortality for all surgical
patients. In 2000-2005, the overall mortality rates (30 days postoperatively) was 4.8%. In the period October 2010 – September 2012
this had dropped to 3.3%.
A downward movement
means that the outcome for a
specific patient was worse
than expected, again the size
of the decrease is a measure
of how much worse the
outcome was than expected
VLAD Chart from 01/04/2011 to 27/02/2014
16
Total number of 30-day survivors = 1410
Total number of 30-day deaths = 31
(Expected - Actual) Deaths within 30 Days
11
VLAD chart
6
Surgical reinterventions
Catheter reinterventions
Surgical and catheter reinterventions
1
01-Apr-11
30-Sep-11
31-Mar-12
29-Sep-12
31-Mar-13
30-Sep-13
-4
-9
Overall our outcomes are better than expected. However, please
note that the baseline will be reset on a regular basis, so we do not
expect to move further and further from the x-axis
-14
-19
29
Deaths in Liver Transplant
CUSUM Chart 6 month lag time
Another of the Trust’s higher risk activities is Liver transplantation.
Although we do not carry out a large number of these, the team monitors the outcome rates posttransplant. The graphs below show that our outcome rates are comfortably within acceptable limits.
Interpretation of the charts
The O-E chart is a useful tool for
observing performance over time.
A downward trend indicates a
lower than expected rate of
mortality compared with the
baseline period, whereas an
upward trend points to an
observed mortality rate that is
higher than expected.
To identify statistically significant
changes the tabular CUSUM chart is
used to complement the O-E chart.
A significant shift in the underlying
mortality rate is evident when the
chart crosses the limit and
generates a signal. The tabular
CUSUM chart can be used to
forewarn of possible future signals
as the chart approaches the limit.
Such ‘signals’ may be due to one of
a number of different reasons. A
signal may be due to
transplantation of patients of
higher risk than previously, a short
run of adverse events, or it may
occur just by chance with no
underlying cause (i.e. a false
positive result).
30
Board of Directors
Public Meeting
Wednesday 30th April 2014
Item 14.84
Enc 05
Strategic Objective/ Enabler
Every child and young person requiring access to
care at BCH will be admitted in a timely way, with no
unnecessary waiting along their pathway
Report Title
Performance – March 2014 Performance Report
Sponsoring Director
Deputy Chief Executive
Author(s)
Deputy Chief Officer Contracting and Performance
Previously considered by
Finance and Resources Committee
Situation
This report provides the March update on this month’s Trust Performance supporting
improving our patient experience. The report highlights where performance is not being met
and any concerns or improvements.
The attachments provide:
Further details on our current and comparative performance
Background
Overall performance against targets shows similar trends to previous months. There
continued to be high levels of elective activity, nearly 15% higher than March 2013, and ED
attendances were the highest since December 2010. The areas of underperformance
remain cancelled operations, diagnostic waits and PIC refusals. 18 week performance met
the required standards. Performance in ED continues to be strong despite the activity and
BCH remains one of the few organisations to consistently meet the 4-hour A&E target.
Year on year performance
The report attached includes a comparison of the overall performance for the year compared
to 2012/13. This shows that performance has worsened for cancelled operations and
diagnostic waits which are both known areas of underperformance and have been discussed
at length through the year. The number of PIC refusals has stayed fairly constant and this
reflects good performance in supporting children in other hospitals and across the network
but it cannot be seen in isolation to the number of cancelled operations. In 2012/13
19%(125) of all cancellations were due to no PICU bed compared to 24% (202) in 2013/14.
The analysis shows the improvements made across all ED metrics and underlines our strong
performance in contrast to many other organisations. CAMHS 18 week performance is also
an area of significant improvement.
With regards to other measures there has been little movement year on year against a
backdrop of increased demand which is positive.
Cancelled operations
In March there were 43 patients or 2% of all operations were cancelled on the day due to
hospital reasons. This is in line with the high figures seen last month and earlier in the year.
There were a further 51 patients that had their operation cancelled by the hospital before the
day of the operation. The total number is above the mean for the year and in line with some
of the peaks seen earlier in the year.
Last month there was a change in the breakdown of reasons behind the cancellations and
specialties affected and this has continued into March. When considering the reasons for
cancellation, which are broken down within the main report, it can be seen that there is more
variation than usual. In contrast to previous months when the primary reason was lack of
Paediatric Intensive Care (PICU) beds, in March lack of ward beds was the primary reason,
followed by more urgent patients and then PICU. In line with February, whilst Cardiac saw
the highest number of cancellation, its proportion of the overall total reduced with a greater
number of cancellations being seen in surgical specialties. This follows pressure on beds in
surgical wards due to increased complexity and patients staying longer in hospital postsurgery. This is being closely managed by the Directorate team but has continued into
March.
The overall number of operations cancelled is 12% higher than at the same time last year
which is a target linked to the Trust priorities and means that the target of a 10% reduction
for the year has not been met. In addition the other key priorities of zero cancellations due
to equipment failure and administrative error was not met with 3 and 8 cancellations
respectively.
Eleven patients had their operation cancelled more than once by the hospital, nine being
cancelled twice and two being cancelled three times.
There were four breaches of the 28 day standard in March. The target is zero except that it
is recognised that there may be breaches due to no PICU capacity, three related to PICU in
March. The final one was due to no ward bed being available.
Cardiac surgery remains the specialty with the highest number of cancellations. Whilst the
team have been successful in reducing the number of on the day cancellations due to
changes in scheduling this masks the underlying challenges that the team is facing. Lack of
access to PICU beds has meant that the number of procedures being performed is low.
Diagnostic waits
There were 146 patients who at the end of March who had been waiting over 6-weeks for a
MRI diagnostic test. This is 13.4% of all diagnostic waits and above the 1% NHS standard.
The overall MRI waiting list size has increased slightly for non-GA activity, this was forecast
to happen and it will reduce in April as the mobile scanner is used. The number of breaches
of the standard in March was in line with forecasts.
The trajectory for zero breaches by the end of June remains and this continues to be
monitored on a weekly basis. This assumes a mobile scanner on site in April, May and
June. The team are continuing to review and identify any other opportunities and are
working closely with the theatres team to identify any additional capacity for general
anaesthetic (GA) activity. There remains limited flexibility in the service and so a shift in the
number and types of referral still has the potential to affect this.
Recruitment for additional radiographers has been successful and interviews for additional
radiologists are in early May with a strong field.
The independent review commissioned with a specialist from the Royal College of
Radiologists transformation team will take place in May and is expected to report in June.
This will consider how the team works and what actions can be taken to improve the
performance. Commissioners have been invited to join this review and they have accepted.
Emergency Department
The Trust continues to perform well against the 4 hour standard and met the target in March.
The 95th percentile performance was 3.95 hours. This was despite significant increases in
activity in month.
There were two Emergency Department (ED) standards that were not met:
The local ED triage objective (all within 15 minutes), the 95 percentile performance
being 36 minutes (previous month was 33).
Median journey time through ED was 70 minutes against a target of 60 minutes.
(previous month was 62)
It should also be noted that performance across most measures has been more consistent
with less significant peaks and troughs. This indicates that actions being taken to improve
throughput and capacity during the winter months appear to be working.
18 weeks waiting time.
The 18-week standard was met in March with performance for admitted patients at 90.3%
against the 90% standard. 112 admitted patients and 12 non-admitted patients were not
treated within 18 weeks due to insufficient capacity.
There was a small increase in the standard for incomplete pathways achieving 92.9%
against 92% standard. As shown on the chart on page 13 the drop in the numbers of those
waiting over 14 weeks without a TCI and over 18 weeks without a TCI seen in January has
been maintained but has not reduced further. However there is an improvement in those
over 8 weeks with a TCI booked or with a TCI over 18 weeks.
Looking forward, based on current assumptions and forecasts the standard will be met in
April but there is greater risk than in previous months.
Of note, the NHS has introduced an 18-week definition change to patients waiting for
treatment. In essence whilst a patient is waiting for inpatient treatment no patient/family
cause of delay can be counted (i.e. operation DNAs, requests to delay treatment) however
the delay is factored into the 18-week measurement when the operation is performed.
The number of patients waiting over 30 weeks is 107 an increase from February.
There are two patients reported to be waiting over 52 weeks, all of these are due to patient
choice and once seen will be validated out. Of note, as part of the national contract,
hospitals will be charged £5000 for all patients waiting over 52 weeks if it is due to hospital
reasons.
The overall waiting list size showed a small decrease which was as expected due to the
strong activity in March.
CAMHS continue to achieve 100% for 18 weeks with the average wait being less than 4
weeks.
Tertiary referrals
There were two West Midlands patients who couldn’t get a bed in March and no out of
region patient. When reviewing the long term trend it can be seen that there has been a
significant drop in refusals since December 2010 with the numbers fluctuating between 0
and 6 each month.
Forty four patients, of which thirty six were West Midlands patients, that were admitted had
to wait over 24 hours before a BCH bed was provided. This is a significant increase on
previous months. When a referral is received the specialty consultant is asked to identify the
time period in which the child should be admitted. This is under 12 hours, 12 – 24 hours or
48 hours. When comparing actual time to admission against recommended time for
admission it can be seen that 80.5% of requests were met of this 85% of patients who were
assessed as needing a bed within 12 hours were admitted within the timeframe. This
reflects a slight worsening of performance compared to prior month and reflects the
challenging bed situation that has been experienced over the last few months.
PICU (Paediatric Intensive Care Unit) referrals
The West Midlands (WM) PICU service is provided by BCH, University Hospitals of North
Staffordshire NHS (UHNS) Trust and the KIDS (Kids Intensive care Decision Support)
service run by BCH.
Six West Midlands (WM) patients and no non WM patients could not be supported due to
hospital reasons.
Overall the KIDS team continue to be successful in supporting local hospitals, 32% of
children did not need to be moved because of the support provided.
CAMHS referrals
The CAMHS Tier-4 (Child & Adolescent Mental Health Service) West Midlands service is
provided by BCH and other providers (some private) with BCH providing the assessment of
all requests. Eleven patients could not be supported by BCH CAMHS in March which was
consistent with last month due to no capacity and urgency. There continues to be significant
capacity pressures across the West Midlands and nationally for Tier 4 beds. We are still
awaiting the results of the national review. Locally commissioners have written to inform us
that there will be a wait of around two weeks for access to a Tier 4 bed with community
services expected to provide support.
Internally the ERA service has now extended to 7 days a week and this has had a positive
impact providing a more rapid response where needed and ensuring young people receive
support whilst waiting.
Assessment
A reduction in capacity due to staffing and a spike in demand has led to an increase in the
waiting times for MRI and pressures around ward beds and PICU beds has led to continued
high levels of cancellations.
Plans to reduce delays include:
PICU Capacity:
We expect a delay to increase beds from 28 to 31 beds. This is predominantly due to
staffing issues. Therefore there will continue to be an impact on performance.
A review is being carried out by NHS England to consider paediatric critical care capacity
across the region, the Trust are supporting this.
Theatre Capacity:
Weekend working is now taking place as well as additional capacity at the Birmingham
Treatment Centre.
A Theatre Working Group is in place with a focus on improving staffing levels to maintain
and increase theatre capacity.
A Cancellations Working Group is in place which is running a series of pilots to reduce
total cancellations. A project is underway to look at how we ensure all elective patients
undergo pre-admission which will help to reduce the risk of cancellation.
