Board of Directors Meeting - nth.nhs.uk · 11/28/2019 · Boardroom University Hospital of North...

Board of Directors Meeting

Thursday, 28 November 2019 at 1:00 pm

Boardroom

University Hospital of North Tees

PG/SH 21 November 2019 Dear Colleague A meeting of the Board of Directors will be held on Thursday, 28 November 2019 at 1.00pm in the Boardroom, University Hospital of North Tees. Yours sincerely

Paul Garvin Chairman

Agenda

Led by

1. (1.00pm) Apologies for Absence Chairman

2. (1.00pm) Declaration of Interest Chairman

3. (1.00pm) Minutes of the meeting held on, 31 October 2019 (enclosed) Chairman

4. (1.10pm) Matters Arising Chairman

Items for Information 5. (1.15pm) Report of the Chairman Chairman

6. (1.25pm) Report of the Chief Executive (enclosed) J Gillon Quality 7. (1.35pm) Nursing & Midwifery, Medical & Dental Workforce Report (enclosed) J Lane Performance Management 8. (1.45pm) Integrated Compliance and Performance Report (enclosed) L Taylor, J Lane A Sheppard & N Atkinson 9. (2.00pm) Emergency Preparedness Resilience and Response (EPRR) Annual Report 2018-19 (enclosed) L Taylor

10. (2.10pm) Winter and Operational Assurance (enclosed) L Taylor 11. (2.20pm) Any Other Notified Business Chairman 12. Date of Next Meeting (Thursday, 30 January 2020, Boardroom, University Hospital of North Tees)

Glossary of Terms

Strategic Aims and Objectives Putting Patients First

• Improve outcomes, achieve performance targets • Effective planning • Develop new approaches that support recovery and wellbeing • Develop new services to meet peoples’ needs • Focus on research to improve services

Valuing Our People

• Promote and ‘live’ the NHS values within a healthy organisational culture • Develop, train and retrain our staff • Ensure a healthy work environment • Listen to the ‘experts’ • Encourage the future leaders

Transforming Our Services

• Deliver cost effective and efficient services, maintaining financial stability • Make better use of information systems and technology • Provide services that are fit for purpose and delivered from cost effective buildings • Ensure future clinical sustainability of services

Health and Wellbeing

• Promote and improve the health of the population • Promote health services through full range of clinical activity • Increase health life expectancy in collaboration with partners • Promote self-care

____________________ * voting member

North Tees and Hartlepool NHS Foundation Trust

Minutes of a meeting of the Board of Directors held on Thursday, 28 November 2019 at 1.00 pm

at the University Hospital of North Tees Present:

Paul Garvin, Chairman* Chairman Steve Hall, Vice-Chair/Non-Executive Director* SH Philip Craig, Non-Executive Director* PG Brian Dinsdale, Non-Executive Director BD Jonathan Erskine, Non-Executive Director* JE Kevin Robinson, Non-Executive Director* KR Rita Taylor, Non-Executive Director* RT Ann Baxter, Associate Non-Executive Director AB Neil Schneider, Associate Non-Executive Director NS Julie Gillon, Chief Executive* CE Deepak Dwarakanath, Medical Director / Deputy Chief Executive* MD/DCE Neil Atkinson, Director of Finance* DoF Barbara Bright, Director of Corporate Affairs and Chief of Staff DoCA&CoS Levi Buckley, Chief Operating Officer* COO Graham Evans, Chief Information & Technology Officer CI&TO Julie Lane, Chief Nurse/Director of Patient Safety and Quality* CN/DoPS&Q Alan Sheppard, Director of Workforce DoW Lynne Taylor, Director of Performance and Planning DoP&P

In attendance:

Samantha Sharp, Personal Assistant (note taker) Peter Wilkinson, Hospital User Group (HUG) Representative Ruth Dalton, Head of Communications and Marketing Tony Horrocks, Lead Governor / Elected Governor, Stockton John Edwards, Elected Governor, Stockton

BoD/4120 Apologies for Absence

There were no apologies for absence

BoD/4121 Declaration of Interests

Declarations of interest were noted from the CI&TO, DoP&P and SH (Non-Executive Director) in respect to their roles with North Tees and Hartlepool Solutions, and the CE, DoCA&CoS and SH (Non-Executive Director) in respect to their roles with Optimus Health Ltd and NTH Solutions, although there was no conflict against any open agenda items.

A declaration of interest was also noted from the CI&TO in respect to his role in the ICS.

BoD/4122 Minutes of the meeting held on, Thursday, 31 October 2019

Resolved: that the minutes of the meeting held on Thursday, 31 October 2019 be confirmed as an accurate record.

BoD/4123 Matters Arising

There were no matters arising.

2

BoD/4124 Report of the Chairman The Chairman reported that he and the Chief Executive had met with Richard Barker, North East and Yorkshire Regional Director and Alan Foster, ICS Executive Lead, North East and North Cumbria to discuss the ICP in the Tees Valley. The Chairman would be attending the NHS Providers Chairs and Chief Executives’ Network on 5 December and would feedback at the next meeting.

Resolved: that, the verbal report be noted.

BoD/4125 Report of the Chief Executive A summary of the report of the Chief Executive included: -

Integrated Care System/Integrated Care Partnership (ICS/ICP): The ICS continued to make progress across all six workstreams. The Trust was visited by the ICS roadshow bus on 29 October as part of a system-wide drive to gain feedback from key stakeholders. The Tees Valley Health and Care Partnership continued to develop the clinical services strategy and future clinical models to improve patient pathways. A Memorandum of Understanding had been developed and approved for the ICS

The CE visited Northern Ireland as part of a learning set for new Chief Executives to gain an understanding and appreciation of their health and care system and the journey they had taken to transform services and leadership. A reciprocal visit had been offered;

An extra £200 million has been announced for new cancer testing and detection technology and the Trust was one of 78 Trusts that would benefit from this funding. New machines would improve screening and early diagnosis of cancer and funding would be made available over the next two years to replace, refurbish and upgrade CT and MRI scanners;

Engagement events had taken place throughout November to listen to midwifery staff on the future of midwifery-led and maternity services;

An event was held on 20 November hosted by Richard Barker, North East and Yorkshire Regional Director which explored the sharing of good practice as well as discussions on the current strategic and operational challenges facing NHS Leaders across the North East and Yorkshire.

Following a query from JE, the CE reported that the healthcare system in Northern Ireland was very different to the one in England but nevertheless, should the team from Northern Ireland accept the invitation of a reciprocal visit, a seminar would be arranged to include the Board, neighbouring Trusts and Local Authority colleagues to gain an understanding and to learn lessons for the future of health and social care.

Resolved: (i) that, the content of the report and the pursuance of strategic

objectives be noted; and (ii) that, a seminar be arranged for the Board, neighbouring Trusts and

Local Authority colleagues to discuss the way forward in health and social care should the team from Northern Ireland accept the invitation of a reciprocal visit.

BoD/4126 Nursing and Midwifery, Medical and Dental Workforce Report The CN/DoPS&Q presented the Nursing, Midwifery, Medical and Dental Workforce Report providing an overview of current nursing and midwifery staffing and recruitment activity

3

across the organisation to support safe staffing. In addition, the CN/DoPS&Q provided an update on current workforce by Care Group, identifying areas where staffing establishment may require further review in line with the business planning process taking place throughout 2019/20 for 2020/21. In October, there were approximately 30 whole time equivalent (wte) Registered Nurse (RN) vacancies and no registered midwifery vacancies. A review of current nursing and midwifery staffing had been undertaken within all ward areas and demonstrated that all services had the required nurse and midwifery staffing levels to provide safe patient care. All red rules were being adhered to. The Trust continued to undertake a number of recruitment initiatives including use of social media platforms and recruitment centres and continued to plan and take forward retention strategies for all staff groups. A review of the Allied Health Professional workforce had been undertaken and vacancies were being actively managed. The Trust remained in the lowest quartile in the country for agency spend. The MD/DCE provided an overview in respect to the medical and dental workforce position highlighting a number of challenges and initiatives being taken forward to address these. There were currently 527.69 whole time equivalent (WTE) clinical staff in post with a 17.41 WTE shortfall against establishment. In order to recruit to consultant vacancies, a number of areas were targeting trainees approaching completion of their specialist training. The overall medical and dental sickness absence rate for April to September 2019 was 1.44%, below the target of 3.5%. A total of £210k was spent on agency locums between April and September 2019, a reduction of £67k when compared to the same period the previous year and a continual reduction over the last five years. There were a number of challenges in regard to medical staff appointments particularly within Anaesthetics, Urology, Emergency Care, Haematology, and Histopathology. The MD reported that since the introduction of the new contract for doctors in training in August 2016, further addendums had been agreed in October 2019 which included an increase to weekend and night shift pay, additional rest break conditions and annual pay uplifts. The Trust had developed an interactive exception reporting dashboard which was presented and discussed at the quarterly forum and educational meetings. The majority of exceptions were related to working beyond contracted hours, time in lieu was given on most occasions. Further work was underway to understand and explore solutions to barriers within working time across the organisation. The CN/DoPS&Q requested that the timing of this bi-yearly report be moved to January and July to fit in with the business planning round. JE sought clarity on how consistency of professional judgement was achieved and the CN/DoPS&Q explained that this was managed by Ward Matrons supported by senior nursing staff. In response to a query raised by KR, the CN/DoPS&Q explained that the appropriateness of up-skilling of staff was continually monitored and supported by senior nursing colleagues and consultants.

Resolved: (i) that, the work undertaken to date in reviewing the nursing,

midwifery, AHP and medical staffing levels across the organisation be noted; and

(ii) that, the significant sustained progress and success in relation to

4

workforce recruitment and retention be noted; and (iii) that, the focus on valuing staffing through recruitment and retention

processes and in supporting ongoing development of the workforcebe noted; and

(iv) that, the timing of the Nursing and Midwifery, Medical and DentalWorkforce biyearly report be moved to January and July to fit in withthe business planning round and to support winter planning.

BoD/4127 Integrated Compliance and Performance Report

The DoP&P presented the Integrated Compliance and Performance Report for the month of October 2019. Key points were: -

Single Oversight Framework: Overall the Trust had performed relatively well againstnational and local indicators achieving compliance against most key standards,though pressures remained around the 62-day cancer standard. The RTT positionhad improved when compared to September. Pathway issues regarding the 62-daycancer standard continued to be addressed, to provide context it was noted that onlyone Trust regionally had achieved the standard. The non-obstetric Diagnosticcapacity issues had been addressed and the back-log reduced by over 50%, and itwas anticipated that the 6 week 99% diagnostic standard would be achieved inQuarter 3; Emergency activity across the organisation had seen an increase of4.95% compared to the same period the previous year. 26.51% of total emergencyadmissions were treated via Ambulatory Care. The Trust continued to test revisedemergency care standards with addition measures being added.

Operational Efficiency and Productivity Standards: Improvement was noted againstDTOC reporting the lowest position this year and super stranded recovering theposition and bringing the Trust back into alignment with the revised trajectory of 64by March 2020. Although improved, Outpatient DNA’s and Readmissions remained akey area of focus in 2019/20, supported by robust project management andmitigating action plan.

Quality and Safety: Largely positive performance against a number of key indicatorsincluding HSMR/SHMI and Dementia Standards. Five Trust attributed cases ofClostridium Difficile was reported in October, taking the total cases to 37 against atrajectory of 32 by the end of October. The Trust was reporting 15 stage 3complaints for October, showing an increase when compared to September, howeverremained within trajectory. When compared against September 2018, this haddecreased from 28 to 15. An expected rise in the number of stage 1 complaints wasseen following Ward Matrons being encouraged to ensure these concerns werecaptured and reported. Reporting of level 1 and 2 pressures ulcers had increasedfollowing implementation of a pilot on 2 inpatient areas which included enhancededucation sessions. All grades of pressure ulcers and falls remain within tolerance.

Workforce: Sickness absence remained the key pressure reporting at 4.15% inSeptember, however this showed a slight improvement when compared to theprevious month but remained above the revised Trust target of 4%. Long term sickreported at 2.47% compared to 2.9% the previous month.‘Anxiety/stress/depression/other psychiatric illnesses’ remained the most prevalentreason of absence. There was a continued focus to understand the underlyingreasons of absence and proactive means to prevent absence where possible.Turnover and attrition rates remained within expected levels. Mandatory training andappraisal compliance was 87% and 86% respectively, remaining static. The numberof active volunteers with the Trust was 346 contributing c.847 hours per week.Recruitment remained positive and the ‘Home but not Alone’ project continued to be

5

piloted on Wards 26/27 and the EAU with plans to roll out further in due course. Volunteers would be fully utilised to support clinical areas during winter pressures.

Financial position: The year to date Group position at Month 7 was a surplus £2.2mcompared to a planned deficit of (£0.4m), therefore the Trust was £2.6m ahead ofplan. The Trust was forecasting to deliver its CIP plans for 2019/20. Cash levelsstood at £20.1m at the end of October. Creditor metrics had improved in recentmonths and operational issues had reduced substantially consequently. Similarly,debtor performance had improved.

The Chairman noted and raised concerns in respect to theatre productivity with the percentage of late starts and early finishes increasing. The DoP&P and the COO explained that this was closely monitored to ensure that no trends were evident and that a deep dive was being undertaken with robust challenging.

Following a query from the Chairman, the CN/DOPS&Q reported that norovirus prevalent in the community was not currently having a major impact upon the Trust though it planned for such events through winter planning.

Resolved: (i) that, the performance against the key operational, quality, finance and workforce standards during October be noted;

(ii) that, the on-going financial pressures be recognised, however with apositive month 7 position against plan; and

(iii) that, the on-going operational performance and system risks toregulatory key performance indicators and the intense mitigationwork that is being undertaken to address these going forward beacknowledged; and

(iv) that, the Trusts on-going participation as a pilot site testing the newproposed access standards and continuation of this throughout thewinter period be noted.

BoD/4128 Emergency Preparedness, Resilience and Response Annual Report 2018/19

The DoP&P presented the Emergency Preparedness, Resilience and Response Annual Report 2018/19 providing the Board with an update of EPRR activities. This formed part of the evidence that the EPRR core standards were being met and that the Trust complied with its statutory emergency planning duties. Assurance was provided in respect of emergency preparedness and business continuity within the Trust.

The Chairman reported that KR had joined the Trust’s Resilience Forum.

Resolved: (i) that, the content of the Annual Report be noted; and (ii) that, assurance be gained of the robust plans in place to comply with

the Trusts legislative responsibilities regarding EmergencyPreparedness, Resilience and Response.

BoD/4129 Winter and Operational Assurance

The DoP&P provided an overview of the 2019/20 Winter Plan providing additional assurance to the Board that the organisation had a robust plan to address the anticipated pressures within the system resource constraints, highlighting the key operational initiatives to manage winter.

RT asked for clarity around OPEL grading and how the Trust were currently reporting. The DoP&P explained the grading system and reported that the Trust were currently reporting a

6

high level 2 OPEL. There had been significant pressures over the past week, particularly with occupancy over the past couple of days. The CE added that a quality summit was scheduled for the beginning of December but that she was not assured that there was resilience across the patch.

Resolved: that, the 2019/20 Winter Plan be received.

BoD/4130 Any Other Notified Business

a. Healthcare User Group (HUG) Visits

The Healthcare User Group representative provided an overview of the visits that had been undertaken by the Healthcare User Group since the last meeting, which had included Wards 40 and 42. Both wards were very busy with positive comments made by staff, visitors and patients. It was noted that there was a high number of dementia patients, particularly on Ward 42. A complaint around the cost of the TV system was made by a family on Ward 40.

b. Change to Board meetings

Following a brief discussion, it was agreed that the format for Board meetings would change in 2020. Meetings would start in the morning with the In-Committee and Group Board followed by the public board meeting starting at 1 pm.

Resolved: (i) that, the verbal updates be noted; and (ii) that, arrangements be made to change the timings of Board

meetings in 2020.

BoD/4131 Date and Time of Next Meeting

Resolved: that, the next meeting be held on Thursday, 30 January 202 at 1.00 pm in the Boardroom, University Hospital of North Tees.

BoD/4132 Exclusion of Press and Public

Resolved: that, representatives of the press and other members of the public be excluded for the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section 1(2), Public Bodies (Admission to Meetings) Act 1960).

The meeting closed at 2:15 pm

Signed: Date: 30 January 2020

1

Board of Directors

Date: 28 November 2019

Prepared by: Julie Gillon, Chief Executive Barbara Bright, Director of Corporate Affairs and Chief of Staff

Executive Sponsor: Julie Gillon, Chief Executive

Purpose of the report This purpose of the report is to provide information to the Board of Directors on key local, regional and national issues.

Action required: Approve Assurance Discuss X Information X

Strategic Objectives supported by this paper:

Putting Patients First

X Valuing our People

X Transforming our Services

X Health and Wellbeing

X

Which CQC Standards apply to this report

Safe X Caring X Effective X Responsive X Well Led

X

Executive Summary and the key issues for consideration/ decision:

The report provides an overview of the health related news and issues that feature at a national, regional and local level from the main statutory and regulatory organisations of NHS Improvement, NHS England, Care Quality Commission and the Department of Health and Social Care.

In addition, information is provided on strategic delivery and positioning and operational issues not covered elsewhere in the agenda.

Key issues for information:

Integrated Care System/Integrated Care (ICS/ICP) Partnership Update

NHS Confederation Study

General Election Purdah considerations Population Health Management

Diagnostic Funding Success

Getting it Right First Time visits

New online registration service for expectant mothers

VIP Visits

COPD Specialist has research paper published Clinical Waste management

Maternity Focus

Performance, A&E and Quality Summit

North East and Yorkshire Leadership Event

How this report impacts on current risks or highlights new risks:

Consideration will be given to the information contained within this report as to the potential impact on existing or new risks.

Committees/groups where this item has been discussed

Items contained in this report will be discussed at Executive Team and other relevant Committees within the governance structure to ensure consideration for strategic intent and delivery.

Recommendation

The Board of Directors is asked to receive and note the content of this report and the pursuance of strategic objectives.

2


Meeting of the Board of Directors

28 November 2019

Report of the Chief Executive 1. Introduction

This report provides information to the Board of Directors on key local, regional and national issues. In addition, information is provided on strategic delivery and positioning and operational issues not covered elsewhere on the agenda.

2. Key Issues and Planned Actions

2.1 Integrated Care System/Integrated Care (ICS/ICP) Partnership Update

The ICS continues to make progress across all six work streams with some key updates as follows:

The Radiology Network has made a number of recommendations in order to develop an imaging workforce strategy;

As part of the Interim People Plan the ICS has been selected as one of the eight areas nationally to test the delivery and readiness of the workforce planning tool;

The roll out has commenced of the digital imaging for Pathology infrastructure, which will allow the regional Pathology expertise, spread across the NENC, to be utilised more effectively providing the ability to work more flexibly.

On 29 October 2019 the Trust was visited by the (ICS) roadshow bus, part of a system-wide drive to gain feedback from key stakeholders. NHSI/E have now approved the proposed models for a single CCG across Durham and, a single CCG across Hartlepool, Stockton and Darlington. Hambleton, Richmond and Whitby will move to the Humber Coast and Vale ICS. Further streamlined commissioning structures are being considered across ICP functions.

In respect to the Tees Valley Integration and Transformation Programme work continues on the four key work streams. Further discussions have been held with clinicians in order to focus on the development of the Managed Clinical Network (MCN), specifically for Urgent and Emergency Care; Women & Children’s services; and Stroke.

A report on Organisational Form is under development for presentation to each of the provider Trust Boards in the Tees Valley Health and Care Partnership. This will have a clear focus on a Group Structure Model with the maintenance of both Board and Executive teams within each provider organisation. This model will continue to support and underpin collaborative working.

The NENC region has been successful in the second cohort of the Yale Leadership programme, concentrating on “Using Education to Prepare the Clinical workforce to deliver the digital future”.

2.2 NHS Confederation Study

2.2.1 Study Visit to Northern Ireland

The NHS Confederation working with NHS England has established a learning set for new Chief Executives, supported by Stephen Dalton, former Chief Executive of the NHS Confederation. As a member of the learning set, I was part of a visit to Northern Ireland, to gain an understanding and appreciation of their health and care system and the journey they have undertaken to transform services and leadership, this will lead to potential opportunities for engagement/ learning for new/ aspiring chief executives in Northern Ireland. 2.2.2 ICS Meeting A regional meeting was held on 21 October 2019 facilitated by the NHS Confederation to look at the future of the ICS and how the Confederation can assist with maturity.

3

2.2.3 Meeting with Regional Engagement Lead, North East and Yorkshire Further work will be ongoing with the Regional Engagement Lead to feed into the local and regional network on a provider collaborative model, population health and prevention, alternative financial frameworks, women in leadership and system leadership.

2.3 General Election Purdah considerations

Due to the General Election taking place on 12 December 2019, the Board of Directors should be aware of the pre-election ‘purdah’ period. The ‘purdah’ period commenced on 6 November 2019 with the dissolution of Parliament and will officially apply until the day following the general election.

2.4 Population Health Management

The Trust has championed a collective, collaborative response to the challenges of population health in the last 6-9 months. Following a ‘local summit’ held earlier this year with Directors of Public Health from Hartlepool and Stockton-on-Tees Local Authorities, representatives from the Clinical Commissioning Group (CCG) and senior staff from the Trust, a ‘Wider Prevention’ workshop was developed taking place on 14 November in Hartlepool. Over 30 key stakeholders convened to discuss how best to tackle obesity, alcohol and smoking within the localities via a systems based approach to contribute towards narrowing the gap in health inequalities across Stockton and Hartlepool and surrounding areas with key contributions from the Directors of Public Health and the Trust’s Medical Director.

The workshop culminated with agreement to move forward with the development of work plans covering the next 30/60/90 days, with organisations and stakeholders committing to key actions and reports planned to the Health and Wellbeing Boards in both localities. The Trust will continue its internal focus on population health management via data modeling to identify and map cohorts of need in partnership with public health colleagues. Dr Peter Acheson, Trust Consultant in Public Health and Dr Hayley Coleman, Trust Registrar in Public Health will continue to co-ordinate this work on behalf of the Trust.

2.5 Diagnostic Funding Success

An extra £200 million has been announced for new cancer testing and detection technology and the Trust is one of 78 trusts that will benefit from this funding. New machines will improve screening and early diagnosis of cancer, and are part of the government’s commitment to ensure 55,000 more people survive cancer each year. The funding will be made available over the next 2 years to replace, refurbish and upgrade CT and MRI scanners – bringing in alternatives with lower radiation levels and breast screening imaging and assessment equipment.

The Trust is in the process of securing allocated funding for new machines based on an assessment of local infrastructure and local population need. This will contribute to the NHS Long Term Plan’s goal of catching three-quarters of all cancers earlier when they are easier to treat.

2.6 Getting it Right First Time visits

A number of visits have taken place across the Trust by the Getting it Right First Time (GIRFT) team including; Acute Medicine, Geriatric Medicine and Spinal services. 2.7 New online registration service for expectant mothers

The Trust implemented a new online pregnancy registration form aimed at further enhancing the care for all women booked to deliver their baby within the Trust. By collecting simple details this enables the right care pathway to be quickly planned and a midwife allocated to deliver the service the woman and her family needs from an early stage.

