Board Integrated Performance Report 27th October 2016 · Board Integrated Performance Report -...

1 of 47 Board Integrated Performance Report - October 2016

1.2 NHS Improvement

Governance

Rating

Board Integrated Performance Report

27th October 2016

September 2016 Data

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Good

1.1 CQC Rating 1.3 NHS Improvement

Sustainability and Performance

Risk Rating

Minimum Requirement: 3

3

Agenda Item: 10

Lead Director: Director of Finance,

Contracting and Facilities

Presented For: Discussion


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

The purpose of this Integrated Performance Report is to assist the Board in assessing the Trust’s performance and progress in

delivery of a broad range of key targets and indictors.

Board Action Key Highlights Slides

NHS Improvement Indicators

Assurance

Information

• All NHS Improvement performance indicators have been met for month 6 and quarter 2.

• NHS Improvement’s new Single Oversight Framework applies from October 2016. The integrated performance

report contains shadow reporting of the Single Oversight Framework operational performance metrics.

• Airedale NHS Foundation Trust and Bradford Teaching Hospitals Foundation Trust performance against the

national standard for Accident and Emergency waits is provided to the Board for the first time, for information,

given the importance of this standard for the Bradford and Airedale health and social care system.

4 – 6

7 – 8

9

Quality

Exceptions

• The August 2016 report highlighted an increase in serious incidents, including suicides, in 2016/17 year to

date compared to 2015/16. This report details actions being taken by the Trust and with West Yorkshire

partners to reduce suicides. A report resulting from the University of Manchester’s National Confidential Inquiry

into Suicide and Homicide by People with Mental Illness was published in October 2016. This presents

findings relating to people who died by suicide in 2004-2014. The confidential enquiry indicates that in general,

suicide rates have risen since the 2008 recession, although the rate in England now appears to be falling, and

that the number of UK suicides by mental health patients has risen in recent years (mainly due to increases in

England and primarily reflecting an increase in the number of people under mental health care in England).

• Information Governance training compliance remains below the 95% target. Targeted interventions are taking

place to increase compliance rates and the Directors’ Transformation and Governance Meeting highlighted the

sustained effort required to reach and maintain the 95% target.

10

16 - 17

Business Unit

Update • The Integrated Performance Report has been completed prior to the October Business Unit Performance

meetings. Key issues relate to finance pressures and risks captured within the finance slides. The Board will

receive a verbal update regarding any new issues identified for escalation.

Change Programme

Exceptions • Of 8 transformational projects, 3 are on track and rated green, 4 are rated amber and 1 is rated red (clinical

document storage). Work is in progress to consider options and achieve substitute CIP savings.

32 - 34


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

The purpose of this Integrated Performance Report is to assist the Board in assessing the Trust’s performance and progress in

delivery of a broad range of key targets and indictors.

Board Action Key Highlights Slides

Finance

Exceptions

• Performance at the end of September highlights the ongoing challenges of delivery during 2016/17 and ongoing need for attention and action.

• At Month 6 all key indicators are rated Amber with the exception of the Statement of Comprehensive Income which is rated Red.

• The Trust planned to make a surplus of £666k at the end of the period but has reported a £224k deficit and adverse plan variance of £890k despite receipt of Moor Lane overage at month 5.

• Cost Improvements are £196k behind plan at the end of the period, but offset non-recurrently through the high risk CIP reserve. Further details and mitigating actions are highlighted.

• Capital Expenditure is £313k below plan, reflecting slippage on both Estates and IM&T schemes and uncommitted contingency reserves (for anticipated in-year pressures) of £14k.

• The position reflects achievement of a Financial Sustainability Risk Rating (FSRR) of 3, compared to a plan FSRR of 4. The Trust forecasts achieving a FSRR of 4 (or 1 under the new Single Oversight Framework), but this is dependant on delivery of a targeted actions in the coming months. Whilst FSRR headroom has increased again, to £450k at month 6, the primary focus remains achieving the control total and £790k Sustainability Funding.

Mitigation Plans: • The probable forecast indicates that risks of around £317k that we forecast being able to manage. Further

downside risk factors of £0.5m have been highlighted, with actions underway to target full mitigation • This does not accommodate any further deterioration with forecasts now effectively ‘fixed’ as control totals. • The Trust is targeting mitigations to deliver the planned surplus in full by Quarter 4 through a range of actions,

with leads identified for taking forward each plan. Key risks include containing medical locum costs, eliminating adult CMHT over spending, achieving the aims of the Meridian Inpatient Agency project, delivering Estates programmed CIPs and departmental actions, maintaining current service forecasts and finalising Agile Workforce Plans for 2017/18 (and impacts in 2016/17).

35

36

43 – 45

46

41 – 42

Summary and Recommendations

The Board integrated performance report shows strong performance against non financial targets in September and quarter 2 of 2016/17 but

ongoing and significant financial pressures.

Correlation of quality information (including patient experience and safety related measures), performance, finance, workforce and health and

safety information has taken place at the Directors’ Business and Transformation Governance meeting.

The Board is recommended to review and consider the exceptions highlighted and note the actions and mitigations.


Indicator M4: In September 2016 there were no delayed transfers of care including patients on Section 3.

Indicator M7: Data is provided in relation to the waiting time element of the new standard for Early Intervention in Psychosis (EIP). This

shows patients who started treatment in September 2016 within two weeks of referral. The number of incomplete pathways (patients waiting)

at the end of September 2016 was 24; 16 of these patients have been waiting for more than two weeks.

A RAG rating has not been applied as although the waiting time element of the new standard is being met, the other components of the

standard (extended age range and provision in accordance with NICE recommendations) are not yet in place. All components must be met

for the standard to be deemed to have been achieved. Additional CCG investment in EIP was confirmed from 1 April 2016; allowing staff

recruitment and training to commence. This will enable the Trust to extend the age range for EIP services to adults up to 65 and to provide a

full package of NICE recommended care. As a result of the recent investment the Trust therefore projects meeting all components of the

new standard from quarter 3 of 2016/17.


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

0.0%

50.0%

100.0%

150.0%

200.0%

250.0%

May14

Jun14

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

90.0%

92.5%

95.0%

97.5%

100.0%

May14

Jun14

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

May14

Jun14

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

80.0%

85.0%

90.0%

95.0%

100.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

90.0%

92.5%

95.0%

97.5%

100.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

80.0%

85.0%

90.0%

95.0%

100.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

80.0%

85.0%

90.0%

95.0%

100.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

90.0%

92.5%

95.0%

97.5%

100.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

80.0%

85.0%

90.0%

95.0%

100.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

80.0%

85.0%

90.0%

95.0%

100.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

90.0%

92.5%

95.0%

97.5%

100.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

0.0%

50.0%

100.0%

150.0%

200.0%

250.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

80.0%

85.0%

90.0%

95.0%

100.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

90.0%

92.5%

95.0%

97.5%

100.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

80.0%

85.0%

90.0%

95.0%

100.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

80.0%

85.0%

90.0%

95.0%

100.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

90.0%

92.5%

95.0%

97.5%

100.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

80.0%

85.0%

90.0%

95.0%

100.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

80.0%

85.0%

90.0%

95.0%

100.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

90.0%

92.5%

95.0%

97.5%

100.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

0.0%

50.0%

100.0%

150.0%

200.0%

250.0%

Jun15

Jul15

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

80.0%

85.0%

90.0%

95.0%

100.0%

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

90.0%

92.5%

95.0%

97.5%

100.0%

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

80.0%

85.0%

90.0%

95.0%

100.0%

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

80.0%

85.0%

90.0%

95.0%

100.0%

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

90.0%

92.5%

95.0%

97.5%

100.0%

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

80.0%

85.0%

90.0%

95.0%

100.0%

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

80.0%

85.0%

90.0%

95.0%

100.0%

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

90.0%

92.5%

95.0%

97.5%

100.0%

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

0.0%

50.0%

100.0%

150.0%

200.0%

250.0%

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

80.0%

85.0%

90.0%

95.0%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

90.0%

92.5%

95.0%

97.5%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

80.0%

85.0%

90.0%

95.0%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

80.0%

85.0%

90.0%

95.0%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

90.0%

92.5%

95.0%

97.5%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

80.0%

85.0%

90.0%

95.0%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

80.0%

85.0%

90.0%

95.0%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

90.0%

92.5%

95.0%

97.5%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

Q3 Q4 Q1 Jul Aug Sep Q2 Q2 Q2

Outturn Outturn OutturnNumerator

Outturn

Denominator

OutturnOutturn

M3

RTT dental 18 weeks waits - incomplete

pathways

(Number of patients who have waited 18

weeks or less/Number of patients waiting)

92.0% 100.0% 100.0% 100.0% 328 328 100.0%

90.9%

as of Aug 16

Next publication date:

10th

Nov 16

M4 Mental Health Delayed Transfers of Care <=7.5% 0.0% 0.0% 0.0% 0 17669 0.0%

M5

Admission to inpatients services had

access to Crisis Resolution Home

Treatment Teams

95.0% 100.0% 100.0% 100.0% 192 192 100.0%

98.1% as of

Q1 - 16/17


Oct 16

M7

Early intervention in Psychosis (EIP):

People experiencing a first episode of

psychosis treated with a NICE approved

care package within two weeks of referral

50.0%

73%

March

2016

Data

74.2% 56.2% 64.2% 75.0% 54 84 64.2%

Indicator

No.

Indicator

TargetNational

BenchmarkGraph

80.0%

85.0%

90.0%

95.0%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

90.0%

92.5%

95.0%

97.5%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

80.0%

85.0%

90.0%

95.0%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

80.0%

85.0%

90.0%

95.0%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

90.0%

92.5%

95.0%

97.5%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

80.0%

85.0%

90.0%

95.0%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

80.0%

85.0%

90.0%

95.0%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

90.0%

92.5%

95.0%

97.5%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16



NHS England Benchmark

Target

Key

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

0.0%

50.0%

100.0%

150.0%

200.0%

250.0%

May14

Jun14

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

90.0%

92.5%

95.0%

97.5%

100.0%

May14

Jun14

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

May14

Jun14

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

0.0%

50.0%

100.0%

150.0%

200.0%

250.0%

May14

Jun14

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

90.0%

92.5%

95.0%

97.5%

100.0%

May14

Jun14

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

May14

Jun14

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

0.0%

50.0%

100.0%

150.0%

200.0%

250.0%

Jun14

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

Jun15

90.0%

92.5%

95.0%

97.5%

100.0%

Jun14

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

Jun15

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Jun14

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

Jun15

0.0%

50.0%

100.0%

150.0%

200.0%

250.0%

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

Jun15

Jul15

90.0%

92.5%

95.0%

97.5%

100.0%

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

Jun15

Jul15

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

Jun15

Jul15

0.0%

50.0%

100.0%

150.0%

200.0%

250.0%

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

Jun15

Jul15

90.0%

92.5%

95.0%

97.5%

100.0%

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

Jun15

Jul15

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

Jun15

Jul15

0.0%

50.0%

100.0%

150.0%

200.0%

250.0%

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

Jun15

Jul15

90.0%

92.5%

95.0%

97.5%

100.0%

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

Jun15

Jul15

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

Jun15

Jul15

0.0%

50.0%

100.0%

150.0%

200.0%

250.0%

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

Jun15

Jul15

90.0%

92.5%

95.0%

97.5%

100.0%

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

Jun15

Jul15

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

Jun15

Jul15

60.0%

70.0%

80.0%

90.0%

100.0%

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

90.0%

92.5%

95.0%

97.5%

100.0%

Aug15

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

60.0%

70.0%

80.0%

90.0%

100.0%

Apr16

May16

Jun16

Jul16

Aug16

Sep16

Oct16

Oct16

Nov16

Dec16

Jan17

Feb17

Mar17

60.0%

70.0%

80.0%

90.0%

100.0%

Apr16

May16

Jun16

Jul16

Aug16

Sep16

Oct16

Oct16

Nov16

Dec16

Jan17

Feb17

Mar17

60.0%

70.0%

80.0%

90.0%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

90.0%

92.5%

95.0%

97.5%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

60.0%

70.0%

80.0%

90.0%

100.0%

Apr16

May16

Jun16

Jul16

Aug16

Sep16

Oct16

Oct16

Nov16

Dec16

Jan17

Feb17

Mar17

90.0%

92.5%

95.0%

97.5%

100.0%

Apr16

May16

Jun16

Jul16

Aug16

Sep16

Oct16

Oct16

Nov16

Dec16

Jan17

Feb17

Mar17



Outturn

Denominator

OutturnOutturn

M8

CPA patients receiving

follow-up contact within 7

days of discharge

95.0% 95.3% 98.6% 98.4% 198 203 97.5%

96.2% as of

Q1 - 16/17


Oct 16

M9

CPA patients having

formal review within 12

months

95.0% 96.5% 96.7% 97.1% 1796 1849 97.1%

68.7% as of

Apr 16


TBC

M10

People with common

mental health conditions

referred to the IAPT

programme will be treated

within 6 weeks of referral

75.0% 85.0%

Q3

88.8%

Q4

91.5%

Q1 93.2%

Provisional

93.5%Provisional

84.8% as at

June 16


25th October 2016

M11

People with common

mental health conditions

referred to the IAPT

programme will be treated

within 18 weeks of referral

95.0% 94.7%

Q3

97.9%

Q4

98.1%

Q196.9%

Provisional

98.9%Provisional

97.5% as at

June 16


25th October 2016

TargetNational

BenchmarkGraph

Indicator

No.