Additional anaesthetists now in place.
Business case for extending capacity through use of the Plaster room approved.
Further business case under development for development of Interventional Radiology
capacity.
Newton have been appointed to support the Trust in terms of flow management through
theatres.
Diagnostic waits - MRI capacity:
A medium term capacity plan for Imaging is being produced which includes new ways of
working.
New consultants are now in place with further interviews in May.
Additional lists for GA were agreed both in week and on Saturdays for January and
March, with discussion over this continuing in future months.
Mobile scanner planned for end of April, May and June.
Extended working hours agreed with radiographer workforce.
New roster agreed with radiologists.
The Medium Term Clinical Estates Strategy is being developed to identify future demand
and solutions to meet demand.
Recommendations
The Board is asked to note the performance and plans for further improvement.
Key Risks
Risk Description
Controls
Insufficient capacity in place Appropriate
to meet service demands
systems in place
Assurances
escalation Daily, weekly and monthly
reporting in place.
Capacity
plans
being Revised capacity plans being
renewed and developed. produced.
This
includes
modelling
capacity/demand
between
now and 2020 (new hospital)
Winter plan implemented
providing
additional bed
capacity & flexibility
Key Impacts
Strategic Objectives
CQC Registration
outcome)
NHS Constitution
This reports covers progress against meeting the strategic
objectives linked to supporting improving our patient
experience.
(state 4: Care and welfare
Yes – treatment within 18-weeks is a requirement within the
NHS Constitution.
Other Compliance (e.g. Many of the indicators are local or national standards
NHSLA,
Information monitored by the Department of Health, Monitor and our
Commissioners.
Governance, Monitor)
Equality, diversity & human The report considers any particular impact on patients with
learning disabilities, and on different ethnic groups.
rights
Trust contracts
Non-delivery of NHS standards can result in financial
penalties
Other
Meeting the strategic objectives raises the profile of Trust
locally, regionally and nationally
Performance Report
Month 12 2013/14
Performance for March 2014
Trust Board – Item 14.84, Enc 05
Georgina Dean
Deputy Chief Officer for Contracting and Performance
1
Performance Indicators
Cancelled operations – national
definitions
ED – Left without being seen
MRI waits over 6 weeks
Cancelled operations – all hospital
cancellations
ED – Unplanned readmissions
In region Tertiary referrals sent elsewhere
Cancelled operations - patients
cancelled more than twice
18 weeks performance (admitted)
Tertiary patients waiting over 24 hours for
a BCH bed
Cancelled operations - equipment
failures or admin errors
18 weeks performance (non admitted)
PICU – WM patients not supported
Cancelled operations – breaches of
28 day standard
18 weeks performance (incomplete)
PICU – non WM patients not supported
ED - time in ED
18 weeks performance - CAMHS
PICU – non WM patients supported
ED – time to seen
Long waiters - patients not treated within
18 weeks due to insufficient capacity
CAMHS Patients that requested a T4 bed
and were not admitted
ED – Time to triage (all)
Long waiters - patients not treated within
30 weeks
Patients with delays after being declared fit
for discharge
ED – time to triage (ambulance)
Long Waiters - patients waiting over 52
weeks
Indicates strategic objective measure
2
Performance Indicators Year on Year
Cancelled Operations - Nationally Reportable
All Hospital Cancelled Operations
Cancelled Ops - Equipment Failure or Admin Error
Cancelled Ops - Breaches
2012/13
2013/14
390
510
761
840
45
48
13
51
18 wks admitted
18 wks non admitted
18 wks incomplete
18 wks - CAMHS
18 wks long waiters due to insufficient
capacity
ED - Time in ED Dept % seen in 4 hours
ED - Time to be Seen (in mins) tgt is 60
ED - Time to Triage (all)
ED - Time to Triage (Ambulance)
ED - left without being seen tgt < 5%
ED - unplanned readmissions < 5%
95.5
97.2
82
57
34
33
14
14
3.8%
2.4%
3.8%
2.8%
MRI waits over 6 weeks
Tertiary referrals sent elsewhere
Tertiary Referrals waiting over 24 hours (NB
collection started Oct 12 so 12/13 is extrapolated)
PICU Patients Not Supported In Region
CAMHS Patients That Requested a T4 Bed
and Were Not Admitted
2012/13
2013/14
90.1
90.6
97.6
97.3
95.3
93.7
88%
95.4
538
1178
93.5%
89%
26
28
302
327
120
118
60
89
3
Cancelled operations trends
Cancelled operations overall position: the number of cancelled operations flagged as nationally reportable in March 2014 is at
the average level for the 1314 year (43) . Total hospital cancellations at 94 are high, and we remain above our strategic goal of a
reduction on 12/13 levels. There were four breaches of the 28 day standard in March.
Nationally reportable* cancelled operations was equal to the
2013/14 monthly average for the year at 43
Cancelled Operations On The Day - National Definition
80
71
* Cancelled by hospital for non medical reasons on the day of admission or after admission
56
All Hospital Cancelled Operations
Data
mean
Jan-14
Oct-13
Jul-13
Apr-13
uci 2stdev
lci 2stdev
Breaches of 28 Day Cancelled
Operations Standard
Total patient
cancellations)
10
20
No Ward Bed
11
15
More Urgent Patient
10
Equipment unavailable
3
Operation would have/did overrun
2
Liver transplant
2
Other reasons
5
Grand Total
43
10
5
Mar-14
Feb-14
Jan-14
Dec-13
Nov-13
Oct-13
Sep-13
Aug-13
0
Jul-13
There were 4 breaches of
the 28 day standard in
March 2014, 3 were due
to no PICU bed.
Jun-13
2013/14
March
February
January
Reasons for cancelled operations
(National Definition)
No PICU bed
December
2012/13
November
October
September
August
July
June
May
April
2011/12
May-13
0
Jan-13
15
10
Apr-13
21
20
Oct-12
33
30
Total
Hospital
Cancelled
Operations
is close to
the upper
confidence
interval in
March 14
(94
cancelled)
120
100
80
60
40
20
0
Jul-12
43
Apr-12
41
40
47
46
Jan-12
54
39
Oct-11
44
50
Jul-11
60
Apr-11
70
4
All Hospital cancelled operations for March 2014 only by
Reason
Staff shortage
2%
Operation
would
have/did
overrun
3%
This is a
postponement
3%
Operation not
needed
5%
All Hospital cancelled operations for March 2014 only by
Specialty
Administration
error
9%
Other Dir 4
5%
Equipment
unavailable
3%
Cancelled by
clinician
9%
Other
5%
Unknown
1%
Cardiac
16%
Other
Dir 3
7%
Other Dir 2
10%
No Ward bed
23%
Urology
5%
More urgent
patient
18%
No ITU bed
17%
Cardiology
5%
More complex
patient
1%
Liver
transplant
caused
cancellation
2%
ENT
13%
T&O
9%
Paed Surg
9%
Radiology
5%
Plastics
15%
The hospital cancelled 94 operations in March 14. Lack of beds account for 39%. Accommodation of more urgent patients is the next
biggest group at 18%. Cardiac specialties are the biggest area affected and account for 22% of the total, this is lower than the
average share for these specialties however and the split by specialty was again more widely spread in March 2014
5
Cancelled operation hot spots by specialty
Year to date in 2013/14 a total of 840 operations have been cancelled
by the hospital. The speciality breakdown for these is shown below
All Hospital Cancelled Operations 2013/14 YTD
Not Specified,
1.8%
Other Dir 4, 7.7%
Other Dir 3, 4.0%
Cardiac, 28.3%
Other Dir 2, 9.0%
Urology, 4.4%
T&O, 5.6%
Cardiology, 5.6%
Radiology, 5.2%
YTD in 2013/14, 34% (285) of all
hospital cancelled operations have
been in Cardiac Surgery and Cardiology.
These patients are cancelled because
of lack of bed availability - 62% of these
cancellations are due to lack of beds in
PICU.
Plastics is the next biggest area with
11.8%
of
all
cancellations.
Cancellations here happen most
commonly because of issues with
theatre capacity, 45% of these relate to
the need to accommodate more urgent
patients or liver patients.
ENT, 9.2%
Plastics, 11.8%
Paed Surg, 7.3%
6
All Hospital Cancelled operations – percentage by
cancellation reason
Year to Date All Hospital Cancelled Operations
Equipment
failure, 1.8%
More complex
patient, 2.9%
Other, 4.6%
Cancelled by
clinician, 2.1%
Equipment
unavailable, 3.2%
No ITU bed,
24.0%
The single largest reason for the Trust having to
cancel operations by far is the absence of PICU
beds, which accounts for 24% of all cancellations.
When no ward bed is added to this number then
bed issues amount to 38% of the problem.
Administration
error, 3.9%
Staff shortage,
5.5%
Liver transplant
caused
cancellation, 8.0%
Operation would
have/did overrun,
8.0%
There have been 840 operations cancelled by the
hospital since April 2013, of which 510 fit the
criteria for national reporting.
More urgent
patient, 13.7%
Issues with cancelling theatre slots in order to
treat urgent or complex or liver patients cause 25%
of the problem.
This is a
postponement,
8.6%
No Ward bed,
13.7%
Figs may vary from Vesper as Unspecified Validated Reasons
have had Theatre System Reasons assigned
7
Multiple cancellations
Cancelled Operations Associated With Patients cancelled more
than once in same specialty during 2013/14
Patients cancelled more than once in same specialty during
2013/14
45
14
40
12
35
10
30
8
25
6
20
4
15
2
10
0
5
0
Twice
3 times
4 times
5 times
6 times
7 times
In March 2014 eleven patients had an operation cancelled who
had previously had an operation cancelled at least once in the
same specialty in the 2013/14 financial year. These 11 patients
had 24 cancellations between them in total during 2013/14 in
the relevant specialty.
Strategic objective: Year to date hospital cancelled
operations are running 10% higher than the equivalent
year to date figure for 2012/13. (Target 10% reduction)
Twice
3 times
4 times
5 times
6 times
7 times
Strategic Objective – patients cancelled more than twice
(Hospital Cancellations Only)
2 patients had an operation cancelled in March 2014 for the
third or more time (NB cancellations have to be in the same
specialty and in the 2013/14 financial year to be counted)
Strategic objective: In March 2014, eight patients or operation
slots were cancelled due to admin error, and three patients due
to equipment failure (Target is zero)
8
All Hospital Cancelled operations – Cardiac Specialties
Fig 2: Trend Cardiac Surgery/Cardiology Cancelled Operations
50
Fig 1: Cardiac Surgery and Cardiology
40
All Hospital Cancelled Operations 2013/14 to Date
30
20
10
Feb-14
Dec-13
Oct-13
Aug-13
Jun-13
Avge
Apr-13
Feb-13
Total
Dec-12
Oct-12
Aug-12
More
urgent/complex
patient, 28, 10%
Jun-12
Apr-12
No Ward Bed,
22, 8%
0
Other, 21, 7%
Linear (Avge)
Fig 4. Size of Inpatient Waiting List
200
Postponement,
38, 13%
No ITU Bed,
176, 62%
150
100
50
0
Fig 3 Activity vs Plan Cardiac Surgery Only
Elective
Emergency
Plan
Actual
Variance
%
610
503
-107
-17%
149
140
-9
-6%
Cardiology
Cardiology Avge
Paediatric Cardiac Surgery
Cardiac Surgery Avge
Cardiac Surgery and Cardiology are the specialties experiencing the most cancelled operations (285) in the Trust, 238 are for Cardiac Surgery patients. 62% of the
cancellations are due to the lack of an ITU bed (Fig 1.) Fig.2 illustrates that there has been a spike in cancellations in the 2nd and 3rd qtrs of the 2013/14 financial year
although these have reduced since November. Overall cancellations were 4% higher for the full financial year 2013/14 than in 2012/13.
