A MEETING OF THE BOARD OF DIRECTORS...Vishal Shah Moorfields medical staff 18/2199 Apologies for absence Apologies were received from: Steve Williams, vice chair and non-executive

A MEETING OF THE BOARD OF DIRECTORS

To be held in public on

Thursday 22 November 2018 at 09:30am

In the Boardroom, 4th Floor, Kemp House, 152 – 160 City Road, EC1V

AGENDA

No. Item Action Paper Lead Mins S.O

Divisional Review Present JQ 00:20

1. Apologies for absence Note Verbal TG

2. Declarations of interest Note Verbal TG

3. Minutes of the meeting held on 28 June 2018 Approve Enclosed TG

4. Matters arising and action points Note Enclosed TG 00:05 5. Chief Executive’s Report Note Enclosed DP 00:10 6. Integrated Performance Report Assurance Enclosed JQ 00:10 7. Finance Report Assurance Enclosed JW 00:10 8. Workforce Report Assurance Enclosed SD 00:10 9. Learning from deaths Assurance Enclosed NS 00:10

10. Annual nurse revalidation Assurance Enclosed TL 00:10 11. Report of the audit and risk committee Assurance Enclosed NH 00:10 12. Report of the finance committee Assurance Enclosed NH 00:10 13. Membership council report Note Enclosed TG 00:10 14. Member’s Week report Note Enclosed TG 00:10 15. Identify any risk items arising from the agenda Note Verbal TG 00:05 16. AOB Note Verbal TG 00:05

17. Date of the next meeting – Thursday 20 December 2018 09:30am

* Strategic Objectives 1 Care 2 Research 3 Knowledge sharing 4 Policy 5 People 6 Infrastructure 7 Finance 8 Enterprise

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MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST

MINUTES OF THE MEETING OF THE BOARD OF DIRECTORS HELD ON THURSDAY 27 SEPTEMBER 2018

Attendees: Tessa Green(TG) Chairman David Probert (DP)

Andrew Dick (AD) Chief executive Non-executive director (for part of the meeting)

Ros Given-Wilson (RGW) Non-executive director Nick Hardie (NH) Non-executive director David Hills (DH)

Sumita Singha (SS) Non-executive director Non-executive director

Nick Strouthidis (NS) Medical director Jenny Greenshields (JG) Interim chief financial officer Peng Khaw (PK) Director of research & development Tracy Luckett (TL)

John Quinn (JQ) Director of nursing and allied health professions Chief operating officer

In attendance: Sandi Drewett (SD) Director of workforce & OD Helen Essex (HE) Company secretary(minutes) Kieran McDaid(KM

Johanna Moss (JM) Director of estates, major projects and capital Director of strategyand business development

Elisa Steele (ES) Chief information officer Ian Tombleson (IT) Director of quality & safety

Governors present: Rob Jones (RJ) Patient governor Paul Murphy (PM) Public governor, NCL Jane Bush (JB) Public governor, NCL Allan MacCarthy(AM) Public governor, SEL

Other attendees: Andrew Brown (AB) CQC Zoe Dronfield (ZB) TrustMarque Debbie Bryant (DB) EA to the chief executive Vishal Shah Moorfields medical staff

18/2199 Apologies for absence

Apologies were received from: Steve Williams, vice chair and non-executive director Nora Colton, director of education Dulcie Dixon and Margaret McGlynn, CQC Emily Brothers, Brenda Faulkner and Richard Collins, membership council

18/2200 Declarations ofinterest

There were no declarationsof interest.

18/2201 Minutes ofthe last meeting

The minutes of the meeting held on 26 July 2018 were agreedas an accurate record.

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18/2202 Matters arising and action points

The board acknowledged that they had found the patient story very helpful and asked for feedback on the point raised about access for patients into research. PK advised that the trust is one of the top recruiters in the region. We know that there is good evidence that research and clinical trial activity is linked to good quality care and we are always looking at different ways of increasing trial activity. There is currently an initiative in place looking at improved ways to involve patients electronically. This also needs to be facilitated by improved informatics within the trust.

DP also thanked the Friends of Moorfields whose volunteers signpost patients and direct them to how they can access information, which has great benefits for the patient experience.

All other actions were attended to via the agenda.

18/2203 Chief Executive’s Report

DP congratulated the pharmacy team following their visit from the general pharmaceutical council which produced a very positive report.

The CQC provider information request (PIR) has been uploaded and the trust is awaiting confirmation from the CQC of the next steps. The only outstanding actions from the previous action plan relate to the refurbishment of St George’s and the development and implementation of the EMR which is due to be rolled out in Q4.

Dr Dawn Sim has been appointed as the clinical lead for tele-ophthalmology and Dr Peter Thomas as the clinical lead for digital innovation. Both will be driving the agenda forward supported by clinical and informatics teams.

The trust will be transferring to ESR on 1 November and the system will improve our ability to gather workforce data. The majority of the data transfer has taken already taken place. There is contingency built in to the programme to be able to address any issues prior to the November payroll deadline.

The trust is engaged with the DHSC and other component parts in relation to Brexit, with the major risks being workforce, pharmaceuticals and research. It has been agreedthat this will form a risk on the BAF in the next iterationbut the executive team need to determine how best to articulate the risk and understand how it might mitigated. The trust is offering legal advice, support, workshops and seminars to staff who are feeling very concerned.

It was acknowledged that in research terms it is hard to prepare for Brexit and that there is a lot of work going on at the highest levels of academia and the government on the potential impact. The research industry currently takes in 2.4bn euros per year and contains high percentages of EU staff.

There has been excellent engagement from the industry for the RIBA design competition. 32 firms have been shortlisted down to five and design workshops are taking place. Internal and external stakeholders will be notified of the next stages in

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the process, which involve a public exhibition and consultation.

There is a risk that the timing of the design competition will not allow sufficient input into the outline business case. However, the public consultation is being progressed and the pre-consultation business case is being prepared for December. This will launch in January/February. Preliminary engagement exercises suggest that accessibility will be the key issue. The outcome of public consultation is unlikely to be delivered until April/May.

DP advised that he would be signing an options agreement on behalf of the trust which sets out the obligations of both the buyer and seller of the two acres of land at the St Pancras hospital site.

DP highlighted the great work taking place in research in collaboration with Google DeepMind. The company is looking to run the AI pathways in three sites (Moorfields, Manchester and Birmingham) and will allow a greater step change in improving the patient experience.

Professors James Bainbridge and Robin Ali were awarded the Champalimaud Award which is hugely prestigious and the first time it has been awarded outside the US. It was agreed that TG should write to congratulate them on behalf of the board.

RGW advised that she would like to understand more about the work being undertaken by the digital clinical leads. This will be scheduled for early in the new year once they have had a chance to embed. It was agreed that they should also be given the opportunity to present to the patient forum in order to get patient input on their work.

TG to write on behalf of the board.

Presentation by clinical leads to be scheduled for early in the new year – HE.

18/2204 Integrated performance report

An executive summary is now included which highlights the key issues. Overall the position is good against nationally reported targets. A&E activity remains slightly down with just under 100,000 attendances.

There have been a number of 52-week breaches due to a specific serious incident. This has been reported through the commissioner quality group which is satisfied with the processes that have been put in place to mitigate. Harm reviews have been conducted on all patients and none have come to harm.

Cancer target figures relate to a small number of patients and there have been issues with staff capacity due to sickness. Ocular oncologists are particularly challenging to recruit. The trust is delivering the national target but the locally agreed 14-day target continues to be challenging.

Following the introduction of the new electronic referral requirement in October, paper referrals from GPs will no longer be funded. The issue relates to the ability of the GP to undertake electronic referrals. The trust is undertaking a shadow process this month but has identified a gap. The narrative from NHSI and NHSE is that referrals should be sent back to the GP but this presents a clinical risk to the patient. It has been agreed that although there will be an initial financial risk to the organisation in taking on paper referrals, this is the most appropriate action to take clinically. There will be

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an improvement over time once people get more used to the process.

The trajectory for reduction in patient journey times is still being achieved and has improved over the last two months. RGW said that it was good to see journey times improving but that assurance is needed that we are able to trust the data. JQ replied that there is still a way to go in terms of data completeness but that we have the ability to undertake a physical audit if required.

SS highlighted the apparent lack of consistency in handing out the FFT to patients and asked if this was related to the fact that we had a lot of temporary staff. The FFT is monitored through the performance review process with each division. There is a very high level of compliance for day-case patients (99% of patients in those cases would recommend Moorfields for treatment). There is a challenge with patients coming in for multiple appointments and managers need to help staff feel confident at being more persistent in asking. Attempts will be made to try and encourage divisions to learn from those that have a high performance.

SD said that there was unlikely to be a correlation between temporary staff and take up of the patient FFT. There is always a seasonal fluctuation with sickness data and the digital transformation work under way should improve the data we have.

A number of the issues relating to cancellation rates come from St Anthony’s. The trust has access to one permanent theatre and there was initially an indication that there would be a second theatre available but this is not consistently applied. The move back to SGH will resolve the issue. The trust is currently agreeing a final snagging list and discussion of the completion rate next week. The rest of the patient and staff experience in St Anthony’s has been good.

A team is working with the clinical lead for quality to make sure incident closure is undertaken in a clinically safe way.

18/2205 Finance report

JG reported a surplus of £80k in month which is a variation of £500k against the plan. The year-end forecast remains at £1.3m as there is more risk later in the year. The favourable position is due to high income, with a lot of injection activity and a balance sheet adjustment of £300k.

Efficiency schemes are currently ahead of target although there has been slippage on the estates and facilities budget due to delays in some of the projects. The forecast is that 78% will be delivered recurrently and 14% non-recurrently. £600k is not yet identified and work is taking place with divisions to catch up. New project management software has recently been implemented and this will provide a report detailing the status of all projects by the end of the month.

It was reported that the declaration of a surplus at the end of M6 will lead to a two for one incentive payment from NHSI.

There has been an 18% increase in NHS specialist commissioning income and the trust is seeing large growth in the paediatric work load. It was noted that it is particularly challenging to recruit paediatric ophthalmologists.

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The board was advised of the current situation with the drug Avastin, which is not currently licenced in the UK. A recent judgement indicates that it should be made available as a treatment for AMD. There is no significant financial risk but a need to understand what it means for patients and staff.

More information to be provided at the next meeting – NS

18/2206 Medical appraisal and revalidation

The purpose of the report is to assure the board that the trust is meeting statutory requirements and complying with responsible officer regulations. The trust has in place a mature and successful process and is seen as an exemplar by NHS England.

There has been an uplift in appraisal rates and an improved culture of responsibility amongst staff. Fellows had been coming in and not realising that they were required to undertake appraisals but they are now informed of the process on induction.

There are 64 appraisers in the trust made up of consultants and associate specialist staff who are required to audit their own appraisal standards and practice. They also need to ensure that everyone is up to date with appraisal training and recruit new people. Appraisees all conduct a feedback exercise at the end of the appraisal process.

The revalidation process is one by which the trust makes a recommendation to the GMC about a doctor’s continuing fitness to practice. This is based on a five-year cycle and the portfolio they present when being appraised.

22 recommendations have been made and all were completed on time. There are three potential outcomes; recommend, defer or reject. Two were deferred, one has been revalidated and one is due in the coming months. The annual organisational audit return is submitted to NHSE and compares performance against other organisations. Moorfields has the highest appraisal rate in the country for acute specialist trusts.

The recommendation is to establish a working group so that the decisions made by the RO are sense checked and deemed to be of an appropriate quality. This will include a lay member or board non-executive.

Although it was acknowledged that attitude towards appraisal depends on the individual, it should be seen as a positive experience building on practice and allowing doctors to achieve more in terms of their aspirations. The process also needs to be replicated for job planning and performance review.

The board congratulated Declan Flanagan for his work as RO over the period and was assured that the report demonstrates a good culture in the organisation for revalidation and appraisal.

18/2207 Safeguarding annual reports

Both reports have been reviewed by the quality and safety committee. The key points to note for assurance relate to resource. The staffing establishment has increased by two WTE and safeguarding advisors (one for children and one for adults) have been

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employed. One of those individuals is an LD nurse and has made improvements in the way the trust is able to manage LD and dementia patients.