Indicator

60.0%

70.0%

80.0%

90.0%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

90.0%

92.5%

95.0%

97.5%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

60.0%

70.0%

80.0%

90.0%

100.0%

Apr16

May16

Jun16

Jul16

Aug16

Sep16

Oct16

Oct16

Nov16

Dec16

Jan17

Feb17

Mar17

90.0%

92.5%

95.0%

97.5%

100.0%

Apr16

May16

Jun16

Jul16

Aug16

Sep16

Oct16

Oct16

Nov16

Dec16

Jan17

Feb17

Mar17



Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Q3

Outturn

Q4

Outturn

Q1

OutturnJul Aug Sep Q2

M12Access to health care for people with a learning

disability 6 Green 6 Green 6 Green 6 Green 6 Green

M13 Data completeness Referral to treatment information 50.0%65.0%

Q3

66.6%

Q4

66.0%

Q1

M14 Data completeness Referral information 50.0%92.9%

Q3

92.5%

Q4

91.9%

Q1

M15 Data completeness treatment activity information 50.0%99.7%

Q3

99.7%

Q4

99.4%

Q1

M16 Data Completeness: identifiers (MHSDS Part 1) 97.0% 99.7% 99.4% 99.5% 99.5%

M17Data Completeness: outcomes for patients on CPA

(MHSDS Part 2)50.0% 75.9% 75.6% 75.8% 75.8%

Indicator

No.

Indicator Target

National

BenchmarkTrend

99.5% as of

April 2016


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Shadow Reporting of Single Oversight Framework Operational Performance Metrics

NHS Improvement’s Single Operating Framework is applicable from October 2016. The framework contains significant changes to the metrics

used to assess providers’ operational performance. These new slides show, where possible, ‘shadow’ Trust performance against the

applicable operational performance metrics. Implications for reporting, performance and any resulting actions were considered at the

September business unit performance meetings, including forecast performance.

Indicators M3 and M5: The Trust forecasts ongoing achievement of these indicators on a monthly and quarterly basis respectively.

Indicator M7: The framework reinforces that this standard applies to anyone experiencing a first episode of psychosis aged 14-65 and that

exclusions must not be made for people aged under 35 who may historically not have had access to specialist Early Intervention in Psychosis

(EIP) services. As reported in slide 4, recent investment has enabled the Trust to extend the age range for EIP services to adults up to 65. All

new staff have been recruited and will be in post by 31 October 2016 and the Trust projects meeting the new standards from November 2016.

Indicator M19: Performance against this standard is assessed as part of the 2016/17 national CQUIN indicator, via national audit. Data is

collected and submitted in quarter 3 or 4 of 2016/17 and the results will be available in quarter 4. The Trust is projecting full achievement of

the CQUIN which audits a ‘snapshot’. The Single Oversight Framework requires sustained and embedded performance, measured on a

quarterly basis. The mental health acute and community services business unit has developed a sustainability plan to maintain achievement

across every quarter in all 3 service areas, however routine delivery of this current CQUIN indicator is not projected until April 2017.

Q3 Q4 Q1 Q2 Q2 Q2


Outturn

Denominator

OutturnOutturn

M3

Maximum time of 18 weeks from point of referral to

treatment (RTT) in aggregate − patients on an incomplete

pathway

92.0% 100.0% 100.0% 100.0% 328 328 100.0%

90.9%

as of Aug 16


10th

Nov 16

M5

Patients requiring acute care who received a gatekeeping

assessment by a crisis resolution and

home treatment team in line with best practice standards

95.0% 100.0% 100.0% 100.0% 192 192 100.0%

98.1% as of

Q1 - 16/17


Oct 16

M7

People with a first episode of psychosis begin treatment

with a NICE-recommended package of care within 2

weeks of referral

50.0%

73%

March

2016

Data

74.2% 56.2% 64.2% 73.9% 53 83 63.8%

Ensure that cardio-metabolic assessment and treatment

for people with psychosis is delivered routinely in the

following service areas:

a) Inpatient Wards 90.0%

b) Early Intervention in psychosis services 90.0%

c) Community mental health services (people on Care

Programme Approach)65.0%

M19

Indicator

No.

Indicator

TargetNational

BenchmarkGraphJul Aug Sep

TBC

80.0%

85.0%

90.0%

95.0%

100.0%

Sep 15 Oct 15 Nov 15Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 May 16 Jun 16 Jul 16 Aug 16 Sep 16

80.0%

85.0%

90.0%

95.0%

100.0%

Sep 15 Oct 15 Nov 15Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 May 16 Jun 16 Jul 16 Aug 16 Sep 1680.0%

85.0%

90.0%

95.0%

100.0%

Sep 15 Oct 15 Nov 15Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 May 16 Jun 16 Jul 16 Aug 16 Sep 16

80.0%

85.0%

90.0%

95.0%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

80.0%

85.0%

90.0%

95.0%

100.0%

Sep 15 Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 May 16 Jun 16 Jul 16 Aug 16 Sep 16

90.0%

92.5%

95.0%

97.5%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Sep15

Oct15

Nov15

Dec15

Jan16

Feb16

Mar16

Apr16

May16

Jun16

Jul16

Aug16

Sep16


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Indicator M20a: This indicator, which comprises NHS number, date of birth, postcode, gender, GP and commissioner, is similar to the

existing Mental Health Services Data Set (MHSDS) data completeness target (indicator M16), though the Trust is clarifying with NHS

Improvement and NHS Digital the data definitions to be used to calculate performance. Based on internal calculation from the MHSDS, the

Trust projects achievement on a monthly basis.

Indicator M20b: This is a new combination of metrics for achievement by 2016/17 year end, assessed monthly, comprising ethnicity,

employment status, school attendance, accommodation status and ICD10 coding. The Trust is clarifying with NHS Improvement and NHS

Digital the data definitions to be used to calculate performance. Whilst Trust recording of ethnicity is above the 85% target, ICD10 coding is

significantly below the target and recording of school attendance is unknown as it is not currently reported from the MHSDS. The Executive

Management Team is considering the approach to ICD10 coding.

Indicator M21: The Improving Access to Psychological Therapies (IAPT) service successfully migrated from SystmOne to PCMIS in May

2016. PCMIS supports accurate reporting of data internally and to NHS Digital. Published data for June 2016 and provisional data for July

and August 2016 already indicates an improvement in recovery rate across the service. This is due to improved completion of data items as

a result of the PCMIS system configuration requiring and reminding staff to complete data. The Trust forecasts achievement of this target

quarterly, at Trust level, from quarter 3 onwards.

Indicators M10 and M11: Trust performance is consistently above both standards and now above the national benchmarks. The Trust

projects ongoing achievement of both indicators, quarterly at Trust level.

Shadow Reporting of Single Oversight Framework Operational Performance Metrics



Outturn

Denominator

OutturnOutturn

M20a

Complete and valid submissions of metrics in the monthly

Mental Health Services Data Set Submissions to NHS

Digital:

* Identifier metrics

95.0%99.5%

June Final

data

99.6%Provisional

99.6%Provisional

97.3%July Provisional


22/10/2016

M20b

Complete and valid submissions of metrics in the monthly

Mental Health Services Data Set Submissions to NHS

Digital:

* Priority metrics

85.0%

M21Proportion of people completing treatment who move to

recovery (from IAPT minimum dataset)50.0% 40.5% 47.0% 47.6%

53.1%Provisional

48.5%Provisional

464 914

50.7%

Provisional

48.8% as of June 16:

Next pub,ication date

25th October 2016

M10

waiting time to begin treatment (from IAPT minimum data

set)

- within 6 weeks

75.0% 85.0%

Q3

88.8%

Q4

91.5%

Q1 93.2%

Provisional

93.5%Provisional

84.8% as at

June 16


25th October 2016

M11

waiting time to begin treatment (from IAPT minimum data

set)

- within 18 weeks

95.0% 94.7%

Q3

97.9%

Q4

98.1%

Q196.9%

Provisional

98.9%Provisional

97.5% as at

June 16


25th October 2016

Indicator

No.

Indicator

Target

TBC

National

BenchmarkGraph

60.0%

70.0%

80.0%

90.0%

100.0%

Apr16

May16

Jun16

Jul16

Aug16

Sep16

Oct16

Oct16

Nov16

Dec16

Jan17

Feb17

Mar17

90.0%

92.5%

95.0%

97.5%

100.0%

Apr16

May16

Jun16

Jul16

Aug16

Sep16

Oct16

Oct16

Nov16

Dec16

Jan17

Feb17

Mar17

40.0%

45.0%

50.0%

55.0%

60.0%

Apr16

May16

Jun16

Jul16

Aug16

Sep16

Oct16

Oct16

Nov16

Dec16

Jan17

Feb17

Mar17


Airedale NHS Foundation Trust and Bradford Teaching Hospitals Foundation Trust performance against the national standard for A&E

waits is provided to the Board for information. The Trust contributes to delivery of the target through a range of services and

interventions.

NHS England and NHS Improvement have designated the West Yorkshire system as an urgent and emergency care ‘Acceleration Zone’.

The key requirement of this is to deliver transformation and interventions will which support delivery of the A&E 95% 4 hour target across

West Yorkshire by 1 March 2017. Further information about A&E performance across West Yorkshire will be added to the Integrated

Performance Report as related Acceleration Zone work progresses.

Accident and Emergency Waiting Times

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Airedale NHS Foundation Trust

Indicator No. Indicator Target Q3 Q4 Q1 July Aug Sep

Total A&E attendances 13,236 13,796 14,324 5,124 4,765

Total attendances within 4 hours 12,524 13,187 13,368 4,628 4,232

M18a % of A&E attendances where service user was admitted,

transferred or discharged within 4 hours 95% 94.6% 95.6% 93.3% 90.3% 88.8%

Bradford Teaching Hospitals NHS Foundation Trust

Total A&E attendances 33,299 34,463 34,456 11,926 10,849

Total attendances within 4 hours 31,070 31,436 31,297 10,714 9,774

M18b % of A&E attendances where service user was admitted,

transferred or discharged within 4 hours 95% 93.3% 91.2% 90.8% 89.8% 90.1%


Indicator No.15/16

outturn September 2016 Performance

16/17

YTD

Q3 141 10 66

0.0

5.0

10.0

15.0

20.0


Serious incidents Other Pressure Ulcers

Absconders/escape/AWOLs Homicides

Suspected Suicides Admissions to adult facil ities of patients who are under 16 years of age.

Serious Incident Numbers

The Trust is working towards

reducing suicides across the

organisation by completing the

following actions:

1. Develop a suicide prevention

strategy for the organisation

2. Form a Suicide Reduction group

that will contribute to:

• Suicide Prevention Work

across the Trust

• Facilitate learning and

workshops on suicide

prevention

• Review ligature incidents and

suicide attempts

• Provide training, support and

advise to staff caring for

suicidal patients

• Review all suicides within the

organisation

• Continue to work with the

Bradford Suicide Prevention

Group and West Yorkshire

Vanguard for Suicide

Prevention

3. Provide specific training to

mental health staff in:

• Assessment of suicide risk

and Suicide Prevention

• Caring for Patients with

personality disorders

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance


Indicator Q4a:

There were 4 reports

completed in the month, 3

were completed within the

12 week target.

1 report took 15 weeks to

complete – this was

because of the investigator

having to take unplanned

leave

Indicator Q4b:

No Pressure Ulcers reports

were completed in

September 2016

Indicator Q4c:

4 reports were completed, 3

were within the 12 week

target time.