Looking at activity (Fig 3), for cardiac surgery there is significant underperformance against plan. 503 electives have been carried out in 2013/14 so far. As there have
been 238 cancellations this means cancellations equate to 47% of all Cardiac Surgery elective activity. Theatre utilisation for Cardiac Surgery only in March was 64%
9
Strategic priorities
Cancelled operations overall position: Three areas were identified in the Trust priorities in 2013/14 around cancelled
operations. The performance for the year is shown in the charts below.
Overall there has been an increase in the total number of
cancelled operations over the year. In the first quarter
there was a reduction however due to the issues in PIC in
the summer this led to an increase and it has continued to
grow since. In later months this has been less to do with PIC
but more linked to ward beds. The chart on page 15
illustrates the change in profile of our patients with a
greater proportion staying more than 7 days than
previously.
The number of multiple cancellations links closely to the this
and peaks were seen in July and November when activity
was high. Whilst actions have been taken in the year to try
to address this it has not been able to deliver the reductions
we had hoped to see against a backdrop of increased
demand and complexity.
10
Emergency Department
95th % time
in A&E:
3.95hrs
95th % time to
triage (all):
36 minutes
95th % time to triage
(ambulance):
13 minutes
ED re-attenders for
related condition
3.11%
Left without being
seen:
2.75%
Median time
to be seen:
70 minutes
ED overall position: we are continuing to meet
most of our key targets in the ED department. The Trust met the overall four hour
target in March 14 despite that month being the busiest month on record for the Trust with 4947 attendances. However in March we
exceeded by 10 minutes the time to be seen standard of 60 minutes (this was the longest median time during 2013/14).
Total A&E Attendances Jan 01 to Mar 13
Total Time Spent in A&E - Standard ≤ 4 hours
6000
4947
4.70
5000
4.50
4000
3000
2000
4.30
2012-13
4.10
2013-14
1000
3.90
0
3.70
1 6 11 4 9 2 7 12 5 10 3 8 1 6 11 4 9 2 7 12 5 10 3 8 1 6 11 4 9 2 7 12
Target
3.50
A
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20132014
M
J
J
A M J
2012-13
J
A
S
O N D
2013-14
J
F M
Target
O
N
D
J
F
M
100
16
15
14
13
12
11
10
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
S
Time to be Seen Standard ≤ 60 minutes
(Median)
Time to Triage - Ambulance Only
Standard ≤ 15 minutes (95th Percentile)
% Patients Who Left ED Without Being Seen
Standard < 5%
A
80
60
40
20
A M
J
J
A
S
O
N
D
J
F
M
0
A M
2012-13
2013-14
Target
J
2012-13
J
A
S
O N D
2013-14
J
F M
Target
11
18 week waits
Admitted
Non admitted
• 90.3%
• 96.4%
Incomplete
• 92.9%
18 weeks overall position: although external targets have been met there is limited flexibility in the position,
especially on
admitted and incomplete pathways. There are high numbers of patients getting TCIs late in the pathway or after 18 weeks. Overall the
waiting list size has increased in 2013/14. Meeting the demand for our services continues to be a challenge and March was an
extremely challenging month.
124 patients were not treated within 18 weeks due to
insufficient capacity
18 weeks admitted performance
94.0%
Patients not treated within 18 weeks due to insufficient capacity
93.0%
14
92.0%
91.0%
14
10
12
11
90.0%
8
7
2012/13
2013/14
2 patients still waiting over 52 weeks
(but will be less than 18 weeks once patient
related pauses are applied)
Target
F
M
Admitted
112
75
Mar-14
J
97
Feb-14
D
118
Jan-14
N
Aug-13
O
Jul-13
S
Jun-13
A
May-13
J
Apr-13
J
Mar-13
M
Feb-13
A
Jan-13
85.0%
Sep-12
86.0%
Dec-12
3
83
73
8
61 56 62
4
54
44
42
41
38
25 29
2
87.0%
105
128 118
Dec-13
0
1
2
Nov-13
2
8
Oct-13
14
3
Sep-13
4
Nov-12
88.0%
Oct-12
89.0%
Non admitted
2 patients were still waiting over 52 weeks. Both these patients have pauses in their
pathways that cannot be applied to their wait until they are admitted. In both cases
applying the pauses would reduce their waiting times to under 18 weeks.
12
18 week waits
Fig 1 - % still waiting for clock stop (Incomplete)
under 18 weeks
Fig 2: 18 Weeks: Current Problem, Future Problem
600
100.0%
500
98.0%
400
96.0%
300
94.0%
92.0%
200
90.0%
100
88.0%
A
M
J
J
2012/13
A
S
O
2013/14
N
D
J
F
M
0
Target
Performance for patients still waiting for their initial treatment (either admitted or non admitted pathway) has increased slightly since last month to
92.9% (Fig 1.)
Regarding patients waiting for an admission (Fig. 2), the green line, (which is the total of the red and blue lines) illustrates the overall potential
problems we have in managing our 18 weeks admitted demand; this showed a large increase in December 13 but is reducing since mid January.
The blue line illustrates patients with a date to come in who are already over 18 weeks or whose TCI date is over 18 weeks – there is little change
since last month. The red line illustrates patients who are waiting 14 plus weeks and do not have a TCI date yet, again this is remaining at about the
same level.
Overall there was an increase in the number of long waiters with TCIs over 18 weeks or patients who get TCIs late in their pathway during Autumn
2013, peaking in Dec 13. The levels have been slowly reducing since then.
13
Whole Inpatient waiting list and long waits
107 RTT patients either still waiting
or whose clock stopped after 30
weeks
All Patients Still Waiting or Whose Clock
Stopped Over 30 Weeks
Inpatient Waiting List Size
4,250
120
3,750
100
3,250
80
2,750
60
Paediatric Plastic
Surgery
109 107
94 99
40
20
Inpatients
Surgical & Cardiac
The overall waiting list for surgical and
cardiac stood at 2129 at 31st March,
with the total list standing at 3836. The
Cardiac/Surgical list is showing a slight
reduction since the new calendar year.
47 53 47
41 39
54 49 54 57 61
73
Overall there are 107 patients either still
waiting at the end of Mar 14 or who had
their clock stopped in the month over 30
weeks. This is the second highest value since
Oct 12. We are experiencing a peak in the
number of long waiting patients in Winter
13/14.
Of the 107 patients 20 had their clock
stopped over 30 weeks and 87 are still
waiting.
Feb-14
Dec-13
Oct-13
Aug-13
Jun-13
Apr-13
Feb-13
0
Oct-12
22/04/2013
06/05/2013
20/05/2013
03/06/2013
17/06/2013
01/07/2013
15/07/2013
29/07/2013
12/08/2013
26/08/2013
09/09/2013
23/09/2013
07/10/2013
21/10/2013
04/11/2013
18/11/2013
02/12/2013
16/12/2013
30/12/2013
13/01/2014
27/01/2014
10/02/2014
24/02/2014
10/03/2014
24/03/2014
1,750
32 39 35
Dec-12
2,250
Specialty break down of the 87 patients
still waiting over 30 weeks
30
Paediatric Surgery
Paediatric Ear Nose
and Throat
15
Paediatric Cardiology
10
Paediatric Urology
Paediatric Trauma
and Orthopaedics
Paediatric
Ophthalmology
Paediatric
Gastroenterology
Paediatric Cardiac
Surgery
Paediatric
Dermatology
Paediatric
Neurosurgery
13
7
3
3
2
2
1
1
14
CAMHS 18 Weeks
CAMHS 18 weeks Performance
18 weeks
performance
100
18 weeks performance
95
2012/13
90
• 100%
2013/14
85
Target
80
CAMHS continue to achieve against their 18
week wait target with 100% of their
patients being seen within target in March.
75
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
CAMHS Time to Assessment
Community CAMHS
Breakdown of Waiting Time to Assessment
A:- 0-4 wks
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
364
708
B:- 4-8 wks
C:- 8-13 wks
D:- >13 wks
383
362
23
146
1060
756
759
870
765
952
1401
1467
2010/2011
1114
2011/2012
871
2012/2013
Financial Years
In 2013/14 CAMHS are successfully assessing more of their
patients within four weeks.
The overall level of
assessments has reduced over time following the
introduction of improved protocols for the management
and assessment of referrals
Average Wait for
Assessment
(weeks)
2010/2011
2011/2012
2012/2013
2013/2014
Total Assessments
6.8
7.8
7.9
3.9
2010/2011
3491
2011/2012
3427
2012/2013
2754
2013/2014
2329
2013/2014
15
CAMHS Referrals
The Blue line
shows the
trend in
patient spells
that last 7
days or
more. This
has been
increasing
significantly
in the final
quarter of
2013/14
CAMHS Patients that requested a T4 bed and were not
admitted (month trend)
16
14
12
10
8
6
4
2
0
All Long Stay Patients
160
140
120
100
80
60
40
20
0
Sum of GT7
Apr May Jun
Jul
Sum of GT30
Sum of GT90
Aug Sep Oct Nov Dec Jan Feb Mar
2012/13
Fit For Discharge Days
2013/14
Long Stay patients at end of Feb - days fit for discharge
40
35
30
25
20
15
10
5
0
CAMHS Tier 4 Gateway Referrals
Patient 9
Total No Referrals
Patient 7
GA Completed
Referred to SCT
Patient 5
Patient 3
Patient 1
0
14
5
1
2
6
6
6
14
10
4
There has been a reduction in referrals and assessments in
March 14 towards levels experienced in first half 13/14.
13
11
100
200
Before fit for discharge
300
400
500
After fit for discharge
9 patients were waiting for discharge in March (5 of these patients were fit
for discharge at the end of February). Four patients were waiting for housing
(one has waited 413 days), three patients are waiting social care/package and
two are waiting on parental training and compliance. In total these 9
patients have been fit for discharge for 851 days. Assuming an average
length of stay (excluding day cases) of 4 days, another 212 patients could
have been seen at the hospital if these patients had been discharged, as they
became fit.
16
Diagnostic waiting lists
The charts below illustrate that demand for diagnostic test continues to be
high and is increasing
Diagnostic waits overall position: we continue to fail to
meet our key target for MRI and are a significant outlier
nationally in this area . Demand continues to be high.
MRI Waiting list
Total WL
Patients
Number of patients waiting over 6 weeks for MRI (actual and
forecast)
146
133
115
97
97
107 104
45
NON GA WL
1000
113
102
500
0
88
71
GA WL
1500
2012-03-19
2012-09-10
2013-03-04
2013-08-27
2014-02-17
68
51
Total waiting list additions by week
Total external referrals
Total Additions by week
Linear (Total Additions by week)
200
0
150
100
50
0
The MRI service continues to be under significant pressure
with 146 patients breaching the 6 week target In March 2014.
The forecasted breaches for April and May have increased
compared to last month. However, it is anticipated that by
June 2014, there will be no waits over 6 weeks.