4

2.8 VIP Visits

Daniel Hartley, Director of Workforce and Organisation NHSI/E, North East and Yorkshire, visited the Trust in October to hear about the innovative approaches to workforce planning, staff engagement, care home training and clinical simulation. Staff from several departments met with Daniel and showcased their work which was very positively received. Daniel gave particular praise to the Trust for engaging with over 1,400 people to develop the CARE acronym and associated customer care charter linked to the Trusts vision and strategic direction. This was a very positive visit which highlighted some of the excellent workforce initiatives in place in the Trust. It was recommended that such initiatives should be put forward for external recognition, which the Trust intends to do so, starting with the collaborative care home work and employee engagement initiatives.

2.9 COPD Specialist has research paper published

Caroline Fernandes-James, a health care professional working in the Healthy Lives Care Group has presented research on Chronic Obstructive Pulmonary Disease (COPD) and pulmonary rehabilitation engagement at the World Contextual Behavioural Science conference, Dublin 2019.

2.10 Management of Clinical Waste across the Health Sector A letter has been received from Simon Corben newly appointed Senior Responsible Officer for clinical waste across the NHS advising NHS Trusts to concentrate on their duty of care around the following; ensuring there is a competent waste manager in place, waste segregation, annual pre-acceptance audits, accurate data and record keeping and removal of plastics from high temperature incineration, with the environment agency commencing inspection of NHS sites from early 2020. 2.11 Maternity Focus Engagement events have occurred throughout November to listen to midwifery staff on the Future of Midwifery Led and Maternity Services, with a specific focus on locality planning, delivering Better Births requirement, revisiting the role of the Local Maternity Services and encompassing the Long Term Plan objectives and future planning. 2.12 Performance, A&E and Quality Summit At the beginning of this winter period it is reported A&E and Emergency Care Performance is suffering on the back of increased demand and seasonal pressures across the NHS and Social Care. A Regional A&E summit was held on 8 November 2019 and a further quality summit will be held on 5 December 2019 to discuss route cause analyses and further collaborative work going forward into winter.

2.13 NE and Yorkshire Leadership Event An event was held on 20 November hosted by Richard Barker, North East and Yorkshire Regional Director which explored the sharing of good practice as well as discussing current strategic and operational challenges facing NHS Leaders across the North East and Yorkshire.

3. Recommendations

The Board of Directors is asked to note the content of this report and the pursuance of strategic objectives.

Julie Gillon Chief Executive

Board of Directors

Title of report: Nursing, Midwifery, Medical and Dental Workforce Report


Prepared by: Emma Roberts, Care Group 2, Adam Ruddock Temporary Staffing Manager Matt Wynne, Care Group 1

Executive Sponsor: Julie Lane, Chief Nurse/Director of Patient Safety & Quality Deepak Dwarakanath, Medical Director

Purpose of the report

The report is the bi annual review of the clinical workforce and seeks to:

Inform the Board of the work and progress to date relating to recruitment and retention of clinical staff across the organisation.

Inform the Board of the current vacancies within, nursing. Midwifery, Allied Health professional and medical staff

Inform the Board of the work and progress to date to reduce the use of temporary bank and agency staff,

Inform the Board of the work and progress to date relating to the management of safe staffing across the nursing and midwifery workforce.

Provide an update of current workforce by Care Group; identify areas where staffing establishment may require further review in line with the business planning process taking place throughout 2019/20

Action required: Approve Assurance x Discuss Information x



x Valuing our People

x Transforming our Services



Safe x Caring x Effective x Responsive x Well Led

x


In October 2018 NHSI published ‘Developing workforce safeguards – supporting providers to deliver high quality care through safe and effective staffing’ which aims to support organisations to use best practice in effective staff deployment and workforce planning. NHS Improvement (NHSI) will now assess Trusts compliance with the ‘triangulated’ approach to deciding safe staffing requirements set within NQB guidance. Combining evidence based tools, professional judgement and outcomes to ensure the right staff with the right skills are in the right place at the right time. Compliance will be assessed using information collected through the single oversight framework (SOF) and the workforce statements within their annual governance statement to ensure that Trust Boards can be assured that workforce decisions are evidenced based and comply fully with Care Quality Commission (CQC) fundamental standards. A review of current nursing and midwifery staffing has been undertaken within all wards areas and demonstrates a nurse to bed ratio of one nurse per bed as a minimum within the ward’s current budgeted establishment.

All services have the required nurse and midwifery staffing levels to provide safe patient care. Alternative staffing models have been developed using activity work follows and developing skills matrix to ensure a robust evidence base is in place.

Registered nurse, Registered Midwifery and un-registered Nurse recruitment centres have continued to be successful in reducing vacancy rates throughout the year. The Trust continues to plan and take forward retention strategies for all staff groups. A review of the Allied Health Professional workforce has been undertaken and vacancies are being actively managed. There are a number of challenges in regard to medical staff appointments particularly within Anaesthetics, Urology, Emergency Care, Haematology, and Histopathology. A number of recruitment initiatives and service reviews are being undertaken to help address the challenges.


Provides assurances that nursing, midwifery and Allied Health Professional safe staffing is in place to enable delivery of safe care to our patients and that there is ongoing monitoring Highlights areas of risk in terms of medical staffing challenges in specific speciality areas.


N/a

Recommendation

The Board of Directors is asked to:

note the work undertaken to date in relation to nursing, midwifery, AHP and medical staffing;

note the significant sustained progress and success in relation to workforce recruitment and retention; and

note the focus on valuing staffing through recruitment and retention processes and in supporting ongoing development of the workforce.

1



28 November 2019

Nursing, Midwifery, Medical and Dental Workforce Report

Report of the Chief Nurse/Director of Patient Safety and Quality and the Medical Director

Strategic Aim Putting patients first.

1. Introduction

1.1 In June 2018, NHS Improvement (NHSI) and the National Quality Board (NQB) published improvement resources in a bid to standardise safe, sustainable and productive staffing decisions within departments and specialities.

1.2 In October 2018 NHSI published ‘Developing workforce safeguards – supporting

providers to deliver high quality care through safe and effective staffing’ which aims to support organisations to use best practice in effective staff deployment and workforce planning using 14 clear recommendations.

1.3 NHS Improvement (NHSI) will now assess Trusts compliance with the ‘triangulated’

approach to deciding safe staffing requirements set within NQB guidance. Combining evidence based tools, professional judgement and outcomes to ensure the right staff with the right skills are in the right place at the right time. Compliance will be assessed using information collected through the single oversight framework (SOF) and the workforce statements within their annual governance statement to ensure that Trust Boards can be assured that workforce decisions are evidenced based and comply fully with Care Quality Commission (CQC) fundamental standards.

1.4 NHSI recognise the need for a more consistent approach to safe staffing levels

across all clinical workforce groups, a clear focus on developing evidence based tools for assessing the impact of variation in patient acuity and dependency. Guidance from NHSI published in 2018 (Developing Workforce Safeguards) urges senior leaders to consider Trusts wider culture in leadership.

2. Purpose 2.1 The purpose of this report is to;

Provide an overview of the current nursing and midwifery workforce position across the organisation.

Provide an overview of the current Allied Healthcare Professionals (AHPs) workforce position across the organisation and to detail some of the current initiatives.

Provide an overview of medical staffing across the organisation

Inform the Board of the work and progress to date relating to the recruitment of the registered and unregistered nursing and midwifery workforce.

2

Inform the Board of the work and progress to date relating to the, up-skilling and retention of substantive staff.

Inform the Board of the work and progress to date to reduce the use of temporary bank and agency staff,

Inform the Board of the work and progress to date relating to electronic rostering and Safe Care Live (SCL) in the management of safe staffing across the nursing and midwifery workforce.

Provide an update of current workforce by Care Group; identify areas where staffing establishment may require further review in line with the business planning process taking place throughout 2019/20.

3. Nursing and Midwifery staffing 3.1 The Trust bases staffing establishments on the case mix and acuity of the patients

within the wards or departments and utilises the Trusts preferred nursing and workforce tool, the Safer Nursing Care Tool (SNCT). This tool is overlaid with professional judgement and quality outcome metrics. The Trust’s nursing workforce tool focuses on patient safety, quality, cost effectiveness and effectively managing staffing resources and is based on a Care Hours per Patient Day CHPPD which reflects patient needs.

3.2 In response to the need to remain flexible in the way nursing and midwifery staffing is

planned the Trust uses the Safe Care Live module (SCL) on a day to day basis to safely and efficiently assess accurate staffing levels and to redeploy nursing staff throughout the organisation.

3.3 SCL provides information on a shift by shift basis for each unit (ward/department)

which includes whether there is an under or over utilisation of staff, the overall percentage of temporary staff working that shift, the detail of any unfilled shifts, the calculated nurse to patient ratio, CHPPD and skill mix. The data within Safe Care Live is currently validated on a daily basis at the morning Trust wide safe staffing meeting although this process is being revisited with the support of NHSI to provide a more structured approach to this validation.

3.4 A small number of areas within the Trust utilise bespoke nationally recognised tools

combined with overarching professional judgement to identify their staffing needs including Birth Rate Plus (BR+) in maternity and the British Association of Perinatal Medicine (BAPM) Standards in the Special Care Baby Unit (SCBU).

3.5 All inpatient areas adhere to the agreed red rules (appendix 3) which include a

minimum of two Registered Nurses on inpatient areas at all times. Red rules have been developed in line with National Institute for Care Excellence (NICE) guidance for safe staffing which was published in 2014.

4. Overall Current Nursing and Midwifery Workforce Position 4.1 Vacancy level – In October 2019 there are approx. 30 whole time equivalent (wte)

Registered Nurse (RN) vacancies and zero Registered Midwife (RM) vacancies. RN vacancies have increased due to planned retirement within the In Hospital Care wards. These vacancies are presented in table 1 with over all budgeted establishment in wte and an overall percentage of the budgeted workforce.

3

Table 1 4.2 Occupancy level – The occupancy rates from April 2019 to September 2019

(inclusive of surge beds) can be seen in table 2. Table 2

Bed Occupancy % by month

2019 / 04 2019 / 05 2019 / 06 2019 / 07 2019 / 08 2019 / 09

88.80% 90.09% 91.14% 90.59% 89.48% 90.81%

4.3 Registered and Un-registered nurse sickness level - Registered nurse sickness

levels remain above the Trust target of 3.5%. Overall registered nursing and midwifery levels from April 2019 to September 2019 have been presented table 3.

Table 3

Trust

Staff Group Apr19 May19 Jun19 Jul19 Aug19 Sep19

HCA's 7.25% 7.27% 7.26% 7.68% 7.73% 6.58%

Midwives 5.38% 7.36% 5.06% 3.74% 4.65% 2.88%

Nurses 4.68% 5.76% 5.33% 4.43% 4.45% 4.07%

Grand Total 5.47% 6.30% 5.88% 5.35% 5.44% 4.75%

*Nursing & Midwifery 4.74% 5.90% 5.31% 4.37% 4.46% 3.96% 4.4 Registered Nursing turnover – Registered Nurse turnover levels as a percentage

of the over all headcount from April 2019 to September 2019 can be found in table 4. Table 4

Trust

Category Apr19 May19 Jun19 Jul19 Aug19 Sep19

Voluntary 8.45% 8.63% 8.54% 8.84% 9.21% 9.25%

Involuntary 2.42% 2.55% 2.56% 2.64% 2.72% 1.32%

Combined 10.87% 11.18% 11.10% 11.47% 11.93% 10.57%

5. Registered and Unregistered Fill Rates 5.1 In line with the National Quality Board (NQB) publication, nursing, midwifery and care

staffing capacity and capability the Trust continues to report the planned and actual staffing data on a monthly basis to NHSI.

5.2 Planned and actual staffing data for September 2019 and October 2019 can be found

in appendix 1 and 2.

End October 2019 RN vacancy wte Vacancy % of workforce

Registered Nursing 30wte 2.25%

Registered Midwifery 0wte 0%

4

5.3 The National Institute of Clinical Excellence (NICE) guidance (appendix 3 identifies a number of red flags which would raise an alert including less than two RNs on duty and a Nurse to bed ratio of <1.0.

5.4 Safe Care Live (SCL) allows the Trust to generate both a required and an actual

CHPPD for all inpatient areas three times per day. This gives a more accurate reflection of staff allocation and staff to patient ratios across a 24 hour period (appendix 4)

6. Nurse and Midwifery Recruitment

6.1 The Trust continues to undertake a number of recruitment initiatives with the aim to see a further increase in both the registered and unregistered nurse establishment across the organisation.

6.2 Frequent use of social media platforms provides information to the public around

vacancies and opportunities within the Trust with a particular focus on promoting the Trust as the employer of choice.

6.3 All band 5 Registered Nurse recruitment continues to be carried out via value based

recruitment centres and this method has proven to be a positive way of attracting pre-registered and registered nurses to the Trust.

6.4 A successful candidate reserve provides a pool of staff awaiting posts in specific

areas/specialities. There are approximately 15-20 nurses in the successful candidate pool and many have taken up interim posts in other wards/departments until their preferred area of work declares a vacancy.

6.5 The Trust is now using the recruitment centre process for the recruitment of

unregistered nursing staff and registered midwifery staff.

6.6 Graph 1 presents the total registered nursing and midwifery vacancy level from November 2017 through to October 2019. A consistent reduction can be clearly seen which supports the success of the recruitment centre approach. An increase in vacancies in July 2019 was due to planned retirement within the In Hospital Care directorate.

6.7 Significant work has taken place to generate an increase attractiveness of some

clinical areas that have recently had increased vacancy levels. Some of these initiatives will be discussed within this paper and the vacancy rate is now seen to be reducing again with successful recruitment in October 2019 a number of which will commence in the organisation in January 2020.

5

Graph 1

6.8 The modern apprentice (MA) programme remains within the organisation as part of

the Trusts strategy to employ future unregistered nurses who have a clear career pathway to access Pre Registration Nursing. Two MAs from recent cohorts have secured places to study for nursing degrees in a local University and there are currently seven MAs in practice.

6.9 This Trust now has a significant number of unregistered nursing staff completing the

Foundation Degree for Assistant Practitioners (APs) using the Apprenticeship Levy. 6.10 10wte Trainee Nursing Associates have successfully completed a two-year pilot

Foundation Degree programme with Health Education England (HEE) and Teesside University. The Nursing Associates are regulated by the Nursing and Midwifery Council (NMC).

6.11 There are currently fifteen Nursing Associate Apprentices in practice with plans for

future cohorts, based on workforce plans. These posts will enhance and support the care provided by Registered Nurses.

6.12 There are currently 16 student Advanced Clinical Practitioners studying the MSc in

Advanced Practice and a further six candidates have been identified for 2020. An Advanced Clinical Practitioner Co-ordinator has been appointed to provide support and guidance for these roles and is believed to be the first of this role in the Region.

6.13 The Trusts vision is to build the nursing workforce of the future and as such has

continuous links with local schools, colleges and Higher Educational Institutes to raise the profile of nursing.

7. Nurse Retention

7.1 Making the NHS the best place to work is a key commitment in both the Long Term Plan and the NHS People Plan. Recently NHS England and NHS Improvement published ‘Retaining our People, retention programme (October 2019) which aims to empower our leaders to provide greater development, flexibility and support options for staff which will all contribute to a more supportive working environment and will lead to a greater retention of staff.

6

7.3 The Faculty for Inter-professional Education and Staff Training (FINEST) commenced in 2017; The FINEST programme continues to offer six month posts for the duration of the nurses first year of employment within the Trust. In September 2019 a total of 12 nurses completed the FINEST programme with rotations across In Hospital Care, Elective Care and Emergency Care and Paediatric services.

7.4 Monthly registered nurse development days are being revised by the Heads of

Nursing and are planned to continue throughout 2020. There will be a continued focus on personal and professional development and the health and wellbeing of staff.

7.5 Clinical skills days for the registered nursing workforce promote continuous learning

and consolidation of essential core clinical skills. Core skills development days are now held monthly with an average of 35 band 5 registered nurses across all Care Groups attending the sessions that are now planned and delivered by the Education Department.

7.6 In 2018/19 The Emergency Care directorate successfully piloted an alternative

approach to the delivery of mandatory training to all staff new into post by developing a condensed training programme delivered in conjunction with preceptorship and local trust induction. Following this successful initiative, the Trust now provides new staff with a block week of mandatory training immediately following the block week of preceptorship training. This ensures that all staff new to the Trust are fully compliant with their mandatory training prior to commencing work in clinical practice.

7.7 Substantive nursing staff are supported to move across specialities within the Care

Groups and are also given the opportunity to discuss the options of more flexible contracts and rotational posts which aim to support staff in maintaining their work life balance and achieving their preferred skill sets.

7.8 In January 2020 there are plans to streamline this process by introducing a ‘transfer

window’ process whereby all staff will be given a number of opportunities across the year to apply for an internal transfer. The transfer windows will support offering fair and equitable opportunities for staff and will provide a more organised and structured process for the Care Groups to manage this process. The transfer window process will be trialled in Care Group 2 initially to establish the benefits.

7.8 Self rostering has been explored to support staff retention via the electronic rostering process. A pilot in the Urgent Care Centre has now been completed and evaluated well. Self rostering has now been rolled out into the Emergency Assessment Unit with positive feedback and is planned to be rolled out to other in patient areas within the Care Groups.

7.9 Developing our current and future leaders is a key priority of the Trust. In October 2018 NHSI published a ‘Ward leaders’ handbook’ which is a guide for those who aspire to be a ward leader, those already in post and for Trusts that want to support and develop this important role. Developing leaders and managers within the Care Groups is essential in ensuring a stable workforce for the future. Career pathways are currently being drafted and one of these pathways will support Registered Nurses moving into Matron and Deputy Matron posts.

7.10 Within Care Group 2 there is a significant focus on the personal and professional

development of staff. Registered nurses will have an individualised skills passport relating to the area they work. In addition, all new nurses taking up a post in the Care

7

Group will be placed onto a developmental pathway which will consist of a three year programme to support their learning needs.

8. Temporary Staffing Usage

8.1 The expenditure trends associated with temporary staffing have increased when compared with the same period in the previous financial year; however, the following mitigation can be applied;

10% increase in bank rates from April 2019 in line with agenda for change pay award

Increased agency rates in line with the increase in NHS Improvement price cap and framework compliance

Increase in activity year on year with the requirement for escalation beds and subsequent staffing.

8.2 Reductions in usage of agency continue to maintain the Trust’s leading position nationally for compliance to ensure the most cost effective safe staffing resource in clinical areas and maintain and improve quality and patient safety. Overall locum expenditure has reduced by £68k whereas agency, bank and overtime have increased.

8.3 Reductions in nursing agency costs continue to be due to reductions in the average monthly volume of agency shifts filled by Tier 3 agencies that attract the highest premium payment. Better use of resources and agency to bank migration has resulted in a month on month increase in bank costs whilst nursing agency costs have decreased cumulatively.

8.4 Analysis of the Model Hospital data highlights the Trust’s overall exceptional performance in agency cost reduction and use of resources. The Trust remains in the top 3 of all Trusts nationally for all temporary staffing metrics, highlights include;

Lowest quartile within national distribution for agency spend as a % of total staffing spend at 0.8%

Lowest provider Trust nationally for difference between actual spend vs. ceiling spend

Lowest provider Trust nationally for agency spend year to date

Lowest provider Trust nationally for average agency cost per shift.

9. Electronic rostering and Safe Care Live efficiencies

9.1 As part of the Lord Carter E-Rostering recommendations nursing rotas are now scheduled to be completed eight weeks in advance of the start date in line with the policy guidance of six to eight weeks. Some areas exceed this target lead time and the average is around six weeks lead time for ward-based nurses.

9.2 A significant roll out plan is in place to ensure that all clinical areas / teams are on

Health Roster by May 2020; this work is being coordinated by the E-rostering Manager and is currently 72% complete. This project commenced October 2018 and has resulted in an increase from 0% to 77% usage across AHP workforce, as well as significant progress in utilisation across all other staff groups.

9.3 The planned work is on target to reach Level 1 E-Rostering Level of Attainment by

May 2020 (NHSI target is April 2021), this requires at least 90% of the clinical workforce to be electronically rostered. Ward-based nurses are currently at Level 2

8

with a clear plan to attain level 3. All other staff groups are at Level 0, presented in table 6.

9.4 Flexible rostering is in use across Urgent Care Services and Emergency Assessment

Unit with significant time-saving implications for managers. Staff in these areas can now request 100% off-duty in line with agreed rules and restrictions for that area or team. Further roll out is being scoped on Ward 36 and Ward 38 in Quarter 4. The plan is to roll out further if this process continues to show efficiencies.

9.5 Regular budget and demand template reviews with Ward Matrons, Senior Clinical

Professionals (SCPs) and Finance Business Partners (FBPs) are undertaken to ensure available shifts in the system do not exceed planned budgeted establishment and that the available budget is used efficiently and effectively in areas where the template cannot be simply aligned to the budget.

9.6 The Safe Care Live (SCL) system has provided the platform for evidence-based decisions to be made when considering safe staffing levels in real time. Since project implementation in October 2017, 36 units are live with 24 units recording patient acuity. Currently, professional judgment is being applied within the system to ensure accuracy in the Care Hours per Patient Day (CHPPD) data and accurate documentation of rationale for the decisions made. 12 units do not record daily patient acuity as they are not in patient areas which are outwith the remit of the tool.

9.7 CHPPD data collected is now used to support decision making, workforce planning

and nursing establishment reviews. The data supplements clinical judgement and decision making relating to safe staffing.

9.8 The redeployment of substantive and temporary staff to ensure safe staffing in all areas has led to significant cost avoidance where high cost agency staff may have previously been requested. Graph 2 shows the estimated cost avoidance associated with redeployment of substantive staff each month; based on the assumption that the shifts would have otherwise been filled by agency workers at price cap, this is estimated at £956k since October 2017. Graph 2

10. Workforce Analysis

10.1 Effective workforce planning is vital to ensure appropriate levels and skills of staff are available to deliver safe, high quality care to patients and service users.

£0.00

£200,000.00

£400,000.00

£600,000.00

£800,000.00

£1,000,000.00

£1,200,000.00

Oct

-17

N

ov-

17

D

ec-

17

Ja

n-1

8

Feb

-18

M

ar-

18

A

pr-

18

M

ay-

18

Ju

n-1

8

Jul-

18

A

ug-

18

Se

p-1

8

Oct

-18

N

ov-

18

D

ec-

18

Ja

n-1

9

Feb

-19

M

ar-

19

A

pr-

19

M

ay-

19

Ju

n-1

9

Jul-

19

A

ug-

19

Se

p-1

9

Oct

-19

(*

)

Cumulative Cost Avoidance Total

9

10.2 NHSI recommendations set out in ‘developing workforce safeguards’ (October 2018)

state that Trust’s annual planning must support effective workforce planning and this includes monthly returns to identify the Trust’s progress and inform the wider strategic workforce plans. The workforce planning process is planned for November 2019 within each Care Group and will be structured in conjunction with Care Group Directors and Managers, Heads of Nursing, Service Leads, Senior Clinical Professionals, Workforce Business Partners and Finance Business Partners A structured approach to this work will ensure a continuous review of workforce plans.

11. Care Hours per Patient Day 11.1 CHPPD reported both in SCL and via the unify data to NHSI for the months of

September 2019 and October 2019 can be found in appendix 4 and appendix 5. Any Care Group specific data will be presented by exception within the workforce analysis and will be supported with relevant narrative to apply further context to the data.