Serious Incidents

No. Closed this

month within

target

(Numerator)

Total number

completed in month

(Denominator)

Percentage

completed in

target time

Q4(a)

Serious incident reports

completed(Total):

Q4(b) + Q4(c)

48.9% 100% 3 4 75.0% 90.0%

Q4(b)Serious incident reports

completed (Pressure Ulcers) 33.3% 100% 0 0 75.0% 98.4%

Q4(c)

Serious incident reports

completed (all others

causes)

90.9% 100% 4 3 100.0% 80.0%

FOT

16/17

September 2016 Performance

Serious incident reporting timescales: Percentage of reports completed within target time

Ref Indicator15/16

outturn

16/17

Target

16/17

YTD

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Aug 15 Sep 15 Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 May 16 Jun 16 Jul 16 Aug 16

Pressure Ulcers Others target

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance


Indicator Q8: 3 complaints were received this month. There was no pattern with regards to the distribution of the complaints.

Indicator Q9: 17 compliments were received in total. 3 were for Child and Adolescent Mental Health Services. The

remainder were evenly distributed amongst a number of services.

Number of Compliments, Complaints and Claims

Indicator

NumberIndicator

15/17

outturn

16/17

Target

September 2016

Performance

16/17

YTD

Q6 Claims Numbers 8 N/A 3 9

Q8 Complaints numbers 74 N/A 3 43

Q9 Compliments numbers 658 N/A 17 240

Number of Compliments and Complaints

05

101520253035404550556065707580859095

100


Complaints numbers Compliments numbers

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance


Q15 - Commissioning for Quality and Innovation (CQUINs) – Forecast 2016/17

National CQUINs Actual / Forecast RAG

Goal Name Indicator Name CQUIN Aim Q2 Milestones

Q1 Q2 Q3 Q4

NHS Staff health and Wellbeing

1a. Introduction of health & wellbeing options

Evidence from the staff survey and elsewhere shows that improving staff health and wellbeing will lead to a higher staff engagement, better staff retention and better clinical outcomes for patients.

• Provide update report on progress to date A F F F

1b. Healthy food for NHS staff, visitors and patients

Providers are expected to achieve a step-change in the health of the food offered on their premises, eg, banning of sugary drinks and foods high in fat, sugar and salt.

• No Q2 milestone requirement A F

1c. Improving the uptake of flu vaccinations for front line staff within Providers

75% of front line staff will have had flu vaccinations by 31st December 2016.

• No Q2 milestone requirement F

Improving physical healthcare to reduce premature mortality in people with Severe Mental Illness

2a Cardio Metabolic Assessment and treatment for patients with Psychoses

Assessing , documenting and acting on cardio - metabolic risk factors for inpatients, EIP and CMHT clients . Audit to be undertaken by Royal College of Psychiatry.

• Produce a report on progress to date including evidence of completed pathways in place that have been disseminated to all clinical teams

A F F F

2b Communication with General Practitioners

An audit to take place in Q2 to ensure an E-discharge form is sent to GP’s after discharge from all inpatient wards to contain mandated information

• Undertake an audit that demonstrates that for 90% of patients audited during the period ( August – September), has provided the GP an up-to-date copy of the patients care plan/CPA and discharge summary which includes; NHS number, all primary and secondary mental and physical health diagnosis, medications prescribed and ongoing monitoring requirements, and ongoing monitoring and/or treatment needs for cardio-metabolic risk factors

F

Full achievement of all quarter 1 milestones was confirmed by commissioners.

Submissions will be made to the relevant commissioners in late October to evidence delivery of the quarter 2 milestones. Formal feedback

from commissioners is expected by the end of November. The Trust continues to forecast full achievement of all indicators.

Continued delivery of CQUINs is overseen by the monthly Business Unit Performance Meetings.

A = Actual F = Forecast

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance



CCG CQUINs Actual / Forecast RAG

Goal Name Indicator Name CQUIN Aim Q2 Milestones Q1 Q2 Q3 Q4

Dementia John’s Campaign Supporting carers and family members of people with dementia (all ages), to be welcomed by hospitals according to the patients’ needs and not restricted by visiting hours

• Provide update report on progress to date A F F F

Joint Working

Joint working with BTHFT to reduce Mental Health frequent attenders at A&E

Both BDCFT & BTHFT are charged with understanding the flow of patients into A&E and to reduce this flow, utilising teams and services within both organisations to improve knowledge, communications and pathways for optimum patient care.

• Providers to undertake three joint MDTs within the quarter with update report provided to commissioners in line with agreed format and content.

A F F F

Discharge Planning

Optimising joint working and discharge planning - Bradford

Working jointly with BTHFT to ensure the right care vision is achieved by changing the culture and mind set of staff and patients around discharge planning.

• First event to be held in line • Following the event a report is to be submitted to the commissioner along with a

SMART development plan of agreed actions A F F F

Optimising joint working and discharge planning - AWC

• First event to be held • Following the event a report is to be submitted to the commissioner along with a

development plan of agreed actions identified to ensure this approach is embedded in practice

A F F F

Self care

Self care - Training To review the training for staff undertaken in 2015/16 and look at building on this in 2016/17

• 25 % of staff to be trained as per agreed roll out plan in Q1 A F F F

Self care – Exacerbation plans

To continue the work commenced in 2015/16 around development of exacerbation care plans for patients, focussing on a condition specific area for the next year , moving this work more into the acute setting to ensure care plans follow the patient throughout their journey.

• Undertake an audit and develop an action plan based on findngs A F F F


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance



NHS England CQUINs Actual / Forecast

RAG

Goal Name CQUIN Aims Q2 Milestones Q1 Q2 Q3 Q4

Recovery colleges for Medium and Low Secure Patients

Recovery colleges deliver peer-led education and training programmes within mental health services. Courses are co-devised and co-delivered by people with lived in experience and by mental health professionals, and are based on recovery principles.

• Provide a report of progress to date including action plan A F F F

Reducing restrictive practices with adult low and medium secure services

The development, implementation and evaluation of a framework for the reduction of restrictive practices within adult secure services, in order to improve service user experience whilst maintaining safe services.

• Preparation for implementation of action plan, including engagement, training of staff, policies, evaluation plan

• Provision of training in accordance with Positive and Proactive Workforce (2015) to ensure staff are committed to and have the necessary skills and competencies to deliver change

• Progress report on action plan submitted in Q1 • Evaluation report of staff / patient engagement process

A F F F

Health Inequalities

The aim of this CQUIN is to improve uptake of Public Health Section 7a Screening and Immunisation programmes for people with learning difficulties or mental health conditions in the eligible population.

• Provide a report of progress to date including action plan A F F F


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance


Workforce – Appraisal & Mandatory Training

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Indicator

No. Indicator

15/16

outturn

16/17

Target Numerator Denominator

Current

Performance

FOT

16/17 Graph

Q17

% Mandatory training

(excl. Information

Governance

Compliance)

91.90% 80.00% 6556 7504 87.37%

Q17a

% Information

Governance Training -

Substantive Staff Only

97.94% 95.00% 2327 2513 92.60%

Q17b

% Information


Tertiary Staff Only

85.83% 95.00% 351 354 99.15%

Q17c

% Information


Substantive and

Tertiary Staff

Combined

96.50%

95.00%

2800 2989 93.68%

Q18 % Staff Receiving

Appraisal 83.14% 80.00% 2019 2476 81.54%

Indicator Q17a, b & c: For substantive staff, compliance has remained below the 95% target (equivalent of 190 people being non-

compliant). HR are working with service managers to bring compliance rates up to target.

Agency providers were advised that from 1 April 2016 the Trust would not deploy tertiary staff who are non-compliant with information

governance training and sought assurance from the providers that all agency staff would remain compliant. Taskmaster are reporting 98.2%

compliance for September (2 staff reported as non-compliant; despite warnings these individuals have not followed the instruction to

complete this training, assignment end dates will be set if they continue to ignore the requests). This month Retinue are reporting 99.24% (1

individual reported as non-compliant) and the Internal Staff Bank continues to report 100% compliance.

Strong performance by the Children’s and Inpatient Specialist Dental & Admin Hubs Business units was particularly

highlighted.

Measure

Target

Trend

Trajectory

Graph Key

70.0%

80.0%

90.0%

100.0%

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

Mar-16

Apr-16

May-16

Jun-16

Jul-16

Aug-16

Sep-16

76.0%

86.0%

96.0%

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

Mar-16

Apr-16

May-16

Jun-16

Jul-16

Aug-16

Sep-16

85.00%

90.00%

95.00%

100.00%

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

Mar-16

Apr-16

May-16

Jun-16

Jul-16

Aug-16

Sep-16

80.0%

85.0%

90.0%

95.0%

100.0%

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

Mar-16

Apr-16

May-16

Jun-16

Jul-16

Aug-16

Sep-16

80.0%

85.0%

90.0%

95.0%

100.0%

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

Mar-16

Apr-16

May-16

Jun-16

Jul-16

Aug-16

Sep-16


Workforce – Appraisal and Mandatory Training Hotspots

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Indicator Q17: In terms of total mandatory training, 10

out of 11 areas are reporting over 80% compliance.

Also, Fire Safety are reporting 11 out of 11 Business

Units as being compliant over the 80% target.

Indicator Q17a: The overall compliance level for

information governance (IG) training remains below the

95% target. There are currently 190 staff non compliant

with IG training. 60 have fallen out of date since last

month. 90 (47.37%) of the 190 are at the top of their pay

band. 63 more employees need to be compliant to

achieve the 95% target. Reminders are sent out from the

workforce development team and senior managers are

being alerted to this, and when staff are due to lapse, in

their one to one meetings with their HR Business

Partner. In business units where compliance has

slipped, the HR Business Partners are liaising with the

head of operations to ensure the appropriate action is

taken. HR Business Partners have cascaded the email

link to managers to distribute to staff so that they can

access the IG Training with ease. Further analysis of the

data suggests that this does work with compliance rates

increasing in response to prompts from HR. Targeted

work will be undertaken with dental services staff to

increase compliance rates, which have dropped from

95% in July to 73.81% in September.

Trust Management (serious incidents team, Programme

Management Office, Directors, executive administration

team) is in the bottom 3 areas for mandatory training

and appraisal. HR Business Partners are linking with the

appropriate managers to ensure accurate recording of

requirements and compliance and to set dates for any

outstanding training and appraisals.

Information Governance Current performance 92.60% Fire Safety Current performance 90.26%

Change from the previous month -0.54% Change from the previous month 0.38%

% Change % Change

Service Governance 100.00% 0.00% Service Governance 96.00% 0.35%

Adult Physical Health Community Services 94.98% -0.05% Specialist Services & Nursing 94.12% -3.38%

Estates, Facilities & Finance 94.66% 0.19% Human Resources 93.10% 0.25%

Human Resources 89.66% 1.94% Trust Management 88.24% -6.36%

Trust Management 82.35% -6.84% Adult Physical Health Community Services 87.66% -1.69%

Research & Development 81.82% -9.09% Research & Development 81.82% -9.09%

92.60% -0.54% 90.26% 0.38%

Infection Prevention Current performance 87.50% Moving & Handling Current performance 84.32%

Change from the previous month 0.30% Change from the previous month -0.01%

% Change % Change

Service Governance 100.00% 4.35% Specialist Services & Nursing 96.97% -0.47%

Specialist Services & Nursing 97.06% -2.94% Human Resources 96.36% -0.06%

Estates, Facilities & Finance 95.15% -0.46% Service Governance 92.00% 5.04%

Mental Health - Acute Inpatient and Community Services85.21% 4.32% Estates, Facilities & Finance 80.30% -6.94%

Adult Physical Health Community Services 81.04% -2.08% Adult Physical Health Community Services 79.17% 0.66%

Trust Management 70.59% -21.30% Trust Management 66.00% -17.78%

87.50% 0.30% 84.32% -0.01%

Appraisal Current performance 81.54%

Change from the previous month 1.20%

% Change

96.43% 14.29% Key

91.67% -4.17% Top three teams and above target

86.11% 9.92% Above target - but in bottom three

Mental Health - Acute Inpatient and Community Services78.38% 0.28% Below target and in bottom three

Research & Development 72.73% -9.09%

Trust Management 69.39% -7.76%

81.54% 1.20%

Business Unit

Business Unit

Business Unit

Grand Total

Grand Total

Business Unit

Grand Total

Grand Total

Business Unit

Grand Total

Human Resources

Service Governance

Specialist Services & Nursing


Workforce – Labour Turnover and Vacancy

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Indicator

No. Indicator

15/16

outturn

16/17


Current

Performance

FOT

16/17 Graph

Q19 % Labour Turnover 11.62% 10.00% 291.85 2467.37 11.83%

Indicator Q19: Labour turnover (LTO) has increased by 0.3% to 11.83% since August. A total of 272.57wte leavers were recorded for the 12 months to September 2015 compared to 291.85wte for the 12 months to September 2016. This is an increase of 19.29wte leavers, which accounts for the overall increase in LTO over the last 12 months, however this gap is slowly reducing. The number of new starters over the last 12 months stands at 292.64wte, indicating that the Trust has recruited 0.21wte less staff than were lost through LTO.