07/01/2013
07/04/2013
07/07/2013
07/10/2013
07/01/2014
GA additions per week
80
60
The Directorate continues to put a range of additional actions
to address this issue. A mobile scanner was hired in January,
thus increasing activity. A scanner will be hired from the end of
April to June to try and ensure that a nil breach position is
achieved.
40
20
0
01/07/2013
01/09/2013
01/11/2013
01/01/2014
01/03/2014
17
Tertiary Referrals
Overall position:
Tertiary referrals in March at 226 is the highest since October 12. As a consequence 2 in region patients did not
get a bed and 44 patients waited over 24 hours . However 80.5% of requests were still met within the required clinical timescale.
226 referrals
for specialist
beds
2 in region
patients unable to
get a bed
0 out of region
patients unable to
get a bed
36 in region
patients waited
over 24 hours to get
a BCH bed
8 out of region waited
over 24 hours to get a
BCH bed
31 patients no
longer required a
BCH bed
Tertiary Referrals Sent Elsewhere
The number of children waiting over 24 hours for a bed
after a tertiary referral is above the average and the upper
confidence
interval for March. This is due to the
unprecedented referral level. However 80% of referrals
were admitted within timescale requested by the clinician.
Paediatrics
T&O
Surgery
Resp Med
Trend - Tertiary Referrals Waiting Over 24 Hours for a Bed
Neurology
50
45
40
35
30
25
20
15
10
5
0
Nephrology
Medical Oncology
ENT
Clin Haem
Cardiology
upper ci
Mar-14
Feb-14
Jan-14
Dec-13
lower ci
Nov-13
Oct-13
Sep-13
Aug-13
Avge
Jul-13
Over 24 Hr Waits
Jun-13
14
May-13
12
Apr-13
Tot 12/13
10
Mar-13
8
Feb-13
YTD 13/14
6
Jan-13
4
Dec-12
2
Nov-12
0
Oct-12
Hepatology
18
Tertiary Referrals
Waiting time vs. clinical target time
The previous slide includes a chart that illustrates performance regarding the admission of tertiary referrals within 24 hours.
However clinicians can request the patient to be admitted in up to 48 hours, dependent on their assessment. The graph below
shows the timescales requested for admittance and what was achieved for March. This graph excludes the 31 patients where a
bed was no longer required. Overall 80.5% of requests were met in March (83% in February).
Performance vs clinical tgt time for patients who required a bed
100
90%
80
85%
85%
60
80%
79%
40
76%
20
75%
0
70%
within 12 hours
12-24 hours
Target Time
Met
Not met
Up to 48 hours
% patients meeting tgt time
Long Term Trend Tertiary Refusals
Tertiary refusals are decreasing over time.
Long Term Trend Tertiary Refusals
Mar-14
Jan-14
Nov-13
Sep-13
Jul-13
May-13
Mar-13
Jan-13
Nov-12
Sep-12
Jul-12
May-12
Mar-12
Jan-12
Nov-11
Sep-11
Jul-11
May-11
Mar-11
Jan-11
Nov-10
Sep-10
Jul-10
May-10
Mar-10
Jan-10
Nov-09
Sep-09
Jul-09
May-09
Mar-09
18
16
14
12
10
8
6
4
2
0
19
PICU Demand and KIDS Service
0 non West Midlands patients
could not be supported
6 West Midlands patients
could not be supported
4 additional non West Midlands
patients were supported
PICU demand overall: Referrals
were lower than the previous month. Twelve patients were refused a BCH bed. However only six
referrals were not supported at one of the locations in the local network.
250
Year on year comparison of total referrals to KIDS
There were 114 referrals to KIDS in March 2014. Demand continues
to impact on elective waiting times, especially for Cardiac Surgery. In
March 32% of referrals were avoided , 36% were admitted to BCH,
27% were referred to other WM hospitals and 5% went out of the
region.
200
150
100
50
Referrals to KIDS Service Taken Out of Region
0
(Leics or Other Non WM Provider)
Apr May
Jun
Jul Aug
2011/12
Sep Oct
2012/13
Nov
Dec Jan
2013/14
Feb
Mar
Outcome of Referrals to KIDS Apr 13 to Mar 2014 - Trend
30
25
20
70%
15
60%
10
50%
5
Total
Avge
0
Mar-14
Jan-14
Nov-13
Sep-13
Jul-13
May-13
Mar-13
Jan-13
Nov-12
30%
Sep-12
Jul-12
40%
20%
10%
0%
Apr May Jun
Jul
Aug
Sep
Avoided Admission
UHNS and Other WM
Oct
Nov Dec
Jan
BCH
Out of Region
Feb Mar
The red line shows that
BCH took fewer referrals
in the first part of Winter
2013, but is now able to
return to a normal level.
For the winter periods patients
are more likely to be taken out of
Region.
20
Board of Directors
Public Meeting
Wednesday 30 April 2014
Item 14.85
Enc 06
Strategic Objective/ Enabler
Every child and young person requiring access to
care at BCH will be admitted in a timely way, with no
unnecessary waiting along their pathway
Report Title
Resources report period 1st April 2013 – 31st March
2014
Sponsoring Director
Chief Finance Officer
Author(s)
Director of Finance and Procurement, Chief Officer for
Workforce and Deputy Chief Officer for Performance
and Contracting
Previously considered by
Finance and Resource Committee
Situation
This report is to communicate the various aspects of Trust performance in the financial
year, period ending 31 March 2014, and to identify any key risks that are evident within
the organisation.
The contents of this report will form the basis of the Trust’s Quarter 4 (Q4) Return to
Monitor.
The Trust is also required to report its predicted status for Governance and Mandatory
Services.
Background
The Trust is required to comply with the finance related legal issues contained within our
Terms of Authorisation as well as other key financial targets. This includes:
Not breaching the Private Patient Cap (a legal requirement);
Performing at plan for Monitor’s Continuity of Service Risk Rating leading to an overall
CoSRR of 4;
Minimising triggering the additional financial indicators; and the
Risk Assessment Framework, which may result in formal discussions with Monitor.
Delivery against these targets is driven by:
The volume and mix of demand experienced by the Trust; and
How the Trust uses its most valuable resource, its staff, in responding to that
demand.
The report explores each of these areas in turn and the impact on the financial position
and performance.
Assessment
Monitor Declarations
The key ongoing governance issue for the Trust is the performance against the 18 week
target for admitted patients. Performance in month was 90.3% ie just above the 90%
threshold. This level of performance has now been achieved for three consecutive
quarters and enabled the Trust to forecast a Green Governance rating for Quarter 4.
From a financial perspective the ratings will be a 4 under the Continuity of Service Risk
Rating method which commenced in Q3. Under the old Compliance Framework a FRR of
4 would also have been reported. These remain strong performances.
Activity
Outpatient, ED and Elective activity all performed above plan in March. Emergency
activity was again below plan in the month. Planned Care was marginally above plan with
the acuity of patients and the increasing numbers of long stay patients at the Trust
causing operational difficulties. Given this, an above plan income performance was
achieved in March.
Workforce
Demand remains high and this has brought into sharp focus the short to medium term
capacity issues faced by the Trust. Sickness levels reduced fractionally in month by
0.07% to 3.73% which remains well above the 3% target. The cumulative rate is now
3.40%, which is a marginal increase of 0.07%.
The combined substantive and bank staff level increased in March with combined staffing
numbers above 3,300wte for the 6th consecutive month (the Trust exceeded 3200wte for
the first time in March 2013). Substantive wtes reduced for the second month running
and are now almost 1% lower than in January. Bank wtes although lower than in previous
years increased in March. Overall bank usage was only 2% below the average for the
year to date but 15% lower than the March 2013 position. Combined wte are 2.5% higher
than the equivalent stage of 2013.
Engaging with staff, especially during periods of pressure, is important and appraisals are
one indication of how well this is working in the Trust. The reported appraisal rate has
remained below 83% in the last month and remains short of the 90% target.
Finance
The Trust’s financial performance has improved above the revised plan and finished the
year £3,556k above target with an overall Trust surplus of £8.209m. This reduces to
£8.083m when the impact of the Trust’s subsidiary is consolidated into the Trust’s
position. This is in line with the forecast agreed at the February Board. This position
formed the basis of the Trust’s Draft Annual Accounts which were initially submitted per
Monitor’s timetable on April 22.
The strong financial performance was underpinned by higher income levels, which has
resulted in 2 of the 5 Clinical Directorates reporting improved positions in March. The
increasing numbers of longer stay patients at the Trust has had an impact on overall
income levels which was reviewed at year-end.
We continued to focus on cost control with revised (downwards) savings targets for the
financial year. Combined staffing levels increased slightly in the month although bank
usage remained below the year to date average. The use of bank staff continues to be
largely driven by vacancies across the Trust and whilst our sickness levels remain low
compared to benchmarks our turnover rate of staff remains comparatively high and is
now at its highest level for 2 years having risen for the 4th consecutive month.
Productivity (measured by unit of activity per wte) improved during quarter 4. Improved
flow through PICU and a shift of the patients treated has supported strong financial
performance and a higher than expected surplus. The additional funding for winter
pressures as reported in previous Resources Reports provided financial support to
schemes that were already in place and included within original forecast position.
Expenditure pressures although eased in-month remain within Directorates’ recurrent
positions, mainly as a result of CIP delivery and underlying pressures. CIP Performance
and plans have deteriorated further in March. Overall CIP performance is 28% below plan
on planned schemes. However, planned schemes only account for 91% of the overall
target so an inherent shortfall was experienced. This combined CIP deficit was £2,878k
(up from £2,708k), of which £2,123k related to performance against actual schemes, and
this needs to be a key financial focus of the Executive and Board when considering the
2014/15 Financial Plan.
The trading position resulted in a strong cash balance, with lower than expected capital
expenditure as a result of delays in electrical infrastructure work, the cancer project and
some capital equipment purchases. There is an ongoing national issue of the payment of
legacy debts from PCTs that we continue to monitor given that it could have an impact on
BCH. Going forward the performance against the longer-term capital programme will
remain a focus of Monitor. The Trust submitted a capital reforecast to Monitor on
December 18 due to actual and forecast expenditure falling outside of agreed 85-115%
parameters. The Month 12 level was at 94% of the reforecast level.
From a financial perspective and governance rating perspective the Trust has concluded
2013/14 with a strong overall performance.
Recommendations
The Board review, discuss and approve the Resources Report.
The Board of Directors is asked to approve a forecast Governance (Green) and
Continuity of Service Risk Rating (“4”) for inclusion in the Monitor Q4 Return, which must
be submitted by April 30.
Key Impacts
Strategic Objectives
Staff and finance are key enablers to meeting the Trust’s strategic
objectives.
CQC Registration (state
outcome)
N/A
NHS Constitution
NHS Constitution has a pledge regarding 18-week waits.
Other Compliance (e.g.
NHSLA, Information
Governance, Monitor)
Monitor metrics are considered in the report.
Equality, diversity & human
rights
N/A
Trust contracts
N/A
Other
N/A
Resources Report
April 2014
Item 14.85, Enc 06
Phil Foster
Theresa Nelson
Georgina Dean
Director of Finance and Procurement
Chief Officer for Workforce
Deputy Chief Officer for Contracting and Performance
1
Reporting on resources use
1. Summary
2. Monitor Assessments and Declarations
3. Volume and mix of activity
4. The impact on our workforce
5. Productivity
6. Financial Performance Summary
2
Summary.