12. Care Group 1 (Healthy Lives) - Holdforth Unit 12.1 Following on from the workforce review carried out in May 2019, the Holdforth Unit

now comprises of 16 inpatient beds and a community hub.

12.2 The Holdforth Unit has 1.16wte RN vacancy. 12.3 The Holdforth Unit has a nurse to bed ratio of one nurse per bed as a minimum within

the ward’s current budgeted establishment. 12.4 The Holdforth Unit are currently planning to incorporate new roles into their current

workforce model, especially in line with the new community hub. This will enable a more flexible workforce to support with tasks such as clinical assessment and prescribing within the hub.

13. Care Group 1 (Healthy Lives) - Out of Hospital Care 13.1 The District nursing team manage and maintain the care of individuals in their own

homes or residential care homes providing complex care for patients including wound care management, continence care and palliative care and provide support to families and carers.

13.2 Due to recent recruitment via the recruitment centres there is currently a 1wte RN

vacancy which is a fixed term post. The current establishment is able to meet the demands of care delivery.

13.3 Rapid response is a crisis intervention team to prevent hospital admission or facilitate

early discharge providing health and social care including administration of intravenous antibiotics and utilisation of specific pathways. The Rapid Response services currently have 1wte band 6, registered nurse vacancy.

13.4 The community nursing services has an effective workforce model that meets the

demands of the service. 13.5 Throughout 2019 there has been significant consideration to the age profile across

adult nursing workforce and the required succession planning to retain skills and expertise within the services, especially those which deliver expert intervention.

10

14. Care Group 1 (Healthy Lives) - Specialist Palliative Care Team (SPCT) 14.1 The SPCT delivers specialist palliative care advice and support to patients and

professionals in both their own homes and hospital settings. 14.2 As part of the current workforce review process the Care Group are planning to

review the SPCT staffing model to strengthen resilience across the service.

15. Care Group 1 (Healthy Lives) - Out Patients Departments 15.1 As part of the initiative to transform outpatients and in line with the Out Patients

Delivering Productivity Programme (DPP), a comprehensive review of the existing workforce was carried out in January 2019.

15.2 Following the nursing workforce review that took place in January 2019; the Out

Patients Department now has an effective workforce model that meets the demands of the service. An Out Patients Implementation Manager has recently been recruited in order to drive forward the initiatives associated with the productivity plan which includes the nursing workforce.

16. Care Group 1 (Healthy Lives) - Women and Children’s Services

16.1 Women and Children’s Services consists of Maternity, Obstetrics, Gynaecology Outpatient, Paediatrics and Special Care. Currently there are zero paediatric registered nurse vacancies and zero registered midwife vacancies based on current budgeted establishment.

16.2 Maternity utilise Birthrate plus (BR+) which is a nationally recognised tool for

maternity services based on the number of deliveries and ante natal and post natal care requirements. Birthrate plus analysis was last undertaken in 2015 and has recently been revisited during February to April 2019. Formal results from this data analysis have provided recommendation to increase the midwifery establishment, with the opportunity to skill mix within certain areas within the postnatal ward area for 2019/20.

16.3 The Directorate at this time has successfully recruited to 4.6wte vacancies; these posts are to cover recent vacancies within the agreed budgeted establishment. However, despite this recruitment there remained a concern that BR+ 2019 would identify a need for an increase in staffing establishment.

16.4 On this basis a recruitment strategy was developed which identified a requirement to increase by 7wte Registered pending the outcome of the BR+ review. The 7wte were successfully recruited to in July 2019 and new starters commenced October 2019.

16.5 Following on from the presentation of the workforce plans at Strategic Workforce Group and the recommendations from Birth Rate plus 2019 there are plans to look at a workforce model which includes adult registered nurses and Band 3 Maternity Assistants who could potentially care for post-partum post-surgery mothers and transitional care within the postnatal ward.

16.6 The Paediatric Day Unit at the University Hospital of Hartlepool continues to provide pre and post-operative services for children undergoing elective surgery. Staff are rotated across the department creating flexibility in the staffing across Inpatient, Assessment Unit and Out Patient services.

11

16.7 Following changes within neonatal services the trust now provides a special care baby unit level 1 service. Staffing continues to be based on the British Association of Perinatal Standards (BAPM) at an 80% occupancy level which is one nurse to four babies within a Special Care Baby Unit. BAPM is not routinely met as there is no supernumerary team lead incorporated into the current establishment. The introduction of this role has been incorporated into the Care Group business plan and by means of daily mitigation there is an assurance that an Advanced Neonatal Nurse Practitioner (ANNP) is on duty on the unit 24hrs per day, seven days per week. Health care assistants (HCA) have been introduced into the unit and a training programme has been established to support the recruited HCA’s.

16.8 The Paediatric Directorate now has full recruitment in both the In-patient Unit and Day Case Unit and continues to utilise a flexible approach to staffing to meet the fluctuating seasonal service needs. There is a current gap of approximately 5wte as the new starters do not take up posts until January 2020. Escalations plans have been refreshed and this includes utilising NHSP to ensure safe staffing

16.9 The Paediatric Department has incorporated the role of the Paediatric Nurse Practitioner (PNP) and the ANNP into their nursing workforce and has supported further members of staff from September 2019 to continue to develop the nursing teams

16.10 Within Paediatric Services the role of the hospital play specialist (HPS) is well

established within the Trust and continues to evolve. The number of qualified play specialists available regionally is an area of concern and the service is looking at ways to ensure the provision and ongoing development of the role

16.11 The Paediatric community service is currently undergoing a review and this will

include plans to review the current nursing workforce to be able to offer a seven day Paediatric Community Nursing Service.

16.12 The directorate is keen to support the role of the Nursing Associate and have

members of staff in their current workforce who would be keen to apply for the Trainee Nursing Associate programme. Both Paediatric and Maternity led versions of this programme are being scoped.

17. Care Group 1 (Healthy Lives) – Allied Healthcare Professionals 17.1 Allied Health Professionals (AHPs) at North Tees and Hartlepool NHSFT are integral

to the delivery of a joined up approach to effective and efficient discharge planning and patient flow. The acute Physiotherapy and Occupational therapy teams work with ward based teams and experienced nursing staff to facilitate discharge planning and promote independence and recovery for patients who find themselves in an acute hospital bed. An integrated discharge team (IDT) is led by therapists and social workers (along with voluntary sector workforce) and they form part of the wider team facilitating patient flow on a daily basis. Recent participation in the alternative work force model on ward 42 has meant that AHP’s have become part of the ward based model delivering safe and efficient care.

17.2 As both an acute and community services provider there is an appreciation of the

value of an integrated single point of access that delivers effective health and social care decision making. At NTHFT we are piloting an integrated approach that has been led by our innovative AHP team alongside colleagues from social care.

17.3 The team is now leading the way in the arena of frailty and work as part of a regional

12

collaborative exploring new ways of working. In early 2018 a ‘frailty coordination’ model was initiated and is now deemed to be good practice amongst surrounding Trusts. This service is led by a small team with both a nursing and AHP background. The service delivers an admission avoidance service as well as a person centered approach to managing difficult scenarios when patients are approaching the end of their lives.

17.4 Currently a large cohort of the Trust’s AHP staffing are using e-rostering. The

staffing of the inpatient (including on-call), outpatient and community therapy services, as well as the Podiatry service are all managed via Health roster. This includes physiotherapists, occupational therapists, Podiatrists and the related assistant workforce. Since moving to e-rostering, staff have an improved clarity of their planned shifts, with shifts released a minimum of four weeks in advance and an improved ability to request leave. The service leads have a clearer picture of staffing levels to ensure an effective use of resource.

17.5 There are numerous innovations led by AHP’s i.e physiotherapists working in

advanced clinical roles as extended scope practitioners within the Musculoskeletal service ensuring appropriate referrals into secondary care and relieving pressure upon primary care. The Trust’s Hospital at Home service has physiotherapists working within both clinical and managerial roles working with their nursing colleagues to effectively manage respiratory patients within the community setting and avoid unnecessary hospital admission. In recent years the Trust’s podiatry team have established a triage service for those patients admitted to hospital who suffer from diabetes. The patients are identified by the team on admission and then visited by the podiatry team for assessment, advice and onward referral into the podiatry service for continued management of their foot care. This had led to a significant increase in the number of patient within the hospital setting with diabetes being assessed, but also resulted in early assess to treatment for identified patients.

17.6 Job planning is being rolled out across AHP staff groups with initial phase including

dietetics, adult Speech and Language Therapy (SLT), children’s SLT, and outpatient Physiotherapy/Occupational Therapy. The challenge and differences in progress with this piece of work is the need for standardisation in services, e.g. length of appointments/sessions and numbers of patients seen in those standards, administration function and roles and responsibilities within different posts. All of these services have been working through the supporting professional activity elements of posts, and leadership elements of posts.

17.7 The tools that are being used are adaptations of the NHSI tools, the final job plan for

each individual member of staff aims to sit alongside their annual appraisal so that the clinical expectations of posts and their roles, responsibilities and project / development plans can be agreed for the year alongside their aims and objectives.

17.8 A Physiotherapist is currently completing the Advanced Clinical Practitioner course at

Masters level in the Community Integrated Assessment team.

13

17.9 A review of the workforce has highlighted the vacancies below which are being

actively managed.

Professional Group Vacancy Factor (wte)

Podiatry 2.4

Physiotherapy 0.46

OT 0.3

Dietetics 1.0

SLT (Adults) 0.1

SLT Children 1.5

Radiology (incl Breast Screening)

11.5

18. Care Group 2 (Responsive Care) - Emergency Care 18.1 The Emergency Care Directorate comprises of the Emergency Department (ED),

Integrated Urgent Care Services (IUCS) on both the North Tees and Hartlepool sites and the Emergency Assessment Unit (EAU), which includes Ambulatory Care and the Initial Assessment Unit.

18.2 The ED has zero RN and zero Paediatric RN vacancies due to successful recruitment. Additional staff have been recruited into fixed term posts to cover planned maternity leave.

18.3 The EAU has zero RN vacancies due to successful recruitment throughout the year,

an element of over recruitment of 2wte RN is in place from January 2020 which will further support safe staffing in response to the natural higher turnover of staff in this area.

18.4 The workforce model within the Integrated Urgent Care Service (IUCS) at North Tees

and Hartlepool continues to meet the demands of the service. 18.5 The IUCS manage recruitment separately to the other areas within the Care Group

due to the requirement of an advanced skills set and the established collaborative working with the North East Ambulance Service (NEAS) as part of the alliance.

18.6 The ED has a nursing workforce model which ensures an appropriate skill mix is in

place to deliver a sustainable service which is fit for purpose. The model in place continues to consider the role of the Associate Practitioners (APs). APs rotate between ED and The EAU to further develop and maintain their clinical skills.

18.7 Throughout 2019 the role of the Advanced Clinical Practitioner (ACP) has been

introduced into the workforce model both within the ED, EAU and the IUCS. There are now nine ACP students in place spread over three cohorts.

18.8 Workforce planning for ACPs is a significant requirement and the new role of ACP coordinator will support this planning process and training objectives.

18.9 There are staff members within the directorate who have recently completed the

Trainee Nursing Associate (TNA) programme and have now been recruited into vacant band 4 roles in April/May 2019. An additional eight TNAs are currently

14

completing the course at varying stages and will all be recruited into band 4 NA posts within the Care Group on successful completion of the course.

18.10 The workforce model within the EAU, Ambulatory Care and Initial assessment unit

continues to provide an appropriate skill mix to deliver a sustainable service which is fit for purpose.

18.11 Other new roles such as the Physician Associate have recently been introduced into the Emergency Care Department workforce model and significant work is underway to ensure that clear expectations of these roles are agreed.

19. Care Group 2 (Responsive Care) – In Patient Wards/Departments 19.1 The in patient wards and departments continually face a higher level of RN vacancies

compared to other areas which challenges the nursing workforce. 19.2 Following planned appointments of nurses and pre-registered nurses throughout

September 2019 to January 2020 there is a forecasted RN vacancy level of approximately 20wte for January 2020. Further recruitment is planned in November and December with the intention that these vacancies will continue to reduce.

19.3 To maintain safety and mitigate the risks associated with current RN vacancies, daily

staffing reviews ensure that all wards are safe and fully supported. In the event of a shift remaining unfilled, NHSP are used to provide additional support and escalation to Tier 3 agencies is occasionally used if all other sources of support have been exhausted.

19.4 The wards and departments have nursing workforce models which meet the

demands of the service. At present, all ward areas have a nurse to bed ratio of one nurse per bed as a minimum within the ward’s current budgeted establishment which is in line with national guidance and recommendations.

19.5 Due to the implementation of the alternative workforce model, ward 42 now has a

nurse to bed ratio of 1:23. Proposals to transfer this methodology to ward 40 are being presented in the Care Group Workforce plans in November 2019. Ward 40 is a 30 bedded ward that cares for acute elderly patients so presents a similar patient group to that of ward 42, thus making the transfer of the methodology straight forward.

19.6 Safe Care Live (SCL) is used on a daily basis to redeploy staff within the Care Group

to maintain the recommended safe staffing levels. SCL presents the required and actual CHPPD for all wards and departments within the Care Groups. The CHPPD for all areas for the months of September and October 2019 can be found in appendix 6 & 7. However, wards 40, 41 and 42 consistently have a higher variance than any of the other ward areas, despite the daily application of professional judgement which supports the current nursing workforce model.

19.7 The Acute Cardiology Unit (ACU) and wards 25, 36, 38 and 42 have zero RN

vacancies.

19.8 All other wards currently have approximately 3wte RN vacancies per ward. Elderly care continues to have challenges with RN recruitment and despite recruiting into most vacancies in 2018 there has since been a higher turnover of staff due to retirement and voluntary relocation. Work streams are in place to focus more

15

consistently on RN recruitment and retention strategies throughout 2019 which include the following;

Care Group specific application processes which will allow for a more detailed advertisement for specific areas, it is essential to showcase some areas more than others.

Education and Development Panel roll out due to the success of this forum within the Emergency Department.

Internal rotations to provide further opportunities for staff and to support the retention of substantive staff.

The development of bespoke roles such as static posts with exposure to specialist nursing services.

Integrated working with other staff groups to allow nurses to expand knowledge and skills

Implementation of skills passports to enable staff to understand their required skills set and how to achieve this.

Planned developmental pathways to support new and existing staff over a three year period.

19.9 New roles such as the Advanced Clinical Practitioner and the Nursing Associate have recently been introduced into the workforce model and significant work is underway to ensure that clear expectations and quality impact assessments of these roles are understood and agreed.

20. Care Group 2 (Responsive Care) - Endoscopy 20.1 Staffing within Endoscopy services is based on national guidance by the British

Society of Gastroenterology and Joint Advisory Group of Gastrointestinal Endoscopy and the British Thoracic Society and currently meets the demands of the service and the Endoscopy department currently has zero RN vacancies across the department. The Endoscopy service continues to develop highly skilled Nurse Endoscopists who contribute to the overall workforce.

20.2 A skill mix review is currently being proposed in this area and activity follows have

commenced. There are possible opportunities within the department to create a band 3 role.

21. Care Group 3 (Collaborative Care) - Elective Care 21.1 The Elective Care services includes surgery and orthopaedic both acute and elective

services; there are approximately 5wte RN vacancies across these areas. 21.2 A review has been undertaken of all ward areas which has shown that all areas have

a nurse to bed ratio of one nurse per bed as a minimum within the ward’s current budgeted establishment.

21.3 Changes in the workforce within more specialised posts i.e. breast and colorectal are

anticipated due to the age profile of many of the current specialist nurses. Recruitment and retention strategies include the ability to rotate into specialist services and thus support succession planning in these areas.

21.4 The services are keen to develop a fluid and flexible nursing workforce and so promote rotation between Surgery (including the Surgical Decisions Unit), Surgical Observations and Orthopaedics.

16

21.5 New roles such as the Advanced Clinical Practitioner and the Nursing Associate

have recently been introduced into the Elective Care workforce model and significant work is underway to ensure that clear expectations of these roles are agreed.

21.6 Work streams are in place to focus more consistently on RN recruitment and

retention strategies throughout 2019 which include the following;

Rotation through different areas and specialities

Clinical training days

Simulation training

Aspiring Ward Matron meetings

Implementation of Education panels

Staff involvement in quality initiatives

Quarterly Care Group band 6 and 7 development sessions.

Quarterly Care Group Specialist Nurse/Practitioner development sessions.

22. Care Group 3 (Collaborative Care) - Anaesthetics and Theatres 22.1 The anaesthetic and theatre services provide pre, peri and post-operative services to

elective, trauma, emergency, and obstetric patients across the Trust. 22.2 The services require a specialised, flexible, and highly skilled workforce. Complex

planning and continual monitoring of skills against lists and procedures is required within the directorate and to have an effective workforce model that meets the demands of the service.

22.3 Following a realignment of the staffing establishment in 2018/19 and successful

recruitment, the department are now declaring 1wte registered nurse vacancies across anaesthetics and scrub roles.

22.4 Proposals within the workforce review process in November 2019 include a Theatre

and day case workforce review in relation to capacity and demand. There is also the introduction of new roles in support of the Anaesthetic workforce in the form of the Physician Anaesthetic Assistants.

23. Care Group 3 (Collaborative Care) - Critical Care 23.1 Critical Care has 3wte registered nurse vacancies. A separate advert has been

advised in order to attract experienced registered nurses to the posts. 23.2 A seasonal demand template has been implemented within Critical Care in order to

manage staffing levels across the year. Enabling an increase in the nursing workforce when faced with the increase in patient activity and acuity in the winter period. The seasonal template is now being reviewed due to the unprecedented pressures over the last six months.

23.3 Due to the dynamic nature of this speciality, the nursing establishment accommodates changes in the level of patient care and flexes the nurse to patient ratio in accordance with national standards. The establishment in Critical Care is based on 100% occupancy of the unit.

23.4 The Critical Care unit has an effective workforce model that meets the demands of

the service. Critical care has implemented ‘red rules’ to ensure senior cover is

17

provided by staff members that possess the appropriate level of knowledge and skills to co-ordinate the department. A daily review of occupancy and acuity takes place to ensure that the nurse in charge remains supernumerary and co-ordinates this highly specialised area and provides senior clinical support. The requirement for cover to maintain patient safety and mitigate risk associated with this is planned.

23.5 The Critical Care Unit is embracing the introduction of new roles into their current workforce models including the Advanced Critical Care Practitioner (ACCP).

24. Specialist Nurse Provision 24.1 Specialist Nurse Job plans were reviewed in October 2018 where by all specialist

nurses completed their job planning process with their associated Senior Clinical Professional. An overall evaluation of this work has taken place which focused on the utilisation of skills and of clinic appointments. Recommendations were made at the time and job planning will be carried out again in Nov/Dec 2019.

25. Enhanced Care 25.1 The enhanced care workforce model was revised in 2018 in response to the growing

demand on the service and to subsequently maintain high quality, safety and efficient care to patients. This revision included the introduction of a 7 day service for the Enhanced Care Coordinator (ECC), ensuring new referrals could be processed daily and the existing caseload reviewed more frequently to meet the service demand.

25.2 A service evaluation has been completed to ensure the future model is fit for purpose

and the evaluation outlined a series of recommendations. A transfer of the enhanced care service to the adult safeguarding, learning disability and dementia team has taken place in May 2019 to ensure central strategic oversight and stability of service delivery, providing the right care, for the right patients at the right time.

25.3 August 2019 brought an increase in the use of temporary staffing in order to safely

deliver the increasing enhanced care requirements of patients. Some wards across the care groups have observed a significant increase in temporary staffing spend and are proposing alternative strategies to manage this. These strategies are pending until a review of the enhanced care workforce model has been agreed.

26. Model Ward and alternative workforce model proposal 26.1 The completion of this piece of work has been essential in making informed decisions

to move towards full multidisciplinary workforce models which best suit the needs of our patients. This work has considered the current and future nursing position and future planning for the nursing workforce.

26.2 An evaluation of this pilot has been completed. Following the success of the alternative workforce model plans are in place to transfer the methodology into other clinical areas.

27. Medical and Dental Workforce 27.1 The Trust currently employs 373 doctors and currently hosting an additional 109

doctors in training (DiT’s) who are provided by the Lead Employer Trust (LET). An additional 68 doctors are employed on a zero hours contract to help cover workforce

18

shortages. A breakdown of the medical workforce, excluding zero hour workers can be seen in Figure 1.

Figure 1: Medical and Dental Workforce Summary

27.2 The budgeted establishment for the medical workforce is 545.1wte, according to the finance general ledger there are 527.69wte in post. Creating a variance of 17.41wte between budgeted and contracted. However, this does not necessarily reflect the actual number of vacancies which may differ due to changes in services, temporary rota re-design, skill mix, or costing. For this reason, actual vacancy data has been collected from the workforce team and directorates as detailed following.

27.3 The turnover rate for medical staff between April 2019 and September 2019 is

5.79%. This is calculated as the number of levers as a percentage of the average headcount of medical staff over the 12 month rolling period, adapted to show a six month rate. If we were to include the attrition rate for non-voluntary leavers the rate would increase to 8.32% as shown below. Figures exclude zero hour workers, flexi- retirees, and trainees who rotate between specialties or trusts every four to six months. However, they may include staff transferred out as part of TUPE arrangements.

Figure 2:

Grade Headcount

Consultant 194

Specialty Doctors and Associate Specialists (SAS) 35

Trust Doctors 39

Training Posts 231

Dental 6

Total 505

Medical and Dental Staff Turnover Apr -Sep 2019

Care Group / Directorate Starters Leavers Voluntary Involuntary Combined

345 Collaborative Care Division 12 11 7.37% 2.76% 10.14%

345 Corporate Division 1 2 14.29% 14.29% 28.57%

345 Healthy Lives Division 1 2 3.33% 0.00% 3.33%

19

27.4 The overall medical and dental sickness absence rate for April to September 2019, at 1.44% it is below the target of 3.5%. The levels for the last six months are presented in figure 3. Please note that these rates do not include reported sickness for trainees employed by the LET as the Trust does not hold this information centrally.

345 Responsive Care Division 8 8 4.95% 2.97% 7.92%

Grand Total 22 23 5.79% 2.53% 8.32%

20

Figure 3: Medical and Dental Sickness Absence Levels

Medical and Dental Staff Sickness Apr - Sep 2019

Care Groups 2019 / 04

2019 / 05

2019 / 06

2019 / 07

2019 / 08

2019 / 09

Grand Total

345 Collaborative Care Division 1.27% 1.05% 1.65% 1.83% 1.70% 1.63% 1.52%

345 Corporate Division 0.62% 1.02% 2.07% 4.83% 1.04% 0.65% 1.67%

345 Healthy Lives Division 1.28% 2.61% 4.38% 1.95% 1.01% 0.23% 1.92%

345 Responsive Care Division 1.82% 1.66% 0.99% 1.03% 0.83% 0.30% 1.11%

Grand Total 1.45% 1.57% 1.90% 1.71% 1.18% 0.77% 1.44%

28. Recruitment Initiatives

28.1 The Trust continues to undertake a number of recruitment initiatives to address

medical workforce vacancies across all specialties. Including international recruitment schemes to attract workers from overseas, such as the Medical Training Initiative (MTI) scheme and international medical training fellowships.