Safeguarding champions have been introduced across the organisation and they support the work being done on staff engagement. Training compliance is good, specifically around Level 3 safeguarding children. The cohort has been increased from 50 to 130. Learning themes from the quarter disseminated to staff.

The focus going forward will be to further embed the work being done in LD and dementia and strengthening the provision for patients requiring mental health support. There is a written process in place and the trust is able to call on local partners if required. The issue is included on both safeguarding and corporate risk registers and the trust is looking to develop an SLA with a local MH trust or to employ someone with specialist MH training.

In relation to working with social care, there is representation from the local authority on the safeguarding committees and discussions are triangulated through the various groups.

In the UAE requirements are different. A quality lead is in place and work has been taking place with them to strengthen arrangements. There are strong links with nurses between UAE and the trust in London with an escalation process through monthly conference calls. The DHCC have clear quality metrics and the trust is measured annually against those.

18/2208 Freedom to speak up report

DP advised that the trust had in place a speaking up programme and undertook a review which indicated that numbers were relatively low. Although this could indicate that people felt able to raise their concerns via other routes it was a possibility that guardians were not as embedded or accessible as they might be.

The trust has now recruited Ali Abbas, Farhana Sultana-Miah, Carmel Brookes and Aneela Raja as new guardians and they are undergoing a training process, with support from the lead guardian. They also have dedicated time scheduled with the chair and chief executive in order to discuss any themes that might be arising.

It was agreed that this function provides an important voice for staff and should be a real benefit for the organisation. Engagement has been very good so far and it is important that the guardians have support to undertake their role. Resourcing will be kept under review and the guardians will be presenting reports to the board in future.

18/2209 Board assurance framework

The board was reminded that the BAF is designed to highlight the key strategic risks to the organisations and that the board should use it to drive its discussion and business. The audit and risk committee reviews the BAF quarterly and the executive team review it quarterly in conjunction with the corporate risk register.

Tariff – there is still no indication of the payment mechanism for next year and what impact this might have on the organisation.

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Project Oriel – this is a huge project for the trust and the NHS. Although the trust needs to provide confidence that it is committed there are a number of different factors that could still affect the outcome.

Commercial growth – the trust needs to be increasing income in this area.

Retention of ‘good’ CQC rating – all staff are working hard to deliver a continually improving service for patients.

Commissioner turbulence – all commissioners are in financial distress. This is leading to sensible and pragmatic conversations about how to move services forward but there is also a danger that services will go out to market competition.

Staff engagement – the biggest challenge for the trust is being spread across a number of sites nationally and internationally and how to manage a consistent level of staff engagement across those sites.

Workforce planning will be a critical element of the management of current and future risks, particularly with a diminishing workforce.

Learning the lessons from clinical incidents – the trust must continue to be a learning organisation and conduct after action reviews, as we as having systematic processes in place to share learning across the divisions.

Development of the BAF will continue to be an iterative process and the document will be continually refined. The trust has limited control over some risks but others are entirely within the control of the organisation.

RGW asked about the balance between clinical risks and financial/strategic risks. It was agreed that all risks relate in some way to the trust’s ability to continue to deliver high quality care but that this should be better articulated in terms of quality.

It was also agreed that Brexit should be included as a risk although it is challenging to understand the impacts and potential mitigation at this stage.

Risks to be articulated to highlight the quality impact. Brexit to be included – HE

18/2210 Service improvement and sustainability update

The board received the Q2 report and was advised that the focus has been on key projects; patient waiting times, high volume cataract surgery, clinical administration and digital innovation. The programme is beginning to gain traction in terms of waiting time reduction. The introduction of kiosks allows wider ability to engage with patients in different ways. 35% to 40% of patients are using kiosks despite not having them fully rolled out across the organisation.

Some of the smaller projects taking place are about embedding change methodology and empowering people to make those changes. Staff will be presenting the outcomes of their projects to the executive in October.

Administration is one of the issues that is raised often in terms of complaints. The project has restructured the clinical administration team which has now been centralised and provides more of a career structure for administrators with an ability to progress and undertake a training and development programme. This should also see improvements in relation to the capacity of clinic clerks and allow them to focus on the patients in front of them, creating a call centre-type facility to take the calls. It was acknowledged that this will take time to embed.

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The board asked about data on patient waiting times, to establish whether or not the trust is an outlier. It was confirmed that waiting times are an issue internationally and that work needs to be done on international and national benchmarking as well as sharing improvement practice.

The methodology appears to be more resilient as once the team steps back the change has sustained. The SIS team presented at the last PCF and received good patient feedback and the strengthening the quality and patient involvement aspect. DP noted that the level of complimentary letters coming in about improvement in patient experience has increased and particularly commended the A&E and glaucoma services on their performance.

The trust will engage with the regulator and NHSI on how to take appropriate risks with a service that will have a beneficial effect long-term.

18/2211 Report ofthe quality and safety committee

The committee covered a number of issues including a review of the WHO audit which has seen a slight reduction in compliance with the team brief but SOPs have now been amended. Theatres at Mile End are currently safe to operate. All serious incidents are on track and the incident closure trajectory is being carefully monitored. There is still work to be done on culture in relation to fire safety.

Three key issues to highlight:

HTA/Eye Bank – the inspection took place in July. Verbal feedback was that there were a number of key findings that needed work. One of these was the licencing for stem cell research, but the committee was assured that the correct licences are now in place and that the trust is fit to run the eye bank. Two external inspections are due before the HTA return in November. The committee will undertake a deep dive at the next meeting.

The EBME department consists of a team of engineers and managers providing asset management, installation and maintenance of 4000 devices. The issue raised is the centralisation of records of medical devices training. Although assurance has been provided that it is going on and being recorded there needs to be central oversight. Otherwise the service seems to be very efficient.

Fellows are an important part of the medical workforce. They are individuals that have completed their main training and specialist training but wish to undertake further subspecialist training. Salaries are paid by the trust. The issue with VISAs has now been addressed but a vulnerability around Brexit remains. Fellows are managed individually but there is no central oversight across the organisation. We need to make sure they fit into workforce planning and to recognise that the trust has been successful in the global market for fellows and must continue to support them in their development. Some fellowships have been created to address specific service need and there has been a contraction in the number of fellows required due to service change. However, the trust is getting a much higher quality of fellows and will not issue a fellowship certificate if people do not reach the required standard. There is also a potential link to the alumni association which should be explored.

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18/2212 Identified risks from the agenda

Brexit will be included in the next iteration of the BAF.

18/2213 AOB

There was no AOB.

18/2214 Date of next meeting – Thursday 22 November 2018

Item 4 BOARD ACTION LOG

Meeting Date Item No. Item Action Responsible Due Date Update/Comments Status

26 Jul 2018 18/2189 Finance report Detail about recurrent and non-recurrent CIP to be

included in the next report

Jenny Greenshields 27 Sep 2018 Closing

26 Jul 2018 18/2188 Infection control annual report Update on microbiology reporting to go to the QSC by the

end of the year Tracy Luckett 1 Dec 2018 Open

26 Jul 2018 18/2196 Identify any items for the risk register arising

from the agenda

Risk on Brexit to be considered as part of the

BAF/corporate risk register

David Probert 27 Sep 2018 Closing

27 Sep 2018 18/2203 Chief Executive's Report Write to Robin Ali and James Bainbridge on behalf of the

board

Tessa Green 22 Nov 2018 Closing

27 Sep 2018 18/2203 Chief Executive's Report Schedule presentation by clinical leads early in the new

year

Helen Essex 7 Feb 2019 Open

27 Sep 2018 18/2205 Finance report More information to be provided on Avastin at the next

meeting

Nick Strouthidis 22 Nov 2019 Open

27 Sep 2018 18/2209 Board assurance framework Risks to be articulated to highlight the quality impact.

Additional risk on Brexit to be included

Helen Essex 22 Nov 2019 Closing

NB Items greyed out have been completed and will be removed from the next log

Bold shows updates Page 1 of 1

Glossary of terms OpenEyes Patient record system developed by Moorfields

Project Oriel A project that involves Moorfields Eye Hospital NHS Foundation Trust and its researchpartner, the UCL Institute of Ophthalmology, along with Moorfields Eye Charity working together to improve patient experience by exploring a move from our current buildings on City Road to a preferred site in the Kings Cross area by 2023.

AAR After actionreview

ACO Accountable Care Organisation

AHP Allied Health Professional

AIS Accessible Information Standard

AMD Age-relatedmacular degeneration

ARVO The Association for Researchin Vision and Ophthalmology

BAF Board Assurance Framework

BRC Biomedical researchcentre

CCG Clinical Commissioning Group

CCIO Chief Clinical Information Officer

CIP Cost Improvement Programme

CPQ Centre for Healthcare Planning and Quality Clinical regulator in Dubai CQC Care Quality Commission UK regulator CQUIN Commissioning for Quality Innovation

CRN Comprehensive research network

DH Department of health

DIPC Director of Infection Prevention and Control

DTA Decision to Admit

EBITDA Earnings Before Income Tax Depreciationand Amortisation

EDI Equality diversity and inclusivity

EDMS Electronic Document Management System

EDS Equality delivery system

EMR Electronic Medical Record

EPPR Emergency Preparedness Planning Resilience

EWTD European Working Time Directive

FBC Full Business Case

FFT Friends and Family Test

FRR Financial Risk Rating

FTSUG Freedom to Speak Up Guardian

GCC Gulf Co-operation Council

GDPR General Data Protection Regulations

HMT Her majesty’s treasury

HSIB Healthcare Safety Investigation Board

IOL Inter-Ocular Lens

IPR Integrated Performance Report

ISA Individual Service Agreements

ITT Invitation to tender

JHOSC Joint healthoverview and scrutiny committee

JVIS Joint vision research strategycommittee

KPI Key Performance Indicators LCFS Local Counter Fraud Service

MDT Multidisciplinary Team MEC Moorfields Eye Charity MEH Moorfields Eye Hospital

MLEB Moorfields Lions Eye Bank

MOU Memorandum of Understanding

MR Medical Retina NAW National apprentice week

NCL North Central London

NIHR National institute of health research NIS Network and Information Systems

OBC Outline Business Case

OHIM Office for Harmonizationin the Internal Market

OSC Overview & Scrutiny Committee

PbR Payment by results PDP Personal Development Plan

PFI Private Finance Initiative

PID Patient Identifiable Data

PMO Project Management Office PSF Provider sustainability fund PSPP Public Sector Payment Policy

QAF Quality Assessment Framework QIPP Quality, Innovation, Productivity and Prevention

QP Quality Partners

QSC Quality & Safety Committee R&D Research& Development

RDCEC Richard Desmond Children's Eye Centre RCA Root Cause Analysis

RIDDOR Reporting of Injuries, Diseases and Dangerous Occurrences

RNIB Royal National Institute for the Blind

RTT Referral to treatment

SGH St Georges University Hospital SI Serious Incident

SIS Service Improvement and Sustainability

SLA Service Level Agreement

SMART Specific, Measurable, Attainable, Relevant, Time-bound SOC Strategic Outline Case STF Sustainability and Transformation Fund

STP Sustainability and Transformation Plan

UAE United Arab Emirates

UCL University College London

UKOA UK ophthalmology alliance VFM Value for money

VR Vitreo Retinal WHO World health organisation

WRES Workforce Race Equality Standards

YTD Year to date

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AGENDA ITEM 05 – CHIEF EXECUTIVE’S REPORT BOARD OF DIRECTORS 22 NOVEMBER 2018

Report title Chief executive’s report

Report from David Probert, chief executive

Prepared by David Probert and the executive team

Previously discussed at Management Executive

Attachments STP monthly report

Link to strategic objectives The chief executive’s report links to all eight strategic objectives

Brief summary of report

The report covers the following areas:

CQC inspection readiness

2018/19 flu campaign

EEB shortlisted for Ophthalmology Honours award

M7 financial update

New appointments

Friends of Moorfields and Gus Gazzardnominatedfor Association of ophthalmology awards

Partnership with BRAP Eye project Uganda

STP quarterly report

Federation of specialist hospitals review

Action required/recommendation.

The board is asked to note the chief executive’s report.