April 2014
The final provisional financial position of the Trust this financial year is a strong one and will provide a good
foundation as we enter a period of severe financial constraint in the NHS over the next four years. The month
12 position is supported by increased demand and a shift in case mix that has again benefitted the ‘bottomline’. The surplus came in slightly above the forecast level at £8.1million (this includes the impact of the Trust’s
subsidiary company) and will allow us to use these resources over the next two years to help fund the capital
investment on the Steelhouse Lane site to provide more capacity.
Controlling the costs of care that we provide remains central to our financial success as downward pressure
continues on the tariffs we are paid. We did not secure the level of savings that we anticipated this financial
year albeit a refocus on cost control meant that revised targets are likely to be achieved releasing £5.6 million
(3%) savings. This is in line with the sector average.
Our productivity (measured by unit of activity per wte) improved in March. Staffing levels reduced in March
with the level of bank usage increasing to counteract this. Bank usage in March was 15% lower than the
equivalent period last year although substantive staffing levels are now 3.7% higher. The productivity trend in
terms of activity per wte staff member improved during quarter 4. Appraisal rates although remaining relatively
static over the last quarter remained below 83%. In-month sickness although reduced remained well above the
3% target.
Our trading position continues to generate strong cash balances, with lower than expected capital expenditure
as a result of unavoidable delays in the electrical infrastructure work on site, repositioning the cancer centre
project and delays in capital equipment purchases. Cash balances were boosted in March by the combination
of one-off receipts for revenue and capital items as well as half of the legacy debts from former PCTs being
paid.
3
2. Monitor Assessments and Declarations
4
Our month 12 regulatory position remains strong.
Month 12
Monitor Quarter 3 2013/14 (Confirmed)
Based on this performance the predicted
measureable Month 12 performance is Green.
Finance risk rating - Continuity of Service Risk Rating
G(4)
Finance risk rating - Compliance Framework
G(4)
Governance risk rating
The Continuity of Service Risk Rating for
March is a 4 (the highest level).
For information under the old Compliance
Framework regime a FRR of 4 would have
been reported in Month 12.
G
Monitor Quarter 4 2013/14 (Predicted)
Finance risk rating - Continuity of Service Risk Rating
Governance risk rating
Finance risk rating - Compliance Framework
G (4)
G
G(4)
The above will result in the Trust achieving its
planned Risk Ratings for 2013/14.
5
3. Volume and Mix of Activity
6
Emergency activity profile
ED attendance
Emergency
department
(ED)
attendances have increased by
2.0% YTD compared with last year.
In March itself there was a 5.5%
increase on the 2013 figure for the
same month.
6000
5000
4000
3000
2000
Emergency /Non Elective FCEs
2000
1500
1000
1000
Activity against plan (YTD) for ED
attendances is 3.2% above plan.
0
A
M
J
J
A
2011/12
S
O
N
2012/13
D
J
F
M
2013/14
2013/14 Emergency department
activity against plan
6000
5000
4000
3000
2000
1000
0
A
M
J
J
A
S
2013/14 actual
O
N
D
J
F M
2013/14 plan
500
Emergency FCE activity in month
has decreased by 15.5% compared
with March 2013 and shows a
decrease of 7.1% in YTD figures
compared to the same period last
year.
0
Emergency FCE activity is 4.9%
behind plan YTD, with March
activity levels being 1.0% lower
than planned.
1800
1600
1400
1200
1000
800
600
400
200
0
A M
J
J
A
2011/12
S
O
N
D
2012/13
J
F M
2013/14
2013/14 Emergency/non elective
FCEs activity against plan
A M
J
J
A
2013/14 actual
S
O
N
D
J
F M
2013/14 plan
7
Planned activity profile
2013/14 All Elective FCE activity against
plan (incl Reg Day Admissions)
All elective FCEs
3000
3000
2500
2500
2000
2000
1500
1500
1000
1000
500
500
0
0
A
M
J
J
2011/12
A
S
O
2012/13
N
D
J
F
M
A
M
2013/14
J
J
A
2013/14 actual
S
O
N
D
J
F
M
2013/14 plan
Elective activity in March was 14.7% higher than in March 2013 and YTD activity shows a 7.7% increase over 2012/13.
Elective activity is now 4.6% above plan YTD. Activity was 1.5% above plan in March 2014.
Haematology and Oncology are the areas with the biggest growth versus plan at 15% combined. Within Medicine there is also
over-performance in Gastroenterology and Neurology. In Specialised Services Cardiac Surgery is 17% under plan. In Surgery
Orthopedics, Burns, Nephrology and Urology are all close to or over 100 FCEs over plan, Plastics is under plan and there may
be an element here offsetting the Burns growth. This level of demand brings into sharp focus some of the capacity issues that
we have experienced over the last twelve months and the reassessment of the level of theatre capacity over the medium term.
We hope that the work that we are doing with Newton and other off site capacity solutions will ease this pressure.
8
Outpatient activity profile
March 2014 saw a 5.8% increase
for new attendances and 14.1%
increase for follow up patients
when compared with March
2013.
New OP attendance
4000
3500
3000
2500
2000
YTD activity shows that new
attendances
have
now
increased by 4.1% and follow
ups YTD have increased by 9.7%
when compared to 2012/13.
1500
1000
500
0
A
M
J
J
A
2011/12
S
O
N
2012/13
D
J
F
M
2013/14
Follow up OP attendance
12000
10000
Against plan, all outpatient
activity was 13.6% above plan in
March 2014 and overall 9.7%
ahead of plan YTD. Areas with
large
increases
include
Paediatrics, Paediatric Surgery,
Ophthalmology, Haematology
and
Oncology,
Neurology,
Urology and Gastroenterology.
2013/14 outpatient activity
against plan (excl AHP CNS and Phone)
16000
14000
12000
10000
8000
6000
4000
2000
0
8000
A
M
J
J
A
S
O
N
D
J
F M
6000
4000
2013/14 actual
2013/14 plan
2000
0
A
M
J
2011/12
J
A
S
O
2012/13
N
D
J
F
M
Activity excludes AHP, CNS and phone attendances
2013/14
9
4. Workforce
10
Workforce Report Summary March 2014
The workforce numbers at 3146 WTE is lower than last month by 17.09 WTE but still above last year.
Sickness Summary – We know our staff are feeling more pressure due to increases in demand and patient acuity. Our managers are
working with staff on managing sickness and whilst it has decreased to 3.73% it is slightly higher than this time last year. Long term sickness
has increased slightly to 2.37%. Short term sickness has decreased slightly to 1.37% during February 2014.
The top 3 reasons for sickness during February are Anxiety/Stress, Musculoskeletal and Gastrointestinal , evidence also demonstrates that
the latter two reasons for sickness may also be caused by stress.
BCH still compares very favourably against other Children's Trusts across the country and is still below the national average.
Bank/Agency Usage – There has been an increase during March 2014 to 182.92 WTE, an increase of 23.67 WTE compared to February
2014, This is the highest month of bank usage since November 2013 Admin usage has increased by 7.19 WTE and continues to be high in
the Medical Secretary profession and also in Health Records, there is a project group looking at how we improve the situation for this staff
group. Areas such as PAU, Ward 7 and Ward 12. Ward 7 are currently opening 4 extra beds which is impacting on their use of bank staff .
PDR Summary - PDR % still remain above 80%. All staff groups have shown a decrease in their % with the exception of Add Prof and
Scientific. Surgical Directorate is the only directorate to see an increase in their % and they are now above the 90% target. The Consultant
Appraisal % has increased from 83% to 89% which is significantly better than previous years.
Turnover Summary - The 12 month rolling Turnover % for the Trust has again increased for the period ending March 2014 and remains
above the Trust KPI 9% at 11.88%. All Directorates have a rolling turnover % above the Trust 9% KPI target. There have been no consistent
themes identified from the exit interview process and we are still improving the quality and access to these.
Junior Doctor Monitoring – The March phase of EWTD and New Deal monitoring has been completed and there are no concerns to
highlight.
11
Workforce Dashboard
Indicator
Sickness % (YTD)
Sickness %
(Month)
Episodes
Trust
Target
CSS
Medical
Specialised
Surgical
CAMHS
Corporate
Trust (Previous
Month)
Trust (Current
Month)
Trend
<3.00%
3.28%
4.28%
3.54%
2.86%
3.51%
2.59%
3.36%
3.40%
▲
<3.00%
3.72%
4.02%
4.59%
3.83%
1.95%
3.10%
3.80%
3.73%
▼
102
111
134
79
36
69
623
531
▼
LT Sickness %
2.08%
2.73%
3.18%
2.24%
0.63%
2.12%
2.33%
2.37%
▲
ST Sickness %
1.64%
1.29%
1.41%
1.60%
1.32%
0.98%
1.47%
1.37%
▼
£41,830.53
£61,087.28
£68,935.88
£31,617.40
£19,307.30
£27,491.67
£294,971.49
£250,270.06
▼
£473,913.83
£817,030.23
£712,528.87
£280,716.32
£306,789.69
£339,438.30
£2,425,235.36
£2,930,417.24
▲
509.51
734.27
971.75
476.66
169.93
441.85
3712.12
3303.97
▼
90%
84.78%
84.80%
78.58%
91.25%
84.19%
73.55%
83.81%
82.11%
▼
90%
77.78%
87.50%
93.24%
90.00%
94.12%
100.00%
83.00%
89.00%
▲
Starters FTE
7.00
22.69
13.50
6.68
0.00
9.80
61.40
59.67
▼
Leavers FTE
6.30
28.20
15.08
9.80
5.70
5.60
76.64
70.67
▼
10.01%
10.90%
14.00%
10.40%
10.90%
13.70%
11.35%
11.88%
▲
0.78%
1.19%
1.10%
1.23%
1.60%
1.14%
1.16%
1.14%
▼
553
486.02
707
648.64
820
751.65
477
441.03
337
303.02
562
516.25
3477
3163.71
3456
3146.62
n/a
n/a
15
13
14
12
8
19
67
81
▲
8.50
49.67
51.59
25.57
7.64
39.93
159.23
182.90
▲
3.47%
3.54%
3.77%
3.81%
4.19%
2.19%
3.56%
3.46%
▼
1
22
7
5
4
9
45
48
▲
2
0
0
0
0
1
5
Org Change
Please note that sickness is still one month behind so we are currently reporting on Februarys data
Current months WTE may be slightly lower due to new starters from the 2nd induction still being inputted onto ESR.