28.2 In order to recruit to consultant vacancies, a number of areas are targeting trainees approaching completion of their specialist training and about to achieve their Certification of Completion of Specialist Training (CCST).

28.3 Areas such as Orthopaedics are working collaboratively with regional providers to try and attract workers into the area. This initiative also includes review of services and future planning of safe patient services.

28.4 Development and further implementation of medical associate roles (MAPs) to

support medical workforce; such as advanced critical care practitioners, surgical care practitioners, physician’s associates, and physician’s assistants. These healthcare professionals work in addition to doctors and can reduce workload pressures by assisting within the capacity of their roles. They can also provide additional cover and stabilisation during trainee rotational periods and support trainee doctors in attending training, clinics, and theatres.

29. Temporary Staffing – Medical Locums

29.1 Agency medical locums can command premium rates. In order to maintain low costs whilst ensuring patient safety and quality, the organisation has clear governance processes in place which ensures all options are fully explored before escalation to agency.

29.2 The total expenditure on agency locum doctors from April 2019 to September 2019 is

£210k, a reduction of £67k when compared with the same period last year. A five-year agency trend is presented in figure 6, highlighting the continuous reduction in spend.

21

Figure 4: Medical and Dental Agency Locum Expenditure – Five Year Trend

29.3 Reasons for the reduction are attributed to a number of factors. These include additional hours worked by substantive staff, transfer of agency workers into substantive posts or onto flexible contracts, participation in the LET regional bank, and changes to process and governance. Vacancies continue to be the main driver for agency usage, with the majority of spend due to senior level vacancies.

29.4 The LET collaborative bank was established in December 2017 and provides both first and second tier cover. From April to September 2019 there have been a total of 264 shifts released to the bank, 124 shifts were filled, 68 unfilled and 71 remained vacant. Fluctuations in fill rates are linked to hourly pay rates, as such Trusts are working together in an attempt to agree regional rates of pay.

29.5 To help maintain service delivery and patient safety, substantive staff and those on zero hour contracts work additional hours. Internal consultants have delivered a number of additional activities outside their agreed job plan. Overtime for locally employed doctors and foundation trainees are absorbed into substantive costs and paid as locally agreed payments.

29.6 The total 2019/20 annual budget for medical and dental staff was £49.6m, the current

spend year to date is £25m. Agency spend accounts for approximately 1% of actual spend, whilst consultant extra duties outside of the contracted job plan account for 3%.

30. Safe Working Hours

30.1 NHS England introduced a new contract for doctors in training as of August 2016, introducing new rules on working hour limits and rest requirements. As the contract was imposed, transition to the new contract has been a phased process commencing in December 2016. Further addendums to the contract have been agreed in October 2019, highlights include; increases to weekend and night shift pay, additional rest break conditions and annual pay uplifts.

30.2 Exception reporting was introduced as part of these new terms and conditions of service for doctors and dentists in training, replacing traditional diary exercises as the mechanism for monitoring safe working hours. The process allows for significant or regular variations from the trainees contractually agreed service commitments and

22

training opportunities to be highlighted. Providing the organisation with the ability to address issues as they arise, supporting our medical workforce and ensuring patient safety.

30.3 A Guardian of Safe Working Hours (GOSW) was appointed to monitor compliance with the limits on working hours and rest; act as a ‘champion’ for safe working hours and be independent of the management structure. Quarterly reports by the GOSW are provided to the Patient Safety and Quality Standards Committee, with a summary report highlighting actions and issues presented to the Board of Directors. Doctors can highlight an exception as an immediate safety concern; these events are escalated to the GOSW of Safe Working Hours and Clinical Directors.

30.4 As part of the role, the GOSW chairs a quarterly forum with trainees. The purpose of the forum is to support the GOSW in ensuring working hours and conditions are effectively monitored. The forum also provides the opportunity for ideas and suggestions to be discussed and put forward for consideration. This supports the Trust in engaging with doctors to develop and improve its services, working conditions, education and training.

30.5 The Trust has developed an interactive exception reporting dashboard (appendix 10) which is presented and discussed at the forum and educational meetings. The majority of exceptions are related to working beyond contracted hours within Medicine specialties with time in lieu was given on most occasions. Further work is underway to understand and explore solutions to barriers within working time across the organisation.

31. Workforce Planning and Deployment: e-Job Planning

31.1 Job planning is a contractual obligation between employers and senior medical grades (Consultants and SAS doctors), and details the attendance and activity expectations for the year ahead. E-job planning software is in place to support the process alongside a Trust policy which outlines expectations, governance arrangements, and the appeals/mediation process.

31.1 A job planning review panel’ which is overseen by the Medical Director is currently in place to manage the process, provide final approval of all job plans, and ensure consistency and compliance with requirements.

31.2 In line with NHS England/ NHS Improvement best practice guidance and to improve engagement with the job planning process, an ‘annual job planning round’ is currently in place, linking timescales with appraisals, clinical excellence awards, workforce planning, and business planning. The model promotes team job planning and aligns the start date of all job plans with the start of the financial year. Once job plans have been agreed they can be varied within the year to reflect service and workforce changes.

31.3 Currently 81% of the job planning cycle is complete. This currently places the Trust at ‘level zero’ of NHSI’s five levels of attainment. This has been escalated to the Care Group Director’s forum for further engagement and progression.

31.4 Following completion of the annual job planning process an evaluation will take place. This will be reported to the Medical Director to agree job planning objectives for the year ahead.

23

31.5 By working with the software providers, e-learning is available to those involved in the publishing and management of job plans. This training has been directed towards rota administrators to develop their skills and knowledge, enabling them to provide support to clinical leaders and managers.

32. Workforce Planning and Deployment: e-Rostering

32.1 Electronic rostering is currently being implemented with all doctors in training to provide visibility of the workforce and support effective deployment.

32.2 Doctors in training, foundation trainees and trust doctors are now electronically rostered within all specialties, excluding Obstetrics and Gynaecology and Paediatrics. These doctors now have mobile access to their rosters and the ability to electronically request annual leave.

32.3 Trainees in Paediatrics and Obstetrics and Gynaecology are due to be implemented in December 2019.

33. Speciality Update: Anaesthetics 33.1 Anaesthetics currently have a total of 4wte consultant vacancies with 2wte appointed, awaiting start dates. There are also 8.79wte specialty doctor vacancies with recruited posts due to start in January 2020. The department have continually struggled to recruit to these posts and a number of actions have been taken to address the shortfall and avoid agency use.

33.2 Consultant vacancies have temporarily been addressed by implementing an alternative working model which combines the critical care and theatre rotas. This is an interim measure until substantive posts are recruited to. 33.3 The department regularly utilise the MTI scheme to attract overseas workers and to fill Trust doctor vacancies.

34. Specialty Update: Emergency Medicine

34.1 Emergency Medicine has had difficulty in recruiting into their 5.3wte consultant vacancies which have been advertised on numerous occasions with limited success. 34.2 Emergency medicine also have 1.25wte registrar vacancies

34.3 In order to address the issue the department is pursuing potential candidates and will be re-advertising posts to try and attract qualifying trainees. In the meantime, they have covered the gaps via internal locums and limited agency usage.

34.4 The department has recently introduced new roles such as the Advanced Nurse Practitioner and Physicians Associates to support their medical workforce.

24

35. Specialty Update: Surgery, Urology, Trauma and Orthopaedics

35.1 There are a total of 5.5 WTE consultant vacancies across the following services;

Service Vacancies (WTE)

Urology 1.5

Colorectal 1

Upper GI 1

Orthopaedics 2

35.2 Currently the services are being supported utilising locum agencies and internal

locums 35.3 Following recommendations from the ‘Getting It Right First Time’ programme, longer- term plans include possible centralisation of acute urology services across the southern Integrated Care Partnership (ICP) at James Cook University Hospital. Reducing the reliance on locums, however, the vacancies across the local health economy is still of concern and a risk.

35.4 The urology service has been successful in appointing two SAS grade doctors who will commence in post during quarter two. This will support the current fragility of the service for our Trust.

35.5 General Surgery also has specialty trainee and trust doctor gaps due to long-term sickness absence and working restrictions, which are being managed through limited agency usage and internal locums. 35.6 The department has recently introduced new roles such as the Advanced Nurse Practitioner and Physicians Associates to support the Medical Workforce.

35.7 The department has recently introduced new roles such as the Advanced Nurse Practitioner and Physicians Associates to support the Medical Workforce.

36. Specialty Update: In-Hospital Care (Medicine Specialties) 36.1 The stroke and elderly care service currently has 1wte consultant vacancy

36.2 Exception reports, trainee feedback, and the GMC survey results have highlighted a number of staffing and rota issues within the department. This includes releasing trainees to teaching sessions and available cover/support at weekends. A chief registrar has been working with trainees, consultants, and trust doctors to review and redesign rotas. Following a consultation process, rotas have been redesigned from August 2019.

36.3 The department has recently introduced new roles such as the Advanced Nurse Practitioner and Physicians Associates to support the Medical Workforce.

37. Specialty Update: Obstetrics and Gynaecology

37.1 Obstetrics and Gynaecology do not have any vacancies at present

25

37.2 The service has managed to appoint trust doctors to overcome short notice vacancies, the GOSW has recommended that all directorates develop a local strategy for dealing with short notice training vacancies.

38. Specialty Update: Paediatrics

38.1 Paediatrics do not have any vacancies at present.

38.2 The Royal College of Paediatrics and Child Health (RCPCH) guidance recommends a one in ten rota. Both internal Community Paediatric posts have been appointed to.

39. Specialty Update: Palliative Medicine

39.1 Palliative medicine currently have 1wte consultant vacancy with recruitment currently underway.

40. Specialty Update: Pathology

40.1 The Pathology management team have explored opportunities with recruitment agencies to help fill 3.8wte vacancies within histopathology, as continuous rolling adverts have failed to yield any suitable candidates via NHS jobs. Substantive Consultants are undertaking additional workload and activities to absorb some of the demand with some routine work outsourced to an external company to avoid delayed turnaround times. This additional workload presents a risk to the wellbeing of the existing Consultant workforce and is being closely monitored.

41. Specialty Update: Radiology

41.1 Radiology currently has two Consultant vacancies, one of which has been recruited into with a start date of March 2020. The remaining post will be re-advertised for recruitment of the qualifying radiology registrars in October 2019.

41.2 Doctors in training are utilized within radiology however are supernumerary and the workforce is controlled by the School of Radiology, therefore, trainee vacancies do not create rota gaps.

42. Resident Medical Officers

42.1 Resident Medical Officer (RMO) out of hours cover at the Holdforth Unit in Hartlepool is a seven doctor rota managed within Elective Care Services. At present there are significant challenges around recruiting to this rota. An opportunity has been taken to develop advance practitioner roles to support the rota and ensure patient care and patient safety within the Hartlepool site

43. Workforce Challenges and Risks

43.1 There are a number of consultant appointments which the Trust has difficulty in recruiting to due to both local and national shortfalls. These include consultants in Anaesthetics, Urology, Emergency Care, Haematology, and Histopathology. Anaesthetics have difficulties in recruiting Trust Doctors and SAS grade doctors. A number of recruitment initiatives and service reviews are being undertaken to help address challenges.

26

43.2 Short notification of vacancies from the relevant training programmes can result in inadequate time to recruit and put pressure on the existing workforce. Strategies are being developed to help manage this risk.

43.3 The use of agency, bank, and internal locums to fill rota gaps can result in financial pressures on services. Since the introduction of NHSI’s agency rules it has become more difficult to acquire agency locums. This has resulted in the organisation becoming more reliant on the existing medical workforce (including trainees) to pick up internal locum shifts.

43.4 This could lead to excessive hours being worked and increase the risk of non-compliance with working time regulations and contractual working hour limits. Which could result in an increased amount of exception reports received, financial penalties, and escalated internal locum rates. In areas where there are a high number of vacancies training could be impacted resulting in exception reports or poor morale.

43.5 Trust fill rates from the regional bank are dropping, data would suggest that this is related to pay rates, especially within medicine specialties. Agreement of regional rates would help in addressing the issue.

43.6 Senior medical vacancies can impact on the Trusts reputation, ability to deliver quality training, and support available to trainees. This could result in training posts being withdrawn which would reduce staffing numbers even further. Exception reporting is in place to monitor the situation closely and address issues as they arise.

43.7 In medicine specialties, weekend staffing is lower than weekday staffing on base wards, in some cases leaving one doctor to oversee 60 patients. Investment in medical associate professions could help address the issue and support seven day services. As an interim measure, a full review of rotas with trainee engagement has been undertaken.

44. Workforce Initiatives and Next Steps

44.1 On-going implementation of electronic rostering for doctors in training and Trust doctors to support effective deployment, including functionality to manage unavailability and vacant shifts.

44.2 Recruitment into consultant vacancies, including consideration of generic engagement half-days. As well as international recruitment, including the MTI scheme, and international medical training fellowships to address Trust doctor and SAS grade gaps.

44.3 Training, development and implementation of new roles, where appropriate, such as advanced practitioners, associate practitioners and nursing associates.

44.4 The exception reporting process and the junior doctor forum will be opened up to all

trainees and Trust doctors, allowing the organisation to monitor and manage the impact of workforce shortfalls and associated risks.

44.5 Continued participation and use of the LET collaborative bank for doctors in training will reduce the pressure on the medical workforce. Consideration of proposed regional rates of pay may improve bank fill rates.

44.6 A working group is currently established to look at innovative ways in which job planning could support flexible working and attract part time workers.

27

44.7 The Director of Medical Education has been nominated to act as ‘Champion of

Flexible Working’, to support less than full time (LTFT) trainees.

44.8 To support the workforce, the Trust is implementing recommendations outlined in the British Medical Association fatigue and facilities charter, rostering best practice guidelines, and the SAS charter. This will help improve the working environment, support training, support professional development, improve work life balance, and retain loyal Trust doctors.

45. Conclusion 45.1 A review of current nursing and midwifery staffing has been undertaken within all

wards areas and demonstrates a nurse to bed ratio of one nurse per bed as a minimum within the ward’s current budgeted establishment.

45.2 All services have the required nurse and midwifery staffing levels to provide safe

patient care. 45.3 Alternative staffing models have been developed using activity work follows and

developing skills matrix to ensure a robust evidence base is in place.

45.4 Registered nurse, Registered Midwifery and un-registered Nurse recruitment centres

have continued to be successful in reducing vacancy rates throughout the year. 45.5 The Trust continues to plan and take forward retention strategies for all staff groups. 45.6 A review of the Allied Health Professional workforce has been undertaken and

vacancies are being actively managed. 45.7 There are a number of challenges in regard to medical staff appointments particularly

within Anaesthetics, Urology, Emergency Care, Haematology, and Histopathology. 45.8 A number of recruitment initiatives and service reviews are being undertaken to help

address the challenges.

46. Recommendations

46.1 The Board is requested to note the work undertaken to date in relation to nursing, midwifery, AHP and medical staffing.

46.2 The Board is requested to note the significant sustained progress and success in

relation to workforce recruitment and retention.

46.3 The Board of Directors is asked to note the focus on valuing staffing through

recruitment and retention processes and in supporting ongoing development of the workforce.

Julie Lane Chief Nurse, Director of Patient Safety and Quality Dr Deepak Dwarakanath Medical Director

28

Appendix 1

September 2019 Day Night

Ward name

Acute Cardiology Unit 86.9% 62.7% 93.8% 146.2%

Critical Care North Tees 83.2% - 89.6% -

Delivery Suite 91.0% 88.3% 95.0% 95.0%

Elective Care Unit 72.2% 55.2% 72.3% 47.2%

Emergency AMB 79.5% 94.9% 86.9% 105.0%

Neonatal Unit 98.8% - 98.9% -

Paediatrics 89.3% 93.2% 95.8% 93.5%

Ward 22 (Post Natal) 89.2% 87.0% 99.0% 96.7%

Ward 24 (Respiratory) 78.2% 108.1% 88.9% 138.7%


Ward 26 (Gastroenterology) 80.3% 106.0% 98.7% 135.7%


Ward 28 (Surgery) 79.1% 88.1% 82.2% 124.5%

Ward 29 (Cardio Diabetes Gen Med)

80.4% 109.6% 78.9% 231.9%

Ward 3 (Holdforth Unit) 61.2% 58.7% 100.0% 79.7%

Ward 30 (Women’s Health) 97.5% 100.7% 193.9% 166.3%

Ward 31 (Surgical Observation Unit)

86.1% 100.0% 82.2% 73.4%

Ward 32 (Fragility Fracture) 89.9% 110.9% 90.9% 148.5%

Ward 33 (Orthopaedic & Spinal) 85.2% 98.1% 97.5% 110.9%

Ward 36 79.0% 108.3% 86.9% 157.1%

Ward 38 91.0% 90.5% 100.0% 160.0%

Ward 40 (Acute Elderly) 68.8% 142.8% 87.8% 273.4%

Ward 41 (Stroke Unit) 83.3% 105.9% 100.0% 128.3%

Ward 42 (Elderly Rehabilitation) 81.3% 102.0% 126.7% 152.5%

Total 83.0% 96.0% 97.2% 134.8%

29

Appendix 2

October 2019 Day Night

Ward name

Acute Cardiology Unit 82.5% 61.8% 95.4% 133.3%

Critical Care North Tees 90.0% #DIV/0! 103.3% #DIV/0!

Delivery Suite 91.5% 87.6% 95.8% 95.4%

Elective Care Unit 65.9% 72.7% 72.9% 66.5%

Emergency AMB 79.1% 86.8% 85.8% 97.5%

Neonatal Unit 98.9% 98.9%

Paediatrics 93.4% 99.1% 95.5% 56.5%

Ward 22 (Post Natal) 90.6% 85.5% 98.9% 98.4%





Ward 28 (Surgery) 77.7% 85.3% 87.0% 118.3%

Ward 29 (Cardio Diabetes Gen Med)

85.1% 83.6% 83.9% 127.5%

Ward 3 (Holdforth Unit) 90.3% 94.8% 100.0% 143.2%

Ward 30 (Women’s Health) 101.6% 100.7% 177.1% 182.1%


77.3% 100.1% 82.9% 56.4%

Ward 32 (Fragility Fracture) 89.4% 114.0% 96.4% 153.1%

Ward 33 (Orthopaedic & Spinal) 88.9% 95.3% 99.8% 99.9%

Ward 36 82.8% 115.9% 85.0% 170.7%

Ward 38 92.0% 84.6% 100.0% 100.0%

Ward 40 (Acute Elderly) 77.7% 139.9% 78.5% 270.5%

Ward 41 (Stroke Unit) 74.0% 97.4% 100.2% 133.8%

Ward 42 (Elderly Rehabilitation) 83.9% 101.3% 122.6% 154.8%

Total 84% 97% 94% 132%

30

Appendix 3

Application of “Red Rules”

Red Rules for Rostering/Setting establishment

1. A registered nurse is band 5 or above.

2. Minimum 2 registered nurses on duty at all times for in patient wards of 30 beds or less.

3. The nurse to bed funded ratio must never drop below 1.0 (e.g. 24 beds = 24 wte staff)

4. Night time RN ratio should not be less than 1:15 (e.g. 15-30 beds = 2 RNs; 31-45 beds = 3RNs; 46-60 beds = 4 RNs. Unregistered staff will support these numbers where appropriate.

5. 60/40 skill-mix should be the minimum – however any occasion where the RN workforce drops below 50%, this will be considered as a serious incident and subject to a Root Cause Analysis.

6. Rostering must be safe, evenly distributed and value for money.

7. Occupancy, acuity and activity must be considered when rostering or setting establishments.

8. Nurse sensitive indicators should be used to inform rostering decisions or setting establishments.

9. Nurse staffing should be a minimum of 60% established staff and 40% temporary staff.

31

Appendix 4

Sept-19

Safe Care Live Variance between required

and actual. Required CHPPD

Actual CHPPD

Acute Cardiology Unit 6.44 6.18 0.08

Critical Care North Tees 21.63 25.67 -0.43

Delivery Suite - -

1.24

Elective Care Unit 7.39 10.54 -1.58

Emergency AMB 4.83 6.32 1.05

Neonatal Unit 11.02 7.95 1.42

Paediatrics 8.69 10.32 -0.07

Ward 22 - -

-0.86

Ward 24 (Respiratory) 6.50 4.83 -0.14

Ward 25 (Respiratory) 5.73 4.94 0.08

Ward 26 (Gastroenterology) 5.70 4.76 0.11

Ward 27 (Gastroenterology) 6.29 5.48 0.40

Ward 28 (Surgery) 7.55 6.71 0.22

Ward 29 (Diabetes Gen Med) 7.35 6.20 0.58

Ward 3 (Holdforth Unit) 8.34 8.02 -0.10

Ward 30 (Women’s Health) 5.83 6.98 -0.06

Ward 31 (Surgical Observation Unit) 9.17 9.00 -0.30

Ward 32 (Fragility Fracture) 8.22 7.64 0.08

Ward 33 (Orthopaedic & Spinal) 6.93 5.50 0.04

Ward 36 5.47 5.28 0.05

Ward 38 7.17 6.44 0.13

Ward 40 (Acute Elderly) 7.79 7.15 -0.62

Ward 41 (Stroke Unit) 9.70 6.03 0.08

Ward 42 (Elderly Rehabilitation) 7.10 5.68 -0.43

Total Variance 1.32

32

Appendix 5

Oct-19

Safe Care Live Unify report to NHSI

Variance between actual in SCL and to NHSI

Required CHPPD

Actual CHPPD

Actual CHPPD

Acute Cardiology Unit

6.39 6.25 6.1 0.15

Critical Care North Tees

22.23 23.24 24.0 -0.76

Delivery Suite

28.4

Elective Care Unit

8.04 12.44 9.7 2.74

Emergency AMB

5.17 6.39 8.2 -1.81

Neonatal Unit

11.14 9.59 8.9 0.69

Paediatrics

9.19 10.93 8.7 2.23

Ward 22

6.5

Ward 24 (Respiratory)

6.76 5.28 5.3 -0.02

Ward 25 (Respiratory)

6.83 5.62 5.8 -0.18

Ward 26 (Gastroenterology)

6.42 5.24 4.8 0.44

Ward 27 (Gastroenterology)

6.58 5.70 5.7 0

Ward 28 (Surgery)

6.43 6.60 6.8 -0.2

Ward 29 (Cardio Gen Med)

6.61 5.03 4.8 0.23

Ward 3 (Holdforth Unit)

8.99 8.27 8.1 0.17

Ward 30 (Women’s Health)

5.93 7.02 6.5 0.52


8.09 8.42 8.5 -0.08

Ward 32 (Fragility Fracture)

8.30 7.55 7.3 0.25

Ward 33 (Orthopaedic & Spinal)

7.24 5.37 5.3 0.07

Ward 36

5.50 5.99 5.9 0.09

Ward 38

6.21 6.03 6.0 0.03

Ward 40 (Acute Elderly)

7.78 7.05 7.1 -0.05

Ward 41 (Stroke Unit)

10.07 7.07 6.6 0.47

Ward 42 (Elderly Rehabilitation)

7.40 6.16 6.4 -0.24

Total Variance

4.74


Board of Directors

Title: Integrated Compliance and Performance Report


Prepared by: Lindsey Wallace, Head of Performance, Planning and Development

Executive Sponsor: Lynne Taylor, Director of Planning and Performance

Purpose of the report To provide an overview of the integrated performance for compliance, quality, finance and workforce for October 2019.