For assurance

For decision

For discussion

To note

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MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST

PUBLIC BOARD MEETING – 22 NOVEMBER 2018

Chief Executive’s report

1. Quality

CQC inspection readiness

As the Board is aware we now have confirmed dates for our well-led inspection. These will be the 5 and 6 December

2018. Following correspondence with the CQC, interview schedules are being put together for these two days. Our

unannounced core services inspection took place on 14/15 November and involved surgery and outpatients at City

Road, Bedford and St George’s.

Flu vaccination update

This year's flu campaign began at the end of September when 26 peer vaccinators underwent training and

assessment provided by the occupational health team from Guys and St Thomas’s Hospital.

Trusts are being asked to achieve near universal vaccination of Trust staff. The CQUIN associated with the program

for improving the vaccinationof front line staff has changed this year. The target has increased from vaccinating 70%

in 2017/18 to 75% in 2018/19 of front line staff, while the financial remuneration linked to the CQUIN has reduced

from £0.3m to £0.2m.

To date, a total of 507 Trust staff have been vaccinated, 36% of these are front line staff. In addition, approx 80 non

Moorfields staff have been vaccinated, these include bank and contract workers, nursing and medical students.

Emergency Endophthalmitis Box initiative shortlisted for Ophthalmology Honours award

Moorfields’ initiative to roll out new Emergency Endophthalmitis Boxes (EEBs) across our sites, led by Ronald Kam,

consultant, and Tanya Serebryanska, lead antimicrobial pharmacist, has been shortlisted for a Bayer’s

Ophthalmology Honours 2018 award.

This annual programme recognises the outstanding work being carried out by multi-disciplinary teams in

ophthalmology throughout the UK. It identifies initiatives that demonstrate clinical excellence and innovation in

ophthalmology, and recognises exceptional individuals who improve the quality of care provided to patients and the

patient experience.

Our EEBs are shortlisted in the best ophthalmology service improvement category. They are drug-inclusive, tamper-

proof packs designed to help staff fight bacterial endophthalmitis, a sight-threatening infection of the eye which can

occur after penetrating injuries and ocular procedures. With over 15,000 cataract surgeries and 35,000 injections

performed at Moorfields in 2017, an efficient system of diagnosis and treatment is required to manage this serious

condition across our large network of sites. We will look to share our learning more widely across the ophthalmic

community.

2. Financial

M7 update

The Trust reported a surplus of £1.44m in month, which was £0.22m adverse to plan. The year to date position is a

surplus of £3.02m, which is £0.02m adverse to plan. Activity levels, particularly in Outpatients, were very high in

October, leading to a favourable NHS clinical income variance of £0.16m. NHS clinical income at £15.68m in-month

was at the highest ever recorded level. Expenditure associated with NHS activity overspent by £0.45m, due to

adverse variances in drugs and clinical supplies required to deliver the activity. Efficiency scheme achievement is

ahead of plan at £3.48m against a plan of £2.84m, a £0.64m favourable variance, although the current forecast

outturn is £0.986m adverse, due to the impact of £1.322m of efficiency schemes that are yet to be identified. The

Trust continues to forecast achievement of the revised Control Total of a £6.7m surplus.

3. People

Chief financial officer

I am pleased to welcome Jonathan Wilson to his first formal meeting of the board and look forward to working with

him in the future. I would also like to express my thanks to Jenny Greenshields who has done an excellent job in the

interim role over the past six months.

I would also like to welcome Victoria Elizabeth Hunt to the role of Head of Nursing for our UAE operation.

Friends of Moorfields and Gus Gazzard shortlisted for Association of Optometrists awards

Friends of Moorfields and Gus Gazzard, consultant ophthalmologist, have been shortlisted in different categories for the awards.

The Friends of Moorfields is shortlisted in the ‘Charity of the Year’ Award. This award recognises charities from all corners of the eye health sector, including those that are dedicated to research, raising awareness of optical issues, or supporting people with sight loss.

Gus has been nominated for lecturer of the year for his ongoing lecture work on a variety of courses, but especially for a new clinical optometry course which he has set up alongside optometrist Jay Varia. The course will be available as an MSc from next year.

I would like to extend my congratulations to the Friends and Gus on behalf of the board for their well-deserved

nominations.

Moorfields to partner with BRAPto developa culture of inclusion

Moorfields has successfully been appointed as one of the first pilot sites for a new programme to develop a culture

of inclusion through supporting leaders to develop their skills and insights.

Building Leadership for Inclusion (BLFI) is focused on raising the level of ambition for inclusion, increasing the pace of

change, and ensuring that leaders are equipped with the skills and knowledge they need to develop a culture in

which every member of staff feels valued and included. BLFI seeks to make more explicit the practices that haven’t

worked, and to stimulate new thinking and innovation.

Moorfields has always strived for excellence, and our ambition in participating in this programme is to ensure that

our working practices and culture support people to grow and thrive. We want to create productive teams in which

people are happy in their roles and, most importantly, deliver excellent patient care.

Eye project Uganda – Primrose Magala presents at parliament Congratulations go to Primrose Magala, senior ophthalmic nurse, who has been responsible for setting up Eye

Project Uganda. This work has been widely recognised, with Primrose taking part in a roundtable discussion with

HRH The Duchess of Cambridge about the importance of strengthening the global nursing workforce and presenting

at parliament alongside the Nursing Now patron, Lord Nigel Crisp, who also heads up the Uganda UK Health Alliance

(UUKHA).

Eye Project Uganda is already sponsoring six postgraduate ophthalmology students. The charity has also obtained

agreement for four Ugandan nurses to come to Moorfields for training as part of a ‘train the trainer’ initiative;

working towards building advanced nurse practitioner pathways in Uganda/ East Africa.

MoorPride launch (9 November)

MoorPride is Moorfields’ LGBT+ staff and patients' network. It aims to promote equality initiatives for LGBT+ staff

and patients. The network aims to increase visibility of the LGBT+ community at Moorfields, to ensure our

communications, policies and information are LGBT+ inclusive, and to provide networking opportunities for staff and

patients. The network supports staff to feel comfortable to bring their whole self to work, and Moorfields to be an

openly inclusive and diverse place to work. MoorPride also organises educational events to promote diversity and

inclusion.

Founded earlier in 2018, the network celebrated its role in the Moorfields' community with a formal launch event on

Friday 9 November. The event included unveiling a portrait of Mr Patrick Trevor-Roper, a gay rights activist and

ophthalmologist at Moorfields in the 1970s and 80s. I was delighted to attend alongside Ian Green, chief executive

officer of Terence Higgins Trust, and Tony Whitehead MBE, founding director of the Terence Higgins Trust, of which

Patrick was a founding member.

4. Strategy

STP monthly report (see appendix)

The trust continues to actively engage with the North Central London STP (known as North London Partners). The

planned care programme has recently initiated a work stream on ophthalmology, which is being led by Dilani

Siriwardena (divisional director for City Road). A multi-disciplinary team from provider and commissioning

organisations is now meeting regularly to develop consistent patient pathways across the sector. The trust also

continues to engage actively in the STP estates works stream through its work with Camden & Islington NHS

Foundation Trust and Whittington Health to take forward proposals to redevelop the St Pancras hospital site. The

attached report sets out the quarterly provider update from the STP.

Federationof specialist hospitals reviewthe role of specialist hospitals across the NHS

I was delighted that Moorfield’s played an active role in the recently published review of specialist hospitals and the

role they can play across the NHS (https://uclpartners.com/review-highlights-potential-bigger-role-specialist-trusts/).

The review was authored by Dr Liz Mear and Dr Charlie Davie and recommended seven ways in which local systems

can benefit more widely from the role of specialist trusts. It was focused mainly on the North West and London

where there are clusters of specialist trusts, to explore the reasons for higher performance indicators often seen in

specialist hospitals, and to identify whether there is potential for organisations to do more. The report will be

presented to the DHSC and other NHS bodies by the Federation.

David Probert

Chief Executive

November 2018

https://uclpartners.com/review-highlights-potential-bigger-role-specialist-trusts/

North London Partners in Health and Care North Central London STP

Quarterly provider update

20 September 2018

Ambitions of the STP

Improve the health and wellbeing of the local

population

Maximise out of hospital

care and build resilient well supported communities

Reduce health inequalities

A partnership of the NHS and local authorities, working together with the public and patients where it’s the most efficient and effective way to deliver improvements.

Ambition for the STP is built on existing CCGs, Local Authorities and Providers values and strategy

Clinical and senior leadership in place across North London Partners

NCL Health and Care Cabinet: Richard Jennings and Jo Sauvage STP Clinical

Leads and Co-Chairs NCL Programme Board and Advisory Board

North London

Councils Adult

Social Care group

Input and membership of clinical working groups from across NCLCCGs, Providers and LAs

Prevention Planned care

Health andcare closerto home

Mental Health

Children and young people

Maternity

Cancer

Urgent and

Emergency Care

Social Care

Dr Karen Sennett (Islington)

Dr Tom Aslan (Camden)

Dr Richard Jennings,

(Whittington)

Dr Debbie Frost (Barnet)

Dr Katie Coleman, (Islington)

Borough based leads for each

CCG

Dr Vincent Kirchner

(C&I)

Dr Jonathan Bindman

(BEH)

Dr Oliver Anglin

(Camden)

Professor

Donald Peebles

Mai Buckley (Royal Free)

Professor Geoff Bellingan

(UCLH)

Dr Clare Stephens (Barnet)

Dr Shakil Alam

(Haringey)

Dr Chris Laing

(UCLH)

Dr Alex Warner (Camden)

Dr Julie Billet (Camden and

Islington)

Prof. Marcel

Levi (UCLH)

Tony Hoolaghan

(H&I)

Paul Jenkins

(TAVI)

Charlotte Pomery

(Haringey LA)

Rachel Lissauer

(Haringey)

Kathy Pritchard

Jones UCLH

Sarah

Mansuralli (Camden)

Dawn Wakeling

(Barnet) SRO

s C

lin

ica

l le

ad

s C

lin

ica

l wo

rkst

rea

ms

Examples of progress so far

Case 1 Case 2

Case 3

New specialist perinatal mental health service for north central London

The service provides specialist treatment andsupport for pregnant and postnatal women with severe mental illness and offers consultation and training with staff in the wider system, supporting them to work more effectively with women with less complex problems. It is improving equity of access to specialist support for local women.

Review of adult elective orthopaedic services across NCL

We have launched a review of adult elective orthopaedic services across NCL to explore how services might be improved.

A review group led by local clinicians, involving patients, commissioners and those who currently carryout these operations is coordinating the development of how this kind of care could be delivered in the future.

We are currentlyengaging with ourstakeholders on the draft case for

change before considering next steps.

Opening oftwo new maternity community hubs

The Better Birthsreport of 2016 has been a driving force at a national level to transform maternitycare. Our work in north central London, as a Better Birthsearly adopter, has been to work collaboratively across Barnet, Camden, Enfield, Haringey and Islington to:

• Improve continuity of care • Improve choice and personalisation • Ensuring maternitycare remains safe and accessible for women

Earlier this year, the team opened a new maternitycommunity hub at Harmood’s Children’s Centre in Kentish Town. – a major step towards improving maternitycare for women in NW Camden postcodes who currently accessservices at the Royal Free and UCLH. A second centre is due to open at Park Lane Children’s Centre in Haringeynext month.

Headlines from across the programme

UEC

• ‘Star divert numbers’ enable clinical staff to get through to a clinical expert for urgent advice and support by dialling

the appropriate number. In the past year star line activity has increased 42%, from 751 calls to 1068 calls per month (1,929 calls in the past year)

• We have made it faster and safer for patients to get home from hospital by agreeing standard ways of working and

working more effectively with social care. Use of the new discharge to assess pathways has increased by 50% over the

past six months.

Planned Care

• Clinical advice and navigation now live across providers in NCL in 8 specialities with further specialties going live in November 2018.

• Review of adult elective orthopaedic care commenced in March 2018 . Our ambition is to create a comprehensive

adult elective orthopaedic service for NCL, which will be seen as a centre for excellence with an international

reputation for patient outcomes and experience, education and research.

Health and Care Close to Home

• Since April 2018 it has been possible for residents to access GP services 8am-8pm across the whole of NCL through extended access.

• Established the first NCL Care and Health Integrated Networks and Quality Improvement Support Teams, focusing on

improving quality and reducing unnecessary variation.