Employee Relations - On going or started during reporting month
Consultant Appraisals % is now YTD figure from April 2013
Turnover now excludes apprentices on a 12 months fixed term contract
3
n/a
Cost of sickness
Cost of sickness
YTD
FTE days lost
sickness
PDR's %
Consultant
Appraisals %
Rolling Turnover %
In Month Turnover
%
Headcount
WTE in post
Active
Recruitment
Bank Usage
Maternity Leave %
Staff in Difficulty
<9%
12
Sickness Absence
BCH Monthly Sickness %
Long and Short Term Sickness %
4.00%
3.50%
3.00%
2.50%
2.00%
12/13
1.50%
13/14
1.00%
Trust Target
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
0.50%
0.63%
2.37%
2.08%
1.37%
1.64%
BCH Trust
Sickness
284 Dir 1
Clinical
Support
Services
2.73%
3.18%
1.29%
1.41%
284 Dir 2
Medical
Directorate
284 Dir 3
Specialised
Services
Short Term Sickness
BCH Sickness Comparison
August
September
April
May
June
July
2.62%
3.20%
3.35%
3.05%
2.79%
3.13%
3.39%
3.58%
3.22%
2.12%
1.32%
0.00%
12/13
2.24%
1.60%
284 Dir 4
Surgical
Directorate
0.98%
284 Dir 5
CAMHS
Services
284 Dir 6
Corporate
Long Term Sickness
October
November
December
January
February
March
2.95%
3.46%
3.45%
3.29%
3.61%
3.29%
3.07%
3.36%
3.74%
3.64%
3.42%
3.80
3.73%
13/14
2.85%
BCH Sickness Absence - February 2014
BCH Total
Clinical Support Services
Medical Directorate
Specialised Services
Surgical Directorate
CAMHS Services
Corporate
Number of Episodes
Monthly Sickness Cumulative 12
%
Month Sickness %
531
3.73%
3.40%
102
3.72%
3.28%
111
4.02%
4.28%
134
4.59%
3.54%
79
3.83%
2.86%
36
1.95%
3.51%
69
3.10%
2.59%
Sickness Absence has decreased slightly in February 2014, however the % is
slightly higher than the same period in 2013. Short term sickness (STS) has
decreased for the overall Trust % and all directorates apart from CSS, Surgical
and CAMHS have seen a small decrease in their %. Long term sickness for the
Trust has increased slightly from 2.33% to 2.37%. Specialised, Surgical and
Corporate have seen an increase in LTS during February 14. In managing
sickness absence the priority for Trust managers needs to be a focus on short
term sickness, as unplanned STS has a greater impact on the service and patient
experience.
In February 2014, 3303.94 WTE days were lost due to sickness absence, this is a
decrease of 408.15 WTE days lost compared to January 2014.
The approximate cost of absence for this period was £250,270.06. (based on
basic pay only).
13
Sickness Comparison Data
Trust Sickness Comparison 2013-2014
6.00%
5.00%
4.00%
3.00%
2.00%
1.00%
0.00%
April
BCH
May
June
July
August
Central Manchester UH NHS - Cumulative = 4.69%
Data indicates that BCH
consistently achieves a
lower absence rate
(average 3.40%) than other
Children’s Trusts apart from
GOSH whose sickness %
has remained below 3%
each month since April 13
BCH is operating at a
sickness rate
considerably below
the national and
West Midlands
Region average*
September
October
Alderhey Childrens**
November
December
Sheffield Childrens**
BCH Sickness rate is
however slightly in
excess of the Trusts
target of 3% and has
been since May 2013
January
February
Great Ormond Street**
Further analysis will
be provided next
month once we have
a full years worth of
data.
*National Sickness Rate for England from April to November 2013 inclusive show an average of 3.95%. The West Midlands Region average
sickness is 4.08% (Dec 2013 to Mar 2014 national statistics unavailable at present) – Source NHS Information Centre.
** Alderhey, Sheffield and Great Ormond Street Trusts – Data taken from Iview - only April to December 2013 data is available.
14
Bank Usage
Oct 13
Nov 13
Dec 13
Jan 14
Feb 14
Mar 14
CSS
8.06
7.11
5.68
8.29
8.20
8.50
Medical
47.18
48.97
40.16
41.03
39.80
49.67
Specialised
58.53
60.59
45.98
47.33
48.30
51.59
30.98
27.88
18.52
17.62
19.60
50.00
25.57
CAMHS
8.34
7.66
9.19
9.27
7.80
7.64
Corporate
47.09
42.57
36.08
40.46
35.54
39.93
Total
200.18
194.78
155.62
163.99
159.24
182.90
49.67 48.30 51.59
60.00
WTE
Surgical
Directorate Bank Usage Comparison February & March 2014
39.80
35.54
40.00
25.57
30.00
20.00
39.93
19.60
8.20
8.50
7.80 7.64
Feb-14
10.00
Mar-14
0.00
D1 Clinical
Support
Services
* The latest month is an indicative figure and about 95% accurate. The previous month figure will be updated
each month
D2 Medical
Directorate
D3
Specialised
Services
D4 Surgical
Directorate
D5 CAMHS
Services
D6 Corporate
Directorates
Top 3 reasons for bank usage
1. Vacancies – 122.29 WTE
2. Sickness – 19.72 WTE
3. Specialist Skills Required – 12.46 WTE
Priority
7
Medical Locum/Agency Usage Cost (£)
The below table shows the cost of medical locum and
agency usage for March 2014.
Locum
% Bank/Agency Usage
March 14
Agency
CSS
9,275.00
7,302.00
Medical
5,613.00
78,365.00
Specialised
22,275.00
13,019.00
Surgical
27,385.00
(1,885.00)
CAMHS
16,903.00
102,156.00
Total
81,450.00
198,957.00
Admin bank and agency usage = 75.29 WTE. This is an increase of 7.19 WTE (Februarys
usage was 68.11 WTE).
Top 3 reasons for Admin usage is vacancies, teacher/training & sickness
Directorate Admin bank and agency is as follows:
41.17
41.98
CSS - 4.04 WTE
D Med – 6.36 WTE
Surgical - 16.79 WTE
CAMHS – 7.04 WTE
Specialised - 5.93 WTE
Corporate – 35.13 WTE
16.85
A&C
Non Reg
Reg
15
Nursing Skill Mix – March 14
Department
Clinical ESR
WTE est.
Skill Mix –
Qualified/Unqualified
Ward 1
17.19
77:23
Ward 2
31.40
84:16
Ward 5
29.20
72:28
Ward 7
19.03
80:20
Ward 8
29.86
81:19
Ward 9
29.93
76:24
Ward 10
26.45
77:23
Ward 11
32.38
84:16
Ward 12
27.60
83:17
Ward 15
56.16
83:17
Burns
21.36
70:30
Emergency Dept
45.36
78:22
Medical Day Care
10.20
86:14
Medical HDU
23.00
96:04
NSW
31.24
80:20
PAU
28.40
81:19
PICU
213.50
88:12
Surgical Day Care
14.80
70:30
Theatres
106.52
75:25
Ashfield
21.33
73:27
Heathlands
19.34
63:37
Irwin
26.60
56:44
Nursing Skill Mix by Band - March 2014
Band 8b
2.00
Band 8a
10.00
Band 7
59.47
Band 6
201.34
Band 5
577.89
Band 4
31.23
Band 3
123.30
Band 2
-800
-600
-400
-200
60.92
0
200
400
600
800
WTE
16
Appraisal Information
Staff Group - Table 1
Oct-13
Nov-13
Dec-13
Jan-14
Add Prof Scientific &
Technical
85.13%
Additional Clinical
Services
84.54%
87.46%
85.09%
88.60%
Admin & Clerical
80.48%
80.37%
76.45%
77.60%
AHP's
85.85%
86.67%
84.11%
Estates & Anciliary
88.46%
87.40%
Healthcare Scientists
74.34%
Nursing
Students
84.97%
87.31%
85.93%
Feb-14 Mar-14
82.09% 84.77%
Oct
Table 2
Nov
Dec
Jan
Feb
Mar
84.96%
85.35% 83.85% 84.88% 83.81% 82.11%
88.90% 86.65% Clinical Support Services
81.09%
85.51%
85.25% 86.56% 86.59% 84.78%
90.24%
89.72%
86.18% 87.15% 86.99% 84.80%
83.81%
76.87% 75.40% Medical Directorate
86.11% 85.46%
83.33%
81.72%
80.98% 81.24% 79.67% 78.58%
86.28%
89.92%
90.40% 88.28%
84.96%
83.78%
83.93%
83.19% 73.39% Surgical Directorate
85.03%
87.21%
84.54% 91.09% 79.74% 91.25%
87.33%
87.09%
86.32%
87.21%
85.53% 83.92% CAMHS Services
92.12%
92.12%
91.94% 92.46% 89.80% 84.19%
100.00%
50.00%
50.00%
50.00%
50.00% 60.00%
81.19%
79.71%
78.38% 76.67% 75.17% 73.55%
BCH
Table 1 shows via staff group the PDR compliance. Compared to
last months report Add Prof Scientific & Technical have seen an
increase in the PDR %. All other Staff groups have decreased
slightly.
Consultant Appraisals
Specialised Services
Corporate
This table shows the PDR %. Each months totals is for PDR’s that have taken place and recorded on
ESR during the last 12 months, so for March the PDR period is April 13 to March 14.
The data in table 2 shows overall the Trust PDR rate has seen a slight decrease
however it still remains above 80%.
All directorates have seen a decrease in their PDR % during February 14 with
the exception of surgical that has increased above the 90% target.
Directorate
Appraisal % Rate
BCH Total
89.00%
Clinical Support
77.78%
Medical
87.50%
Specialised
93.24%
Surgical
90.00%
CAMHS
94.12%
The ESR beginner and refresher training sessions run by HR are continuing to
be popular with managers.
Consultant Appraisals are
continuing to show an
increase. The overall % has
increased from 83% in
February to 89% in March.
17
DBS Compliance – The trust is required to check all
staff every three years and we have a rolling process to ensure we
capture all relevant staff.
Directorate
Number of Staff required
to complete DBS Check
Number
Completed
%
Completed
CSS
33
9
27.3%
Medical
64
13
20.3%
Specialised
63
8
12.7%
Surgical
29
5
17.2%
CAMHS
26
6
23.1%
Corporate
33
9
27.3%
Total
248
50
20.2%
Pensions Update
It is important to note the regular
DBS refresher process. We have just
started this phase and expect all
outstanding checks to be completed
by the end of May 2014.
A new service has been launched to provide advice and information to staff about
their NHS Pensions.
The Pension Support Service provides access to information; answers and where
required assistance relating to questions you may have about your pension.
Over the next year there will be many changes to the NHS Pension Scheme and
whilst as an employer we are unable to provide advice, we can provide you with
information about how to answer the questions you may have to ensure you
understand the changes and most importantly how they may impact you on a
personal level.
Many of the planned changes require formal legislative approval and as this occurs
more information will be provided to help you to understand any impacts. 3
18
NHS Pay Award 2014/15 and 2015/16
Staff at Top of Band
2014/15
2015/16
Agenda for Change Staff
WTE
2014/15
Number of
staff on top
of band
2015/16
WTE
2015/16
58
52
65
59
Band 2
76
65
80
68
Band 3
130
107
153
127
Band 4
133
116
148
128
Band 5
251
205
306
256
Band 6
169
140
201
178
Band 7
164
137
181
152
Band 8a
91
81
109
97
Band 8b
38
33
45
39
Band 8c
22
18
30
26
Band 8d
12
9
12
9
Band 9
4
4
5
5
1148
967
1335
1142
Consultant
19
15
67
61
SPR / SHO
44
42
60
57
0
0
0
0
63
57
127
118
1211
1025
1462
1260
Number of
staff on top of
band 2014/15
Band 1
Sub total
Staff at the top of their pay band , will receive a non-consolidated payment of 1% of
their basic pay. This 1% is a non-recurrent payment and will be paid in monthly
instalments and backdated to 1 April 2014. This will not count towards pension and
will not apply to unsocial hours payments, additional programmed activities,
overtime, on call, clinical excellence awards and other allowances.
65% of staff who are not top of the band will receive their usual incremental rise as
per the 2013 AfC/medical dental pay scales.
Those employees who are top of their pay scale as at 31 March 2014 will receive a
1% pay award in 2014/15 and a further 1% (total of 2%) in 2015/16.