Action required: Approve Assurance x Discuss x Information x






x



x


The report outlines the Trust’s compliance against key access standards in October, including quality,

workforce and finance in accordance with the SOF.

The Trust has experienced significant pressures across many standards however has performed

relatively well in comparison to national and local outcomes. Pressures persist within Cancer 62 days,

Diagnostics and RTT.

Field Testing continues into the Emergency Care Standards with the 4 hour standard not reportable

during this period.

Operational efficiency standards indicate improvement, however with further work required across

readmission rates, DNA rates and theatre utilisation.

Quality standards indicate positive performance against a number of key indicators, including

HSMR/SHMI, C-difficile, Dementia standards and level 1 and 2 pressure ulcers.

Sickness absence remains the key pressure within Workforce, however with multiple actions implemented to understand the underlying reasons.

The year to date position is a surplus (£2.2m). This compares to a planned deficit of (£0.4m). The Trust is therefore £2.6m ahead of plan at this point in the year.


Continuous and sustainable achievement of key access standards across elective, emergency and cancer pathways, alongside a number of variables outside of the control of the Trust within the context of system pressures and financial constraints. Financial recovery continues to be the Trust’s key challenge. Compliance for sickness absence continues to be a key pressure. Continuous and sustainable achievement of key quality indicators including Healthcare Acquired Infections.


ETM is the first committee for presentation of the Trusts latest position on performance in relation to key metrics.

Recommendation

The Board of Directors is asked to note the performance against standards within compliance, quality, finance and workforce whilst recognising on-going pressures.

1



28 November 2019

Integrated Compliance and Performance Report

Report of the Director of Planning and Performance, Chief Nurse/Director of Patient Safety and Quality, Director of Workforce and Director of Finance

1. Introduction/Purpose

1.1 The integrated Compliance and Performance Report highlights performance against

a range of indicators against the Single Oversight Framework (SOF) and the Foundation Trust terms of licence for the month of October 2019. Due consideration has been given to both positive and negative variances and progress against monthly, annual and in year improvement targets.

1.2 The Integrated Dashboard is attached in Appendix 1- 5, with additional commentary provided against key metrics, providing month on month trend analysis. Appendix 1 outlines the trend analysis against the key Compliance indicators, Appendix 2 outlines Operational Efficiency and Productivity, Appendix 3 demonstrates Quality metrics, Appendix 4 Workforce and Appendix 5 relates to Finance.

2. Performance Overview

2.1 The Trust has experienced significant pressures across many standards this month, however has performed relatively well in comparison to national and local outcomes.

2.2 Pressures have continued across most of the pathways which has unfortunately impacted upon the 62-day standard in September reporting a validated position of 80.7%. October suggests the pressures continue with a provisional position of 74.2%. The Trust remains above national (76.9%) and local (79.13%) benchmarking with only one Trust regionally achieving the 62 standard. Most tumour groups struggled to achieve, other than breast and skin.

2.3 The Trust continues to address issues within the weekly cancer PTL meeting to escalate any delays immediately and continues to work in collaboration with the Cancer Alliance and CCG colleagues. Key issues include; increase in two-week rule referrals, patient choice, pressures with diagnostic and elective capacity, Radiology and Histology reporting and capacity versus demand across most tumour groups. The Tertiary centre has similar pressures; therefore collaborative working is under review, linked to the ICP work. In general the Trust is seeing more complex pathways emerging, with increasing patients crossing multiple provider sites before diagnosis and treatment.

2.4 The Trust reported compliance against the RTT standard in October with an

improved position against September. Care Groups have been asked to review their waiting lists as a matter of urgency to enable a deep dive into key issues and reasons for delays with clock stops. An action plan has been implemented to help drive improvement, recover the position and reduce the overall size of the waiting list.

2

2.5 Non obstetric ultrasound experienced pressures as a result of unexpected staffing issues in Q2 which has persisted into October, however a significant improvement can be see this month with the number of breaches more than halved. Full recovery is expected in Q3.

2.6 The Trust continues to work with NHS England in ‘testing’ the revised emergency care standards therefore no A&E 4 hour performance data is reported within Integrated Performance report. Phase Two is now complete though data collection will continue over the winter period with 6 additional metrics being considered.

2.7 Emergency activity across the organisation has seen an increase of 4.95% (n=198) in October compared to the same period last year, with emergency activity including 1113 who were treated via Ambulatory Care, equating to 26.51% of total emergency admissions.

2.8 The report indicates the Trust has performed above or within expected for the majority of efficiency and productivity indicators, demonstrating performance above the national average, as outlined within the main report. Improvement is noted against DTOC reporting the lowest position this year and super stranded recovering the position and bring the Trust back into alignment with the revised trajectory of 64 by March 2020. Outpatient DNA’s and Readmissions remain a key area of focus in 2019/20, supported by robust project management and mitigating action plans.

2.9 The Trust continues to remain within the expected range for both HSMR and SHMI values. The latest data for HSMR is 92.00 (August 2018 to July 2019) increasing from 91.40 (July 2018 to June 2019). The latest SHMI position sees a decrease to 96.15 (July 2018 to June 2019) from the previous reported period value of 96.88 (June 2018 to May 2019).

2.10 For October 2019 the Trust is reporting 5 Trust attributed cases of Clostridium difficile infection (3 HOHA - Hospital Onset Healthcare Acquired and 2 COHA - Community Onset Healthcare Acquired). The Trust total stands at 37, against a trajectory of 32 by the end of October 2019.

2.11 The Trust is reporting 15 stage 3 complaints for October 2019. This has increased from the 14 stage 3 complaints in September 2019. When compared against September 18, this has decreased from 28 to 15. However remains within trajectory

2.12 Following a focus on capturing all concerns and improved reporting the Trust has seen an expected rise in the number of stage 1 complaints which will continue to be monitored.

2.13 There has been an increase in reporting of level 1 and 2 pressures ulcers following implementation of a pilot on 2 inpatient areas which included enhanced education sessions. Early indications are that this has had a significant impact on reducing incidence on these areas which will be validated and presented in the next integrated performance report. All grades of pressure ulcers remain within tolerance.

2.14 The Trust continues with its excellent performance in relation to dementia standards maintaining 100% compliance.

2.15 Increased acuity of patients and a significant increase in patients requiring enhanced care has led to an increase in HCA fill rate on night duty. An evaluation of the current enhanced care provision is complete and is currently being reviewed by the finance team prior to presentation to Executive team for consideration.

3

2.16 Overall quality of care for the patients cared for by the Trust remains high all metrics remain within tolerance. Work continues to continually review and improve quality of care across the organisation.

2.17 The sickness absence rate for September (latest available position) is reported at 4.15%, which is 0.15% above the revised Trust target of 4.0%. When comparing to the previous months there has been a decrease of 0.47%.

2.18 Long term sickness absence rate for September is reported at 2.47%, a decrease of

0.43% when compared to the previous month (2.90%). Short-term sickness absence rate is reported at 1.68%, a decrease of 0.04% when compared to the previous month (1.72%). The cost of sickness absence is reported as £200,691 for the month of September which has increased by £11,520 compared to August (£188,338).

2.19 ‘Anxiety/stress/depression/other psychiatric illnesses’ continues to account for the

highest proportion of all sickness absence reasons at 30.2%, which is a decrease of 0.4% compared to August 2019 (30.6%).

2.20 An Action Plan is currently being formulated in order to prioritise the initiatives and

projects for the forthcoming year to improve the health and wellbeing of staff; this will take into account specific areas of the Trust with a targeted approach where necessary in order to improvement the management of sickness absence. All stakeholders have had the opportunity to contribute to the final document to ensure all areas are working collaboratively and effectively to fulfil the Trust's aim of a 'Healthy Workforce'.

2.21 The turnover rate for October 2019 is reported at 9.86%, an increase of 0.21% when

compared to the previous month (9.65%) and the attrition figure is reported at 1.25%, a decrease of 0.03% when compared to the previous month (1.28%).

2.22 The overall compliance for mandatory training is reporting at 87% which has

remained the same compared to the previous month. Appraisal compliance is reported at 86% which has remained the same compared to the previous month.

2.23 As at 31 October 2019 the Trust has 181 internal volunteers and 165 external

volunteers (supporting Radio Stitch, RVS, League of Friends and Bookbase). Numbers have started to increase during October and this trajectory should continue as the Trust moves towards a time of winter pressures. Meetings are on-going with external volunteer providers to increase the numbers of volunteers supporting these organisations in line with the Third Party Agreements. The time on average that internal volunteers contribute per week equates to 847 hours, taking into account any notified absences, which is the equivalent to 22.9 WTE. The Trust continues to strive to reach the target of 200 volunteers and 1000 hours committed per month.

2.24 The number of applicants for volunteer posts continues at an increasing pace, an

assessment centre was held where a further 13 candidates were assessed and successful. There are three interview assessments already booked for November as a result of demand from local colleges and existing applicants. A number of applicants are going through the pre-employment stage and will commence with the Trust during November, providing support into areas across the Trust.

2.25 Although shortlisted for their respective national awards both the Volunteer Driver,

(National Volunteer Team of the Year) and the Volunteer Coordinator, (the National Volunteer Leader Award) narrowly missed out on their respective awards but both were awarded Highly Recommended Certificates.

4

2.26 Work continues with the ‘Home but not Alone’ project, with baseline data now established and a data collection exercise underway. The pilot phase continues on Wards 26/27 and the Emergency Assessment Unit, roll out will be implemented over the winter period in order to broaden the scope and scale of the programme. The Trust continues to recruit into these areas to maximise the effect of the programme.

2.27 Working with both the Palliative Care and the Chaplaincy teams, Volunteer Services

continue to explore the provision offered by volunteers within an End of Life setting. They have explored similar provision across the country and have attended a sharing best practise workshop. The Trust continues to develop a team to support patients undergoing cancer treatment and also develop the support offered to new mums regarding breast feeding.

3. Finance Overview

3.1 The Group Month 7 (October) year to date position is a surplus of (£2.2m). This

compares to a planned deficit of (£0.4m). The Group is therefore £2.6m ahead of plan at this point in the year.

3.2 The Trust is forecasting to deliver the 2019/20 CIP requirements through a

combination of corporate, directorate and non-recurrent schemes. The year to date delivery is on plan with the emphasis remaining on converting non recurrent schemes into recurrent cost improvement.

3.3 Cash levels stand at £20.1m at the end of October. Creditor metrics have improved

in recent months and operational issues have reduced substantially consequently. Similarly, debtor performance has improved.

4. Key Challenges 4.1 Continuous and sustainable achievement of key access standards across elective,

emergency and cancer pathways. 4.2 Delivery against the Lord Carter operational efficiency recommendations and

associated cash releasing savings. 4.3 Continuous and sustainable achievement of key quality indicators including

Healthcare Acquired Infections which is reflected within the Board Assurance Framework.

4.4 Compliance for appraisal and sickness absence continues to be significantly adrift

from the target position. Plans are in place to monitor and improve percentage compliance.

4.5 Financial recovery continues to be the Trust’s key challenge.

5. Conclusion/Summary

5.1 The Trust has performed relatively well against the majority of key operational national and local standards within October, notwithstanding the on-going financial pressures. The Trust continues to develop the performance reporting framework to ensure it meets the needs of both corporate and directorate level delivery, reflecting the multiple internal and external performance requirements.

5

5.2 The Trust continues to work closely with NHSI colleagues to deliver robust financial recovery plans.

6. Recommendations

The Board of Directors is asked to note:

The performance against the key operational, quality and workforce standards during October.

Recognise the on-going financial pressures, however with a positive month 7 position against plan.

Acknowledge the on-going operational performance and system risks to regulatory key performance indicators and the intense mitigation work that is being undertaken to address these going forward.

Note the Trusts participation to be a pilot site testing the new proposed access standards and continuation of this throughout the winter period.

Lynne Taylor, Director of Planning and Performance Julie Lane, Chief Nurse/Director Patient Safety and Quality Alan Sheppard, Director of Workforce Neil Atkinson, Director of Finance

Integrated Performance and Compliance Report

October 2019

Developed by: Performance Team

Development lead: Lindsey Wallace

Measure (click on

measure for trend graphs)

Reporting

periodTarget Actual Q2 Trend Details

Emergency Care Activity Oct-19

On aggregate, activity remained similar to the same time last year with the overall IUC activity (Type 1 and Type 3) seeing a net decrease of 0.18%

(n=27) in the month of October in comparison to the same period last year, with admissions seeing an increase of 5.45% (n=119).

Streaming continues to prove successful in August with A&E streaming 398 patients into the Urgent Care Centre, 10% of the overall patients who

presented at the Type 1 facility. Overall, the Integrated Urgent Care Centre, including ED, streamed 774 patients to the most appropriate service

accounting for 5.21% of total attendances.

Field testing of the new Emergency Care standards continues. Data will remain non disclosable including the four hour target.

New Cancer 31 days subsequent

Treatment (Drug Therapy) Sep-19 98.0% 100.0% 100.0%

New Cancer 31 days subsequent

Treatment (Surgery) Sep-19 94.0% 92.9% 97.7%

New Cancer 62 days (consultant

upgrade) Sep-19 85.0% 85.7% 90.4%

New Cancer 62 days (screening) Sep-19 90.0% 96.8% 95.3%

New Cancer GP 62 Day (New

Rules) Sep-19 85.0% 80.7% 80.1%

Pressures have continued across most of the pathways which has unfortunately impacted upon the cancer 62 day standard in September and Q2, with a

validated position reporting at 80.7% and 80.1% respectively (Q2 165/206).

Following further internal validation, the Trust achieved the standard in August reporting at 85.4% (51.5 patients/7.5 breaches). However, this

performance will not be reflected in the National Cancer Waiting Times data until December 2019.

Regionally, most tumour groups struggled to achieve with only 1 Trust achieving the cancer standard in September with the North East position reporting

at 79.13% and nationally reporting at 76.9%.

Pressures evident across outpatient clinics, diagnostics, Histology reporting and inpatient pathways.

The Executive Led Cancer Recovery Group was re-launched in September with action plans developed and agreed across each of the tumour groups.

The impact of the continued pressures are being seen in October with a provisional position reporting at 74.15% (73.5 patients/19 breaches).

Not applicable during Emergency Care Standards testing

period

Integrated Performance and Compliance Dashboard - October 2019

SINGLE OVERSIGHT FRAMEWORK

The Trust achieved against this standard for the month of September (latest validated position) and for Q2.

Page 2 of 37

Measure (click on


Reporting



period



New Cancer Current 31 Day (New

Rules) Sep-19 96.0% 98.6% 99.0%

New Cancer Two week Rule (New

Rules) Sep-19 93.0% 93.0% 93.2%

Breast Symptomatic Two week

Rule (New Rules) Sep-19 93.0% 98.0% 96.9%

The Trust achieved against this standard for the month of September (latest validated position) and for Q2.

Page 3 of 37

Measure (click on


Reporting



period



RTT incomplete pathways wait

(92%) Oct-19 92.00% 92.53% 93.02%


(92nd percentile) Oct-19 28.00 17.60 17.30


(Median) Oct-19 7.20 5.40 5.70

RTT incomplete pathways >52

week wait Oct-19 0 0 0 No patients waited longer than 52 weeks

Number of patients waiting less

than 6 weeks for diagnostic

procedures

Oct-19 99.00% 94.44% 93.09%Pressures have continued within non obstetric ultrasound however a good recovery is noted in October with full recovery expected within Q3.

CIDs -Referral information Sep-19 50.00% 96.25% 96.07%

CIDs- Referral to Treatment

informationSep-19 50.00% 96.59% 95.64%

CIDs- Treatment Activity

InformationSep-19 50.00% 95.51% 95.28%

The Trust continues to perform well against the Community Information Datasets, with all standards reporting above the 50% targets. All community

indicators are under review moving into 2019/20 with realignment of proposed targets.

The Trust reported compliance against the incomplete RTT standard. That said, the waiting list has seen a 8% (n=905) increase in October compared to

March 2019. Care Groups have been asked to review their long waits in an attempt to reduce the overall waiting list size.

The average incomplete waiting time is 7 weeks demonstrating the majority of patients have a relatively short waiting time ranking in the upper quartile

nationally. The Trust remains above national and regional position. To add context to long waits, the Trust reported an average of 284 patients waiting

over 26 weeks in October which equates to 2.5% of the overall RTT waiting list (excluding MSK and Dental).

Page 4 of 37

Measure (click on


Reporting



period



Performance Overview / Key

Highlights

Conclusion and recommendation

The Trust has experienced significant pressures particularly around the cancer standards and non obstetric ultrasound diagnostic tests this month, however has performed well against a number of other standards.

Whilst the Trust has robust governance processes in place for the monitoring and management of all performance standards there is recognition that current pressures across the whole health economy may ultimately impact on

consistent delivery, therefore presents an on-going risk. This risk is outlined within the Trust’s Risk Register and Board Assurance Framework, with supporting mitigation and recovery plans, alongside internal and external

governance assurance processes.

Please note:

• Performance against the key operational, quality and workforce standards.

• Recognise the on-going financial and operational pressures.

• The detailed review of performance against the Single Oversight Framework and NHS Long Term Plans requirements and the key national indicators including compliance, workforce, quality and finance.

• The on-going operational performance and system risks to regulatory key performance indicators and the intense mitigation work that is being undertaken to address these going forward.

Page 5 of 37

Measure (click on


Reporting


New to Review ratio (cons led) Sep-19 1.45 1.27 1.28 The Trust continues to see a downward trend with an improved position noted.

Outpatient DNA (new) Oct-19 7.20% 7.89% 7.52%

Outpatient DNA (review) Oct-19 9.00% 9.88% 10.13%

Average depth of coding Sep-19 3.01 6.92 6.92Average depth of coding is reporting in a positive position reflecting the significant work being carried out within the Data Quality

Improvement Programme (DQIP).

Length of Stay Elective Jul-19 3.34 1.89 - The Trust is reporting within target and significantly below the peer target.

Length of Stay Emergency Jul-19 4.20 3.41 - The Trust is reporting within target (includes Ambulatory Care activity).

Day case Rate Jul-19 76.66% 76.95% -No exceptions to report. The Trust works well to ensure appropriate procedures are undertaken as a day case where clinically

appropriate to do so.

Pre - Op Stays Oct-19 4.50% 1.36% 2.34% The internal pre-op stay data indicates the Trust is reporting in a very positive position keeping pre op stays to a minimum.


EFFICIENCY AND PRODUCTIVITY

DNA rates are showing a downward trend however has plateaued over recent months which is similar to the trend seen nationally.

The Trust has recently established a project group to review the terms and conditions of the reminder service to ensure maximum

utilisation and functionality. 'Review' DNAs are showing an improved position.

Page 6 of 37

Measure (click on


Reporting




Revised Occupancy Trust Oct-19 85.00% 90.83% 90.28%

Readmission rate 30 days (Elective

admission)Aug-19 0.00% 4.66% -

Readmission rate 30 days

(Emergency admission)*Aug-19 9.73% 14.36% -

Readmission rate 30 days (Total) Aug-19 7.70% 10.24% -

ASI's - (No SLOT analysis) Sep-19 4.00% 4.10% 3.57%ASI have seen a slight increase this month as a result of additional pressures however the Trust remains the best performing in

region with the highest rate reporting at 36.6%. The regional average reported 17.7% and the national reported 21.7%.

Cancelled procedures (Non

medical)Oct-19 0.80% 0.14% 0.66% The Trust has seen significant improvement this month in the number of cancellations on the day for non clinical reasons (n=5).

Readmission within 28 days of non

medical cancelled operationOct-19 0 0 3 No patients waited more than 28 days

Bed pressures continue to be felt across the organisation during times of surge with resilience beds opened up to 27 (averaging

5.9 beds per day).

The Trust recognised further work is required to reduce potential avoidable readmissions and so a revised process has been

agreed which has seen the development of a standardised template to capture data which will be clinically led. Results were

presented to the Learning and Improvement Committee, the Transformation and Improvement Committee and the PPC. Care

Groups have submitted action plans to demonstrate learning following audits.

Page 7 of 37

Measure (click on


Reporting




Number of ambulance handovers

between ambulance and A&E

waiting more than 30 minutes

Oct-19 0 5 35

In October the Trust reported 5 ambulance handover between 30 - 60 minutes. In comparison, the North East average

handovers greater than 30 minutes reported at 192 (range 46-497).

The Trust reported 48.9% ambulance turnaround times (valid) within 30 minutes during October, in comparison the North East’s

position at 33% with performance ranging between 22.7% and 48.9%.

Number of ambulance handovers

between ambulance and A&E

waiting more than 60 minutes

Oct-19 0 1 0The Trust reported 1 validated ambulance handover delay greater than 60 minutes. The North East average handovers greater

than 60 minutes reported at 35 (range 0 – 159).

TCS 19 - % of Community Patients

that have had an unplanned

admission LOS <=2 days (Defined

set of conditions)

Oct-19 17.00% 13.13% 9.60%

TCS 19 is used to monitor the progress being made in reducing avoidable emergency admissions for patients on a community

case load, covering a defined set of conditions : Diabetes complications, Nutritional deficiencies, Iron deficiency anaemia,

Hypertension, Congestive heart failure, Angina, Chronic obstructive pulmonary disease and Asthma.

TCS 24 - % of Patients achieving

improvement using a EQ5

validated assessment tool

Oct-19 93.50% 98.11% 98.35%

TCS 24 - The percentage of patients on a community caseload achieving improvement, as measured using a validated

assessment tool appropriate to the scope of the practice, is used by the Community Integrated Assessment Team (CIAT) to

monitor progress during/post treatment.

No exceptions to report.

TCS 35 - % of standard wheelchair

referrals completed within five daysOct-19 90.00% 61.46% 69.03%

Compliance with a 5 day turnaround has been impacted by some loss of clinic capacity and resource. All issues have been

escalated and resolved so improved performance should be noted next month.

Following supply issues relating to standard wheelchairs, discussions have been held with the main supplier who have provide

assurance that the position will improve. Alternative suppliers continue to be tested in order that a viable alternative option is

available in the event the current supplier continues to struggle with meeting demand. The wheelchair service has also migrated

to electronic records onto SystmOne at the start of November. There will be some short term loss of capacity during this transition

but there will be long term gains realised as the service moves to a paper light position.

Delayed Transfers of Care Oct-19 3.50% 1.77% 2.59%

DTOC is reporting the lowest month this year.

The Trust continues to see an improved position with reduced number of stranded patients and are on target to deliver against

trajectory. A revised objective has been set for 2019/20, with the Trust required to reduce to an average of 64 by the end of

March 2020.

The Trust continues to submit a 'Discharge Patient Tracking List (PTL) as part of the national pilot. The Trust is already working

hard as part of an Integrated Discharge Team which is led by a senior member of the team who has devolved responsibility to

escalate any actions.

Page 8 of 37

Measure (click on


Reporting




Super Stranded Reduction (per day

average)Oct-19 66 63 70


Highlights

The Hospital Evaluation Data (HED) within the main report provides a summary of the Trusts benchmark position against a number of performance indicators covering clinical quality, operational

efficiency, patient safety and finance. Success against the reduction in super stranded patients.

DTOC is reporting the lowest month this year.