Mental Health

• A new women’s psychiatric intensive care unit at Camden and Islington NHS Foundation Trust service opened in

November 2017. All women who require intensive care services can now be treated close to where they live. All women have been repatriated back from out of area placements (OAPs) and we currently have zero women in OAPs.

UEC

SRO: Sarah Mansuralli

Overall workstream objective:

A consistent and reliable UEC service by 2021 that is accessible to the public, easy to navigate, inspires confidence, promot es consistent standards in clinical practice and leads to a reduction in variation of patient outcomes. Work focuses on Admissions avoidance, ambulatory care, end of life and discharg e to assess.

Notable progress made this reporting period (Q2 2018) Notable progress planned for next reporting period (Q3 2018) • Direct Booking from 111 into GP Federation Hubs (extended hours &

weekends) is live across NCL;

• Mental Health Patients being warm transferred to MH teams via NHS 111 • Single Choice policy relatedto Discharge approved;

• Standardised specification for Rapid Response community services ready in October; • System wide demand and capacity based 7 day community model to supportmore patients to

return home through Discharge to Assess. • Agreed NCL approach to Single Point of Access for out of hospital palliative care

Priority project Impact* Major Independencies Key Care Settings Partner involvement

Integrated urgent care £, Q, P, E, C Digital Acute, GPs, Pharmacies, NHS111 Partners involved: • Acute Trusts, Community services, MH providers GP Practices;

Care Homes Potential future commitments: • Last phase of life single point of access model • Common provider choice policy for discharge • Stroke business case to increase community rehab

Admission avoidance £, Q, P, E, C Digital, Workforce Acute, GPs / Community

Simplified discharge £, Q, P, E, C Digital, Social Care Acute, Care Homes, Community

Last Phase of life £, Q, P, E, C Digital, Social Care Care Homes, NHS111, Remote

Planned

Care

SRO:

Marcel Levi

Overall workstream objective

Deliver bettervalue planned care throughnew models of care and reducing unwarranted variation across providers.

Notable progress made this reporting period (Q2 2018) Notable progress plannedfor next reporting period (Q3 2018) • Advice and guidance service live across primary care and acute trusts

• Public engagement on orthopaedic review case for change

• Teledermatology service to go live across NCL


Using NHS money wisely £, Q, C - GPs, Providers Partners involved: • Acutes, CCGs, GPs Potential future commitments: • Common NCL PoLCE Policy • Teledermatology and Advice and Navigation services

implemented across NCL • Involvement in orthopaedic review

Advice & Navigation £, Q, P, E, C Digital GPs

Dermatology £, Q, C Digital GPs, Acute Providers

Urology £, Q, C HCCH Acute Providers

Orthopaedic review £, Q - Acute Providers

Health and

Care Closer

to Home

SRO: Tony

Hoolaghan


A ‘place-based’ population health system of care base around neighbourhoods of 50-80k which draws together social, community, primary and specialist services underpinned by a systematic focus on prevention and supported self-care.

Notable progress made this reporting period (Q2 2018) Notable progress plannedfor next reporting period (Q3 2018) • Launch of Quality Improvement network • Full population coverage of neighbourhoods

• Commence procurement process for online consultations provider


CHIN/Neighbourhood C Workforce, Estates, Digital GP practices, social care, community Partners involved: • CCGs, GP, community pharm , Mental Health & Social Care Potential future commitments: • NCL-wide strategy for General Practice • NCL wide approach to Atrial Fibrillation improvement • NCL model for social prescribing • Enhanced services review • Contracting for Care & Health Integrated Networks

Quality Improvement £, Q Workforce Virtual, GP practices

P. Care Commissioning £, Q, E CCGs, GPs

Social Prescribing £, Q Workforce GP practices, social care, community

Primary Care at Scale £, Q, P, E GP practices

* £ = Savings, Q = Quality, P=Performance, E=Efficiency, C=Clinical Outcomes ** See appendix 2 for detail on interdepe ndencies

Mental

Health

SRO: Paul


• Working to address inequalities for those with SMI and provide consistentcare. • Deliver services closer to home, reducing demand on the acute sector and mitigating the need for additional MH inpatientbeds.

Notable progress made this reporting period (Q2 2018) Notable progress plannedfor next reporting period (Q3 2018) Jenkins • NCL STP met the CYP access standard for 2017/18

• Funding for Adult HBPoS, Dementia, W2 perinatal, & CAMHS Projects.

• Agreed common PROM/PREM for Primary Care MH Services across NCL.

• MH Liaison options developed for 2019/20. • Initial evaluation of IAPT Long Term Conditions Pilot and lessons learnt available.

• Workforce development programme to improve CYP MH skills across settings


Improve acute care E HCCH, Social Care, UEC Acute, MH Trusts, Community Partners involved: • CCGs, Acute, GPs/CHINs, MH Trusts, HEE

Maternity

Improve CAMHS Q CYP Schools, GPs, Community, MH Trusts

MH Liaison services Q, P, £ UEC Acute, MH Trusts, Community

Primary Care MH inc. IAPT Q, P, £ HCCH, Digital, Estates (2) GPs, Community

MH Workforce Q, P, £ Workforce (3), Digital Acute, MH Trusts, Community, GPs


Potential future commitments: • Development of frontline mental health services across settings • Agree single approach to Psych Liaison services in acute

• Expand workforce to ensure capacity to meet national targets for improved access.

SRO: Rachel Lissauer

Delivery of the National Maternity Transformation programme through improved continuity and safety of perinatal care for wome n, working across professional and organisational boundaries to drive better patient experience and integrated care.

Notable progress made this reporting period (Q2 2018) Notable progress plannedfor next reporting period (Q3 2018) • Earlier this year, the teamopened a new maternity community hub at

Harmood’s Children’s Centre in Kentish Town

• Second centre is due to open at Park Lane Children’s Centre in Haringey next month


Quality & Safety Q Digital Acute, community Partners involved: • Acute trusts

Personalisation & choice Q Digital Acute, community

Single point of access £,Q Digital , Workforce Acute, community

Community services dvt Q HCCH Community settings

Potential future commitments: Portability of staff across services Single point of booking across NCL

Health and

Prevention

NCL collaborative working £, Q Workforce Acute, community


Driving system-wide approach to prevention and population healthworking to enable success in the overall STP strategy for care

Notable progress made this reporting period (Q2 2018) Notable progress plannedfor next reporting period (Q3 2018) SRO: Julie

Billet • Agree a consistentand coordinatedapproach to NCL wide MECC training

• Submittedbidto DWP funded Challenger Fund for improving workforce

retention for people with mental health needs

• Working with Cancer workstream tosupport delivery of awareness and earlydiagnosis

programme in NCL.


Workforce for prevention E, P Workforce, Estates, Digital Acute, MH Trusts, Community Partners involved: • GP practices

Healthier environment O Workforce Acute, MH Trusts, Community

Healthier choices C, Q Workforce


Potential future commitments: • Working to towards healthier workplaces • Alignment of organisational strategies • Commitment to prevention (primary and secondary)

* See appendix 2 for detail on interdependencies

Cancer

SRO: Kathy

Pritchard-

Jones


Delivery of improved survival, patient experience, efficiency of service delivery including services closer to home; reduced costs £ financial sustainabilit y; reduced variation.

Notable progress made this reporting period (Q2 2018) Notable progress plannedfor next reporting period (Q3 2018) • Findings from annual review – 1-year survival rate better than England average • Workforce modelling re: radiology gaps in employment

• % people in NCL diagnosed at early stage good relative to England average • System work on 62 day target


Cancer waits Q, P Diagnostics capacity Acute, Primary Care , community Partners involved: • Acute providers, GPs

Early diagnosis Q, P HCCH, Prevention Acute, Primary Care , community

Living w & beyond cancer Q HCCH, Planned Acute, Primary Care , community


Potential future commitments: • TBC

Children

and Young People

‘Right care, right place, right time’. Transformed health & social care services: equitable, accessible, efficient & deliver improved outcomes. Enabling high quality, responsive services for children, young people & families, delivered locally where possible, with shared focus on promoting wellbeing, reducing health inequalities & improving health & social outcomes.

Notable progress made this reporting period (Q2 2018) Notable progress plannedfor next reporting period (Q3 2018) SRO:

Charlotte

• Admissions Avoidance baseline report complete • Agreed priorities/initiatives for Complex Needs project • #AAA Asthma NCL communications campaign

• Asthma logic model workshop with agreed NCL outcomes, objectives and measures • CYP Surgery case for change report • Complex Needs enhanced data review

Pommery Priority project Impact* Major Independencies Key Care Settings Partner involvement

Paediatric surgery Q Workforce, digital Acute trusts (GDH & Tertiary) Partners involved: Acute Trusts, Primary Care, Commissioners, Pharmacy, Public Health, Local Authority

Asthma Q Prev, HCCH, workforce, digital Acute, Primary Care , community

Complex Needs £, Q UEC, HCCH, Mental Health Acute Trusts, LA Placements

Paed. admissions avoid. £, P, Q UEC, Prev, HCCH, workforce, digital Acute, Primary Care , community


Potential future commitments: System approach to managing & preventing asthma in C&YP • Developing surgical network across NCL • Preventative approach to care & support for CYP & families

Social Care

SRO: Dawn

Working to address careinequalities in provisionandimproving longer termstrategicapproach to workforceand caremarket.

Notable progress made this reporting period (Q2 2018) Notable progress plannedfor next reporting period (Q3 2018)

Wakeling • Detailed analysis of all boroughs purchasing of care homes informing a joint commissioning strategy; councils and CCGs collaborating with LPH around

exploring sustainable price bandings for nursing care.

• Develop proposals for an NCL Care Academy • First draft of Care Analytics report on sustainable care prices for residential and nursing care


Ind. Care Sector Workforce £, E, Q HCCH, UEC, Workforce Home Care, Care Homes Partners involved: Local authorities, CCGs, care providers Potential future commitments: Joint commissioning strategy

Digital

SRO: David

Sloman

Social Care Markets Q, £, E HCCH, UEC, MH, Workforce Home Care, Care Homes

Notable progress made this reporting period (Q2 2018) Notable progress plannedfor next reporting period (Q3 2018) • Submission of provider digitisation funding bid • Begin work on technical delivery across partner organisations


Health Information Exch Q, £ Clinical Workstreams All Partners involved:

Pop Health Management Q, £ Clinical Workstreams

All • Acute Trusts, Primary Care, Commissioners, Pharmacy, Public

Health, Local Authority Potential future commitments: Ongoing partnership working to delivery Health Information exchange

* £ = Savings, Q = Quality, P=Performance, E=Efficiency, C=Clinical Outcomes

Workforce

SRO:

Overall workstream objective To attractpeopleto liveandwork in NCLso wehavethebestpossibleworkforce to deliverhigh quality services to our community

Notable progress made this reporting period (Q2 2018) Notable progress plannedfor next reporting period (Q3 2018) Siobhan

Harrington • Detailed work on financial benefit of Collaborative bank • Funded priority areas through securing of £500k HEE money

• ACP begin placements (18 funded) • Physician associates begin placements (up to 43)

• Training of care home staff and AHP in new ways of working


UEC prep. winter 2019 P, Q UEC Acute, Community, Primary care Partners involved: • All

Portability (including passports, MAST)

P, Q, £ Prevention, HCCH Acute, Community, Primary care Potential future commitments:

• Standardisation of mandatory training to aid portability

Temporary Staffing £, Q, C - Acute and Community trusts • Standardisation of employment contracts to aid portability

Social & Primary C /Community/Place based

£, P, Q UEC Community, Primary care

Estates

SRO: Simon

Goodwin

Analytics (WF planning) £ All

Overall workstream objective To provide a fit for purpose, cost-effective, integrated, accessible estate which enables the delivery of high quality health and social care services for our local population.

Notable progress made this reporting period (Q2 2018) Notable progress plannedfor next reporting period (Q3 2018) • Estates strategy drafted and submitted to NHSE&I. • Production of the NCL STP Delivery Plan to take forward key priorities in the NCL Estates Strategy

• Workshop on NCL STP principles of placed based care community – 8 Nov 18. • Locality planning – phase 1 to be completed by end of financial year to be ready for wave 5 and London

Estates board capital pipeline.