The next slide provides an analysis of reasons given by staff for leaving. The top three reasons over the last 12 months are (with the exception of Not Known/Other); relocation (51.9wte, 17.73%), retirement (43.9wte, 14.97%) and promotion (31.9wte, 10.9%). Feedback will be collated on the new process to increase numbers of staff who engage with exit interviews; to support development of appropriate interventions to increase staff retention rates.

The next slide analyses areas that account for the highest numbers of leavers. Almost 55% of leavers in the 12 month rolling period were attributed to the six service areas listed, as were 52% of the Trust’s new starters over the same time period. These areas have also recorded high levels of sickness. 24.59% (72.01wte) of leavers over the 12 month period left the Trust within 12 months of employment.

Current actions to mitigate the increase in labour turnover include;

• Rolling recruitment adverts in hot spot areas to help ensure vacancies are filled as quickly as possible;

• Data analysis from new exit interview processes, combined with analysis alongside vacancy, sickness and temporary staffing levels.

Indicator

No. Indicator

15/16

outturn

16/17


Current

Performance

16/17

YTD

FOT

16/17

Q21 %

Vacancy rate 7.17% 10% 188.38 2656.24 7.11% 7.11%

Q21a

% Vacancy rate

(Spec IP, Dental

& Admin)

9.93% 10% 74.66 553.19 13.50% 13.50%

Indicator Q21: The vacancy rate of 7.11%

equates to approximately 188.38wte, with

39.53% of all vacancies recorded within

Specialist Inpatients, Dental & Admin.

Current mitigations include over recruitment

to posts and one-stop campaigns with further

actions being developed following review by

Deputy Directors. We are also heavily

recruiting to staff bank posts to provide short

term support; including over 100 staff whose

training in managing violence and aggression

has been fast tracked.

8.00%

10.00%

12.00%

14.00%

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

Mar-16

Apr-16

May-16

Jun-16

Jul-16

Aug-16

Sep-16


Workforce – Labour Turnover Exceptions

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Hotspot areas / ExceptionsTurnover percentage starters and leavers WTE per month - Oct 15 to Sep 16

Labour Turnover Leavers Starters

% Headcount WTE WTE

Specialist Inpatient Specialist - Inpatient 19.14% 262 46.33 40.79

453 Daisy Hill Intensive Therapy Centre - ITC (113019) 69.23% 13

453 District Hub - Psych Therapies-BFD (113090) 20.76% 33

453 Dementia Assessment Unit - DAU (113501) 25.62% 30

453 Bracken Ward (OPMH) - (113600) 34.24% 31

Specialist Inpatient Administration Services 9.84% 154 12.51 9.50

453 Single Point of Access (115085) 22.40% 17

453 District Integrated Team 3 Management (115300) 17.24% 6

453 Administration - Lynfield Mount (115305) 17.74% 18

Adult Physical Health Community Nursing 12.64% 374 40.91 47.30

453 DN Team Haworth Surg (115008) 20.00% 9

453 DN Team Westcliffe (115025) 26.42% 9

453 DN Team Windhill MC (115027) 31.35% 10

453 DN Team Horton Park Team 1 (115032) 127.18% 3

453 DN Team The Ridge (115048) 20.57% 23

453 DN Team Haigh Hall MC (115057) 52.61% 10

453 DN Team Moorside (115059) 40.21% 11

MH Acute and Community Acute - Inpatient 14.09% 254 33.94 30.91

453 Maplebeck Ward (AMH) (113004) 15.74% 23

453 Oakburn Ward (AMH) (113005) 23.13% 30

453 Clover (PICU Airedale) (AMH) (113010) 61.22% 20

MH Acute and Community IAPT 11.83% 113 12.63 16.16

453 Step 4 Aire/Wharfe/Craven Locality Psych Therapy Team (115225)59.70% 5

453 City IAPT (115234) 18.19% 13

453 South IAPT (115235) 14.06% 26

MH Acute and Community CMHT - Adult 10.32% 141 13.69 7.00

453 CMHT Community 7 (114040) 33.33% 3

453 CMHT Communities 8 &10 (113041) 18.63% 18

453 Wharfedale CMHT (113054) 11.57% 11

Hotspot area Leavers Total (WTE) 160.01 151.66

Trustwide Leavers Total (WTE) 292.85 Trustwide Starters Total (WTE) 292.64

% Hotspot area total against Trustwide total 54.64% % Hotspot area total against Trustwide total 51.82%

Hotspot area Starters Total (WTE)

Business Unit Service AreaReasons for leaving - 12 months (Oct 15 to Sep 16)

Reasons for Leaving WTE %

VR - Other/Not Known 73.83 25.21

VR - Relocation/Moved to new role 51.92 17.73

Retirement 43.85 14.97

VR - Promotion 31.91 10.90

VR - Work Life Balance 25.47 8.70

Dismissal 14.19 4.84

VR - Better Reward Package 10.52 3.59

VR - Health 8.53 2.91

End of Fixed Term Contract 8.42 2.88

VR - Child Dependants 6.31 2.15

VR - To undertake further education or training 6.20 2.12

Death in Service 3.93 1.34

VR - Incompatible Working Relationships 3.40 1.16

VR - Lack of Opportunities 2.76 0.94

VR - Adult Dependants 1.62 0.55

292.85

Number of Leavers - leaving within first 12 months of employment

Reasons for Leaving WTE

VR - Other/Not Known 19.36

VR - Relocation/Moved to new role 11.39

VR - Work Life Balance 8.96

End of Fixed Term Contract 5.77

VR - Promotion 5.00

VR - Better Reward Package 3.96

VR - Health 3.93

VR - Child Dependants 3.71

Dismissal 3.00

VR - To undertake further education or training 2.56

VR - Incompatible Working Relationships 1.60

VR - Lack of Opportunities 0.96

VR - Adult Dependants 0.95

Retirement 0.85

72.01


Workforce – Sickness Absence

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Indicator

No. Indicator

15/16

outturn

16/17


Current

Performance

16/17

YTD

FOT

16/17

Q20

%

Sickness

absence

rate

4.53% 4% 3,558.87 74,053.20 4.81% 4.88%

Indicator Q20: The sickness absence rate for

September 2016 shows a 0.41% reduction from the

revised August figure of 5.21% (originally reported in last

month’s Board report as 4.95%), short term sickness

has reduced since August whilst long term sickness has

increased. The average working days lost has increased

slightly from last months figure of 15.69 .

Long term absence

The number of cases has reduced from 96 cases in

August to 93 cases in September, with stress and

anxiety being the main cause. The number of life

threatening cases has remained at 2. 12.90% of long

term sickness is attributed to musculoskeletal/back

concerns. Estates maintenance and inpatient settings

were reporting significant levels of musculoskeletal

related absence, which have now reduced.

Short term absence

The Bradford Factor Score table opposite demonstrates

that short term absence has been increasing and details

the number of cases being managed under each stage

of the Bradford Factor Score system. This also

demonstrates that short term sickness cases are being

managed through to capability review meetings (those

with a score of 300+) in a timely manner. There will be

targeted interventions to tackle musculoskeletal and

prevent it developing into long term sickness.

There were 224 new episodes of sickness absence in

September 2016, 35.71% of those were due to either

gastrointestinal problems (22.77%) or musculoskeletal

(12.95%). 65 of those episodes remain open; 18.46% of

those are due to musculoskeletal problems, 18.46% are

due to stress/anxiety.

Staff Sickness Absence Total Number

Total days lost 38804

Total staff 2467

Average working days lost 15.73

Bradford Factor Score Points Previous Month Current Month

Informal process: 20 - 99 points 414 422

Informal process: 100 - 299 points 135 131

Formal process: 300 points and above 49 48

3.50%

4.00%

4.50%

5.00%

5.50%

6.00%

6.50%

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

Mar-16

Apr-16

May-16

Jun-16

Jul-16

Aug-16

Sep-16

Sickness Absence Rate

Sickness Rate Target


Workforce – Sickness Absence Exceptions

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Mental Health – Acute Inpatient and Community Services Short term absence is 0.75% and long term absence 4.38%. Long term absence has increased, with 32 long term cases currently being actively managed. 7 cases have been closed since August 2016 with 12 new cases now being monitored. 9 are related to stress/anxiety. 16 of the 32 cases are within Acute Inpatient Services, with short term sickness predominantly due to back problems or cold/flu. There are 15 new absence episodes which are open ended and could potentially be long term by next month 4 are stress related.

Adult Physical Health Community Services Short term absence is 0.75% and long term absence 4.69%. Long term absence has reduced, with 20 long term cases currently being actively managed. 16 cases have been closed since August 2016 with 9 new cases now being monitored, 6 are related to stress. 13 of the 20 cases are within Community Nursing Services, with short term sickness predominantly due to stress or cold/flu. There are 17 new absence episodes which are open ended and could potentially be long term by next month, 3 are stress related, and 3 are due to musculoskeletal.

Specialist Services & Nursing Short term absence is 2.03% and long term absence 7.52%. Long term absence remained the same, with 2 long term cases currently being actively managed. 1 case has been closed since August 2016 with 1 new case now being monitored. Both are related to stress. Short term sickness is entirely due to infectious diseases.

Specialist Inpatient Services, Dental & Administration Both of the life threatening long term sickness cases, 1 of which is a new case. However reporting a 0.57% reduction in sickness absence, falling just outside the bottom 3. Long term sickness has increased, with 22 long term cases currently being actively managed. 5 cases have been closed since August 2016 with 9 new cases now being monitored. 7 are related to stress/anxiety.

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

4.50%

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

Mar-16

Apr-16

May-16

Jun-16

Jul-16 Aug-16

Sep-16

Long Term/ Short Term - Sickness Absence Rate

Long Term Short Term

Absence Current performance 4.81%

Current YTD 4.88%

Change from the previous month -0.41%

% Change

Trust Management 0.00% -2.19%

Research & Development 0.45% -0.13%

Service Governance 0.59% -3.52%

Mental Health - Acute Inpatient and Community Services5.13% -0.87%

Adult Physical Health Community Services 5.44% -0.14%

Specialist Services & Nursing 9.55% 2.48%

4.81% -0.41%

Key

Top three teams and below target

Below target - but in bottom three

Above target and in bottom three

Grand Total

Business Unit


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Workforce: Staff Family and Friends Test

Indicator

No. Indicator Q1 Q2 Q3 Q4 Graph

Q22a

% Staff recommending

the Trust to Family

and Friends as a

place to be treated

74.70% 75.16%

Q22b

% Staff recommending

the Trust to Family

and Friends as a

place to work

54.90% 53.59%

The Staff Family and Friends Test is a national initiative with two mandatory questions. The purpose is to enable staff to provide timely and

regular feedback to the Trust that supports further improvements.

Indicator Q22a: Out of 153 respondents (5.27% of Trust total workforce) 115 would recommend the Trust to Family and Friends as a place to

be treated.

Indicator Q22b: Out of 153 respondents (5.27% of Trust total workforce) 82 would recommend the Trust to Family and Friends as a place to

work.

Despite ongoing communications and engagement the response rate remains low and is not statistically significant. HR and services will

continue to focus on responding to feedback received from the staff satisfaction survey and from other staff engagement interventions such as

the cultural conversations, Board walkabouts and staff governor feedback.

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

Quarter 1 Quarter 2 Quarter 3 Quarter 414/15 15/16 16/17 Linear (15/16)

40.0%

50.0%

60.0%

70.0%

80.0%

Quarter 1 Quarter 2 Quarter 3 Quarter 4

14/15 15/16 16/17 Linear (15/16)


Q23a - Safer Staffing: Inpatient Services - September 2016

Summary Monitor Quality Locality Change

Programme

Finance

Risks:

- Hotspot areas in terms of vacancies (in Bracken, DAU, and

Thornton wards) meaning safe staffing levels cannot be sustained

long term without posts being permanently recruited to.

Contingency/ Mitigating Actions:

- Roster review / risk assessment in place on a daily basis

- Staff re-distributed across services as required.

- New eRostering system will allow baseline requirements to be

amended in real time according to patient acuity. SafeCare

module was tested on 3 wards during September with roll-out

planned across all wards by the end of the year

- Meridian productivity has commenced a project to optimize

rostering and improve use of resource

- Full programme of recruitment fayres being attended during the

next few months. Rolling recruitment ongoing and

specialist programmes being explored for specialist areas such

as DAU where a new Band 4 role is being trialled.