The Trust continues to see an improved position with reduced number of stranded patients and are on target to deliver against

trajectory. A revised objective has been set for 2019/20, with the Trust required to reduce to an average of 64 by the end of

March 2020.

The Trust continues to submit a 'Discharge Patient Tracking List (PTL) as part of the national pilot. The Trust is already working

hard as part of an Integrated Discharge Team which is led by a senior member of the team who has devolved responsibility to

escalate any actions.

Page 9 of 37

Measure (click on


Reporting

periodTarget Actual Trend Details

HSMR Mortality Rates

(Rolling 12 month value)Jul-19 108.00 92.00

The latest HSMR value is now 92.00 (August 2018 to July 2019), this has increased from the previously reported 91.40 (July 2018 to

June 2019). The value of 92.00 continues to remain inside the ‘as expected’ range; the national mean is 100.

When benchmarked against the same period last year (August 2017 to July 2018) this has decreased from 102.58 to 92.00.

HSMR Crude mortality Rate

(Rolling 12 month value)Jul-19 3.63% 3.31%

The Trust crude mortality rate for HSMR has increased slightly to 3.31% (August 2018 to July 2019) from 3.27% (July 2018 to June

2019).

When benchmarked against the same period last year (August 2017 to July 2018) this has decreased from 3.63% to 3.31%.

SHMI Mortality rate

(Rolling 12 month value)Jun-19 109.00 96.15

The latest SHMI value is now 96.15 (July 2018 to June 2019), this has decreased from the previously reported 96.88 (June 2018 to

May 2019) value.

SHMI Crude mortality Rate

(Rolling 12 month value)Jun-19 3.58% 3.32%

The Trust crude mortality rate for SHMI is now 3.32% (July 2018 to June 2019), this has decreased slightly from the previously

reported 3.37% (June 2018 to May 2019) value.

When benchmarked against the same period last year (July 2017 to June 2018) this has decreased from 3.58% to 3.32%.

Dementia - % of patients aged 75

and over, admitted as emergencies,

stayed more than 72 hours and

were asked the dementia case

finding question

Oct-19 90.00% 100.00%The Trust is reporting that 100% of patients aged 75 and over, who were admitted as emergencies, stayed more than 72 hours were

asked the dementia case finding question.

Dementia - % of patients undergone

a diagnostic assessmentOct-19 90.00% 100.00% The Trust is reporting that 100% of patients identified as potentially having dementia underwent a diagnostic assessment.

Dementia - % of those that received

a diagnostic assessment that were

referred onto another service or

back to GP

Oct-19 90.00% 100.00% The Trust is reporting that 100% of those that received a diagnostic assessment were referred onto another service or back to GP.


QUALITY AND SAFETY

Page 10 of 37

Measure (click on


Reporting



QUALITY AND SAFETY

Complaint Stage 1 - Informal Oct-19 64 97

The Trust is reporting 97 stage 1 complaints for October 2019. This has decreased from the 99 stage 1 complaints in September

2019.

When benchmarked against the same period last year (October 18) this has increased from 64 to 97.

Complaint Stage 2 - Formal Meeting Oct-19 7 7

The Trust is reporting 7 stage 2 complaints for October 2019. This has decreased from the 9 stage 2 complaints in September

2019.

When benchmarked against the same period last year (October 18) this has remained the same at 7.

Complaint Stage 3 - Formal Chief

Executive LetterOct-19 28 15

The Trust is reporting 15 stage 3 complaints for October 2019. This has increased from the 14 stage 3 complaints in September

2019.

When benchmarked against the same period last year (October 18) this has decreased from 28 to 15.

Never Events Oct-19 0 0There has been no Never Events reported in this period.

Category 2 Pressure Ulcers (In-

Hospital)Sep-19 14 28

The Trust is reporting 28 category 2 pressure ulcers for September 2019. This has increased from 24 category 2 ulcers reported for

August 2019.

When benchmarked against the same period last year (September 18) this has increased from 14 to 28.


Hospital)Sep-19 4 5

The Trust is reporting 5 category 3 pressure ulcers for September 2019. This has increased from the 3 category 3 ulcers reported

for August 2019.

When benchmarked against the same period last year (September 18) this has increased from 4 to 5.

Page 11 of 37

Measure (click on


Reporting



QUALITY AND SAFETY


Hospital)Sep-19 0 0

The Trust is reporting zero category 4 pressure ulcer for September 2019. This has remained the same from August 2019 when

zero case was reported.

When benchmarked against the same period last year (September 18) this has remained at zero.

Page 12 of 37

Measure (click on


Reporting



QUALITY AND SAFETY

Fall - No Injury (In-Hospital) Oct-19 81 82

The Trust is reporting 82 falls resulting in no injury for October 2019. This has increased from the 77 falls reported for September

2019.


Fall - Injury, No Fracture (In-

Hospital)Oct-19 18 12

The Trust is reporting 12 falls resulting in an injury, but no fracture for October 2019. This has decreased from the 17 falls resulting

in an injury reported for September 2019.


Fall - With Fracture (In-Hospital) Oct-19 1 0

The Trust is reporting zero falls resulting in a fracture for October 2019. This has decreased from 2 reported for September 2019.

When benchmarked against the same period last year (October 2018) this has decreased from 1 to zero.

VTE Risk Assessment Oct-19 95.00% 97.52%

The Trust is reporting that 97.52% of patients admitted to hospital were risk assessed for venous thromboembolism (VTE) during

October 2019. This has increased from 97.30% reported in September 2019.

Hand Hygiene Compliance Oct-19 95.00% 97.00%

The overall Trust compliance score for hand hygiene is 97% for October 2019; this has decreased from 98% reported in September

2019

Page 13 of 37

Measure (click on


Reporting



QUALITY AND SAFETY

Clostridium difficile (C.diff) Oct-19 4 5

For October 2019 the Trust is reporting 5 Trust attributed cases of Clostridium difficile infection (3 HOHA - Hospital Onset

Healthcare Acquired and 2 COHA - Community Onset Healthcare Acquired), this has decreased from the previous reporting period.

The Trust total stands at 37, against a trajectory of 32 by the end of October 2019.

Methicillin-Resistant Staphylococcus

Aureus (MRSA) bacteraemiaOct-19 0 0

The Trust is reporting zero Trust attributed cases of MRSA bacteraemia in October 2019. This remains the same from previous

reporting period and the target of zero cases.

Methicillin-Sensitive Staphylococcus

Aureus (MSSA) bacteraemiaOct-19 3 2

The Trust is reporting 2 Trust attributed case of MSSA bacteraemia for October 2019. This remains the same from previous

reporting period


Escherichia coli (E.coli) Oct-19 5 5

The Trust is reporting 5 Trust attributed cases of E coli bacteraemia in October 2019. This has increased from the 4 reported case

in September 2019.

When benchmarked against the same period last year (October 2018) this has remained the same at 5.

Klebsiella species bacteraemia

(Kleb sp)Oct-19 0 1

The Trust has reported 1 Trust attributed case of Klebsiella species bacteraemia in October 2019. This has remained the same

from the previous reporting period.

When benchmarked against the same period last year (October 2018) this has increased from zero to 1.

Page 14 of 37

Measure (click on


Reporting



QUALITY AND SAFETY

Pseudomonas aeruginosa

bacteraemia (Ps a)Oct-19 1 2

The Trust has reported 2 Trust attributed cases of Pseudomonas aeruginosa bacteraemia in October 2019. This has increased

from zero in September 2019.


Page 15 of 37

Measure (click on


Reporting



QUALITY AND SAFETY

Friends & Family - (Ward) [National

Score based on % ‘extremely likely’

& 'Likely' to recommend to F&F]

Oct-19 70.00% 98%The in-patient position for Friends and Family for ‘Would Recommend’ was 98% for October 2019; this decreased from the

previously reported 99% in September 2019.

Friends & Family - (A&E)

[National Score based on %

‘extremely likely’ & 'Likely' to

recommend to F&F]

Oct-19 70.00% 75%The A&E position for Friends and Family for ‘Would Recommend’ was 75% for October 2019; this has decreased from the reported

88% in September 2019.

Friends & Family - (Birth)

[National Score based on %

‘extremely likely’ & 'Likely' to

recommend to F&F]

Oct-19 70.00% 89%

For maternity – (Question 2 – birth) the Friends and Family ‘Would Recommend’ is 89% for October 2019; this has decreased from

the previously reported 95% for September 2019. The reason for this decrease can be accounted for by 4 patients stating 'Don't

Know' on their responses and 1 stating 'Extremely Unlikely'.

Patient and Staff Experience Score

(100% max)Oct-19 90.00% 89.95%

For the month of October 2019 the patient and staff experience score was 89.95%, this has decreased from 90.08% in September

2019.

When benchmarked against the same period last year (October 18) this has decreased from 92.58% to 89.95%.

Patient and Staff Experience Survey

Number of surveys undertakenOct-19 20 19

For the month of October 2019, there were a total of 19 Patient and Staff audits conducted. This has increased from the 16 audits

conducted in September 2019.


Registered Nurse/Midwife day shift

fill rates Oct-19

>=80% and

<=109.99%84.11%

Registered Nurse/Midwife day shift fill rates across inpatient areas for the month of October 2019 is 84.11%, up from 82.70% in

September 2019.

Registered Nurse/Midwife Night

shift fill rates Oct-19

>=80% and

<=109.99%94.21%

Registered Nurse/Midwife night shift fill rates across inpatient areas for the month of October 2019 is 94.21%, up from 93.01% in

September 2019.

Page 16 of 37

Measure (click on


Reporting



QUALITY AND SAFETY

Care Staff day shift fill rates Oct-19>=80% and

<=109.99%97.43% Care Staff day shift fill rates across inpatient areas for the month of October 2019 is 97.43% up from 96.22% in September 2019.

Care Staff Night shift fill rates Oct-19>=110% and

<=125.99%131.66%

Care Staff night shift fill rates across inpatient areas for the month of October 2019 is 131.66%, down from 133.03% in September

2019.

Trust - Harm Free Care % Sep-19 97.50% 97.80% The Trusts overall Harm Free care in September 2019 was 97.80% this has decreased from 99.30% in August 2019.


Highlights

Conclusion and recommendationThe Board of Directors is asked to note the content of the report; current performance and work to continuously improve. The Board are asked to note the excellent HSMR and SHMI values

which continue to remain within the expected range.

The latest data for the Trusts HSMR is 92.00; this has increased slightly from the previously reported 91.40, with the Trusts latest SHMI at 96.15 decreased from the previously reported

position of 96.88

For October 2019 the Trust is reporting 5 Trust attributed cases of Clostridium difficile infection (3 HOHA - Hospital Onset Healthcare Acquired and 2 COHA - Community Onset Healthcare

Acquired), this has decreased from the 10 cases reported during the previous month. The Trust is currently at 37 cases of Clostridium difficile infection (23 HOHA - Hospital Onset Healthcare

Acquired and 14 COHA - Community Onset Healthcare Acquired) against a trajectory of 32 by the end of October2019.

Page 17 of 37

Measure (click on


Reporting


Sickness Sep-19 4.00% 4.15% 4.39%

The sickness absence rate for September 2019 is reported at 4.15%, which is 0.15% above the revised Trust target of 4.0% (latest data). When comparing September 2019 to the previous months’

sickness absence rate of 4.62%, there has been a decrease in the Trust’s sickness absence rate of 0.47%.

The long term sickness absence rate for September 2019 is reported at 2.47% a decrease of 0.43% when compared to the previous month (2.90%). The short-term sickness absence rate for September

2019 is reported at 1.68%, a decrease of 0.04% when compared to the previous month (1.72%).

The cost of sickness absence is reported as £200,691 for the month of September 2019. This has increased by £11,520 compared to August (£188,338).

Benchmarking - The latest national sickness absence data available is for the month of June 2019 and supplied by NHS Digital. NHS Digital Sickness absence data may vary from internal reported

figures due to the variance in methodology and time of data collection.

North Tees and Hartlepool NHS Foundation Trust has the 3rd highest regional sickness rate with a reported sickness absence rate of 4.74% in June 2019.

Turnover (12 months rolling data) Oct-19 10.00% 9.86% 9.65%

The turnover rate for October 2019 is reported at 9.86% an increase of 0.21% when compared to the previous month (9.65%).

The attrition figure for October 2019 is reported at 1.25%, a decrease of 0.03% when compared to the previous month (1.28%).

Mandatory Training Oct-19 80% 87% 87% The overall compliance for mandatory training for October 2019 is 87% which has remained the same compared to the previous month.

Appraisals Oct-19 95% 86% 86% Appraisal compliance is reported at 86% for October 2019 which has remained the same compared to the previous month.

WORKFORCE


Page 18 of 37

Measure (click on


Reporting


WORKFORCE



Highlights

Conclusion and recommendation

North Tees & Hartlepool NHS Foundation Trust

When comparing September 2019 to the previous months’ sickness absence rate of 4.62%, there has been a decrease in the Trust’s sickness absence rate of 0.47%.

The sickness rate for September (4.15%) is the Lowest for the period January - September 2019. The highest was 5.43% in January 2019.

‘Anxiety/stress/depression/other psychiatric illnesses’ continues to account for the highest proportion of all sickness absence reasons at 30.2% for September, which is a decrease of 0.4% compared to August 2019 (30.6%).

An Action Plan is currently being formulated in order to prioritise the initiatives and projects for the forthcoming year to improve the health and wellbeing of staff; this will take into account specific areas of the Trust with a targeted approach where necessary in

order to improvement the management of sickness absence. All stakeholders have had the opportunity to contribute to the final document to ensure all areas are working collaboratively and effectively to fulfil the Trust's aim of a 'Healthy Workforce'.

As at 31st October 2019 the Trust has 181 internal volunteers and 165 external volunteers, (supporting Radio Stitch, RVS, League of Friends and Bookbase). Numbers have started to increase during October and this should increase as we move towards

a time of winter pressures. Meetings are on-going with external volunteer providers to increase the numbers of volunteers supporting these organisations in line with the Third Party Agreements. The time on average that internal volunteers contribute per

week equates to 847 hours, taking into account any notified absences, which is the equivalent to 22.9 WTE. We continue to strive to reach the target of 200 volunteers and 1000 hours committed per month.

The Board is asked to note the contents within the workforce report and positive performance against standards together with the on-going work to integrate performance reporting.

Page 19 of 37

Measure KPI Period Apr-19 May-19 Jun-19 Q1 Jul-19 Aug-19 Sep-19 Q2 Oct-19 Nov-19 Dec-19 Q3 Jan-20 Feb-20 Mar-20 Q4

Target Sep-19 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0%

CancerNew Cancer 31 days subsequent Treatment (Drug

Therapy) Sep-19 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 0.0% 0.0%

Target Sep-19 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0%

CancerNew Cancer 31 days subsequent Treatment

(Surgery) Sep-19 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 92.9% 97.7% 0.0% 0.0%

Target Sep-19 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0%

New Cancer 62 days (consultant upgrade) Sep-19 80.0% 75.0% 88.9% 80.0% 95.5% 88.9% 85.7% 90.4% 0.0% 0.0%

Target Sep-19 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0%

Cancer New Cancer 62 days (screening) Sep-19 97.2% 97.4% 100.0% 98.2% 96.2% 92.3% 96.8% 95.3% 0.0% 0.0%

Target Sep-19 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0%

New Cancer GP 62 Day (New Rules) Sep-19 80.1% 80.2% 90.3% 83.3% 78.1% 82.4% 80.7% 80.1% 0.0% 0.0%

Target Sep-19 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0%

Cancer New Cancer Current 31 Day (New Rules) Sep-19 97.9% 96.5% 98.4% 97.6% 99.4% 99.1% 98.6% 99.0% 0.0% 0.0%

Target Sep-19 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0%

New Cancer Two week Rule (New Rules) Sep-19 90.6% 91.8% 91.1% 91.1% 93.3% 93.2% 93.0% 93.2% 0.0% 0.0%

Target Sep-19 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0%

Cancer Breast Symptomatic Two week Rule (New Rules) Sep-19 88.8% 92.6% 94.7% 91.7% 95.5% 97.7% 98.0% 96.9% 0.0% 0.0%


APPENDIX 1 - SINGLE OVERSIGHT FRAMEWORK

Page 20 of 37



APPENDIX 1 - SINGLE OVERSIGHT FRAMEWORK

Target Oct-19 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00%

RTT RTT incomplete pathways wait (92%) Oct-19 94.00% 94.24% 94.06% 94.10% 93.85% 92.82% 92.37% 93.02% 92.53% 0.00% 0.00%

Target Oct-19 28.00 28.00 28.00 28.00 28.00 28.00 28.00 28.00 28.00 28.00 28.00 28.00 28.00 28.00

RTT RTT incomplete pathways wait (92nd percentile) Oct-19 15.70 16.30 16.40 16.10 16.40 17.40 17.70 17.30 17.60 0.00 0.00

Target Oct-19 7.20 7.20 7.20 7.20 7.20 7.20 7.20 7.20 7.20 7.20 7.20 7.20 7.20 7.20

RTT RTT incomplete pathways wait (Median) Oct-19 5.40 5.30 5.40 5.40 5.40 5.70 5.70 5.70 5.40 0.00 0.00

Target Oct-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0

RTT RTT incomplete pathways >52 week wait Oct-19 0 0 0 0 0 0 0 0 0 0 0

Target Oct-19 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% 99.00% 99.00%

DiagnosticsNumber of patients waiting less than 6 weeks for

diagnostic proceduresOct-19 98.11% 99.19% 99.69% 99.01% 99.02% 90.66% 89.29% 93.09% 94.44% 0.00% 0.00%

Target Sep-19 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00%

CIDS CIDs -Referral information Sep-19 96.23% 95.98% 96.37% 96.16% 95.82% 96.15% 96.25% 96.07% 0.00% 0.00%

Target Sep-19 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00%

CIDS CIDs- Referral to Treatment information Sep-19 95.82% 95.44% 95.72% 95.65% 95.61% 94.52% 96.59% 95.64% 0.00% 0.00%

Target Sep-19 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00%

CIDS CIDs- Treatment Activity Information Sep-19 95.46% 95.50% 95.87% 95.68% 94.42% 96.01% 95.51% 95.28% 0.00% 0.00%

Page 21 of 37


New to review Target Sep-19 1.45 1.45 1.45 1.45 1.45 1.45 1.45 1.45 1.45 1.45 1.45 1.45 1.45 1.45

New to review New to Review ratio (cons led) Sep-19 1.20 1.34 1.31 1.26 1.32 1.26 1.27 1.28 0.00 0.00

Target Oct-19 7.20% 7.20% 7.20% 7.20% 7.20% 7.20% 7.20% 7.20% 7.20% 7.20% 7.20% 7.20% 7.20% 7.20%

DNA Outpatient DNA (new) Oct-19 8.84% 8.65% 8.26% 8.50% 7.68% 7.83% 7.25% 7.52% 7.89% 0.00% 0.00%

Target Oct-19 9.00% 9.00% 9.00% 9.00% 9.00% 9.00% 9.00% 9.00% 9.00% 9.00% 9.00% 9.00% 9.00% 9.00%

Outpatient DNA (review) Oct-19 11.26% 11.56% 9.78% 10.85% 10.10% 9.97% 10.50% 10.13% 9.88% 0.00% 0.00%

Target Sep-19 3.01 3.01 3.01 3.01 3.01 3.01 3.01 3.01 3.01 3.01 3.01 3.01 3.01 3.01

Coding Average depth of coding Sep-19 7.03 7.00 6.92 6.92 6.92 6.94 6.92 6.92 0.00 0.00

Target Jul-19 3.20 3.20 3.18 3.19 3.34

LOS Length of Stay Elective Jul-19 1.75 1.81 1.85 1.85 1.89 - 0.00 0.00

Target Jul-19 4.08 4.09 4.08 4.08 4.20

Length of Stay Emergency Jul-19 3.42 3.43 3.40 3.40 3.41 - 0.00 0.00

Target Jul-19 76.59% 76.54% 76.66% 76.60% 76.66%

Day case Day case Rate Jul-19 77.17% 76.64% 77.16% 77.16% 76.95% - 0.00% 0.00%

Target Oct-19 4.50% 4.50% 4.50% 4.50% 4.50% 4.50% 4.50% 4.50% 4.50% 4.50% 4.50% 4.50% 4.50% 4.50%

Pre - Op Stays Oct-19 2.87% 2.13% 2.37% 2.71% 1.65% 2.55% 2.57% 2.34% 1.36% 0.00% 0.00%

Target Oct-19 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00%

Occupancy Revised Occupancy North Tees Oct-19 89.94% 91.11% 92.08% 91.04% 92.24% 91.06% 92.53% 91.94% 92.52% 0.00% 0.00%

Target Oct-19 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00%

Revised Occupancy Hartlepool Oct-19 72.72% 75.91% 77.99% 75.54% 67.11% 64.87% 66.45% 66.83% 67.30% 0.00% 0.00%

Target Oct-19 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00%

Revised Occupancy Trust Oct-19 88.80% 90.09% 91.14% 90.01% 90.59% 89.35% 90.81% 90.28% 90.83% 0.00% 0.00%

Integrated Performance and Compliance Dashboard - October 2019 (2018-2019 against target)

APPENDIX 2 - EFFICIENCY AND PRODUCTIVITY

Page 22 of 37




Target Sep-19 998 998 998 2994 998 998 998 2994 998 998 998 998 998 998

Bed days Excess bed days Sep-19 485 339 403 1227 684 509 889 2082 0 0

Target Oct-19 535 535 535 1605 535 535 535 1605 535 535 535 535 535 535

Delayed bed days Oct-19 371 324 365 955 469 376 348 1193 277 0 0

Target Aug-19 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Readmissions * Readmission rate 30 days (Elective admission) Aug-19 3.97% 3.89% 4.55% 4.09% 3.89% 4.66% - 0.00% 0.00%

Target Aug-19 9.73% 9.73% 9.73% 9.73% 9.73% 9.73% 9.73% 9.73% 9.73% 9.73% 9.73% 9.73% 9.73%

Readmission rate 30 days (Emergency admission)* Aug-19 14.77% 14.87% 15.06% 15.06% 12.40% 14.36% - 0.00% 0.00%

Target Aug-19 7.70% 7.70% 7.70% 7.70% 7.70% 7.70% 7.70% 7.70% 7.70% 7.70% 7.70% 7.70% 7.70%

Readmission rate 30 days (Total) Aug-19 10.37% 9.91% 10.43% 10.31% 8.71% 10.24% - 0.00% 0.00%

Target Oct-1995.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

EDSElectronic Discharge Summaries within 24 hours

(incl. A&E)Oct-19 89.59% 91.86% 93.15% 91.55% 91.56% 90.71% 89.84% 90.72% 91.48% 0.00% 0.00%

Target Oct-19 15.60% 15.60% 15.60% 15.60% 15.60% 15.60% 15.60% 15.60% 15.60% 15.60% 15.60% 15.60% 15.60% 15.60%

C-sections Emergency c-section rates Oct-19 15.12% 11.76% 19.91% 15.54% 12.98% 12.28% 14.51% 13.20% 10.95% 0.00% 0.00%

Target Sep-19 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00%

ASI's ASI's - (No SLOT analysis) Sep-19 5.40% 3.80% 3.10% 4.10% 3.20% 3.40% 4.10% 3.57% 0.00% 0.00%