NCL estates strategy £, Q All All STP partners Partners involved: • CCGs and Trusts

St Pancras devt. – C&I £, Q Mental Health C&I hospital site

St Ann’s devt.– BEH £, Q All BEH hospital site

Project Oriel Q - Moorfields, C&I hospital sites

Potential future commitments: Partnership working on NCL estates strategy iteration

Provider Productivity

Reducing void spaces £, Q All All STP partners

Overall workstream objective To scope and take forward areas of savings requiring collaboration across providers

Notable progress made this reporting period (Q2 2018) Notable progress plannedfor next reporting period (Q3 2018) SRO: Tim Jaggard

• Scoping of 5 areas of opportunity including detailed work on financial benefit of Collaborative bank

• Presentation to Provider Chief executives of scoped opportunity for decisions on programme of work


Partners involved: • Providers

Potential future commitments: • Consideration of collaborative bank option • Ongoing engagement in modelling, scoping and emerging

programme of work


Workforce £ Workforce NHS Trusts

Procurement £ - NHS Trusts

Facilities management £ - NHS Trusts

Diagnostics £, Q Planned Care NHS Trusts

Appendix 1: Capacity to delivery change

Dedicated capacity now in place across majority of workstreams to facilitate working across partner organisations to deliver agreed STP initiatives.

Workstream Programme lead Email Address

Adult Social Care Richard Elphick [email protected]

Cancer Nasar Turabi [email protected]

Children and Young People Sam Rostom [email protected]

Digital Martyn Smith [email protected]

Estates Dianne MacDonald [email protected]

Health and Care Closer to Home Sarah McIlwaine [email protected]

Maternity Kaye Wilson TBC

Mental Health Chris Dzikiti [email protected]

Planned Care Donal Markey [email protected]

Prevention Mubasshir Ajaz [email protected]

Productivity Shahbaz Bhutta [email protected]

Orthopaedic review Anna Stewart [email protected]

Urgent and Emergency Care Alex Faulkes [email protected]

Workforce Sarah Young [email protected]

mailto:[email protected]













Report to Trust Board

Report Title Integrated Performance Report - October 2018

Report from John Quinn, Chief Operating Officer

Prepared by Performance And Information Department

Previously discussed at

Attachments

Brief Summary of Report

This Integrated Performance Report highlights a series of metrics regarded as the Key Indicators of Trust Performance and cover a variety of organisational activities within Operations, Quality and

Safety, Workforce, Finance, Research, Commercial and Private Patients . The report uses a number of mechanisms to put performance into context, showing achievement against target, in

comparison to previous periods and as a trend. The source of each KPI is also shown, namely; the Single Oversight Framework (SOF); NHS England (NHSE); NHS Improvement (NHSI); Care Quality

Commission (CQC); Trust derived (Local) or a Strategic Objective (SO, followed by a number to indicate which objective). Importantly, the report also identifies additional information and Remedial

Action Plans for those KPIs falling short of target and requiring improvement.

Executive summary

The Trust continues to show a positive to the Trust and nationally reported standards are performing well (exceptions discuss ed below).

A&E activity remains down and based on this trend the Trust will see just under 100,000 patients the rate of decline in attendances is stabilising. However both outpatient and admissions activity is

strong.

Overall RTT performance above is above target however there remains a small number of 52 day breaches as we are still managing and treating patients discovered from the serious incidents over the

last few months namely A&E, Mailbox at St Georges and DRSS. No patient harm has been reported due to these delays.

Cancer first appointments remain challenging. There has been a 2 week wait breach in month due to patient choice. This one breach has meant the 2ww target has dropped below the standard for the

months however the YTD standard has still been met. The 14 day locally agreed standard remains a challenge with patients still remaining to choose to delay their initial appointment for personal

reason. Also there has been a number of delays due to capacity issues specifically staffing. Last month it was reported that there was an issue with consultant numbers hence capacity, we have now

an very experienced additional consultant working with us now. . Increasing staffing number is being looked at.

In October GPs were required to refer all patients electronically. The Trust continues to improve its trajectory however it may be difficult to reach 100% due to urgent referrals. This will be explored

internally and with commissioners.

Patient journey times continue to be meeting the improvement target for both news and follow ups. The journey time for new still meets the target however it has increased slightly and we will undertake

a deep dive to understand this further and make corrective actions where necessary. Although data completeness targets are not reaching the target they have all improved showing that the delivery of

the waiting time is based on a more robust information data set.

Action Required/Recommendation

The report is primarily for information purposes but will inform discussion regarding how the Trust is performing against its key organisational measures. This may in turn generate subsequent action.

As this is the first Integrated Performance Report produced in this format, the Board is also asked to provide feedback on the style and content of the report, so that these can be considered for future

iterations.

For Assurance X For decision For discussion To Note

Intergrated Performance Report - October 2018 Page 1

Trust Executive Summary By Strategic Objective - October 2018

G A R

G A R

'Monthly Trend' Key

Colour of symbol shows

Red, Amber Green rating

of current month against

target.

* Red, Amber, Green ratings are used to identify whether or not a KPI is

achieving target. Where there are data issues, these are highlighted in blue.

* Grey ratings represent zero return and therefore a percentage can not be

calculated, or where a target has not been set or is 'tbc'

* Metrics for which data is either not available or are not applicable to reporting

period (i.e. Quarterly figures) are shown as black.

'Current Rating' Key

No metrics available for this objective SO4

SO2 Research 4 0 0

SO1

Referral To Treatment 1 0 1

Accident & Emergency 2 0 0

Cancer 2 0 2

Clinic Management 2 0 5

Diagnostics 1 0 0

DNA Rates 2 0 0

Cancellations 3 0 1

Theatre Practice 2 0 0

Ward Management 3 0 0

Data Quality 5 0 1

Mortality 1 0 0

Infection Control 6 0 0

Patient Safety 6 0 3

Safer Staffing Checklist 5 0 0

Patient Experience 6 1 1

SO3 Training Compliance 2 0 1

SO5 Staff & Voluntary Experience 2 0 0

Recruitment and Turnover 2 0 2

SO6 Organisational Health 1 2 0

Capital Development 1 0 1

SO7 Annual Surplus Delivery 4 0 1

Liquidity 3 0 0

Use Of Resources Metrics 1 0 0

SO8 Contribution To ROI 1 0 2


Trust Executive Summary By CQC Domain - October 2018 G A R G A R

'Monthly Trend' Key

Colour of symbol shows

Red, Amber Green rating

of current month against

target.

Safe




Safer Staffing Checklist 5 0 0

Well-Led

Organisational Health 1 2 0


Staff & Voluntary Experience 2 0 0

Training Compliance 1 0 1

Research 4 0 0

Use of

Resources

Capital Development 1 0 1

Liquidity 3 0 0

Contribution To ROI 1 0 2

Annual Surplus Delivery 4 0 1


Use Of Resources Metrics 1 0 0

Financial Metrics 0 0 0

Carter Metrics 0 0 0

Responsive

Referral To Treatment 1 0 1

Accident & Emergency 2 0 0

Cancer 2 0 2

Clinic Management 2 0 5

Diagnostics 1 0 0


Effective

DNA Rates 2 0 0

Cancellations 3 0 1

Theatre Practice 2 0 0

Mortality 1 0 0

Data Quality 5 0 1

Caring

Patient Experience 6 1 1



Training Compliance 1 0 0

Organisational Health 0 0 0


* Red, Amber, Green ratings are used to identify whether or not a KPI is

achieving target. Where there are data issues, these are highlighted in blue.

* Grey ratings represent zero return and therefore a percentage can not be

calculated, or where a target has not been set or is 'tbc'

* Metrics for which data is either not available or are not applicable to reporting

period (i.e. Quarterly figures) are shown as black.

'Current Rating' Key

Responsive 12

10

8

6

4

2

0

Safe 25

20

15

10

5

0

Effective 14

12

10

8

6

4

2

0

Caring 14

12

10

8

6

4

2

0

Well-Led 12

10

8

6

4

2

0

Use of Resources 14

12

10

8

6

4

2

0

Lines split by financial year due to different number of metrics

Integrated Performance Report - October 2018 Page 3

1 2 2 1 Amber 0 2 0 0 0 Amber 0 0 0 1 1 Amber

12

Executive Summary - CQC Domain Trends

2 4 3 3 3 6 4 3 1 1 2 0 2 Red

0 3 0 1 2 0 1 2 2

13 10 9 10 7 9 5 8 7 6 7 6 Green

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

2 1 0 1 3 2 2 0 1 0 1 1 1 Red

0 0 0 0 0 0 0 0

14 21 16 15 15 14 14 20 19 20 19 19 19 Green


8 9 8 10 8 8 9 7 7 6 6 7 8 Red

0 0 0 0 2 1 1 0

9 8 9 8 9 9 9 9 9 10 9 10 9 Green


KP

I RA

G S

tatu

s K

PI R

AG

Sta

tus

KP

I RA

G S

tatu

s K

PI R

AG

Sta

tus

KP

I RA

G S

tatu

s K

PI R

AG

Sta

tus

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

Green 6 6 5 6 5 6 5 11 12 12 12 12 12

Amber 0 0 0 0 0 0 0 1 1 1 1 1 1

Red 0 0 1 0 1 0 1 3 2 2 2 2 2


Green 9 9 9 8 10 9 11 9 10 10 8 7 9

Amber 2 2 2 2 2 2 2 1 3 1 4 4 2

Red 6 5 6 6 5 6 3 2 2 3 2 4 3


Green 12 12 12 13 13 12 9 7 11 13 13 12 11

Amber 1 0 0 0 0 0 0 1 0 0 0 0 0

Red 2 3 3 2 2 3 6 5 4 2 2 3 4


These figures are not subject to any finance or commissioning business logic. They present all activity, whether chargeable or not

+ 4.9%

+ 6.4%

+ 3.4%

- 10.8%

21,780 22,846

19,395 20,631

621 642

1,764 1,573

+ 1.1%

+ 1.8%

- 3.6%

- 6.0%

3,337 3,374

3,004 3,059

83 80

250 235

Admission

Activity

Total Admissions

Day Case Elective Admissions

Inpatient Elective Admissions

Non-Elective (Emergency) Admissions

+ 8.3%

+ 7.1%

+ 9.3%

+ 6.5%

76,019 82,359

329,513 352,889

73,906 80,784

255,607 272,105

+ 4.5%

+ 9.8%

+ 12.7%

+ 8.9%

11,889 12,424

50,556 55,502

11,429 12,882

39,127 42,620

Outpatient

Activity

Number of Referrals Received

Total Attendances

First Appointment Attendances

Follow Up (Subsequent) Attendances

YTD

Variance

- 3.0%

+ 9.2%

Year To Date

2017/18 2018/19

59,807 58,028

999 1,091

Monthly

Variance

+ 1.0%

- 34.9%

October 2018

2017/18 2018/19

8,401 8,484

43 28

Accident &

Emergency

A&E Arrivals (All Type 2)

Number of 4 hour breaches

Context - Overall Activity - October 2018

* Figures Provisional for October 2018

** Figures backdated for Aug and Sept 2018

Where issued for a metric, the page number of the Remedial Action Plan (RAP) can be found in column 'RAP Pg'


Objective 1 We will pioneer patient-centred care with exceptional clinical outcomes and excellent patient experience October 2018

Strategic

Issue

Metric Description

CQC Domain

Target

Cu

rren

t

RA

P P

g

Year to

Date

Reporting

Frequency

Jul 18

Aug 18

Sep 18

Oct 18

13 Month

Trend

vs

. L

as

t

Referral To

Treatment

18 Week RTT Incomplete Performance * Responsive ≥92% G

94.6%

Monthly 94.9% 94.2% 93.9% 94.0%

52 Week RTT Incomplete Breaches * Responsive Zero

Breaches R 11 39

Monthly 16 9 2 4

Accident &

Emergency

A&E Four Hour Performance Responsive ≥95% G

98.1%

Monthly 96.7% 99.7% 99.4% 99.7%

A&E Unplanned Reattendance Responsive ≤5% G

5.2%

Monthly 5.4% 4.8% 5.1% 4.2%

Cancer

Cancer 2 week waits - first appointment urgent GP referral Responsive ≥93% R 12 95.5%

Monthly 83.3% 88.9% 100.0% 87.5%

Cancer 14 Day Target - NHS England Referrals (Ocular Oncology) Responsive ≥93% R 13 76.1%