Narrative on data extracts regarding staffing levels on 13 wards during

September 2016

Exact/over compliant shifts - Over compliant shifts recorded in September

were mainly attributed to the Heather, Ashbrook, Dementia Assessment Unit

(DAU), Clover (Psychiatric Intensive Care Unit) and Thornton (Low Secure)

wards due to the acuity (complexity of need) of the ward and the requirement

for skill mix within the units. 32% of all shifts worked were bank or agency with

a majority of these shifts requesting unregistered staff. The main requirement

reasons for bank and agency are; vacancy (45%) within DAU (Specialist

Inpatients), Clover and Ashbrook ward (Acute Inpatients) and

observation/specialing. There Is currently a high level of recruitment activity in

an attempt to reduce the vacancy rate.

Under compliant shifts - There were approximately 50 incidents reported

relating to staffing shortages in September. With the exception of 3 all were

reported within Specialist Inpatient areas. Approximately 10 of these related to

the Dementia Assessment Unit due to the ward having a number of long term

sick cases and vacancies. Wider issues are being addressed organisationally

through the overtime scheme for substantive staff working within Inpatient

services and further development of the bank. The internal Staff Bank has

increased recruitment levels from 65 to circa 150 since April, with a target of

200 new workers to be recruited and available to work by December. The new

eRostering system (inclusive of the Bank module) has now been implemented

across all inpatient areas with increased levels of information combining

working patterns/ overtime/ and bank and agency usage now visible.

Non-compliant shifts – One shift was recorded as non-compliant in

September. This was on Ilkley ward (Low secure) but was covered by a

qualified staff member across the Low Secure unit. Although no major

incidents occurred on the ward for that shift the levels of staff were below

planned and not ideal and therefore this shift has been recorded as remaining

‘non-compliant’.

No. shifts

Exact/ Over Compliance 2269

Under Compliance 415

Non Compliance 1


Q23a - Safer Staffing: Inpatient Services – September 2016


Programme

Finance

Only complete sites your

organisation is

accountable for

Specialty 1 Specialty 2

Total

monthly

planned staff

hours

Total

monthly

actual staff

hours

Total

monthly

planned staff

hours

Total

monthly

actual staff

hours

Total

monthly

planned staff

hours

Total

monthly

actual staff

hours

Total

monthly

planned staff

hours

Total

monthly

actual staff

hours

Fern 710 - ADULT MENTAL ILLNESS 710 - ADULT MENTAL ILLNESS 907.5 892.5 892.5 832.5 279 437.1 837 753.3 98.3% 93.3% 156.7% 90.0%

Heather 710 - ADULT MENTAL ILLNESS 710 - ADULT MENTAL ILLNESS 907.5 1207.5 892.5 1410 279 279 837 1199.7 133.1% 158.0% 100.0% 143.3%

B racken 710 - ADULT MENTAL ILLNESS 715 - OLD AGE PSYCHIATRY 900 1005 1350 1290 279 279 837 827.7 111.7% 95.6% 100.0% 98.9%

Ashbrook 710 - ADULT MENTAL ILLNESS 710 - ADULT MENTAL ILLNESS 990 997.5 1260 1732.5 279 279 837 1255.5 100.8% 137.5% 100.0% 150.0%

Maplebeck 710 - ADULT MENTAL ILLNESS 710 - ADULT MENTAL ILLNESS 922.5 1042.5 1297.5 1110 279 297.6 837 827.7 113.0% 85.5% 106.7% 98.9%

Oakburn 710 - ADULT MENTAL ILLNESS 710 - ADULT MENTAL ILLNESS 952.5 922.5 1297.5 1357.5 279 279 837 827.7 96.9% 104.6% 100.0% 98.9%

Baildon 710 - ADULT MENTAL ILLNESS 712 - FORENSIC PSYCHIATRY 1012.5 862.5 1080 562.5 288.3 297.6 576.6 576.6 85.2% 52.1% 103.2% 100.0%

Ilkley 710 - ADULT MENTAL ILLNESS 712 - FORENSIC PSYCHIATRY 930 630 1162.5 975 288.3 297.6 576.6 576.6 67.7% 83.9% 103.2% 100.0%

Thornton 710 - ADULT MENTAL ILLNESS 712 - FORENSIC PSYCHIATRY 900 780 900 1537.5 279 297.6 837 1255.5 86.7% 170.8% 106.7% 150.0%

Assessment & Treatment

Unit (LD)700- LEARNING DISABILITY 700- LEARNING DISABILITY 900 735 1350 1402.5 279 288.3 837 883.5 81.7% 103.9% 103.3% 105.6%

Clover (PICU) 710 - ADULT MENTAL ILLNESS 710 - ADULT MENTAL ILLNESS 922.5 990 1755 2220 279 279 1116 1729.8 107.3% 126.5% 100.0% 155.0%

Step Forward (Rehab) 710 - ADULT MENTAL ILLNESS 710 - ADULT MENTAL ILLNESS 450 502.5 675 637.5 279 279 279 279 111.7% 94.4% 100.0% 100.0%

Dementia Assessment Unit

(DAU)710 - ADULT MENTAL ILLNESS 715 - OLD AGE PSYCHIATRY 907.5 832.5 1785 2227.5 558 511.5 846.3 1134.6 91.7% 124.8% 91.7% 134.1%

Fill rate indicator returnStaffing: Nursing, midwifery and care staff

Average fill

rate -

registered

nurses/

midwives

(%)

Average fill

rate - care

staff (%)

Average fill

rate -

registered

nurses/

midwives

(%)

Average

fill rate -

care staff

(%)

Day Night

Ward name

Main 2 Specialties on each wardRegistered

midwives/nursesCare Staff

Registered

midwives/nursesCare Staff

Day Night


Recommended Ratio

The recommended ratio for FNP is based on the national licensing agreement.

The Health Visitor ratio is based upon nationally recommended levels amended to reflect local needs.

The School Nursing ratio is locally developed based upon pupil numbers and numbers of pupils in pre-determined priority support needs

and is reflective of the school nursing staff mix, not just school nurses.

Special Needs School Nursing does not have a national recommendation, therefore it has been set locally.

EIP/AOT, CMHT and CAMHS ratios are based on national standards.

The Community Matrons and Case Managers ratio is based upon Bradford & North Commissioning Alliance Service Delivery Plan.

The red, amber, green thresholds are established by local managers using their professional judgement.

Q23b: Staffing Ratio (Trends): Community Services

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Sep-16 Actual

Service Arearecommend

ratio

Ratio of

Cl ients to

s taff

Amber i f

greater

than

Red i f

greater

than

O N D J F M A M J J A S

FNP 25:1 17 25 28

Health Visitors 312:1 307 312 362

School Nursing 2200:1 2487 2200 2500

Special Need School Nursing 75:1 63 85 90

EIP 15:1 19 15 18

AOT 15:1 16 15 18

CMHT 35:1 33 33 35

CAMHS 40:1 42 35 40

Community Matrons 70:1 74 77 84

Case Managers 70:1 80 77 8480


Deputy Director,

Nursing, Children and Specialist Services

School Nursing: Improvements to working practices in

school nursing are being established to free up resources.

FNP: No concerns, work progressing on developing the

new service delivery model known as ADAPT.

Health Visitors: Remains green – no concerns.

Local Authority Review: The outcome of the Local

Authority review of Health Visiting and School Nursing was

presented at a workshop for all children's staff on 4 October.

Q23b: Staffing Ratio Community Services

Deputy Director

Mental Health Acute and Community

EIP: Significant spike in referrals across the last 3 months

with particular issues end of August into September.

Caseloads particularly in City & District above appropriate

levels. Risk register updated to reflect capacity issues.

New posts coming into service October/November 2016 -

to accommodate increasing the age range for the service.

Their addition will support capacity which managers will

monitor closely.

CAMHS: Recruitment for service developments funded as

part of the Children and Young People’s Transformation

Programme is proceeding well, which will support capacity

in specialist CAMHS.

Deputy Director

Adults Community Physical Health

Matrons and Case Managers: in coming months there

will be a change to the way in which the information is

presented (on previous slide) as the case manager and

matron teams merge in November following reviews of

work.


Programme

Finance

Legend / Glossary:

FNP: Family Nurse Partnership;

EIP: Early Intervention in Psychosis;

AOT: Assertive Outreach Team

CAMHS: Child and Adolescent Mental Health Services

CMHT: Community Mental Health Teams

0 10 20 30

FNP

0 5 10 15 20

EIP/AOT

0 100 200 300 400 500

Health Visitors

0 20 40 60 80 100

Special Needs School Nursing

0 20 40 60 80 100 120

Matrons and Case Managers

0 10 20 30 40

CMHT

0 10 20 30 40 50

CAMHS

0 1000 2000 3000

School Nursing


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Q25 – Black and Minority Ethnic (BME) Diversity in Employment Strategy

15/16 Outturn15/16

outturn

16/17

Target

Total Headcount Headcount Not Stated White BME % BME Q1 Q2 Q3 Q4

Band 1 48 12.50 57 6 39 12 21.05 5.15 5.37

Band 2 346 27.46 336 22 221 93 27.68 0.78 -0.56

Band 3 369 27.64 365 18 249 98 26.85 -1.50 0.97

Band 4 255 23.14 258 6 189 63 24.42 1.19 -0.29

Band 5 576 22.74 544 8 422 114 20.96 -0.42 -2.26

Band 6 777 16.22 777 31 619 127 16.34 -0.35 0.60

Band 7 288 13.19 280 5 237 38 13.57 0.74 -0.02

Band 8a 114 16.67 110 2 91 17 15.45 -0.74 -1.36

Band 8b 36 2.78 34 2 31 1 2.94 -0.08 0.24

Band 8c 12 25.00 13 1 10 2 15.38 -1.92 -7.69

Band 8d 11 0.00 14 0 13 1 7.14 0.00 7.14

Exec Team 6 0.00 5 0 5 0 0.00 0.00 0.00

Medical Staff 85 47.06 78 19 25 34 43.59 1.09 -4.56

Dental Staff 22 40.91 22 0 13 9 40.91 0.00 0.00

Non-Exec Team 5 20.00 6 3 2 1 16.67 0.00 0.00

Trust Total 2950 21.36 2899 123 2166 610 21.04 -0.07 -0.34

% change from previous quarterIn Quarter whole staff statistics

35

Positive

changes in BME

representation


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Q25 - BME Diversity in Employment Strategy

20.40

20.60

20.80

21.00

21.20

21.40

21.60

21.80

Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16

Trust Total % BME

Trust Total

0.00

10.00

20.00

30.00

40.00

50.00

60.00

Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16

Bands 1-4 Bands 5-7 Bands 8+ Exec Team Medical Staff Dental Staff Non-Exec Team


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Q25 - BME Diversity in Employment Strategy

Indicator Q25:

Quarter 1 Data Analysis

• The overall total of BME staff employed in the Trust shows a slight negative change of 0.34% to 21.04% across the Trust within Q2,

and reflects no change over the last 12 months.

• Positive change can be seen across 6 of the 15 band groupings, the most significant within band 1. In terms of recruitment across

the quarters - 28.78% of new starters are from BME backgrounds. It should be noted however that 5.39% of new starters chose not

to disclose this information.

• The negative changes from quarter 2 in across bands 2, 3, 7, 8a, 8b, 8c and 8d are primarily due to slight increases in headcount of

non-BME staff and slight reductions in BME staff.

• In terms of recruitment (excluding not stated) 30.42% of new starters are from BME backgrounds, 28.60% of those were recruited to

band 2 positions, and 25.71% of those were recruited to band 5 positions.

• The trajectory chart shows analysis of achieving the 35% target by March 2020. This calculates to a requirement of a 3.49%

increase in BME staff per year. Current data shows no increase over the last 12 months.

• Work will continue to implement the BME in Employment strategy and to seek opportunities to encourage applications from a BME

background through more local advertising of roles, recruitment fairs and radio advertising for example. In addition 2017 will see the

roll out of cultural competence training and recruitment and selection training that includes unconscious bias.

15

20

25

30

35

40

Trajectory (% BME)


Q40: Service User Experiences

The Friends and Family Test questionnaire asks if service users: “felt safe”; “were treated with kindness and compassion”; “were involved

in their care as much as they would have liked” and if “they were treated with kindness and compassion”. Where a reviewer responds to

these questions with “Totally” a score of 5 is recorded, where the response is “Not at all” then a score of 1 is recorded. The charts show

the average score for the service business units, and starts at 3 (a neutral opinion).

Further information is provided to Board if the average score for a given question for a business unit falls below 4.0. During September

2016 there were no scores below 4.0 for any questions / business units.