Target Oct-19 72.86% 72.86% 72.86% 72.86% 72.86% 72.86% 72.86% 72.86% 72.86% 72.86% 72.86% 72.86% 72.86% 72.86%

Theatres Operation Time Utilisation Oct-19 75.70% 71.80% 75.06% 74.10% 75.25% 72.83% 77.48% 75.40% 74.55% 0.00% 0.00%

Target Oct-19 87.07% 87.07% 87.07% 87.07% 87.07% 87.07% 87.07% 87.07% 87.07% 87.07% 87.07% 87.07% 87.07% 87.07%

Run Time Utilisation Oct-19 88.61% 88.01% 89.05% 89.19% 90.92% 87.41% 94.05% 91.25% 89.39% 0.00% 0.00%

Target Oct-19 92.50% 92.50% 92.50% 92.50% 92.50% 92.50% 92.50% 92.50% 92.50% 92.50% 92.50% 92.50% 92.50% 92.50%

Planned Session Utilisation * Oct-19 95.16% 94.95% 93.09% 92.64% 75.11% 90.98% 91.22% 91.17% 92.43% 0.00% 0.00%

Page 23 of 37




Target Oct-19 0.80% 0.80% 0.80% 0.80% 0.80% 0.80% 0.80% 0.80% 0.80% 0.80% 0.80% 0.80% 0.80% 0.80%

Cancelled procedures (Non medical) Oct-19 0.42% 0.46% 0.33% 0.40% 0.46% 0.71% 0.83% 0.66% 0.14% 0.00% 0.00%

Target Oct-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Readmission within 28 days of non medical

cancelled operationOct-19 0 0 0 0 1 1 1 3 0 0 0

Target Oct-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Cancelled Urgent Operations for second time Oct-19 0 0 0 0 0 0 0 0 0 0 0

Target Oct-19 8.80% 8.80% 8.80% 8.80% 8.80% 8.80% 8.80% 8.80% 8.80% 8.80% 8.80% 8.80% 8.80% 8.80%

Cancelled on day of operation Oct-19 8.01% 7.80% 7.28% 7.69% 8.27% 9.21% 7.21% 8.27% 9.23% 0.00% 0.00%

Target Oct-19 33.11% 33.11% 33.11% 33.11% 33.11% 33.11% 33.11% 33.11% 33.11% 33.11% 33.11% 33.11% 33.11% 33.11%

Late Start % Oct-19 32.44% 41.08% 34.63% 36.10% 35.50% 38.81% 40.37% 37.96% 39.93% 0.00% 0.00%

Target Oct-19 46.13% 46.13% 46.13% 46.13% 46.13% 46.13% 46.13% 46.13% 46.13% 46.13% 46.13% 46.13% 46.13% 46.13%

Early Finishes % Oct-19 44.27% 43.77% 43.11% 43.71% 46.95% 46.12% 36.30% 42.93% 44.37% 0.00% 0.00%

Target Oct-19 12.89% 12.89% 12.89% 12.89% 12.89% 12.89% 12.89% 12.89% 12.89% 12.89% 12.89% 12.89% 12.89% 12.89%

Session overruns (>30 minutes) Oct-19 14.50% 13.80% 14.13% 14.13% 16.03% 14.16% 15.19% 15.50% 12.97% 0.00% 0.00%

Target Oct-19 00:15 00:15 00:15 00:15 00:15 00:15 00:15 00:15 00:15 00:15 00:15 00:15 00:15 00:15

A&EA&E Time to Initial Assessment -Ambulance arrivals

(95th percentile) - Type 1Oct-19 00:44 00:41 00:46 00:44 00:52 00:46 00:49 00:49 00:46 00:00 00:00

Target Oct-19 01:00 01:00 01:00 01:00 01:00 01:00 01:00 01:00 01:00 01:00 01:00 01:00 01:00 01:00

A&E Time to Initial Treatment (Median) - Type 1 Oct-19 01:03 01:00 01:03 01:02 01:14 01:07 01:08 01:09 01:03 00:00 00:00

Target Oct-19 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00%

A&E unplanned returns within 7 days - Type 1 Oct-19 1.67% 1.60% 1.36% 1.54% 1.46% 1.49% 1.37% 1.44% 1.06% 0.00% 0.00%

Target Oct-19 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00%

A&E left without being seen - Type 1 Oct-19 3.45% 3.22% 3.43% 3.43% 3.92% 3.93% 3.73% 3.86% 3.23% 0.00% 0.00%

Page 24 of 37




Target Oct-19 04:00 04:00 04:00 04:00 04:00

A&E Time to departure (95th percentile) - Type 1 Oct-19 05:51 05:47 06:19 06:02 06:31 06:25 06:43 06:34 06:26 00:00 00:00

Target Oct-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Number of ambulance handovers between

ambulance and A&E waiting more than 30 minutes Oct-19 10 9 12 31 10 17 8 35 5 0 0

Target Oct-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Number of ambulance handovers between

ambulance and A&E waiting more than 60 minutesOct-19 0 0 0 0 0 0 0 0 1 0 0

Target Oct-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0

A&E 12 Hour Trolley waits - Type 1 Oct-19 0 0 0 0 0 0 0 0 0 0 0

Target Oct-19 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

Screening Diabetic Retinopathy Screening Oct-19 98.52% 98.54% 98.47% 98.51% 98.60% 98.24% 98.28% 98.37% 98.40% 0.00% 0.00%

Target Oct-19 17.00% 17.00% 17.00% 17.00% 17.00% 17.00% 17.00% 17.00% 17.00% 17.00% 17.00% 17.00% 17.00% 17.00%

TCS

TCS 19 - % of Community Patients that have had an

unplanned admission LOS <=2 days (Defined set of

conditions)

Oct-19 13.33% 9.52% 11.92% 11.39% 11.43% 9.13% 8.86% 9.60% 13.13% 0.00% 0.00%

Target Oct-19 93.50% 93.50% 93.50% 93.50% 93.50% 93.50% 93.50% 93.50% 93.50% 93.50% 93.50% 93.50% 93.50% 93.50%

TCS 24 - % of Patients achieving improvement using

a EQ5 validated assessment tool Oct-19 100.00% 100.00% 98.70% 99.58% 98.02% 99.00% 97.50% 98.35% 98.11% 0.00% 0.00%

Target Oct-19 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00%

TCS 35 - % of standard wheelchair referrals

completed within five daysOct-19 94.16% 91.26% 95.54% 93.42% 76.24% 70.89% 61.01% 69.03% 61.46% 0.00% 0.00%

Target Oct-19 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

AudiologyThe % patients treated within 18 weeks of referral to

audiology (Hpool site)Oct-19 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 0.00% 0.00%

Target Oct-19 18.30 18.30 18.30 18.30 18.30 18.30 18.30 18.30 18.30 18.30 18.30 18.30 18.30 18.30

Audiology non admitted wait (92nd percentile) Oct-19 6.00 4.00 6.00 5.00 6.00 6.00 6.00 6.00 5.00 0.00 0.00

Target Sep-19 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00%

Patient identifier Patient Identifier Indicator Sep-19 95.46% 95.50% 95.87% 95.68% 94.42% 96.01% 95.51% 95.28% 0.00% 0.00%

Page 25 of 37




Target Sep-19 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00%

EOL End of Life measure Sep-19 83.08% 84.95% 82.20% 83.64% 80.81% 87.65% 82.89% 83.81% 0.00% 0.00%

Target Oct-19 3.50% 3.50% 3.50% 3.50% 3.50% 3.50% 3.50% 3.50% 3.50% 3.50% 3.50% 3.50% 3.50% 3.50%

DTOC Delayed Transfers of Care Oct-19 2.52% 2.08% 2.43% 2.34% 3.02% 2.43% 2.31% 2.59% 1.77% 0.00% 0.00%

Target Oct-19 68 68 68 68 67 67 67 67 66 66 66 65 65 64

Super Stranded Super Stranded Reduction (per day average) Oct-19 61 66 65 64 62 72 76 70 63 0 0

* Validated Position - August 19

Page 26 of 37


Unplanned Target Sep-19 169.8 169.8 169.8 169.8 154.4 154.4 154.4 167.9 167.9 167.9 199.7 199.7 199.7

UnplannedEmergency admissions for acute conditions that

should not usually require hospital admissionSep-19 151.2 163.8 159.7 160.6 171.2 161.1 150.7 164.7 0.0 0.0

Target Sep-19 20.02 20.02 20.02 20.02 23.0 22.99 22.99 23.36 23.36 23.36 21.51 21.51 21.51

Unplanned hospitalisation for asthma, diabetes and

epilepsy in under 19sSep-19 13.35 16.69 21.13 17.1 22.3 10.01 26.70 19.65 0.00 0.00

Target Sep-19 56.8 56.8 56.8 56.8 60.5 60.5 60.5 67.4 67.4 67.4 73.3 73.3 73.3

Unplanned hospitalisation for chronic ambulatory

care sensitive conditions (adults)Sep-19 85.3 67.0 55.5 70.7 53.0 55.8 60.3 58.0 0.0 0.0

Target Sep-19 23.36 23.36 23.36 23.36 14.46 14.46 14.46 105.67 105.67 105.67 44.49 44.49 44.49

Unplanned hospitalisation for respiratory tract

infections in under 19sSep-19 28.92 21.13 16.69 22.3 8.90 5.56 16.69 10.38 0.00 0.00

Target Sep-19 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00%

StrokeStroke admissions 90% of time spent on dedicated

Stroke unitSep-19 82.61% 92.86% 96.30% 89.70% 97.67% 92.59% 96.00% 95.24% 0.00% 0.00%

Target Sep-19 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00%

High risk TIAs assessed and treated within 24 hours Sep-19 77.78% 100.00% 66.67% 80.00% 100.00% 83.33% 100.00% 92.86% 0.00% 0.00%



Page 27 of 37


Staff Target Sep-19 3.50% 3.50% 3.50% 3.50% 3.50% 3.50% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00%

Staff Sickness Sep-19 4.55% 4.94% 4.91% 4.77% 4.64% 4.62% 4.15% 4.39% 0.00% 0.00%

Target Oct-19 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00%

StaffTurnover (12 months rolling data) - revised

methodology from Nov-18 *Oct-19 8.59% 8.92% 8.97% 8.97% 9.39% 9.54% 9.65% 9.65% 9.86% 0.00% 0.00%

Target Oct-19 80.0% 80.0% 80.0% 80.0% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00%

Staff Mandatory Training Oct-19 86.0% 87.0% 87.0% 87.0% 88.00% 87.00% 87.00% 87.00% 87.00% 0.00% 0.00%

Target Oct-19 95.0% 95.0% 95.0% 95.0% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

Staff Appraisals Oct-19 84.0% 83.0% 83.0% 83.0% 84.00% 85.00% 86.00% 86.00% 86.00% 0.00% 0.00%


APPENDIX 4 - WORKFORCE

Page 28 of 37

Measure KPI Period Jan-19 Feb-19 Mar-19 Q4 Apr-19 May-19 Jun-19 Q1 Jul-19 Aug-19 Sep-19 Q2 Oct-19 Nov-19 Dec-19 Q3 Jan-20 Feb-20 Mar-20 Q4

HMSR Target Jul-19 109.00 109.00 109.00 108.00 108.00 108.00 108.00 108.00 108.00 108.00 108.00 108.00 108.00 108.00 108.00

HMSRHSMR Mortality Rates

(Rolling 12 month value)Jul-19 96.17 95.80 93.66 91.07 92.20 91.40 92.00 91.40 0.00 0.00

Target Jul-19 3.46% 3.49% 3.54% 3.72% 3.66% 3.68% 3.63% 3.60% 3.59% 3.59% 3.63% 3.54% 3.45%

HMSRHSMR Crude mortality Rate

(Rolling 12 month value)Jul-19 3.45% 3.41% 3.29% 3.26% 3.30% 3.27% 3.31% 0.00% 0.00% 0.00%

Target Jun-19 110.00 110.00 110.00 109.00 109.00 109.00 109.00 109.00 109.00 109.00 109.00 109.00 109.00 109.00 109.00

SHMISHMI Mortality rate

(Rolling 12 month value)Jun-19 98.71 98.01 97.11 96.20 96.88 96.15 0.00 0.00 0.00

Target Jun-19 3.64% 3.64% 3.66% 3.67% 3.59% 3.58% 3.60% 3.54% 3.49%

SHMISHMI Crude mortality Rate

(Rolling 12 month value)Jun-19 3.40% 3.38% 3.37% 3.35% 3.37% 3.32% 0.00% 0.00% 0.00%

Target Oct-19 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00%

Dementia

Dementia - % of patients aged 75 and over, admitted

as emergencies, stayed more than 72 hours and

were asked the dementia case finding question

Oct-19 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 0.00% 0.00%

Target Oct-19 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00%

DementiaDementia - % of patients undergone a diagnostic

assessmentOct-19 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 0.00% 0.00%

Target Oct-19 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00%

Dementia

Dementia - % of those that received a diagnostic

assessment that were referred onto another service

or back to GP

Oct-19 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 0.00% 0.00%

Target Oct-19 74 60 59 193 57 42 55 154 63 78 70 211 64 49 50 73 64 60

Complaints Complaint Stage 1 - Informal Oct-19 73 64 60 197 61 79 87 227 83 85 99 267 97 0 0

Target Oct-19 10 10 8 28 7 9 6 22 14 8 8 30 7 9 6 5 13 8

Complaints Complaint Stage 2 - Formal Meeting Oct-19 5 13 8 26 7 5 6 18 13 4 9 26 7 0 0

Target Oct-19 18 19 7 44 18 6 10 34 16 16 12 44 28 20 12 14 30 10

Complaints Complaint Stage 3 - Formal Chief Executive Letter Oct-19 14 30 10 54 13 12 13 38 9 15 14 38 15 0 0


APPENDIX 3 - QUALITY AND SAFETY

Page 29 of 37




Target Oct-19 5 4 4 13 3 3 3 9 6 9 8 23 8 10 8 9 7 7

Risks Corporate & Departmental Risks (Red) Oct-19 9 7 7 23 6 6 7 19 7 7 7 21 7 0 0

Target Oct-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Never Events Never Events Oct-19 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0

Target Sep-19 0 3 3 6 0 2 2 4 3 4 3 3 4 6 8 8 6 0

Pressure Ulcers Catergory 1 Pressure Ulcers (In-Hospital) Sep-19 8 6 8 22 7 11 7 25 19 7 3 0 0 0

Target Sep-19 13 19 16 48 13 26 13 52 14 17 14 15 9 19 15 15 28 0

Pressure Ulcers Category 2 Pressure Ulcers (In-Hospital) Sep-19 15 28 15 58 23 26 27 76 24 24 28 0 0 0

Target Sep-191 2 0 3 5 5 1 11 0 2 4 2 3 2 1 3 4 0


Target Sep-19 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0


Target Oct-19 90 106 105 301 119 98 79 296 82 82 87 251 81 79 79 84 72 80

Falls Fall - No Injury (In-Hospital) Oct-19 84 72 80 236 74 90 76 240 67 87 77 231 82 0 0

Target Oct-19 32 27 25 84 13 11 8 32 15 10 9 34 18 21 23 28 20 16

Falls Fall - Injury, No Fracture (In-Hospital) Oct-19 28 20 16 64 19 22 21 62 21 20 17 58 12 0 0

Target Oct-19 2 1 2 5 1 1 1 3 1 1 1 3 1 3 4 2 3 4

Falls Fall - With Fracture (In-Hospital) Oct-19 2 3 4 9 1 3 0 4 2 1 2 5 0 0 0

Target Oct-19 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

VTE VTE Risk Assessment Oct-19 97.83% 96.90% 97.86% 97.53% 97.75% 97.16% 97.57% 97.49% 96.71% 97.02% 97.30% 97.01% 97.52% 0.00% 0.00%

Page 30 of 37




Target Oct-19 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

Hand Hygiene

ComplianceHand Hygiene Compliance Oct-19 96.00% 96.00% 97.00% 96.00% 96.00% 97.00% 98.00% 97.00% 98.00% 98.00% 98.00% 98.00% 97.00% 0.00% 0.00%

Target Oct-19 1 1 1 3 5 5 5 15 4 5 4 13 4 5 4 5 5 5

Infections Clostridium difficile (C.diff) Oct-19 5 5 2 12 4 7 3 14 2 6 10 18 5 0 0

Target Oct-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

InfectionsMethicillin-Resistant Staphylococcus Aureus (MRSA)

bacteraemiaOct-19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Target Oct-19 1 3 4 8 1 2 1 4 0 2 2 4 3 1 4 1 3 1

InfectionsMethicillin-Sensitive Staphylococcus Aureus (MSSA)

bacteraemiaOct-19 1 3 1 5 0 7 1 8 4 2 2 8 2 0 0

Target Oct-19 5 1 1 7 4 3 3 10 8 2 3 13 5 3 2 2 1 3

Infections Escherichia coli (E.coli) Oct-19 2 1 3 6 3 6 4 13 4 7 4 15 5 0 0

Target Oct-19 6 1 2 9 1 2 3 6 2 2 2 6 0 3 1 1 2 1

Infections Klebsiella species bacteraemia (Kleb sp) Oct-19 1 2 1 4 2 0 0 2 1 0 1 2 1 0 0

Target Oct-19 1 0 0 1 0 1 2 3 0 0 1 1 1 1 2 1 0 0

Infections Pseudomonas aeruginosa bacteraemia (Ps a) Oct-19 1 0 0 1 0 0 0 0 0 0 0 0 2 0 0

Target Oct-19 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00%

FFTFriends & Family - (Ward) [National Score based on

% ‘extremely likely’ & 'Likely' to recommend to F&F]Oct-19 97.00% 97.00% 98.00% 97.00% 99.00% 98.00% 97.00% 98.00% 95.00% 97.00% 99.00% 97.00% 98.00% 0.00% 0.00%

Target Oct-19 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00%

FFT

Friends & Family - (A&E)

[National Score based on % ‘extremely likely’ &

'Likely' to recommend to F&F]

Oct-19 91.00% 89.00% 88.00% 89.00% 89.00% 84.00% 92.00% 88.00% 74.00% 80.00% 88.00% 81.00% 75.00% 0.00% 0.00%

Target Oct-19 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00%

FFT

Friends & Family - (Birth)

[National Score based on % ‘extremely likely’ &

'Likely' to recommend to F&F]

Oct-19 100.00% 100.00% 98.00% 99.00% 97.00% 99.00% 100.00% 99.00% 100.00% 100.00% 95.00% 98.00% 89.00% 0.00% 0.00%

Page 31 of 37




Target Oct-19 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

Experience

SurveyPatient Experience Survey Score (100% max) Oct-19 94.09% 93.39% 98.15% 96.16% 97.49% 91.12% 94.55% 94.39% 94.62% 91.60% 90.68% 92.30% 91.44% 0.00% 0.00%

Target Oct-19 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

Experience

SurveyStaff Experience Survey (100% max) Oct-19 88.36% 96.13% 93.63% 89.78% 95.12% 93.84% 98.31% 95.76% 91.60% 96.55% 91.34% 93.16% 87.88% 0.00% 0.00%

Target Oct-19 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00%

Experience

SurveyPatient and Staff Experience Score (100% max) Oct-19 91.95% 94.33% 96.41% 93.68% 96.68% 98.22% 96.00% 96.97% 93.42% 93.72% 90.08% 92.41% 89.95% 0.00% 0.00%

Target Oct-19 20 20 20 60 20 20 20 60 20 20 20 60 20 20 20 20 20 20

Experience

Survey

Patient and Staff Experience Survey

Number of surveys undertakenOct-19 22 15 19 56 19 20 20 59 20 21 16 57 19 0 0

Target Oct-19>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

Workforce Registered Nurse/Midwife day shift fill rates Oct-19 90.33% 85.38% 84.82% 86.84% 84.71% 84.71% 84.26% 84.56% 85.14% 83.02% 82.70% 83.62% 84.11% 0.00% 0.00%


<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

Workforce Registered Nurse/Midwife Night shift fill rates Oct-19 96.42% 93.56% 91.32% 93.77% 92.44% 92.79% 93.26% 92.83% 94.69% 93.47% 93.01% 93.72% 94.21% 0.00% 0.00%


<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

>=80% and

<=109.99%

Workforce Care Staff day shift fill rates Oct-19 88.71% 89.11% 92.55% 90.12% 91.73% 92.03% 95.66% 93.14% 97.80% 99.74% 96.22% 97.92% 97.43% 0.00% 0.00%


<=125.99%

>=110% and

<=125.99%

>=110% and

<=125.99%

>=110% and

<=125.99%

>=110% and

<=125.99%

>=110% and

<=125.99%

>=110% and

<=125.99%

>=110% and

<=125.99%

>=110% and

<=125.99%

>=110% and

<=125.99%

>=110% and

<=125.99%

>=110% and

<=125.99%

>=110% and

<=125.99%

>=110% and

<=125.99%

>=110% and

<=125.99%

>=110% and

<=125.99%

>=110% and

<=125.99%

Workforce Care Staff Night shift fill rates Oct-19 129.77% 117.87% 119.03% 122.22% 123.39% 122.06% 119.22% 121.56% 118.05% 132.00% 133.03% 127.69% 131.66% 0.00% 0.00%

Target Sep-19 97.84% 97.84% 97.84% 97.50% 97.50% 97.50% 97.50% 97.50% 97.50% 97.50% 97.50% 97.50% 97.50% 97.50% 97.50% 97.50% 97.50%

Safety

ThermometerTrust - Harm Free Care % Sep-19 97.86% 98.75% 98.49% 98.37% 98.57% 98.53% 97.25% 98.12% 98.75% 99.30% 97.80% 98.62% 0.00% 0.00%

Target Sep-19 2.16% 2.16% 2.16% 2.50% 2.50% 2.50% 2.50% 2.50% 2.50% 2.50% 2.50% 2.50% 2.50% 2.50% 2.50% 2.50% 2.50%

Safety

ThermometerTrust - New Harm % Sep-19 2.14% 1.25% 1.51% 1.63% 1.43% 1.47% 2.75% 1.88% 1.25% 0.70% 2.20% 1.38% 0.00% 0.00%

Page 32 of 37

Measure National North EastNorth Tees &

Hartlepool

S Tyneside &

SunderlandN Cumbria Gateshead Newcastle Northumbria S Tees Durham & Darlington

RTT - September 19

Incomplete Pathways waiting <18 weeks 84.8% 92.4% 92.1% 72.0% 92.2% 90.3% 92.2% 83.4% 89.9%

Half of patients wait less than 8 5 6 11 7 8 7 9 6

Half of admitted patients wait less than 11 6 13 20 10 9 9 6 13

19 out of 20 patients wait less than 38 27 29 51 30 33 27 39 35

Half of Non admitted Pathways waited less than 7 3 7 9 6 7 6 6 5

19 out of 20 patients wait less than 27 18 22 43 23 23 26 21 17

Cancer 62 Day Standard - September 19 National North EastNorth Tees &

Hartlepool

S Tyneside and

SunderlandN Cumbria Gateshead Newcastle Northumbria S Tees Durham & Darlington

Breast 91.89 (102/111) 100 (17.5/17.5) 0 (0/0.5) 94.44 (17/18) 90.57 (24/26.5) 60 (6/10) 100 (16/16) 100 (9.5/9.5) 92.31 (12/13)