Monthly 74.7% 65.1% 83.3% 68.2%

Cancer 31 day waits - diagnosis to first appointment Responsive ≥96% G

97.5%

Monthly 95.2% 100.0% 91.7% 96.3%

Cancer 31 day waits - subsequent treatment Responsive ≥94% G

100.0%

Monthly 100.0% 100.0% 100.0% 100.0%

Cancer 62 days from urgent GP referral to first definitive treatment Responsive ≥85%

100.0%

Monthly 100.0% n/a n/a n/a

Clinic

Management

Median Clinic Journey Times - New Patient appointments Responsive Mth:≤ 100m G

94

Monthly 91 94 93 96

Median Clinic Journey Times -Follow Up Patient appointments Responsive Mth:≤ 91m G

91

Monthly 91 89 89 90

Percentage of patients using kiosks or alternative technology on sites where they are and are embedded. Responsive TBC

Monthly from Oct

In Development

Data completeness for Clinic Journey Time (Total) Responsive Mth:≥ 72.0% R 14 43.7%

Monthly 44.2% 48.6% 48.9% 49.9%

Data completeness for Clinic Journey Time (Glaucoma) Responsive Mth:≥ 77.2% R 15 57.1%

Monthly 56.9% 63.2% 68.8% 65.4%

Data completeness for Clinic Journey Time (MR) Responsive Mth:≥ 76.7% R 16 52.7%

Monthly 57.0% 57.7% 51.8% 52.5%

Percentage of GP referrals From Electronic Booking - trajectory target of 100% for Oct 2018

Responsive 100% R 17 80.0%

Monthly 80.3% 85.1% 91.7% 96.5%

Electronic Booking Appointment Slot Issue (ASI) Rate

Responsive

≤ 4.0%

R

18

23.1%

Monthly

(Month in

Arrears)

20.1%

27.1%

20.0%

27.6%






Strategic

Issue

Metric Description

CQC Domain

Target

Cu

rren

t

RA

P P

g

Year to

Date

Reporting

Frequency

Jul 18

Aug 18

Sep 18

Oct 18

13 Month

Trend

vs

. L

as

t

Diagnostics Percentage of Diagnostic waiting times less than 6 weeks Responsive ≥99% G

100%

Monthly 100% 100% 100% 100%

DNA Rates Outpatients DNA rate - 1st appointment Effective ≤12.3% G 11.8% Monthly 11.9% 12.7% 12.1% 11.5%

Outpatients DNA rate - follow up appointment Effective ≤10.8% G 10.4% Monthly 10.3% 10.4% 11.1% 10.2%

Cancellations

Outpatient Cancellation rate (Hospital cancellations) Effective ≤2.85% R 19 3.51% Monthly 3.92% 2.74% 3.07% 3.19%

Theatre Cancellation Rate (Overall) Effective ≤7.0% G 7.0% Monthly 6.8% 6.4% 7.7% 6.5%

Theatre Cancellation Rate (Non-Medical Cancellations) Effective ≤0.8% G 0.88% Monthly 0.80% 0.88% 1.13% 0.73%

Number of non-medical cancelled operations not treated within 28 days * Effective Zero

Breaches G

8

Monthly 0 0 0 0

Theatre

Practice

Theatre Sessions starting late Effective ≤32.7% G

33.8%

Monthly 35.9% 35.6% 31.1% 31.8%

Percentage of Emergency re-admissions within 30 days following an elective or emergency spell at the Provider (excludes Vitreoretinal)

Effective ≤3.77% G

3.34%

Monthly 2.90% 5.26% 3.39% 0.00%

Ward

Management

Delayed Transfer of Care (Number of days) Responsive Zero Days G

0

Monthly 0 0 0 0

Inpatient (Overnight) Ward Staffing Fill Rate Safe ≥90% G

94.9%

Monthly 103.7% 96.5% 91.1% 90.0%

Mixed Sex Accommodation Breaches Caring Zero

Breaches G

0

Monthly 0 0 0 0

Data Quality

Data Quality - Ethnicity recording (Outpatient and Inpatient) Effective ≥98% R 20 91.7% Monthly 91.7% 91.5% 91.4% 90.4%

Data Quality - NHS Number recording (Outpatient and Inpatient) Effective ≥99% G 99.5% Monthly 99.5% 99.5% 99.5% 99.5%

Data Quality - GP recording (Outpatient and Inpatient) Effective ≥98% G 99.9% Monthly 99.9% 99.9% 99.9% 99.8%

Data Quality - Ethnicity recording (A&E) Effective ≥95% G 99.9% Not Set 99.9% 99.9% 99.9% 99.8%

Data Quality - NHS Number recording (A&E) Effective ≥95% G 94.8% Not Set 95.2% 95.1% 95.2% 95.2%

Data Quality - GP recording (A&E) Effective ≥95% G 99.4% Not Set 99.1% 99.2% 99.5% 99.5%

Mortality Summary Hospital Mortality Indicator Effective Zero Cases G n/a Monthly n/a n/a n/a 0






Strategic

Issue

Metric Description

CQC Domain

Target

Cu

rren

t

RA

P P

g

Year to

Date

Reporting

Frequency

Jul 18

Aug 18

Sep 18

Oct 18

13 Month

Trend

vs

. L

as

t

Infection

Control

Endopthalmitis Rates - Cataract (per 1000 incidents) Safe ≤0.4

0.32

Quarterly

0.00

Endopthalmitis Rates - Intravitreal (per 1000 incidents) Safe ≤0.5

0.21

Quarterly 0.34

Endopthalmitis Rates -Glaucoma (per 1000 incidents) Safe None Set

0.85

Quarterly 0.00

Endopthalmitis Rates - Corneal EK procedures (per 1000 incidents) Safe ≤3.6

4.98

Quarterly 0.00

Endopthalmitis Rates - Corneal PK procedures (per 1000 incidents) Safe ≤1.6

0.00

Quarterly 0.00

Endopthalmitis Rates - Vitreoretinal (per 1000 incidents) Safe None Set

0.45

Quarterly 0.00

MRSA Bacteraemias Cases Safe Zero Cases G

0

Monthly 0 0 0 0

Clostridium Difficile Cases Safe Zero Cases G

0

Monthly 0 0 0 0

Escherichia coli (E. coli) bacteraemia bloodstream infection (BSI) - cases Safe Zero Cases G

0

Monthly 0 0 0 0

MSSA Rate - cases Safe Zero Cases G

0

Monthly 0 0 0 0

Hand Hygiene Audit Compliance Caring ≥95% G

99.0%

Monthly 98.0% 99.0% 99.0% 99.0%

Cleanliness Audit Compliance Caring ≥95% G

99.5%

Monthly 99.0% 99.8% 99.8% 99.0%






Strategic

Issue

Metric Description

CQC Domain

Target

Cu

rren

t

RA

P P

g

Year to

Date

Reporting

Frequency

Jul 18

Aug 18

Sep 18

Oct 18

13 Month

Trend

vs

. L

as

t

Patient Safety

Occurrence of any Never events Safe Zero Events R 21 2 Monthly 0 0 0 1

Number of Serious Incidents remaining open after 60 days

Safe

Zero Cases

R

22

Monthly

(Reporting

Month)

1

0

1

1

Percentage of Incidents (excluding Health Records incidents) remaining

open after 28 days

Caring

Mth ≤ 37%

R

23

Monthly

(Reporting

Month)

70.1%

67.6%

55.0%

39.3%

NHS England/NHS Improvement Patient Safety Alerts breached Safe Zero Alerts G Monthly 0 0 0 0

VTE Risk Assessment Safe ≥95% G 98.4% Monthly 98.9% 98.1% 98.8% 97.7%

Posterior Capsular Rupture rates Safe ≤1.95% G 0.97% Monthly 1.26% 0.55% 0.99% 0.77%

Percentage of responses to written complaints sent within 25 days

Caring

≥80%

G

79.8%

Monthly

(Month in Arrears)

80.0%

76.9%

90.5%

80.0%

Percentage of responses to written complaints acknowledged within 3

days

Caring

≥80%

G

90.1%

Monthly

(Reporting Month)

92.3%

100.0%

80.0%

81.8%

Duty of Candour (Percentage of conversations informing family/carer that

a patient safety incident has ocurred within 10 working days of the incident

being reported to local risk management systems)

Safe

100%

G

100.0%

Monthly

(Month in

Arrears)

100.0%

100.0%

100.0%

100.0%

Safer Staffing

Checklist

Safer Surgery Checklist: Percentage of audited "Team Briefing" stage elements compliant with requirements **

Safe ≥90% G

94.3%

Monthly 97.1% 86.4% 100.0% 99.1%

Safer Surgery Checklist: Percentage of audited "Sign In" stage elements compliant with requirements **

Safe ≥90% G

99.9%

Monthly 99.8% 99.8% 100.0% 99.9%

Safer Surgery Checklist: Percentage of audited "Time Out" stage elements compliant with requirements **

Safe ≥90% G

99.8%

Monthly 99.8% 99.2% 99.7% 100.0%

Safer Surgery Checklist: Percentage of audited "Sign Out" stage elements compliant with requirements **

Safe ≥90% G

99.1%

Monthly 99.0% 97.9% 99.1% 99.0%

Safer Surgery Checklist: Percentage of audited "Team Debrief" stage elements compliant with requirements **

Safe ≥90% G

98.9%

Monthly 100.0% 96.0% 100.0% 100.0%






Strategic

Issue

Metric Description

CQC Domain

Target

Cu

rren

t

RA

P P

g

Year to

Date

Reporting

Frequency

Jul 18

Aug 18

Sep 18

Oct 18

13 Month

Trend

vs

. L

as

t

Patient

Experience

Inpatient Scores from Friends and Family Test - % positive Caring ≥90% G

99.4%

Monthly 99.7% 99.4% 99.5% 99.1%

A&E Scores from Friends and Family Test - % positive Caring ≥90% G

94.1%

Monthly 92.6% 95.7% 94.5% 95.3%

Outpatient Scores from Friends and Family Test - % positive Caring ≥90% G

96.7%

Monthly 96.8% 96.9% 96.8% 97.3%

Paediatric Scores from Friends and Family Test - % positive Caring ≥90% G

98.1%

Monthly 98.0% 97.9% 98.1% 98.4%

Inpatient Scores from Friends and Family Test - % response rate Caring ≥30% G

53.2%

Monthly 54.8% 40.0% 50.1% 52.7%

A&E Scores from Friends and Family Test - % response rate Caring ≥20% R 24 9.6%

Monthly 10.0% 13.8% 10.2% 9.7%

Outpatient Scores from Friends and Family Test - % response rate Caring ≥15% A 25 11.7%

Monthly 12.2% 12.2% 10.8% 11.3%

Paediatric Scores from Friends and Family Test - % response rate Caring ≥15% G

20.8%

Monthly 22.7% 18.8% 17.7% 25.7%


Remedial Action Plans for Strategic Objective 1 We will pioneer patient-centred care with exceptional clinical outcomes and excellent patient experience


Remedial Action Plan - October 2018 Strategic

Objective SO1 CQC Domain Responsive

52 Week RTT Incomplete Breaches Lead Manager Jennifer McCole Responsible

Director John Quinn

Target Rating YTD Jul-18 Aug-18 Sep-18 Oct-18 50

0

Zero Breaches Red 39 16 9 2 4

Divisional Benchmarking City Road North South

(Oct 18) 3 0 1

Previously Identified Issues Previous Action Plan(s) to Improve Target Date Status

City Road - there were two breaches of the 52 day target in August

due to a weakness in process in the diabetic retinal screening referral

process.

The referral process has been reviewed and an additional

control has been implemented to avoid any patients being

impacted by this going forward. An audit has also been

undertaken to ensure no other patients have been affected. A

Dec 2018

Complete

City Road - The reliance on paper and manual intervention with

internal referral process prior to Windip being implemented. One city

road patient unfortunately had a process issue.

City Road - Windip was implemented in July 2018 and,

subsequently integrated with OpenEyes, such that there all

internal referrals are now made electronically.

Aug 2018

Complete

South - 52 week breach due to un-monitored generic email at St

George's. Patients affected have been contacted and booked to clinic.

No harm identified currently.

All but 2 patients now treated (due to patient choice) and all

mailboxes across the Trust have now been reviewed.