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

3.00

3.20

3.40

3.60

3.80

4.00

4.20

4.40

4.60

4.80

5.00

Apr May Jun Jul Aug Sep

Did You Feel Safe

Adult Physical Health Community

Inpatient Services, Dental andAdministration

Mental Health Adults and Community

Nursing, Children and Specialist

3.00

3.20

3.40

3.60

3.80

4.00

4.20

4.40

4.60

4.80

5.00


Were you involved as much as you liked





3.00

3.20

3.40

3.60

3.80

4.00

4.20

4.40

4.60

4.80

5.00


Were you treated with dignity and respect





3.00

3.20

3.40

3.60

3.80

4.00

4.20

4.40

4.60

4.80

5.00


Were you treated with care and compassion






Quality Assurance

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Indicator

Number Target Target met this month Yes/No

Q5 Never Events Y

Q7 Meet Central Alert System (CAS) timelines Y

Q10 No MRSA bacteraemia cases Y

Q11 No Methicillin sensitive staphylococcus aureus (MSSA) bacteraemia cases Y

Q12 No Clostridium difficile (C.diff) cases Y

Q15 Meet nationally mandated Commissioning for Quality and Innovation (CQUINs) – Forecast

2016/17. Y

Q15 Meet CCG local Commissioning for Quality and Innovation (CQUINs) – Forecast 2016/17 Y

Q16 Meet NHS England Commissioning for Quality and Innovation (CQUINs) – Forecast 2016/17 Y

Q32 No Complaints to Information Commissioners Office (ICO) Y

Q33 No Information Governance Serious Incidents (STEIS) Y

Q34 Maintain Mixed sex accommodation status Y

Q35 Meet Dental Referral To Treatment within 52 weeks Y

Q37 Maintain Publication of the Formulary on Provider’s website Y

Q38a Meet duty of candour requirement to notify the relevant person of a suspected or actual

reportable patient safety incident Y

Q38b Number of duty of candour incidents 0


Programme summary: 2016/17

The 2016/17 Change Programme is monitoring 8 transformational and 30 transactional cost improvement projects.

Forecasts demonstrate a shortfall of £272k on live transformational, £131k on closed transformational and £92k on transactional schemes

for 2016/17. Substitutions for Salary Sacrifice shortfalls from VAT recovery (non-recurrent) were confirmed at the October Change

Programme Board. The High Risk Reserve mitigates the risk while substitutions are targeted.

Of the 8 transformational projects, 3 are on track and rated green; 4 are rated amber and 1 is rated red.

1) Estates/Document Storage – In the absence of a records rationalisation strategy, the £125k cost improvement project will not

achieve. At the October Change Programme Board it was agreed this project would be closed and then re-scoped for 2017/18.

2) Agile Project and Agile Resource Reductions – The first Trust site to be set up with agile infrastructure is nearing completion. The

in-year cost improvement saving is expected to achieve but with £188k pay only met non-recurrently, but with travel savings for

2016/17 already reached. The next 10 sites are being scoped for rationalisation to a 7:10 desk ratio in quarters 3 and 4. 2017/18

workforce planning is behind schedule.

3) IM&T – Telephony - Additional savings now expected of over £100k each year from 2017/18. However there is a shortfall of £153k in

the savings forecasted for 2016/17. Non-recurrent mitigation will be via the high risk reserve if substitutions cannot be identified.

4) CPPP (Care Packages & Pathways) - Cluster performance is still below target (82% against 95% target). There is no cost

improvement attached to this project. Cluster based tariffs are expected from 2017/18 with 95% target achievement required prior to

this.

2 schemes were formally closed in October; Drugs pricing £50k (2016/17) and Pharmacy £81k (2017/18) leaving a recurrent CIP shortfall

of £131k. A new proposal for Pharmacy is to be developed.

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

The purpose of the Change Programme is to effectively govern the Trust's strategic transformation projects. Projects for major change

activities are reported to and monitored by the Change Programme Board and have project management arrangements in place to

ensure project delivery and a consistent approach to Quality Impact Assessments (QIA).

Specific tasks of the Change Programme are to:

• Monitor Transformational and Transactional Change Programme Projects. Highlights reports provided for transformational projects;

• Approve detailed Project Initiation to reflect emerging and new Change Programme Board projects;

• Provide appropriate and effective governance arrangements;

• Review the overall programme risks and ensure appropriate mitigation is in place;

• Monitor the Quality Impact Assessment status of the projects in the Change Programme.

Overall Programme Summary

Jun-16 Jul-16 Aug-16 Sep-16


Quality

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

1.2 Agile Project P Hubbard & S Long

• First pilot site with agile infrastructure nearing completion, lessons

learned planned for October. Smartphone deployment and change

management support underway

• 10 sites being scoped for quarters 3 and 4 to move to a standard

7:10 desk ratio and agile set up.

5.7 Care Packages and Pathways S Long

• Clustering performance target continues not to be achieved and on

a year on year comparison September 2016 (81.7%) is lower than

September 2015 (82.8%).

• A league table approach has been initiated and will be reviewed in

October to provide a focus on amber and red cases.

• Training videos have been developed and will be uploaded onto

Connect during October.

5.1 IM&T - Telephony M Waugh

• A shortfall of £153k is expected in 2016/17. Additional mitigation

schemes are being considered.

• There is now a plan to deliver £100k more in CIP savings

recurrently, i.e. from 2017/18.

• Smartphone deployment commenced, although lower numbers than

planned. Resources to be fully in place in October.

• An agreed asset process is now in place for new starter telephony

equipment though concern remains over the existing inventory.

5.2.1 Estates Rationalisation (Records Storage) A Morris

• The Change Programme Board agreed to close this £125k project

for 2016/17 following agreement that it could not progress or

achieve the planned savings linked to the ongoing national review.

The project will be re-scoped for 2017/18, following completion of

the Trust's records strategy and with a focus on release of benefits

relating to non clinical records storage.


Quality

Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

2.1.3 Out of Area Placements S Long

• Work has commenced on ward bed usage to plan for 2017/18 business

case options.

• Cost improvement continues to be on track for out of area placements.

1.2 Agile Resource Reductions P Hubbard & S Long

• 2016/17 net savings (of reserve) are on track however £188k rated RED

at plan remains unachieved for Adult Community Nursing team.

• Financial forecasts on the resource reduction elements of Agile have so

far identified just 28% of the overall projected £1.868m saving for

2017/18. The October Change Programme Board requested the urgent

acceleration of work to finalise staff skill mix and workforce

transformation plans. This has slipped from an initial target of

September 2016 and is needed to confirm whether previously targeted

savings can be delivered 2017/18. Details have been requested by

Executive Management Team on 1st November.

1.11 Children's Schemes C Woffendin

• All health visiting modules now merged, other IT schemes -

secure email, tele-health, SMS messaging delayed pending

resources.

• Staff aware of new models and teams, roll out of clusters to be

determined with caseloads transferred.

• Working with estates to determine optimum agile work locations

• Pilot commenced in Cluster 4

• Temporary document records centralisation space identified

• Outcome of Local Authority reviews of health visiting and school

nursing confirmed and shared with staff

• CIP saving shortfall of £75k will be mitigated by vacancies.

5.20 Bank + Agency F Sherburn

• E-Rostering plan on schedule.

• Financial trend shows agency costs reducing and use of staff

bank increasing.

• Monthly agency spend below the Monitor Cap set.

• Further work to ensure engagement across the whole Trust.

Work underway to engage with medics to ensure e rostering

used for junior doctor rosters.

• Current CIP position indicates overspend of £278k driven by high

vacancies and sickness in mental health acute services, medical

staffing and specialist inpatients. Plan to mitigate actions to be

discussed at the new combined Bank & Agency and E-Rostering

Steering Group.


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Proposed Board RAG Rating YTD FOT Commentary

Statement of Comprehensive Income (SoCI)

A deficit of £224k year to date is £890k below the planned surplus of £666k.

This reflects the degree of challenge in the financial plan for 2016/17 and will

require rapid, ongoing and robust action planning to ensure delivery of the

planned surplus.

Statement of Financial Position (SoFP)

Current assets (including cash, receivables, accruals, prepayments) are

£2.2m above plan. Current liabilities are £2.9m above plan. These variances

underpin the adverse year to date cash flow variance.

Statement of Cash Flows (SoCF)

Cash balances are £1.4m below plan at the end of the year. The main

reasons for the cash variance relates to the Month 6 SOCI variation from

plan of £885k. The remaining cash variance, is due to the non-payment of

the insurance monies for the flood damage at New Mill, now due in October

and an increased level of prepayments in 2016/17. The Trust forecast

achievement of the planned outturn cash of £14,589k.

Financial Sustainability Risk Rating (FSRR)

Use of Resources Metric (UoR)

Achievement of a FSRR of 3 in Month 6, however a further deterioration in

the I&E position of £450k would result in an overall FSRR of 2. The Trust

forecasts achieving the planned surplus and a rating of 4.

From M07, the new 'Use of Resources (UoR)' metric comes into force. At

M06, the new metric is in shadow format and shows a 2 (1 = Best, 4 =

Worst) rating.

Cost Improvement Programmes (CIPs)

CIPs are under achieving by £196k YTD (before reserve). This includes

schemes rated RED when the plan was approved. The full year forecast

shows an under achievement of £494k against the gross annual CIP of

£5,787k , this underachievement is mitigated by the £500k high risk CIP

reserve. Programme Leads are now progressing required (mitigating) actions

to ensure delivery of the gross plan.

Capital Expenditure

Capital expenditure is £313k below plan at the end of the period mainly due

to the timing of expenditure for key schemes in Estates and IM&T, and no

calls on the capital contingency at this point in the year. Plans are in place

to fully commit the capital programme. There is still uncertainty regarding a

Capital Control Total.

Executive Summary

(500)

0

500

1,000

1,500

M01 M02 M03 M04 M05 M06 M07 M08 M09 M10 M11 M12

In Month Surplus/(Deficit) - Plan vs Actual/Forecast

Plan Actual/Forecast

0

10,000

20,000

M01 M02 M03 M04 M05 M06 M07 M08 M09 M10 M11 M12

In Month Cash Balances - Plan vs Actual


0

1

2

3

4

5

M01 M02 M03 M04 M05 M06 M07 M08 M09 M10 M11 M12

In Month FSRR - Plan vs Actual


300

450

600

M01 M02 M03 M04 M05 M06 M07 M08 M09 M10 M11 M12

In Month CIPs - Plan vs Actual/Forecast


0

200

400

600

M01 M02 M03 M04 M05 M06 M07 M08 M09 M10 M11 M12

In Month Capital Expenditure - Plan vs Actual/Forecast



Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Plan Actual Variance Plan Actual Variance

Operating income (inc in EBITDA)

NHS Clinical income (52,173) (53,258) 1,085 (104,636) (106,587) 1,951

Non-NHS Clinical income (9,393) (9,098) (295) (18,786) (18,400) (386)

Non-Clinical income (3,917) (4,824) 907 (7,191) (8,553) 1,362

Total (65,483) (67,180) 1,697 Green (130,612) (133,540) 2,928 Green

Operating expenses (inc in EBITDA)

Employee expense 52,065 51,558 507 103,878 101,781 2,097

Non-Pay expense 10,169 13,265 (3,096) 20,239 25,308 (5,069)

PFI / LIFT expense 100 102 (2) 199 202 (3)

Total 62,333 64,925 (2,591) Red 124,316 127,291 (2,975) Amber

EBITDA (3,150) (2,256) (894) Red (6,296) (6,249) (48) Green

EBITDA Margin % 4.81% 3.36% Red 4.82% 4.68% Red

Operating expenses (exc from EBITDA)

Depreciation & Amortisation 1,577 1,572 5 3,155 3,143 12

Total 1,577 1,572 5 Green 3,155 3,143 12 Green

Non-operating income

Finance income (30) (21) (10) (63) (63) (0)

Total (30) (21) (10) Red (63) (63) (0) Green

Non-operating expenses

Interest expense (PFI / LIFT) 79 79 (0) 157 157 (0)

PDC expense 858 850 8 1,713 1,677 36

Total 937 929 8 Green 1,870 1,834 36 Green

(Surplus) / Deficit after tax (666) 224 (890) Red (1,335) (1,335) 0 Amber

Sustainability & Transformation Fund (790) (790) 0

Control Total Balancing (15) (15) 0

Total (666) 224 (890) Red (2,140) (2,140) 0 Amber

Statement of Comprehensive Income

Year to Date£000's

FOT

RAG

Year End ForecastYTD

RAG


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Statement of Comprehensive Income

Risk Mitigation

Specialist

Inpatients,

Dental &

Admin

There are projected pay pressures in the Admin Hubs and

Learning Disabilities of £427k for the year.

Agreement to charge for reception staffing in NHSPS

properties where BDCFT is not the sole occupant has yet

to be secured. Admin Hub Re-design – 5 (of 29) reception

areas to remain at an annual cost of c £120k.