If an employee is currently at the penultimate point of their pay scale and is due to
receive their increment in 2014/15 then they will not receive the 1% pay award.
Instead they will receive their incremental award as usual taking them to the top of
the pay scale. However, in the following financial year 2015/16, because they have
reached the final point of the pay scale they will then receive a 1% pay award.
Medical Staff
SAS
Sub total
Total
For our nursing staff, 349.86 WTE (38%) are top of the band in 2014/15 and will
receive a 1% pay award.
In 2015/16 a further 72.9 WTE reach the top of their band and will receive 1%. The
staff who reached top of their band in 2014/15 will receive 2%.
19
BCH Nursing Staffing:
Nursing Workforce actions:
• Newly Registered Nurse
recruitment strategy
• Clinical Support Worker
development program
• Real time ward staff dashboard
• Business case for Ward
Manager supervisory status
Clinical Wards data
Nurse Staffing Non RN RN
Wd Mgr
Establishment
168.4
742.5
31
In Post
174.7
699.1
28.8
Gap
+6.3
-43.5
-2.2
Variance
3.7%
-5.9%
-7.0%
Monthly
Ave
Act vs.
Plan
Acuity
Skill Mix Vacancy
Annual
Leave
Mat
Leave
Sickness Bank
Mar- 14
98.1%
TBC
79.2%
16.6%
4.8%
8.1%
7.5%
3.3%
Junior Doctor Monitoring 2014 - 1st Round
Part 1
Date Monitored
Rota
Current Banding
Banding Outcome
Valid
Actions
10/03/14-24/03/14
CAMHS SHO
1C (20%)
1C (20%)
Valid
Re-Monitor 2nd Round – 15/09/14
10/03/14-24/03/14
CAMHS MiddleGrade
1B (40%)
1B (40%)
Valid
Re-Monitor 2nd Round – 15/09/14
10/03/14-24/03/14
Paeds Surgery SHO
1A (50%)
1A (50%)
Valid
Re-Monitor 2nd Round – 15/09/14
10/03/14-24/03/14
Paeds Surgery MiddleGrade
1A (50%)
1A (50%)
Valid
Re-Monitor 2nd Round – 15/09/14
10/03/14-24/03/14
T+O MiddleGrade
2B (50%)
2B (50%)
Valid
Re-Monitor 2nd Round – 15/09/14
10/03/14-24/03/14
Liver Transplant
1A (50%)
1A (50%)
Valid
Re-Monitor 2nd Round – 15/09/14
10/03/14-24/03/14
Haem/Onc MiddleGrade
1A (50%)
1A (50%)
Valid
Re-Monitor 2nd Round – 15/09/14
10/03/14-24/03/14
Anaesthetics MiddleGrade
1B (40%)
1B (40%)
Valid
Re-Monitor 2nd Round – 15/09/14
10/03/14-24/03/14
ED MiddleGrade
1A (50%)
Invalid
Invalid
Re-Monitor 1st Round – 05/05/14
Monitoring 2014 1st Round
Part 2 - planned
Date Monitored
Rota
Current Banding
Banding Outcome
Valid
Actions
05/05/14-19/05/14
H@N SHO
1A (50%)
TBA
TBA
Awaiting Monitoring
05/05/14-19/05/14
H@N SPR
1A (50%)
TBA
TBA
Awaiting Monitoring
05/05/14-19/05/14
Plastic Surgery MiddleGrade
1A (50%)
TBA
TBA
Awaiting Monitoring
05/05/14-19/05/14
Cardiac Surgery Middlegrade
1A (50%)
TBA
TBA
Awaiting Monitoring
05/05/14-19/05/14
ED SHO
1A (50%)
TBA
TBA
Awaiting Monitoring
05/05/14-19/05/14
Gastro MiddleGrade
1A (50%)
TBA
TBA
Awaiting Monitoring
05/05/14-19/05/14
Hepatology MiddleGrade
1A (50%)
TBA
TBA
Awaiting Monitoring
05/05/14-19/05/14
Cardiology MiddleGrade
1B (40%)
TBA
TBA
Awaiting Monitoring
05/05/14-19/05/14
PICU MiddleGrade
1A (50%)
TBA
TBA
Awaiting Monitoring
05/05/14-19/05/14
Radiology MiddleGrade
1A (50%)
TBA
TBA
Awaiting Monitoring
21
5. Productivity
22
Productivity Headlines.
We continue to track our productivity as an organisation and as with the public sector as a whole finding a measure
that reflects the complexity of what is delivered is a challenge. Using financial metrics alone can mislead as they can
skew performance. The measures we use are proposed by the Institute for Healthcare Improvement.
We continue to look at a combination of activity and financial information benchmarked against either staff numbers
or staff cost. In March:
•
•
Income per wte remained above plan and increased on the February position in line with the strong income
performance. Our operating expenditure per inpatient episode was also higher than planned.
Activity per whole time equivalent, whilst there have been some variation over the past 18 months, has
remained at broadly the same level.
The investment of resources into the transformation programme, with the support of Newton, should improve unit
productivity across the Trust in 2014/15; albeit the full impact will not be felt until 2015/16.
Note:
Clinical Activity = All Inpatients, Outpatients, PICU Augmented Care Periods, ED attendances and Unbundled
diagnostics;
Clinical wte = all wte excluding Admin & Clerical staff and Estates and Ancillary;
Plan figures – solid lines;
Actual figures – dotted lines.
23
Productivity per wte
Income, Opex and Activity per wte
60
A
c
t
i
v
i
t
y
p
i
s
o
d
e
s
Mar 14
Jan 14
60
Feb 14
62
Dec 13
64
62
Oct 13
64
Nov 13
66
Sep 13
68
66
Jul 13
68
Aug 13
70
Jun 13
70
Apr 13
72 E
May 13
74
72
Mar 13
74
Jan 13
76
Feb 13
78
76
Dec 12
78
Oct 12
80
Nov 12
80
Sep 12
82
Jul 12
82
Aug 12
84
Jun 12
86
84
Apr 12
'000
86
May 12
Headlines
• Activity per wte has increased slightly in
March. As experienced in previous years
March is typically a high month of activity.
However, high Outpatient activity coupled
with a strong inpatient performance, has
improved this metric further;
• Total Opex per wte has increased in March.
Greater activity levels result in higher costs
although as we also built in a number of yearend one-off provisions as well as incurring
one-off costs and these have a slight skewing
effect on this metric;
• Total income per wte improved in the month
which was boosted by both higher than
expected inpatient activity but also a richer
case mix;
• The differential between Income per wte and
Opex per wte is now at its highest point of the
year July, with a further minor improvement in
March;
• Contribution per wte has remained on a par
with the November 2013 levels.
Average Total Income per wte Plan £'000 (cum)
Average Total Income per wte Actual £'000 (cum)
Average Total Opex per wte Plan £'000 (cum)
Average Total Activity per wte Plan (cum)
Average Total Opex per wte Actual £'000 (cum)
Average Total Activity per wte Actual (cum)
Contribution per wte
20.0
18.0
16.0
£'000
14.0
12.0
10.0
Apr
12
Jun Aug Oct Dec Feb Apr
12 12 12 12 13 13
Jun Aug Oct Dec Feb
13 13 13 13 14
Total Contribution per wte Plan £'000 (cum)
Total Contribution per wte Actual £'000 (cum)
24
Income Metrics
Headlines
•
•
•
•
Clinical Income per wte and per Clinical wte
The level of clinical income earned per Medical and
Clinical wte remains above plan;
The level of Clinical income per Medical wte and per
Clinical wte has improved in the month;
The number of Medical Staff at the Trust reduced in
February and this level was maintained in March. This
has caused an upward shift in medical staffing
productivity;
The level of clinical income earned per wte has remained
above plan after dropping below for the first time in
September;
Due to the strong Outpatient performance the clinical
income per activity value remains below plan in March
but has again improved in-month for the 5th month
running.
100
90
80
£'000
70
60
50
Apr 12
May 12
Jun 12
Jul 12
Aug 12
Sep 12
Oct 12
Nov 12
Dec 12
Jan 13
Feb 13
Mar 13
Apr 13
May 13
Jun 13
Jul 13
Aug 13
Sep 13
Oct 13
Nov 13
Dec 13
Jan 14
Feb 14
Mar 14
•
Annual
Annual
Annual
Annual
Clinical Income per wte Plan £'000 (cum)
Clinical Income per wte Actual £'000 (cum)
Clinical Income per Clinical wte Plan £'000 (cum)
Clinical Income per Clinical wte Actual £'000 (cum)
Clinical Income per Medical wte
580
560
Total Clinical Income per activity
540
£'000520
900
500
880
480
860
460
Apr 12
May 12
Jun 12
Jul 12
Aug 12
Sep 12
Oct 12
Nov 12
Dec 12
Jan 13
Feb 13
Mar 13
Apr 13
May 13
Jun 13
Jul 13
Aug 13
Sep 13
Oct 13
Nov 13
Dec 13
Jan 14
Feb 14
Mar 14
£ 840
820
Annual Clinical Income per Medical wte Plan £'000 (cum)
800
Annual Clinical Income per Medical wte Actual £'000 (cum)
Apr 12
May 12
Jun 12
Jul 12
Aug 12
Sep 12
Oct 12
Nov 12
Dec 12
Jan 13
Feb 13
Mar 13
Apr 13
May 13
Jun 13
Jul 13
Aug 13
Sep 13
Oct 13
Nov 13
Dec 13
Jan 14
Feb 14
Mar 14
780
Total Clinical Income per Activity Plan £ (cum)
Total Clinical Income per Activity Actual £ (cum)
25
6. Financial Performance
26
Financial Performance Summary
FINANCIAL PERFORMANCE REPORT
Monitor Financial Performance Framework
Criteria
Metric
Underlying Performance
Achievment of Plan
Financial Performance
Plan
Actual
EBITDA margin
3
3
EBITDA, % achieved
5
5
Financial Efficiency
Return on Assets
5
5
Financial Efficiency
I&E surplus margin
4
5
Liquidity
Liquidity ratio
Overall
4
4
4
4
Status
Direction
of Travel






The Monitor Risk Rating is per the Plan of 4. This is forecast to continue through to year-end
Issue
Plan
£'000
Actual
£'000
Variance
£'000
Income and Expenditure
4,653
8,209
3,556
Cash Balance
28,715
48,564
19,849
Capital Programme
11,194
10,559
-635
CIP
8,436
5,557
-2,878
Status
Direction of
Travel




Incom e and Expenditure
Year to date surplus and EBITDA have seen further improvement in month 12 and remain above both
the Monitor Plan and the revised plan. The provisional year-end position is per the Forecast Outturn.
(M o nito r assesses financial risk o n a scale fro m 1(high risk) to 5 (lo w risk)
Cash Balance
Monitor Risk Assessment Framework
Criteria
At the end of March the cash balance w as 69.1% above plan.
Plan
Actual
Status
Direction
of Travel
Capital Service Capacity
4
4
Liquidity
4
4


Capital Program m e
The Trust performing at 94% of the revised capital plan submitted to Monitor during Q3. This is
only 73% of the original YTD plan and given know n slippage w as at the top end of expectations.
The new Risk Assessment Framew ork seeks assurance regarding w hether the Trust is a going concern.