Oct 2018

Complete

Reasons for Current Underperformance Action Plan(s) to Improve Performance Target Date

South - There was one breach remaining from the Mailbox SI patient.

The patient required additional diagnostic tests before planned

treatment in November. Clinical harm review completed - no harm

Track patient closely to ensure treatment in November

November 2018

City Road - Historically referrals from A&E into consultant led service

were paper based and not electronic. This referral was discovered and

the patient & GP contacted, not successful immediately and therefore

patient written to inviting to contact

A&E team to continue to audit Windip use from A&E to

booking services

Ongoing

City Road - Missed internal referral found in notes following patient

DNA

Windip has been subsequently implimented, this is an historic

issue that would not occur under new system.

November 2018




Cancer 2 week waits - first appointment urgent GP referral Lead Manager Tim Reynolds Responsible

Director John Quinn

Target Rating YTD Jul-18 Aug-18 Sep-18 Oct-18 100%

80%

60%

≥93% Red 95.5% 83.3% 88.9% 100.0% 87.5%


(Oct 18) 85.7% n/a 100.0%


No Outstanding Issues Or Actions


There was one breach to the two-week-wait standard in October. This

was an Adnexal patient who chose to be seen outside the mandated

period - the appointment initially scheduled coincided with another

hospital appointment.

Patient offered the next convenient date at day 16 which they

attended

No Resolution Date




Cancer 14 Day Target - NHS England Referrals (Ocular Oncology)

Lead Manager Tim Reynolds Responsible

Director John Quinn


80%

60%

≥93% Red 76.1% 74.7% 65.1% 83.3% 68.2%


(Oct 18) 68.2% n/a n/a


18 NHSE 14-day breaches in August were as a result of a lack of

available capacity. Case mix meant that a high proportion of incoming

referrals were srutinised for Ocular Oncology; patients could not all be

accomodated within the service's finite clinic capacity. Annual leave in

Robust monitoring of leave, proactive recruitment and weekly

clinic forecasting continue to be undertaken. Longer term

plans to improve the resiliance of the service are being

developed.

Dec 2018

Complete

NHSE 14-day breaches a result of patient choice.

Improvement in month but patient choice still an issue.

Further meeting planned to discuss whether tolerance on

patient choice can be applied to this target.

Dec 2018

Complete


14 x NHSE 14-day breaches in October were as a result of a lack of

available capacity. Capacity was reduced in month due to the

unplanned absence of the service lead.

Locum consultant now in place to cover the unplanned

absence. Clinic capacity has been restored to normal levels.

November 2018

13 x NHSE 14-day breaches were as a result of patient choice. Patient

choice remains a significant a factor as this is a national service with

patients attending from a long distance away in some cases, meaning

time is required to make travel plans.

Clinical intevention continues to be sought where patients do not

demonstrate understanding of the reason that their referral is urgent.

Clinical intevention continues to be sought where patients do

not demonstrate understanding of the reason that their

referral is urgent.

Ongoing

1 x NHSE 14-day breach was due to a delayed internal referral.

Assistant Divisional Manager will raise directly with the

consultant concerned and reiterate well publicised

expectations.

November 2018




Data completeness for Clinic Journey Time (Total) Lead Manager Naomi Sheeter Responsible

Director John Quinn


50%

30%

Mth:≥ 72.0% Red 43.7% 44.2% 48.6% 48.9% 49.9%


(Oct 18) 51.2% 46.9% 51.5%


Variable administrative standard operating

procedures in use across the Trust's sites and

services.

Administrative standard operating procedures in use across the Trust are being reviewed and

rewritten to provide a single standard operating procedure trustwide. The first tranche of SOPs have

been drafted and are in review. The work being done divisionally is overseen by the Clinical

Administration Working Group which meets fortnightly & is attended by operational management,

administration and and service improvement teams.

These SOPs are now in the testing phase and will be prepared for release in November. Individual

site and service data completeness is reviewed weekly and shared with the operational

management teams. Performance has plateaued in trustwide data collection in month, although this

remains variable by site and service. We continue to reinforce the rationale for collecting data is

being reinforced with the operational teams to ensure buy-in.

Nov 2018

In Progress

(Update)


Variable administrative standard operating

procedures in use across the Trust's sites and

services.

Administrative standard operating procedures in use across the Trust are being reviewed and

rewritten to provide a single standard operating procedure trustwide. The first tranche of SOPs have

been drafted and are in review. The work being done divisionally is overseen by the Clinical

Administration Working Group which meets fortnightly & is attended by operational management,

administration and and service improvement teams.

These SOPs are now in the testing phase and will be prepared for release in November.

Performance has plateaued in trustwide data collection in month, although this remains variable by

site and service. We continue to reinforce the rationale for collecting data with the operational teams

to ensure buy-in. Individual site and service data completeness is reviewed weekly and shared with

the operational management teams for their regular team & performance meetings.

November 2018




Data completeness for Clinic Journey Time (Glaucoma) Lead Manager Naomi Sheeter Responsible

Director John Quinn


40%

Mth:≥ 77.2% Red 57.1% 56.9% 63.2% 68.8% 65.4%


(Oct 18) 75.6% 58.5% 52.4%


Differing performance across

the divisions, sites and

services

The 2017-18 service improvement project (patient stratification) in Glaucoma at City Road resulted in a significant

improvement in data completeness for this site as a whole, particularly the Glaucoma service. This project is being rolled out

to sites in the North and South divisions as well as to other clinics within City Road. Fortnightly data is supplied to the

Glaucoma Service Manager to hold administrative teams to account and progress is monitored on a 2-weekly basis.

Nov 2018

In Progress

(Update)

Variable administrative

standard operating

procedures in use across the

Trust's sites and services.

Administrative standard operating procedures in use across the Trust are being reviewed and rewritten to provide a single

standard operating procedure trustwide. The first tranche of SOPs have been drafted and are in review. The work being done

divisionally is overseen by the Clinical Administration Working Group which meets fortnightly & is attended by operational

management, administration and and service improvement teams.

These SOPs are now in the testing phase and will be prepared for release in November. Individual site and service data

completeness is reviewed weekly and shared with the operational management teams. Rationale for collecting data is being

reinforced with the operational teams to ensure buy-in. There has been a continuous improvement in data completeness

since June 2018 although it remains below trajectory to date.

Nov 2018

In Progress

(Update)


Differing performance across

the divisions, sites and

services

the 2017-18 service improvement project (patient stratification) in Glaucoma at City Road resulted in a significant

improvement in data completeness for this site as a whole, particularly the Glaucoma service. This project is being rolled out

to sites in the North and South divisions as well as to other clinics within City Road. Fortnightly data is supplied to the

Glaucoma Service Manager to hold administrative teams to account and progress is monitored on a 2-weekly basis.

November 2018

Variable administrative

standard operating

procedures in use across the

Trust's sites and services.


standard operating procedure trustwide. The first tranche of SOPs have been drafted and are in review. The work being done

divisionally is overseen by the Clinical Administration Working Group which meets fortnightly & is attended by operational

management, administration and and service improvement teams.

These SOPs are now in the testing phase and will be prepared for release in November. Individual site and service data

completeness is reviewed weekly and shared with the operational management teams. Rationale for collecting data is being

reinforced with the operational teams to ensure buy-in. There was a continuous improvement in data completeness from

June 2018 although it remains below trajectory to date and has dipped this month.

November 2018




Data completeness for Clinic Journey Time (MR) Lead Manager Naomi Sheeter Responsible

Director John Quinn


40%

Mth:≥ 76.7% Red 52.7% 57.0% 57.7% 51.8% 52.5%


(Oct 18) 57.8% 34.5% 60.6%


Marked difference in The 2017-18 service improvement project in Glaucoma at City Road (patient stratification) resulted in a significant

performance in the North improvement in data completeness. This project is now being modified for MR with a focus on improving data completeness

division in contrast to the City and stratifying patient care (including utilising digitally enhanced clinics more effectively) on a site-by-site basis, targeting

sites in the North and City Road divisions initially. Implementation for November will support the SOP work that is already Road and South divisions ongoing and should be contributing to increased data completeness in advance of this project.

Nov 2018

In Progress

(Update)


standard operating procedure trustwide. The first tranche of SOPs have been drafted and are in review. The work being done Variable administrative divisionally is overseen by the Clinical Administration Working Group which meets fortnightly & is attended by operational

standard operating management, administration and and service improvement teams.

procedures in use across the These SOPs are now in the testing phase and will be prepared for release in November. Individual site and service data

Trust's sites and services. completeness is reviewed weekly and shared with the operational management teams. There has been a dip in performance in MR service data collection in month, although this remains variable site by site. We continue to reinforce the rationale for

collecting data is being reinforced with the operational teams to ensure buy-in.

Nov 2018

In Progress

(Update)


Marked difference in The 2017-18 service improvement project in Medical Retinal at City Road (patient stratification) resulted in a significant

performance in the North improvement in data completeness. This project is now being modified for MR with a focus on improving data completeness

division in contrast to the City and stratifying patient care (including utilising digitally enhanced clinics more effectively) on a site-by-site basis, targeting sites in the North and City Road divisions initially. Implementation for November will support the SOP work that is already

Road and South divisions ongoing and should be contributing to increased data completeness in advance of this project.

Ongoing

Variable administrative Administrative standard operating procedures in use across the Trust are being reviewed and rewritten to provide a single

standard operating standard operating procedure trustwide. The first tranche of SOPs have been drafted and are in review. The work being done

procedures in use across the divisionally is overseen by the Clinical Administration Working Group which meets fortnightly & is attended by operational

Trust's sites and services. management, administration and and service improvement teams.

Ongoing




Percentage of GP referrals From Electronic Booking - trajectory target of 100% for Oct 2018

Lead Manager Lindsay Ramsey Responsible

Director John Quinn


50%

100% Red 80.0% 80.3% 85.1% 91.7% 96.5%


(Oct 18) 98.5% 97.8% 94.1%


Currently meeting the national CQUIN regarding the number of e-

referral slots available. This stands at 90% of our appointments at the

moment. In terms of actual patients booked. Performance as of the

first week of July is 87% and improving week on week.

Demand and capacity steering group continuing to work on

clinical templates to ensure e-referral demand is matched to

capacity. The demand and capacity operational service

workstream is working through all services to ensure e-

referral demand is matched to capacity. Service improvement

are supporting this programme. External has now been

agreed with the clinical lead and will be the template specialty

to agree with all the other services. On track to hit the 100%

target in October.

Ongoing

(Added Jun

18)

In Progress

(No Update)


There remain a small number of urgent paper referrals being received

and the Trust have agreed not to reject these for clinical reasons until

further discussion

Continue to feedback to GPs on a case by case basis to

ensure that they are using the eRS to log all referrals

including urgent.

Ongoing

There are some routine referrals which require validing to confirm if

they have been accepted electronically before being rejected

Complete validation of all routine referrals to confirm they

have

November 2018




Electronic Booking Appointment Slot Issue (ASI) Rate (Month in Arrears)

Lead Manager Lindsay Ramsey Responsible

Director John Quinn

Target Rating YTD Jul-18 Aug-18 Sep-18 Oct-18

20%

0%

≤ 4.0% Red 23.1% 20.1% 27.1% 20.0% 27.6%


(Sep 18) n/a n/a n/a


Clinical templates not aligned to current demand and capacity causes

ASI when some patients are referred by GPs who can not see any

clinic capacity.

South templates being changed in October whilst City Road

services are on -going.

Oct 2018

Complete


City Road - ASIs are occuring in Cataract services at City Road. A

review is taking place of how this can be managed across the

Moorfields sites more effectively

Complete action plan with recommendations for the future

capacity of cataract services across the Trust

December 2018

North - General Opthalmology being used to refer patients

Investigate the reasons for the increase in ASIs over the last

month and how this can be reduced over time

November 2018



Objective SO1 CQC Domain Effective

Outpatient Cancellation rate (Hospital cancellations) Lead Manager TBC Responsible

Director John Quinn


4%

2%

≤2.85% Red 3.51% 3.92% 2.74% 3.07% 3.19%


(Oct 18) 2.54% 3.32% 4.88%


Clinical rostering steering group has identified a number of rotas that

are not visible from the management team, which leads to short notice

cancellations or clinic cover gaps.