Savings on pay in other areas (especially Dental and Psychological Therapies)

reduce the forecast adverse position to £255k with further action needed to

mitigate this.

Review NHSPS contract legality of landlord / reception recharges – meetings

ongoing with NHSPS to progress. Business has reviewed reception staff tasks

and are reducing staffing levels.

Acute &

Community

Mental

Health

Establishment & agency costs in adult CMHTs and IHTT,

medical Locum costs.

IAPT room hire & training backfill.

CMHT Drug spend.

Head of Service leading review and monitoring of position, forecast and

mitigating actions. Controls and actions to minimise Agency spend and Medical

Locum costs are being led by the DD, Head of Service and Medical Director.

Fixed term contracts being used where possible instead of locums. Skill mixing

of vacancies to use resource efficiently.

Business Unit work with the Estates/VCS to explore options of using cheaper

rooms has led to a current estimated monthly Estates saving of £10k. Levels of

backfill to reduce in Q3 removing this from the risk log.

Work is ongoing to establish options to mitigate CMHT drug spend, service has

established areas for investigative work.

Adult

Physical

Health

Projected District Nursing pay and non-pay, Continence

products, Nursing Support Team recharge pressures. Red

rated £187k Agile CIP at plan.

A non recurrent risk reserve has been established to mitigate the £187k Agile

risk. Options are currently being explored to reduce Nursing Support Team

pressures and establish residual risk. Expenditure review and controls are in

place to mitigate non pay pressures. Budget transfers have reduced District

Nursing pay pressure. Deep dive underway to review remaining District Nursing

pressures.

Corporate

Functions

Estates Engineering maintenance pressures and

unachieved CIPs are contributing to the adverse variance

in non pay expenditure.

Detailed analysis and forecasting has been undertaken to assess the impacts of

mitigations, the residual Estates pressure will be £424k. CIP mitigations/actions

are outlined on the CIP slides.

Non pay CIPs slippage for Estates Rationalisation (£125k),

Telephony (£153k), Addaction (50k), Drug Pricing (£50k)

and Stoney Ridge savings (£61k).

Mitigations/actions are outlined on the CIP slides where plans have been

identified.


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Key Risks Key Mitigations & Action Plans

Higher creditors will impact on BPPC performance and higher

debtors may result in not achieving the cash target.

Overall movement between other current assets and other current

liabilities includes the difference in the outstanding charges and

income relating to NHS Property services, along with the

outstanding debt relating to local NHS providers, GP’s and voluntary

sector organisations.

Increased prepayments against plan have also impacted on the

variance of other current assets.

Receivables continue to be monitored closely and escalation plans

are in place. Month end balances with some NHS acute

organisations and the local CCG’s are higher than planned, of which

have been escalated and thoroughly investigated and reported in

the quarter 2 national NHS Agreement of Balances exercise. All

other receivables, as part of current assets, are being monitored

weekly and discussions are taking place to ensure outstanding

amounts are settled.

In respect of liabilities, discussions continue with NHS Property

Services and regarding the outstanding charges. A national

newsletter was issued by the DH providing clear guidance on

charging principles to be adopted by NHSPS. The Trust are

proactively working towards an agreement that matches funding.


Non-current Assets

Property, Plant & Equipment 49,601 48,792 809 50,520 50,520 0

On-balance sheet PFI 4,454 4,578 (124) 4,220 4,220 0

Total 54,055 53,370 685 Amber 54,740 54,740 0 Amber

Current Assets

Cash and cash equivalents 13,652 12,236 1,417 14,589 14,589 0

Other current assets 3,857 7,460 (3,603) 4,620 4,620 0

Total 17,509 19,696 (2,187) Green 19,209 19,209 0 Amber

Current Liabilities

PFI / LIFT leases-CA (343) (342) (2) (339) (339) 0

Other current liabilities-CA (9,153) (12,151) 2,999 (10,238) (10,238) 0

Total (9,496) (12,493) 2,997 Amber (10,577) (10,577) 0 Green

Non-current Liabilities

PFI / LIFT leases-NCA (2,891) (2,892) 1 (2,721) (2,721) 0

Other non-current liabilities-NCA (630) (521) (109) (630) (630) 0

Total (3,521) (3,413) (108) Amber (3,351) (3,351) 0 Green

Total Assets Employed 58,547 57,160 1,387 Green 60,021 60,021 0 Green

Reserves 58,547 57,159 1,388 Amber 60,021 60,021 0 Green

Statement of Financial Position

FOT

RAG£000's

Year to Date Year End ForecastYTD

RAG


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance


The main reasons for the cash variance relates to the Month 6

SOCI variation from plan of £885k.

The remaining cash variance, is due to the none payment of the

insurance monies for the flood damage at New Mill, now due in

October and an increased level of prepayments in 2016/17.

Specifically in respect of key Commissioners and other local NHS

bodies and voluntary organisations, both the Head of Contracting

and Head of Financial Accounting are liaising personally with

counterparts to ensure that cash receivable is remitted in full on a

monthly basis.

Discussions are to take place at Deputy Director meetings to

ensure we are proactively managing prepayments for all future

contracts, working closely with Supplies to only authorise prepaid

contracts if significant discounts are awarded.

The cash position continues to be closely monitored, with

variations from plan being thoroughly investigated. Actions will be

identified to rectify variances from plan at an early stage.


Surplus (Deficit) from Operations 1,569 684 885 Red 3,141 3,141 0 Green

0

Operating activities 1,578 1,572 6 Green 3,155 3,155 0 Green

0

Movements in working capital (3,383) (4,436) 1,052 Red (2,223) (2,223) 0 Green

0

Investing activities (1,563) (1,241) (322) Amber (3,795) (3,795) 0 Green

0

Financing activities (1,140) (1,092) (48) Green (2,280) (2,280) 0 Green

0

Opening cash and cash equivalents less bank overdraft 16,591 16,748 (157) 16,591 16,591 0

Closing cash and cash equivalents 13,652 12,235 1,416 Amber 14,589 14,589 0 Green

£000'sYear to Date FOT

RAG

Statement of Cash FlowsYear End ForecastYTD

RAG


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Position Statement – Fixed Assets

Abelia Mount – Trust owned

Two storey dwelling in Bradford 7, currently occupied by Local Authority commissioned Supported Living Services. As part of a rental

negotiation for occupying the property, a potential option to buy was discussed. The preferred Trust option would be to dispose of this

asset through a sale. An acceptable verbal offer to purchase the asset has been submitted and the Trust are now waiting the formal

written offer before proceeding. On receipt of the agreed formal offer, the property sale will potentially complete in quarter 4.

Park Road Health Centre – Finance Lease

Park Road Health Centre was built in 1997 on Trust owned land and is accounted for as a finance lease on the Trust balance sheet.

NHS Property Services hold the head lease for this building directly with the vendor. The Trust have no invested interest or responsibility

in the way this site is both occupied or managed. As a result, we are in the process of working closely with both NHSPS and KPMG to

review the accounting treatment of the finance lease that is currently reported on our balance sheet. The outcome of this work with

determine the next steps. We anticipate to complete this work and action any changes this financial year.

Green Lane Land – Trust owned

The land is located to the West of Bradford City Centre in Thornton Village. The land was previously part of the grounds of Ashfield

House, a property formerly owned by the Trust but which was sold to Yorkshire Housing Association (YHA) in January 2003. The Local

Authority (and YHA) terminated the lease in August 2014, since which time the Trust has been holding the land pending a surplus asset

declaration, disposal planning, marketing, and sale. Formal approval to declare assets as surplus and held for sale will be required

through the FBI committee. There have been two interested parties for the land of which the highest offer was £176k. The Trust have

accepted the higher offer and are proceeding with the sale, which is expected to complete in the early stages of quarter 4.

Stoney Ridge – Trust owned

Stoney Ridge and New Ridge is a trust owned property and formally occupied mainly by Home Farm Trust (linked to the Section 75

agreement). HFT has vacated the property and the associated income streams have ceased. The property is less then 50% occupied

and significant capital investment is required to improve the site to an acceptable standard. As a result, the best option would be to

market the site for external sale. In order to decant the site and relocate the services, capital investment is required at both Daisy Hill

House and Waddiloves. In addition, discussions are taking place with other external providers for sessional use of a pool for

hydrotherapy and rebound therapy. Once vacant, the asset can be officially held of sale. Formal approval to declare assets as surplus

and held for sale will be required through the FBI committee. The proposal is to potentially relocate services and sell the asset by the end

of this financial year.


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Description of Key Metrics

Capital Service Cover: Metric currently weighted at 25% and shows how many times income covers the servicing of capital costs.

Liquidity: Metric currently weighted at 25% and shows how liquid the Trust is in respect of days’ operating expense cover.

I & E Margin: Metric currently weighted at 25% and shows normalised surplus as a % of income.

I & E Margin Variance From Plan: Metric currently weighted at 25% and shows I & E Margin actual compared to planned.

Overall Rating: Aggregate rounded average of all metrics.

Key Risks, Mitigations & Actions

Key risks stem from the requirement to achieve a 1% surplus in the period to maintain an I&E Margin metric of 4. The I&E margin %

rating is 1.36% below plan to date and the I&E margin variance to plan is below plan by 1.34%. These result in a RED rating due to

the Monitor formula used for variation. The Trust reports a FSRR of 3 for September and forecasts achieving an end of year outturn

rating of 4 against the FSRR for 2016/17. Mitigating action plans are being progressed as a priority.

A consultation on a proposed Single Oversight Framework closed on 4th August and proposed revision of the financial metrics and

their weights and including other operational and quality targets supporting closer regulatory alignment i.e. with CQC.


Capital Service Cover

Revenue Available for Capital Service 3,179 2,277 (902) 7,165 5,772 (1,393)

Capital Service (1,109) (1,103) 6 (2,218) (2,182) 36

Capital Service Cover metric 2.87 2.07 (0.80) 3.23 2.65 (1)

Capital Service Cover rating 4 3 Amber 4 4 Green

Liquidity

Working Capital for FSRR 7,995 7,185 (810) 8,614 8,614 0

Operating Expenses within EBITDA, Total (62,336) (64,924) (2,588) (124,301) (127,276) (2,975)

Liquidity metric 23.1 19.9 (3) 24.9 24.4 (0.58)

Liquidity rating 4 4 Green 4 4 Green

I & E Margin

Surplus/(deficit) before impairments,

disposal on FA & restructuring costs 666 (223) (890) 2,140 2,140 (0)

Total operating & non operating income 65,515 67,201 1,686 131,466 133,048 1,582

I & E Margin % metric 1.02% -0.33% -1.35% 1.63% 1.61% -0.02%

I & E Margin % rating 4 2 Red 4 4 Amber

I & E Margin Variance

I & E Margin 1.02% -0.33% -1.35% 1.63% 1.61% (0)

I & E Margin variance from plan -0.02% -1.35% -1.33% -0.02% -0.02% 0.00%

I & E Margin Variance From Plan Rating 3 2 Red 3 3 Amber

Financial Sustainability Risk Rating 4 3 Amber 4 4 Amber

Financial Sustainability Risk Ratings

£000'sYear to Date Year End Forecast FOT

RAG

YTD

RAG


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Description of Key Metrics

Capital Service Cover: Metric currently weighted at 20% and shows how many times income covers the servicing of capital costs.

Liquidity: Metric currently weighted at 20% and shows how liquid the Trust is in respect of days’ operating expense cover.

I & E Margin: Metric currently weighted at 20% and shows normalised surplus as a % of income.

I & E Variance From Plan: Metric currently weighted at 20% and shows I & E Margin actual compared to planned.

Agency : Metric currently weighted at 20% and shows performance against the agency expenditure ceiling.

Overall Rating: Aggregate rounded average of all metrics.

Key Risks, Mitigations & Actions

The Single Oversight Framework comes into force from 1st October. The table above shows the new financial metrics (Use of Resources

(UoR)) in their shadow form. The main change is the reversal of the scores (i.e. 1 is now the highest score compared to 4 previously) and

the addition of an Agency metric which has diluted the weightings of the current metrics to 20% each (25% previously).