CIP
This remains the key concern. The year to date shortfall of 34% or £2,878k is significantly
(M o nito r assesses financial risk o n a scale fro m 1(high risk) to 4 (no evident co ncerns)
higher than expected at this stage of the year. Of the £2,878k, £755k relates to a gap in identified
Foundation Trust Requirements
Issue
Measure
Plan
Actual
Status
Direction
schemes. Performance against actual schemes w as 72%.
of Travel
Prudential Borrow ing Limit to be determined
£2m
£2m
Private Patient Cap
0.4%
0.1%
Not to exceed 49%



Working Capital Facility
Not to use
Not Used
Not Used
All categories are performing to or w ithin plan although from an I&E perspective a close w atch needs to
be maintained on Private Patient income
27
Income and Expenditure against Plan
The Trust has finished the year as expected with a
continued performance ahead of the plan submitted to
Monitor. Strong activity performance during March
meant that the expected £8m surplus was achieved.
Headlines are:
• The Trust exceeded its planned surplus of £4.653m;
• The forecast £8m surplus was marginally overachieved at £8.209m which has allowed the Trust’s
consolidated accounts (when the Trust’s position is
added to that of its subsidiary company) to record a
surplus of £8.083m;
• NHS Clinical Income, at £4.789m above plan, was the
key driver behind the Trust’s strong financial
performance in 2013/14;
• March’s operational expenditure in 3 of the 5 Clinical
Directorates was above plan with all Directorates
finishing the year in deficit;
• The year-end cumulative position of the 5 Clinical
Directorates was £0.004m inside the target set in
Month 7;
• The key expenditure issue remains the shortfall
against the savings (CIP) target.
2013/14 I&E to March 2014
Income from activities
Other Income
Operating Expenses
EBITDA
Interest Receivable
Depreciation
Profit/(Loss) on Asset Disposal
Impairment
PDC Dividend
Interest Paid
Net Surplus/(Deficit)
Brackets indicate adverse
variance
Clinical Support Services
Medical Directorate
Specialised Services
Surgical Directorate
CAMHs
Corporate
Total Operational Budgets
Bad Debts
Donated Assets
Operating Leases
Teaching & Research
Reserves and Provisions
Total Other Budgets
Total Budgets
Annual
Revised
YTD Plan
Plan per Annual Plan per LTFM
LTFM
£'000
£'000
£'000
210,989
216,607
210,989
20,034
23,278
20,034
-217,499
-226,178
-217,499
13,525
13,707
13,525
230
230
230
-6,107
-6,288
-6,107
0
0
0
0
0
0
-2,670
-2,670
-2,670
-325
-326
-325
4,653
4,653
4,653
Revised
YTD Plan
£'000
216,607
23,278
-226,178
13,707
230
-6,288
0
0
-2,670
-326
4,653
March
Income
Variance
Pay
Variance
Non-Pay
Variance
Total
Variance
160
175
-451
-135
36
1,405
1,190
-49
416
-555
-37
-60
-875
-1,160
-600
-1,332
-1,476
-453
-70
-4,271
-8,202
0
-489
-742
-2,482
-625
-94
-3,741
-8,172
0
1,022
163
0
4,877
6,062
-2,110
1,022
163
0
1,022
2,212
4,044
4,044
2,884
833
996
-7,206
YTD Actual
£'000
221,396
25,470
-230,500
16,366
158
-5,495
0
0
-2,525
-295
8,209
Variance
£'000
4,789
2,192
-4,322
2,659
-72
793
0
0
145
31
3,556
February
Variance
£000
In-month
Movement
£000
-497
-649
-2,214
-583
-126
-1,109
-5,179
0
-0
155
-338
5,336
5,153
-26
8
-93
-268
-42
32
-2,631
-2,993
0
1,022
8
338
-459
909
-2,084
28
Profitability against Target
The EBITDA (Earnings Before Interest, Taxation, Depreciation
and Amortisation) Margin
ended the year
significantly above target (6.6% compared
with 5.9%). In monetary terms EBITDA was
also above the Monitor Plan, which is the
measure of efficiency used in the Financial
Risk Rating calculation. In-month EBITDA is
ahead of plan. When compared with other
specialist
Foundation
Trusts
BCH’s
profitability doesn’t compare so well – the
sector average for our type of organisation
was 7.0 per cent at end of quarter three.
The I&E Surplus Margin ended the year
above plan (3.3% compared with 2.0%),
reflecting the EBITDA margin and assisted by
reduced depreciation expenditure arising out
of the 2012/13 valuation.
EBITDA Margin
7.5%
7.0%
6.4%
6.5%
6.0%
6.6%
6.7%
6.4% 6.4% 6.5%
6.1% 6.1%
5.7%
6.6%
6.0%
Actual
5.6%
5.5%
Plan for
Year
5.0%
4.5%
4.0%
Apr May Jun
Jul
Aug Sep Oct Nov Dec
Jan
Feb Mar
I&E Surplus Margin
4.0%
3.2% 3.2%
3.5%
3.5%
2.8% 2.8%
3.0%
2.5%
2.0%
2.7%
3.1%
2.9% 3.0%
3.3%
2.4%
2.0%
Actual
1.5%
1.0%
Plan for
Year
0.5%
Both of these were strong performances and
will assist in the financing of the future
investment at the Trust.
0.0%
Apr May Jun
Jul
Aug Sep
Oct Nov Dec
Jan
Feb Mar
29
CIP
The final CIP delivery for 2013/14 is 34.1% or £2.88m below target at month 12. Contributing to this reported shortfall is the part
year effect of a £0.75m full year gap in formal plans for 2013/14.
All directorates reported deficits against YTD plans and targets. The reported deficits have largely remained constant compared with
prior periods.
The final outturn deficits were slightly above the predicted shortfall of £2.7m or 32%. As outlined in previous reports Directorates
had been set a target based on the YTD performance, projections for the balance of the year and what was deemed controllable as
part of their financial portfolio. Overall these targets were realised.
The year-end delivery of £5.6 million (3%) savings was against the initial plan of £8.1million (4.4%). Across the FT sector Monitor
reported that Trusts had met 2.9 per cent of CIP plans at the end of quarter three which was 18 per cent below plan (17% at quarter
two).
Directorate
Clinical Support Services
Medical Directorate
Specialised Services
Surgical Directorate
CAMHs
Corporate
Total
all figures £k
Target
1,077.0
1,797.0
2,253.5
1,184.0
625.0
1,499.0
8,435.5
Plan
1,000.8
1,819.8
1,791.6
1,214.4
625.2
1,228.5
7,680.4
Actual
860.0
1,322.8
962.0
899.9
612.0
900.5
5,557.2
Against Plan
Variance % Achieved
-140.9
85.9%
-497.0
72.7%
-829.5
53.7%
-314.5
74.1%
-13.3
97.9%
-328.1
73.3%
-2,123.2
72.4%
Against Target
Variance % Achieved
-217.0
79.9%
-474.2
73.6%
-1,291.5
42.7%
-284.1
76.0%
-13.0
97.9%
-598.5
60.1%
-2,878.3
65.9%
Annual Plan Values
Non-Rec Plans FYE of Rec Plans
105
1,023
618
1,681
604
1,335
210
1,376
70
578
246
1,081
1,854
7,074
30
Cash and Capital
•
•
•
The Capital performance in March was below the
revised capital plan submitted to Monitor (94%
YTD) and well behind the original Monitor plan
(73%).
Given slippage in a small number of high value
equipment schemes, most notably purchase of the
new gamma camera, this final performance was at
the top end of expectations.
Actual
Mar-15
Jan-15
Feb-15
Dec-14
Oct-14
Nov-14
Sep-14
Jul-14
Aug-14
Jun-14
Apr-14
2013/14 Plan
May-14
Mar-14
Jan-14
Feb-14
Dec-13
Oct-13
Nov-13
Sep-13
Jul-13
Aug-13
Jun-13
continued slippage on the original capital plan, coupled
with a strong in-month I&E performance;
Receipt of Technology Fund monies;
Receipt of Community CAMHs funding for 18 months;
and
Payment of 50% of legacy debt issues.
Apr-13
50,000
45,000
40,000
35,000
30,000
£k 25,000
20,000
15,000
10,000
5,000
0
Mar-13
•
2013/14 Cash Position and Rolling Forecast
May-13
Cash is 69.1% above plan at year-end. At £48.6m
the cash balance has increased in-month (£44m at
month 11) as has the variance above plan in both
percentage and absolute terms. Over the course of
the year the cash balance has increased by £12.4m.
The increased variance from plan, especially in
Month 12, is primarily a result of:
Rolling Forecast
2013/14 Cumulative Capital Expenditure against Plan and Monitor
Margins
16,000
14,000
12,000
10,000
£k
8,000
6,000
4,000
2,000
Apr
May
Jun
Jul
Aug
Sep
Oct
13/14 Actual
13/14 85%
13/14 Plan - Revised
13/14 Plan - Original
Nov
Dec
Jan
Feb
Mar
13/14 115%
31
Debtors and Creditors
Debtors over 90 days have reduced in March in
both percentage and actual terms. The Trust’s
largest debt was paid in late March which leaves
two PCTs’ debt within the current top five debts
over 90 days. These debts have transferred to NHS
England as part of the national resolution process.
Dialogue continues with NHSE and the DH on the
speed and path of resolution for these. It is
envisaged that payment will be received during
May.
As a result of the payment of the BEN PCT debt,
Birmingham Women’s Hospital now has the 5th
largest debt over 90 days old. Discussions on this
will continue as part of the Annual Accounts
Agreement of Balance exercise.
The Creditors position over 90 days has decreased
in both percentage and value terms during the
month. The overall level of creditor invoices
increased by £3.5m in March which was the key
determinant in the reduced % of 90+ days creditors.
% Debtors and Creditors over 90 days
60%
50%
40%
30%
20%
10%
0%
Apr
May
Jun
Jul
Debtors>90 days %
Top 5 Debts Over 90 Days Old
Customer
Aug
Sep
Oct
Nov
Dec
Creditors>90 days %
31st March 2014
Jan
Feb
Mar
Target
28th February 2014
Age
(Days)
Value
(£k)
Age
(Days)
308
Value
(£k)
658
Solihull PCT
367
464
308
464
Private Patient - MK
972
139
913
139
Slater & Gordon (UK) LLP
174
136
115
136
South Birmingham PCT
367
132
308
132
Birmingham Women's Hospital
168
107
BEN PCT
978
1,529
32
Financial summary.
March 2014
The Monitor Financial Risk rating is 4 per plan, with liquidity remaining strong. This 4 is per the Compliance
Framework and the Continuity of Service Risk Rating (CoSRR).
The I&E position is above both the Monitor plan and the revised plan at £8.209m. This excludes the impact
of the Medicine Chest, which reduces the overall “Group” surplus to £8.083m.
The EBITDA and Income Surplus margins are 0.7% and 1.3% above plan, respectively.
Clinical Income performance in March was ahead of the Monitor plan, and this is also ahead of plan on a
cumulative basis. Income is considerably ahead of that generated in the same period in 2012/13.
CIP remains a key concern and a primary area of focus. Only 72% of the YTD plan is achieved, when the gap
for which no schemes exist is built in this decreases to 66%.
Cash balances remain above plan in Month 12, increasing to £19.9m above the planned position. Capital in
month 12 performed ahead of plan bringing the overall spend up to 94% of the revised capital plan.
The Forecast position for the Trust was to exceed the planned surplus of £4.653m, excluding any benefit of
donated asset income. The forecast position of £8m was achieved.
33