Lung 67.71 (65/96) 56.52 (6.5/11.5) 68.18 (7.5/11) 52.94 (4.5/8.5) 41.67 (2.5/6) 72.97 (13.5/18.5) 100 (13.5/13.5) 61.54 (12/19.5) 66.67 (5/7.5)

Gynae 65 (26/40) 100 (4/4) 100 (3.5/3.5) 70 (3.5/5) 47.83 (5.5/11.5) 37.5 (1.5/4) 50 (1/2) 70.59 (6/8.5) 66.67 (1/1.5)

Upper GI 66.1 (39/59) 85.71 (6/7) 100 (3.5/3.5) 37.5 (3/8) 100 (2/2) 38.46 (5/13) 100 (6.5/6.5) 73.91 (8.5/11.5) 60 (4.5/7.5)

Lower GI 75.51 (74/98) 76.47 (6.5/8.5) 95.45 (10.5/11) 80 (8/10) 28.57 (1/3.5) 66.67 (11/16.5) 86.67 (13/15) 81.25 (13/16) 71.43 (11/17.5)

Uro (incl testes) 73.95 (149/201.5) 76.92 (15/19.5) 74.23 (36/48.5) 64.52 (10/15.5) 61.9 (6.5/10.5) 65.63 (21/32) 83.33 (17.5/21) 78.9 (43/54.5) 0 (0/0)

Haem (incl AL) 84.42 (32.5/38.5) 80 (4/5) 100 (8/8) 100 (2/2) 100 (1/1) 86.67 (6.5/7.5) 71.43 (2.5/3.5) 76.92 (5/6.5) 70 (3.5/5)

Head & Neck 56.82 (25/44) 0 (0/1) 81.82 (4.5/5.5) 16.67 (0.5/3) 0 (0/0) 91.43 (16/17.5) 0 (0/0) 22.22 (3/13.5) 28.57 (1/3.5)

Skin 94.26 (197/209) 100 (0.5/0.5) 100 (5/5) 96.55 (28/29) 0 (0/0) 88.57 (62/70) 100 (5/5) 94.37 (33.5/35.5) 98.44 (63/64)

Sarcoma 75 (6/8) 0 (0/0) 100 (2/2) 0 (0/0) 0 (0/0) 75 (3/4) 0 (0/0) 66.67 (1/1.5) 0 (0/0.5)

Brain/CNS 0 (0/0) 0 (0/0) 0 (0/0) 0 (0/0) 0 (0/0) 0 (0/0) 0 (0/0) 0 (0/0) 0 (0/0)

Children's 100 (1/1) 0 (0/0) 0 (0/0) 0 (0/0) 0 (0/0) 0 (0/0) 0 (0/0) 0 (0/0) 100 (1/1)

Other 85.71 (6/7) 100 (0.5/0.5) 100 (2/2) 0 (0/0) 0 (0/0) 50 (1/2) 0 (0/0) 100 (1/1) 100 (1.5/1.5)

All 76.9% 79.13 (722.5/913) 80.67 (60.5/75) 82.09 (82.5/100.5) 77.27 (76.5/99) 69.67 (42.5/61) 75.13 (146.5/195) 90.91 (75/82.5) 76.34 (135.5/177.5) 84.49 (103.5/122.5)

Integrated Performance and Compliance Dashboard - October 2019 Benchmark Regional

Data not

available

Page 33 of 37

Integrated Performance and Compliance Dashboard - October 2019 Workforce Sickness Benchmarking

North East Region Trusts - Sickness Rates June 2019 (*latest available)

The chart above shows the sickness absence figures for Acute and Mental Health Trust's in the North East region for June 2019. North Tees and Hartlepool NHS Foundation Trust is represented by the green column. The average rate for all North East Acute and Mental Health Care Trust's is shown by the yellow column. The red line is the average rate for the whole of the NHS in England.

Two Trusts, Newcastle-upon-Tyne and South Tees, report a rate lower than the national average this month. The rate for Gateshead i s the same as the national average.

Newcastle-upon-Tyne Hospitals report the lowest sickness absence rate for June 2019 at 3.91%.

The highest sickness absence rate in the North East region for June 2019 is reported by Northumberland, Tyne and Wear NHS Foundation Trust at 5.45%.

North Tees and Hartlepool NHS Foundation Trust ranks 7th out of the 9 North East NHS Trusts reported on, in terms of sickness absence rate (lowest to highest) for June 2019, with a reported sickness absence rate of 4.74%.

Page 34 of 37

Integrated Performance and Compliance Dashboard - October 2019 Benchmark HED

Page 35 of 37

Integrated Performance and Compliance Dashboard - October 2019 Benchmark HED

Page 36 of 37

Integrated Performance and Compliance Dashboard - October 2019 Finance

APPENDIX 5 - FINANCE

Page 37 of 37

Board of Directors

Title of report: Emergency Preparedness, Resilience and Response (EPRR) - Annual Report 2018/19


Prepared by: Elizabeth Harvey Emergency Planning Officer (EPO) Lindsey Wallace, Head of Performance, Planning and Development

Executive Sponsor: Lynne Taylor, Director of Planning and Performance


To provide the Board of Directors with assurance that EPRR and business continuity arrangements within the Trust are robust and support the EPRR Core Standards Assurance Process.

Action required: Approve Assurance X Discuss Information



X Valuing our People

Transforming our Services



Safe X Caring Effective X X Well Led

X


The Trust must plan for and be able to respond to a wide range of emergencies and business continuity incidents that could affect health or patient care. These could range from fire, flooding, an infectious disease outbreak, or planned industrial action. Under the Civil Contingencies Act (2004), the Trust is designated as a Category 1 responder. This means that it must be able to provide an effective response in emergencies whilst still maintaining service provision. The Trust is subject to the full range of civil protection duties, including risk assessment to inform contingency planning and sharing information with other responders to enhance co-ordination. This work is referred to as Emergency Preparedness, Resilience and Response (EPRR). The aim of this report is to provide the Board with an update of EPRR activities. This forms part of the evidence that the EPRR core standards are being met and the Trust is complying with its statutory emergency planning duties. This report is intended to provide assurance in respect of emergency preparedness and business continuity within the Trust.


Risks are reported via the Trusts Risk Register with 1 risk recorded against EPRR and Business Continuity ( Risk ID6062).


ETM

Recommendation

The Board of Directors is asked to note the contents of the Annual Report and receive it as assurance of the robust plans in place to comply with the Trusts legislative responsibilities regarding Emergency Preparedness, Resilience and Response.

1



28 November 2019

Emergency Preparedness, Resilience and Response (EPRR) Annual Report 2018/19

Report of the Director of Planning and Performance

1. Background

1.1 The Trust must plan for and be able to respond to a wide range of emergencies and

business continuity incidents that could affect health or patient care. These could range from fire, flooding, an infectious disease outbreak, or planned industrial action. Under the Civil Contingencies Act (2004), the Trust is designated as a Category 1 responder. This means that it must be able to provide an effective response in emergencies whilst still maintaining service provision. The Trust is subject to the full range of civil protection duties, including risk assessment to inform contingency planning and sharing information with other responders to enhance co-ordination. This work is referred to as Emergency Preparedness, Resilience and Response (EPRR).

1.2 The aim of this report is to provide the Board with an update of EPRR activities. This

forms part of the evidence that the EPRR core standards, version 6, are being met and the Trust is complying with its statutory emergency planning duties. This report is intended to provide assurance in respect of emergency preparedness and business continuity within the Trust.

2. Governance 2.1 The Trust’s EPRR Framework and Business Continuity Management Policy (RM17)

have been combined into a single revised policy document. This policy provides the framework which the Trust will follow in maintaining and improving its business continuity system and in carrying out all of its EPRR requirements, not only the duties under the Civil Contingencies Act and associated Cabinet Office guidance, but also under the Health & Social Care Act (2012), the NHS Standard Contract (section 30 on Emergency Preparedness, Resilience and Response), NHS England Core Standards, NHS Business Continuity Management Framework (service resilience) and ISO 22301 Societal Security – Business Continuity Management Systems – Requirements. This policy will be reviewed on an annual basis to ensure that the Trust remains compliant with all its EPRR responsibilities.

3. Risk Assessment 3.1 Risk assessment is the first stage in the emergency planning cycle. Joint risk

assessment at Cleveland Local Resilience Forum ensures that responding organisations have plans that are relevant to current risks and proportionate both to the severity and likelihood of occurrence.

3.2 The Trust EPRR Risk Assessment Framework outlines the emergency preparedness

and business continuity risks alongside existing plans and on-going work. The

2

content of this risk register needs to be reviewed against the risks held by individual Care Groups and corporate directorates to ensure all emergency preparedness and business continuity risks are being effectively managed and mitigated. The framework will be amended to take account of the revised 2019 National Security Risk Assessment.

4. Emergency Planning 4.1 The Incident Response Plan details arrangements for responding and managing

critical or major incidents. The plan was reviewed and updated following lessons identified during a number of Emergency Planning exercises and to include reference to new guidance documents.

4.2 The main changes included:

• Revised call out cascades • Use of Vocera to contact key staff • Reference to the new Cleveland Local Resilience Forum Disaster Appeals

Protocol and Victim of Terrorism documentation • Revision of the Mass Casualty guidance card. • More staff need to be trained to support in the Incident Coordination Centre (ICC) • Additional training and exercising required of “back of house” response and

recovery. • Revisions to Business Continuity plans • Review of training for on call managers and directors.

5 Major and Critical Incidents

5.1 The Trust has neither participated in any major incidents nor declared any critical incidents in this time period.

6 Business Continuity

6.1 The business continuity process has been revised and redefined. The first step in the business continuity cycle is a review of the business impact analysis (BIA). A review of existing business continuity processes determined that the BIA was not always refreshed by services. The new BIA includes the time dependency of internal and external suppliers, and the actions taken to mitigate risks prior to invoking the business continuity plan. Completion of the BIA has now been incorporated into the business planning cycle.

6.2 The business continuity plan template has been revisited and revised to ensure that

services now better record critical supplies and suppliers. This builds on the supply review undertaken by Procurement in relation to EU Exit.

6.3 The Trust has participated in, and will continue to participate, in the North East

Business Continuity Forum to share best practice and learning from incidents. It will undertake four key supplier assurance audits in the coming year on behalf of the Forum members and will share findings.

7 Training and Exercising

7.1 The Trust EPRR Training and Exercising Programme is set for a period of 6 months and is shared and reviewed at Trust Resilience Forum. It details training provided on

3

all aspects of emergency planning. The programme is revised to take account of lessons identified from exercises and learning from internal and external incidents.

8 Recommendation

8.1 The Board of Directors is asked to note the contents of the Annual Report and receive it as assurance of the robust plans in place to comply with the Trusts legislative responsibilities regarding Emergency Preparedness, Resilience and Response.

Lynne Taylor Director of Planning and Performance



Title: Winter Plan 2019/20


Prepared by: Lindsey Wallace, Head of Performance, Planning and Development / Linda Hunter, Programme Manager

Executive Sponsor: Levi Buckley Chief Operating Officer Lynne Taylor Director of Planning and Performance


To provide the Board of Directors with a summary of the winter plan for 2019/20.

Action required: Approve x Assurance x Discuss x Information x








x


Each winter brings a number of challenges to how health and social care services are delivered. Effective winter planning and surge management has been a key priority across the Trust and is linked to the wider NHS and social care system resilience. The Board of Directors received a detailed Winter and Operational Resilience paper at the July 2019 meeting which described the reflections on the previous winter and planned service developments.

This paper provides additional assurance to the Board that the organisation has robust winter plans to address the anticipated pressures within the system resource constraints and highlights the key operational initiatives to manage this winter. While it is not possible to accurately forecast the requirements for the winter of 2019/20 or surges in activity the Trust has reflected on the previous winter period and the challenging pressures across the system. The winter plan identifies additional resource requirements to manage patient flow, including safe staffing, maintaining quality, safety and patient experience whilst sustaining operational and financial efficiency. In addition, the plan considers the issues of uncertainty surrounding Brexit.


Detailed associated risks are embedded within the full winter plan however key issues are;

The Registered Nurse ongoing recruitment campaign

Potential impact of supporting additional resilience beds

Additional financial pressures associated with winter

Maintaining planned elective activity.


The full Winter Plan has been considered at Executive Team Meeting and Planning, Performance and Compliance Committee.

Recommendation The Board of Directors is asked to receive the winter plan.

1 Freedom of Information Act 2000 – Section 22 – information intended for future publication



28 November 2019

Winter and Operational Assurance

Report of the Chief Operating Officer and Director of Performance

and Planning

1 Introduction 1.1 Each winter brings a number of challenges to how health and social care

services are delivered. Effective winter planning and surge management has been a key priority across the Trust and is linked to the wider NHS and social care system resilience.

1.2 The Board of Directors received a detailed Winter and Operational Resilience

paper at the July 2019 meeting which described the reflections on the previous winter and planned service developments.

1.3 While it is not possible to accurately forecast the requirements for the winter of

2019/20 or surges in activity the Trust has reflected on the previous winter period and the challenging pressures across the system. The winter plan identifies additional resource requirements to manage patient flow, including safe staffing, maintaining quality, safety and patient experience whilst sustaining operational and financial efficiency. In addition, the plan considers the issues of uncertainty surrounding Brexit.

1.4 This paper provides additional assurance to the Board that the organisation has

robust winter plans to address the anticipated pressures within the system resource constraints and highlights the key operational initiatives to manage this winter.

2 Context and System Governance 2.1 In order to deliver key deliverables, the Trust is focussed on delivering:

Integrated Emergency Care with front door clinical triage and streaming ensuring patients are directed to the service best suited to meet their needs

Same day Emergency Care (Initial Assessment and Ambulatory led care);

A focus on mental health services in A&E including that for children and young people

Emergency Care dataset in A&E to enable better tracking of the quality and timeliness of care

A focus on frailty, supporting both admission avoidance and early discharge

Reduce the number of patients delayed in hospital, reducing length of stay

Strengthened support to care homes

Integrated Discharge Team (IDT)

Hospital at Home Care. 2.2 NHS England/Improvement has not yet issued the overarching priorities for


Winter 2019/20 however the Trust continues to plan in the same vein as last year to;

Ensure enough capacity to meet the pressures of winter

Reduce delayed transfers of care (DTOC) and Super Stranded patients

Reduce bed occupancy by ensuring correct bed base to meet demand with the ability to flex

Ensure robust Resilience Command and Control (RCC) with appropriate escalation policy

Elective planning to reduce risk of cancelled procedures

Support delivery of Emergency Care standards, encompassing ‘every second counts’ for timely patient care

Flu planning - Reflect on last year’s campaign and vaccination uptake alongside predicted flu pressures for 2019/20, based on Public Health data, with the aim to implement a comprehensive action plan to mitigate risks. This will include;

o Immunisation training and identification of vaccinators on each ward including out of hospital

o Governance and monitoring will continue via the Flu Steering Group o The vaccination programme will commence in October with a

communication strategy beforehand.

Daily SitRep reporting including weekends and Christmas period incorporating the weekly ‘Discharge Patient Tracking List’ submission (DPTL) to monitor long lengths of stay.

2.3 Risks have continued to be identified to ensure that mitigation can be introduced

into the system to minimise any impact on safety, quality and financial and operational efficiency. The newly formed Care Groups within the Trust, with a focus on integrated pathway development, will ensure a collaborative approach to working with Clinical Commissioning Groups (CCG) and local authorities to improve the timeliness of continuing health care and social care assessments together with Integrated Discharge Team (IDT).

3. Service Developments 2018/19 3.1 The current Winter Plan began with a reflection on last winter including service

developments and initiatives as follows;

The Trust’s bed base was re-aligned to meet the increasing emergency activity coming into the organisation, providing resilience for the periods of seasonal demand and flexibility within service delivery

The elective bed base is configured to provide a flexible week day and weekend resource to achieve maximum operational efficiency, including improved use of the Hartlepool site, supported by the NHSI 100-Day Elective Care programme

Bed bureau within the Integrated Single Point or Access (ISPA) to facilitate clinical triage of general practice (GP) admissions avoiding hospital admission

Direct pathways, which sees the direct admissions of patients to Emergency Assessment Unit (EAU), Ambulatory Care, Surgical Assessment Unit and Paediatric Day Unit to avoid unnecessary waits in A&E.


4 Winter Plans 2019/20 (How to deliver) 4.1 Initiatives 4.1.1 In addition to the service developments listed in the section above the Trust is

committed to continuously develop, implement new initiatives, striving towards excellence with patient safety being paramount especially moving into the new winter period.

4.1.2 All Care Groups have amplified innovative ways of working with the intention of

keeping patients out of hospital and within their own homes where possible, reducing long lengths of stay and enhancing early and timely discharge.

4.1.3 Plans include;

Out of Hospital delivery of intravenous antibiotics, Out of Hours outreach model and Chronic Obstructive Pulmonary Disease (COPD) hospital at home

Rapid Response are now available to help support discharges were appropriate and District Nursing is scoping the possibility of an ‘in reach District Nurse’ role to support discharges with patients who are known to their caseloads, preventing avoidable admissions by managing patients in their own home or place of residence

An elective resilience plan for the winter period, including front loading of elective activity pre the start of the winter pressure periods, with a reduction in elective inpatient activity in January, increasing day case procedures at North Tees and moving additional activity to the Hartlepool site. This initiative demonstrated the successful management of both winter pressures and the maintenance of elective activity

100-day challenge to reduce the number of outpatient reviews (were clinically appropriate) to release outpatient capacity

Reduced outpatient clinics over the January period to release consultant resource onto the ward areas

The Trust’s Holdforth Unit, which provides a nurse/therapy led step down/rehabilitation facility to support improved pathway management, has been further developed to support a ‘step up’ model to avoid unnecessary admissions for a number of assessments and treatments i.e. IV antibiotics, IV diuretics and Trial Removal of Catheters (TROCs)

Frailty teams at the front of house support admission avoidance and improved discharge planning to ensure frail, elderly patients are seen, diagnosed, treated and discharged, with appropriate support, as soon as possible

John’s campaign’ - Volunteers and family members of patients with dementia assist in their care (with appropriate training given to volunteers)

Home Safer Sooner - A Weekend Discharge review has commenced to look at anticipated discharges, comparing these to those patients who actually went home

Workforce skills are being explored to manage those patients with additional needs such as alcohol/ drug dependency or mental health issues to allow a more collaborative and integrated working with partner agencies, with the aim of promoting earlier discharge

A more focused and targeted piece of work is underway to review Long length of stay patients and patients who are re admitted within 30 days to promote discharge sooner


Every Second Counts - The field testing of the Urgent and Emergency Care Standards is allowing the Trust to work towards improving care for the sickest patients by allowing a more focused priority of this cohort of patients. The strapline ‘every second counts’ is a requirement for patients to flow through the Emergency Department without delay and that every second they are in the department impacts on their journey and experience

Senior matron cover on site will support patient flow and decision making during the weekend period from November onwards

iSPA will continue over the winter months. The team are currently working with partners to pilot a virtual ward approach to frail patients, to try and plug any potential gaps in communication and prevent any avoidable readmissions

Implement the theatre schedule plan, which is reflective of last year

The communication strategy and the vaccination programme will commence on 1 October 2019.

4.1.4 There is a commitment to the continued review and improvement of patient

pathways, through integrated acute and community care and collaborative working with primary care, primary care networks social care and neighbouring acute providers.

4.1.5 As a last resort and once all alternative options have been explored, should a

patient require hospital admission, then the opening of resilience beds will be escalated in accordance with OPEL levels.

4.2 Workforce

4.2.1 The Trust values staff development, recognising continuous training as part of

this. Whilst this is maintained over the winter period, front loading of mandatory training during the summer month’s forms part of the plans to ensure resilience is maintained, with some staff in non-clinical or training roles supporting wards during times of pressure.

4.2.2 Rotas will be planned 6-8 weeks in advance in line with Lord Carter

recommendations. This approach will ensure the most effective use of resource and avoid unnecessary recourse to bank/agency. The Trust has and will continue to attempt to invite those staff who has recently retired to return to work on an ad hoc basis.

4.2.3 Winter 2019/20 North Tees and Hartlepool Solutions (NTHS) will proactively

manage the provision of additional resource such as porters and domestics to support the winter plan together with the appropriate use of volunteers.

4.2.4 Plans are being developed for a model of block purchasing or spot purchasing

additional rehabilitation capacity in both localities.

4.3 Resilience Beds 4.3.1 It is suggested, based on last year’s plans and the positive outcomes in

managing the additional surges and pressures, that similar resilience beds will be proposed.


4.3.2 The table below summarises the flexibility of resilience beds;

5 Operational, Tactical and Strategic Command and Control 5.1 The Operational Pressure and Escalation Levels (OPEL) have provided an

objective and consistent process, resulting in a more objective rationale for escalation and its associated actions. The Trusts OPEL matrix provides and objective and consistent process of escalation.

5.2 The severity of pressure, due to surges in activity, will continually be assessed

by the Manager on Call (MoC) and escalation activated according to the OPEL. At each level of the OPEL associated actions include from reassessment of training and utilisation of clinical staff in non-clinical roles to declaration of a critical incident level 1.

5.3 There is a risk that escalation is insufficient to manage pressures out with the

Trusts control. There is a system in place to initiate a system wide escalation through the A&E Delivery Board.

5.4 The successful and tested implementation of the Resilience Command and

Control Centre (RCC) function served to support escalation during the winter surges, whereby the operational leads were supported with regard to coordination of advice, guidance and logistics.

6 Risks and Mitigation 6.1 Detailed associated risks are embedded within the full winter plan however key

issues are;

The Registered Nurse on-going recruitment campaign

Potential impact of supporting additional resilience beds

Additional financial pressures associated with winter

Maintaining planned elective activity.

7 Summary and Conclusion 7.1 In summary the Trust has reflected on the previous winter period and the


challenging pressures across the system resulting in additional resource requirements to manage patient flow, including the associated costs, safe staffing and quality of service provision. This in turn, informed the preparation and planning for operational resilience and surge management for 2019/20, noting winter was managed efficiently and within budget controls during 2018/19.

7.2 The Trust has further developed services and pathways during 2019, which will

support enhanced resilience management going into winter 2019/20.

7.3 Robust governance processes remain in place, supported by the newly formed Care Group structure, which will further support integrated pathway delivery both in and out of hospital.

7.4 A significant amount of work has been undertaken during 2019 to develop

initiatives within both acute and out of hospital to improve patient flow, facilitate discharge and reduce avoidable admissions, stranded patients and DTOCs.

7.5 Recruitment of medical and nursing staff continues to present an issue and

whilst the most recent recruitment roadshow proved positive, staff are unable to be in post before this winter. This therefore poses the greatest risk, not only to expenditure, but to the ability to flex bed capacity.

8 Recommendations 8.1 The Board of Directors is requested to note the content of this report and accept

the due diligence applied to the winter planning process and proposals for managing surges in activity over the winter months, and throughout the year, whilst maintaining quality, patient experience and operational and financial efficiency.

Presented by Levi Buckley, Chief Operating Officer Lynne Taylor, Director of Performance and Planning


Plan on a Page

Board of Directors Meeting - nth.nhs.uk · 11/28/2019 · Boardroom University Hospital of North...

Documents

Transcript of Board of Directors Meeting - nth.nhs.uk · 11/28/2019 · Boardroom University Hospital of North...