Capital Service Cover

Revenue Available for Capital Service 3,179 2,277 (902) 7,165 7,116 (49)

Capital Service (1,109) (1,103) 6 (2,218) (2,182) 36

Capital Service Cover metric 2.87 2.07 (0.80) 3.23 3.26 0.03

Capital Service Cover rating 1 2 Amber 1 1 Green

Liquidity

Working capital balance 7,995 7,185 (810) 8,614 8,614 0

Operating Expenses within EBITDA, Total (62,336) (64,924) (2,588) (124,301) (127,276) (2,975)

Liquidity metric 23.1 19.9 (3.2) 24.9 24.4 (0.6)

Liquidity rating 1 1 Green 1 1 Green

I & E Margin

Surplus/(deficit) adjusted for donations and

asset disposals666 (223) (890) 2,140 2,140 (0)

Total operating income for EBITDA 65,483 67,180 1,697 131,402 134,330 2,928

I & E Margin % metric 1.02% (0.33%) (1.35%) 1.63% 1.59% (0.04%)

I & E Margin % rating 1 3 Red 1 1 Amber

I & E Margin Variance From Plan

I & E Variance From Plan (1.35%) (0.04%)

I & E Margin Variance From Plan rating 3 Red 2 Red

Agency

Agency staff, total (3,657) (3,029) 628 (7,313) (4,915) 2,398

Agency ceiling (3,920) (3,920) 0 (7,840) (7,840) 0

Agency metric (6.72%) (22.73%) (16.01%) (6.72%) (37.31%) (30.59%)

Agency rating 1 1 Green 1 1 Green

Use of Resources Metric (UoR) 1 2 Amber 1 1 Amber

Use of Resources Metrics (UoR)

£000'sYear to Date Year End Forecast FOT

RAG

YTD

RAG


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Business Unit & Scheme

£000's Plan Actual Variance Plan Actual VarianceRAG

Rating

Adult Physical Health Community Services 493 541 (47) 1,250 1,256 (6)

1.1.3-SLT Income generation contribution 13 13 0 25 25 0

1.2-Agile project staffing - (No plans for CIP) 94 0 94 187 0 187

1.2-Agile project staffing - RED rated 27 27 0 168 168 0

1.2-Agile project staffing-Lead 358 358 0 776 776 0

1.2b-Agile project staffing (phasing for OD) (141) 0 (141) (193) 0 (193)

3.3-Substance Misuse % reductions 143 143 0 287 287 0

Childrens 529 529 (0) 1,058 1,058 (0)

1.11-Childrens - New models for FNP 176 176 (0) 352 352 (0)

1.11-Childrens - Secondments & career breaks 23 23 0 45 45 0

1.11-Childrens Management overhead reduction 90 90 0 180 180 0

1.11-Childrens Non pay procurement savings 15 15 0 30 30 0

1.11-Childrens -Reduction in staff hours 36 36 0 71 71 0

1.11-Childrens Skill mix efficiencies 141 141 0 281 281 0

1.11-Childrens Use of technology to free clinical time 49 50 (0) 99 99 (0)

Corporate 177 141 37 488 357 131

2.1.2-CAMHS Eating disorders contribution (contract income) 10 10 0 20 20 0

5.21-Executive director savings 25 25 0 49 49 0

5.4.1-Salary sacrifice increased income from new and existing schemes 75 75 0 226 226 0

5.4.2-Corporate overheads - Executive Pas 25 25 0 49 49 0

5.5.1-Drug pricing target reductions 25 0 25 50 0 50

5.5.3-Reduction in SLA costs for pharmacy SLA with BTHFT 12 0 12 81 0 81

5.22-Trust Board efficiencies 7 6 0 13 13 0

Estates & Facilities 234 155 78 557 371 186

1.2-Agile - Estates Project 118 88 30 235 235 0

5.2.1-Estates rationalisation 18 0 18 125 0 125

5.23-Mitigate Stoney Ridge cost pressure by CIP 31 0 31 61 0 61

5.9-Release of NHS property services overhead costs 68 68 0 136 136 0

Finance 108 108 0 250 250 0

5.13-Salary sacrifice increased income from new and existing schemes 33 33 0 100 100 0

5.14-Reduce SBS contract value 15 15 0 30 30 0

5.15-Reduce computer maintenance & support 15 15 0 30 30 0

5.16-Reduce trust wide finance budget 18 18 0 35 35 0

5.17-Reduce finance training budget 5 5 0 10 10 0

5.18-Restructure finance team 23 23 0 45 45 0

Cost Improvement Schemes 2016/17

Year to date September 2016 Year End Forecast


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Business Unit & Scheme

£000's Plan Actual Variance Plan Actual VarianceRAG

Rating

Human Resources 94 94 0 210 210 0

5.11-HR Childcare cost reduction 13 13 0 25 25 0

5.11-HR Contribution from CCG's HR/OD Contract 37 37 0 74 74 0

5.11-HR non pay efficiencies 21 21 0 42 42 0

5.11-Salary sacrifice increased income from new and existing schemes 23 23 0 69 69 0

IM&T 195 57 138 389 236 153

5.1-IM&T Strategy CIP (telephony) 167 29 138 334 181 153

5.6-CHIS cost reduction from CSU contract 28 28 0 55 55 0

Medical Director 112 112 0 223 223 0

2.1.1-Locum budget reserve reduction 75 75 0 150 150 0

5.8.1-Research & Development recurrent reduction 3 3 0 6 6 0

5.8.1-Research & Development non recurrent vacancy reduction 20 20 0 40 40 0

5.8.1-Research & Development reduce BDCT provision 14 14 0 27 27 0

Mental Health Acute & Community Services 377 377 0 813 813 0

1.2-Agile project staffing 223 223 0 447 447 0

1.2b-Agile NR reserve (phasing for OD) (46) (46) 0 (63) (63) 0

2.1.3-Out of area placements reduction 200 200 0 400 400 0

2.1.4-IAPT post reductions 0 0 0 29 29 0

Specialist Inpatients 22 22 0 44 44 0

3.6-Dental savings 22 22 0 44 44 0

Trust wide 253 261 (8) 506 476 30

1.2-Agile - Travel cost reductions 48 73 (25) 96 99 (3)

5.10-Recharge to Addaction 47 30 17 94 61 33

5.4.2-Reduction in operational management costs 46 46 0 92 92 0

5.5.2-Procurement savings 112 112 0 224 224 0

Total 2,594 2,396 197 5,787 5,294 494

High Risk CIP Reserve (113) 0 (113) (224) 0 (224)

High Risk CIP Reserve Pay (113) 0 (113) (224) 0 (224)

High Risk CIP Reserve Non Pay 0 0 0 0 0 0

High Risk CIP Reserve Income 0 0 0 0 0 0

Grand Total 2,481 2,396 84 5,563 5,294 270

Cost Improvement Schemes 2016/17

Year to date August 2016 Year End Forecast


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

Current Status, Key Risks & Mitigations Current Status, Key Risks & Mitigations

Children's Business Unit: £352k CIP relating to Better Start Bradford

commenced delivery in month 3. The SLA has been signed and any in-

year shortfall has been mitigated from vacancies within the FNP teams.

Plans for the £99k use of technology to free clinical time are being

completed. The shortfall will be met from vacancies within the unit.

Estates: Plans for The Agile Estates CIP has been agreed and the CIP

is expected to deliver in full. The Stoney Ridge CIP will not now achieve

and in the absence of a records rationalisation strategy the Estates

Paperless scheme is also predicted to not achieve in 16/17.

Finance SBS Contract – This scheme will not deliver the planned

savings in 2016/17. The shortfall will be fully mitigated by retrospective

VAT savings with the expectation of achieving recurrently.

Salary Sacrifice – Expected lease car overachievement will be offset by

underachievement on IM&T & Childcare. A net forecast shortfall will be

substituted non-recurrently by retrospective VAT savings in year. HMRC

is consulting on proposals that would adversely impact salary sacrifice

schemes for lease cars and IM&T.

Drugs - Planned savings are not now anticipated meaning that mitigations

will be required for the £50k target. Mitigations are being explored bit are

not anticipated to deliver until 2017/18.

IM&T Strategy CIP (telephony) – This scheme is now forecast to deliver

planned savings recurrently but a shortfall of £153k is expected in

2016/17, due to delays in scheme implementation. Options to mitigate

from within IM&T are still being confirmed – to conclude in October.

Substance Misuse Services External Recharge - Negotiations are

underway with partial recovery demonstrated in billing but a risk of non-

settlement. Local Authority Commissioners appraised of issue and copied

into communications. The revised value of income chargeable has been

calculated at £64k. If agreed a risk remains of £31k.

0

1,000

2,000

3,000

4,000

5,000

6,000

M01 M02 M03 M04 M05 M06 M07 M08 M09 M10 M11 M12

Actual Actual Actual Actual Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast

£0

00

's

CIP Plans Deliverability

Unachieveable - substitution required Achievable but risks identified Delivered/deliverable Target


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance


• Capital under spending could be interpreted by the regulator as

a sign that there would be minimal impacts from introducing a

capital control total.

• Estates schemes are under committed by £220k which includes;

£25k Flood Recovery works (commence on site on 19th

September), £166k Energy Centre (Certification and Fees now

expected in month 7).

• IM&T schemes are under committed by £78k which includes

£47k on IT infrastructure improvements, to review the work

around data network capacity and £31k relating to clinical

system integration.

• Uncommitted Reserves account for a further £14k to date.

Uncertainty regarding the timing or value of any 2016/17 capital

control total linked to in-year capital pressures that are likely to

require all plan reserves (including those forming part of the £700k

plan control total mitigation).

Close management of all capital schemes is required to ensure

that the schemes are brought in on budget and as profiled at plan.

Funding in the first 6 months represents anticipated minimum

capital requirements with the exception of £120k (6/12s) of

contingency reserve.

The last CPIG meeting received assurance that the Energy Centre

Scheme would be back on track by October. The Deputy Director

of Informatics also confirmed their schemes are fully committed to

spend against the capital funding allocation for 2016/17.

The key focus is ensuring that the capital plan is fully committed in

line with the plan profile (to mitigate against additional external

control total challenge) and fully expended by the end of the

financial year, balanced against the need to be able to flex plans

should an external cap be imposed.

The capital plan was constructed to phase £700k in the last 6

months to mitigate against any unknown national control totals.

Potential cost pressures have now been identified.

Plan

£000

Actual

£000

Variance

£000

Plan

£000

Actual

£000

Variance

£000

Capital expenditure

Plant and equipment - Information Technology 375 297 78 Green 723 723 0 Green

Plant and equipment - Other 120 106 14 Green 940 940 0 Green

Property, plant and equipment - other expenditure 1,098 878 220 Green 2,193 2,193 0 Green


Capital expenditure funding sources

Depreciation 526 528 (2) Green 3,155 3,155 0 Green

Other 1,067 752 315 Green 701 701 0 Green


Capital ExpenditureYear to Date Year End Forecast

FOT

RAG

YTD

RAG


Summary NHS

Improvement Quality

Business Unit

Change Programme

Finance

NHSI Agency Price Cap

Key Risks, Mitigations & Action Plans

Agency staff price caps were introduced during 2015/16, with stepped reductions from February and April 2016 to reduce premium hourly

rates paid. There is an escalation procedure for approval of non compliant agency staff however patient safety is the only reason accepted by

NHS Improvement. The price caps from April 2016 generate breaches if rates exceed 55% above substantive staff rates. From 1st July, we

were also required to report any wage cap breaches (agency workers paid a maximum wage rate) in addition to price cap breaches.

Current performance :

A total of 106 shifts were above the price cap at the end of September - 37 nursing shifts (8 of these are only marginal (10p or less per hour)

and the Trust will ensure that these are negotiated to within the cap immediately), 18 allied health professional shifts and 46 medical and

dental shifts.

A total of 116 shifts were above the wage cap at the end of September - 50 nursing shifts, 20 allied health professional shifts and 46 medical

and dental shifts. Urgent conversations are being taken forward with Retinue to ensure that rates quoted by them are accurate and that staff

are placed with agencies that are compliant with the price and wage cap arrangements.

Medical Locum agencies remain the high risk area with expected ongoing compliance breaches. Issues are being experienced at a local and

national level due to Medical agencies failing to respond to the NHS price and wage caps and linked to elevated consultant vacancies and

recruitment concerns. Work continues with Retinue to target agencies that are not complying with NHSI price and wage caps. Retinue have

been instructed to use alternative agencies when specific suppliers are not compliant. Regular meetings are being held to monitor and

manage progress. Compliance reports are produced and circulated widely on a weekly basis.

Discussions are ongoing with Retinue regarding their interpretation of whether all elements of the management fee should be included in the

rate which is compared to the NHSI price cap. Retinue are in discussions with NHS Improvement regarding this issue.

0

50

100

23

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30

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07

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Agency shifts worked that cost over the NHS Improvement Price Cap

Clinical contracts Non Clinical contracts Medical & Dental Scientific, Therapeutic & Technical (AHPs) Administration and Estates Other Nursing, Midwifery & Health Visiting

Board Integrated Performance Report 27th October 2016 · Board Integrated Performance Report -...

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