E-rostering team in place, and South Division have set up a

project to review all of their clinics routinely 6 weeks in

advance.

Oct 2018


Increase in hospital cancellations in North and South divisions above

target. (NB small improvement in South division from last month)

South and North divisions to review the clinical areas that are

producing hospital cancellations

December 2018



Objective SO1 CQC Domain Effective

Data Quality - Ethnicity recording (Outpatient and Inpatient) Lead Manager Donna Flatt Responsible

Director John Quinn


95%

85%

≥98% Red 91.7% 91.7% 91.5% 91.4% 90.4%


(Oct 18) 91.8% 84.4% 93.7%


This is a long standing issue for the organisation and whilst

benchmark performance is better than many other trusts the national

target has never been achieved and is extremely stretching.

Underlying reasons include the lack of comprehensive operating

procedures, customer service training and the inherent sensitivities

surronding the collection if these data.

The pilot exercise carried out in the North East directorate whereby clinic

clerks were supplied with prompt cards to simplify the requesting of

patients ethnicity status will be extended across the Trust and linked to the

Standard Operating Procedures documents currently being compiled.

Mar 2019

In Progress

(No Update)

As Above

At the June Data Quality and Information Management Group it was agreed

that alongside the prompt card process being used across the trust it would

be useful to have a floor walking exercise to collect ethnicity from patients

and explain the reaosn for collecting the data. The DQ team could support

this process

Ongoing

(Added Jun

18)

In Progress

(No Update)


No Further Issues or Actions



Objective SO1 CQC Domain Safe

Occurrence of any Never events Lead Manager Julie Nott Responsible

Director Ian Tombleson


2

0

Zero Events Red 2 0 0 0 1


(Oct 18) 1 0 0


No Outstanding Issues or Actions


Wrong site strabismus surgery never event declared in October 2018

(incident date October 2018).

Immediate actions were identified at SI panel and have been

completed. Investigation has commenced.

January 2019



Objective SO1 CQC Domain Safe

Number of Serious Incidents remaining open after 60 days Lead Manager Julie Nott Responsible


Target Rating YTD Jul-18 Aug-18 Sep-18 Oct-18 4

2

0

Zero Cases Red 8 1 0 1 1


(Oct 18) 0 0 1


Serious incident open after 60 days

This breach has been actively discussed with the responsible

division. Whilst the breach occurred within September it was

also finalised and submitted before the end of the month.

Oct 2018

In Progress

(Update)


Serious incident open after 60 days. Completed in October.

This breach has been actively discussed with the responsible

division. Whilst the 1 week breach occurred within October it

was also finalised and submitted before the end of the month.

November 2018



Objective SO1 CQC Domain Caring

Percentage of Incidents (excluding Health Records incidents) remaining open after 28 days

Lead Manager Julie Nott Responsible



50%

0%

Mth ≤ 37% Red n/a 70.1% 67.6% 55.0% 39.3%


(Oct 18) 32.4% 40.5% 39.4%


Divisional performance has improved shown by steady improvements

in this indicator.

Divisions have improved their incident allocation process.

Consistency and control of the closure process is being

applied to return performance to green. This is being

supported by monitoring and exception reporting by the

central risk and safety team.

Oct 2018

In Progress

(Update)


Divisional performance has continued to show improvement, with only

minor fluctuations above the target of 37% for the month

Divisions continue to show commitment to achieving the

target. The number of days by which the 28 day target is

breached is reducing. The central team continues to monitor

and exception report on a weekly basis

November 2018




A&E Scores from Friends and Family Test - % response rate Lead Manager Tim Withers Responsible



20%

0%

≥20% Red 9.6% 10.0% 13.8% 10.2% 9.7%


(Oct 18) 9.7% n/a n/a


Lack of consistancy in handing out FFT cards and encouraging

patients to complete them. However, trend is upwards.

All staff groups to be encouraged to participate. Work

experience participants from Project Search will be engaged

to hand the cards out.

Sep 2018

In Progress

(Update)


Staff are not being managed to engage in the process of asking

patients to complete the test.

DrDoctor may have a facility that allows patients to

completethe test through an app and to text the test to

patients following their visit. Other providers are being

sourced should this not prove possible.,

March 2019




Outpatient Scores from Friends and Family Test - % response rate

Lead Manager Tim Withers Responsible



10%

0%

≥15% Amber 11.7% 12.2% 12.2% 10.8% 11.3%


(Oct 18) 10.6% 13.7% 10.2%


Lack of consistancy in handing out FFT cards and encouraging

patients to complete them. However, trend is upwards.

All staff groups to be encouraged to participate. Work

experience participants from Project Search will be engaged

to hand the cards out.

Sep 2018

In Progress

(Update)


Staff are not being managed to engage in the process of asking

patients to complete the test.

DrDoctor may have a facility that allows patients to

completethe test through an app and to text the test to

patients following their visit. Other providers are being

sourced should this not prove possible.,

March 2019

vs

. L

as

t

Objective 2 We will be at the leading edge of research, making new discoveries with our partners and patients October 2018

Strategic

Issue

Metric Description

CQC Domain

Target

Cu

rren

t

RA

P P

g

Year to

Date

Reporting

Frequency

Jul 18

Aug 18

Sep 18

Oct 18

13 Month

Trend

vs

. L

as

t

Research

70 Day To Recruit First Research Patient Well-Led ≥80% G 100.0% Monthly 100.0% 100.0% 100.0% 100.0%

Percentage of Patients Recruited Against Target (Studies Closed In Month)

Well-Led 100% G

105.8%

Monthly 103.7% 108.3% 105.9% 108.3%

Percentage of Research Projects Achieving Time and Target Well-Led ≥65% G 71.4% Monthly 75.0% 75.0% 71.4% 71.4%

Total patient recruitment to NIHR portfolio adopted studies (YTD cumulative)

Well-Led ≥1050 G

1825

Monthly 397 167 379 200

Percentage of Trust Patients Recruited Into Research Projects Well-Led TBC Monthly In Development (Due Nov)

Objective 3 We will innovate by sharing our knowledge and developing tomorrow’s experts

October 2018

Strategic

Issue

Metric Description

CQC Domain

Target

Cu

rren

t

R

AP

Pg

Year to

Date

Reporting

Frequency

Jul 18

Aug 18

Sep 18

Oct 18

13 Month

Trend

Training

Compliance

Mandatory Training Compliance Well-Led ≥80% G

Monthly 80.4% 85.5% 86.9% 83.6%

Appraisal Compliance Well-Led ≥80% R 28

Monthly 77.7% 79.8% 78.1% 78.8%

Safeguarding - Mandatory Training Compliance Caring ≥80% G

Monthly 84.8% 84.2% 91.0% 93.2%

Objective 4 We will collaborate to shape national policy

October 2018

There are currently no metrics available for this strategic objective




Remedial Action Plans for Strategic Objective 2 to 4 We will be at the leading edge of research, making new discoveries with our partners and patients

We will innovate by sharing our knowledge and developing tomorrow’s experts

We will collaborate to shape national policy



Objective SO3 CQC Domain Well-Led

Appraisal Compliance Lead Manager Nicky Wild Responsible

Director Sandi Drewett


80%

60%

≥80% Red n/a 77.7% 79.8% 78.1% 78.8%


(Oct 18) n/a n/a n/a


Appraisal is an on-going competence Continuning development of managers to complete

appraisals and improve compliance

Nov 2018 In Progress

(Update)

Staff are included in appraisal compliance figures from starting in post Review of scoping of competence in line with managers

expectations

Nov 2018 In Progress

(No Update)


Support managers not experienced or confident in undertaking

appraisals.

Regular HR clinics are taking place with all staff encouraged

to attend and managers are allocated slots. Appraisal

compliance is discussed at these and training needs for

appraising managers identified and put in place.

Ongoing

Raise awareness of non compliance across all areas.

Appraisal compliance is reported at monthly divisional

meetings and any action required for non compliant teams

discussed and agreed.

Ongoing

Encourage proactive planning of appraisals.

Managers are sent appraisal reports on a weekly basis. City

Road managers have been given access to Insight and

training to enable them to download reports and appraisal

data for their teams themselves and there are plans to adopt

this in all areas.

Ongoing



Objective 5 We will attract, retain and develop great people October 2018

Strategic

Issue

Metric Description

CQC Domain

Target

Cu

rren

t

RA

P P

g

Year to

Date

Reporting

Frequency

Jul 18

Aug 18

Sep 18

Oct 18

13 Month

Trend

vs

. L

as

t

Staff &

Voluntary

Experience

Percentage of Staff agreeing with the staff survey statement "If a friend or relative needed treatment, I would be happy with the standard of care

provided by this organisation"

Well-Led

≥90%

G

Quarterly

97.5%

96.0%

Percentage of Staff agreeing with the staff survey statement "I would

recommend my organisation as a place to work"

Well-Led

≥70%

G

Quarterly

76.1%

72.2%

Recruitment

and Turnover

Staff Turnover (Rolling Annual Figure) Well-Led ≤15% G

Monthly 13.3% 12.7% 12.8% 12.9%

Proportion of Temporary Staff Well-Led RAG as per

Spend R * 15.8%

Monthly 15.6% 16.6% 14.6% 16.3%

Temporary Staff Spend Well-Led ≤ Plan (£) R * 5860

Monthly 878 878 780 898

Agency Spend v trajectory Use of

Resources 1 G

1

Monthly 1 1 1 1

Number of Apprenticeship staff started within the Trust Well-Led Qtr:10

YTD:45

16

Quarterly

11

* For commentary, please refer to the Finance Report presented to board, there are no Remedial Action Plan generated for Strategic Objective 5



Objective 6 We will have an infrastructure and culture that supports innovation October 2018

Strategic

Issue

Metric Description

CQC Domain

Target

Cu

rren

t

RA

P P

g

Year to

Date

Reporting

Frequency

Jul 18

Aug 18

Sep 18

Oct 18

13 Month

Trend

vs

. L

as

t

Organisational

Health

Staff Sickness (Month Figure) Well-Led ≤4% A 32 Monthly

(Month in 3.8% 4.5% 4.6% 4.0%

Staff Sickness (Rolling Annual Figure)

Well-Led

≤4%

A

33

Monthly

(Month in

Arrears)

4.1%

4.2%

4.2%

4.2%

Staff Stability Well-Led ≥80% G

Monthly 88.2% 88.8% 88.8% 88.1%

Staff Vacancy Rates Well-Led ≤10%

Monthly 15.9% 16.2% 15.8% Du

e

De

c

Du

e Dec

Staff Vacancy Rates - Nursing & AHP Well-Led ≤10%

Monthly 16.8% 15.5% 15.0%

Capital

Development

Capital Service Capacity Use of

Resources 1 G

1

Monthly 1 1 1 1

Capital Expenditure (Variation To Plan forecast) Use of

Resources ≥0 R * -0.40

Monthly 0.10 -0.30 -0.20 -0.40

* For commentary, please refer to the Finance Report presented to board


Remedial Action Plans for Strategic Objective 6 We will have an infrastructure and culture that supports innovation




Staff Sickness (Month Figure) (Month in Arrears) Lead Manager Nicky Wild Responsible



3%

≤4% Amber n/a 3.8% 4.5% 4.6% 4.0%




Improved reporting through health roster has led to increases in

sickness absence figures

Additional training and coaching support for line managers in

managing sickness

Additional reporting for directorates on formal sickness employee relations cases

Nov 2018

In Progress

(Update)

Difficulties in reporting short term and long term absences

Introduction of ESR in November 2018 will improve reporting

for services on long term and short term absence and

reasons for absence enabling managers and HR to work together to resolve issues

Nov 2018

In Progress

(No Update)


Encourage proactive management of sickness absence in all areas


to attend and managers are allocated slots. Sickness

absence is discussed at these and training needs or support

required for managers is identified and put in place.

Ongoing

Ensure all managers are adequately trained in the absence

management process

Roll out of sickness absence management workshops across

the trust with new managers invited as part of their induction.

These commenced in October 2018 and the aim is to have

run these in all areas by end of March 2019.

March 2019

Raise awareness of current sickness issues in each area.

Monthly report of sickness absence and Bradford scores

provided to managers who are required to confirm actions

taken to address.

Ongoing




Staff Sickness (Rolling Annual Figure) (Month in Arrears) Lead Manager Nicky Wild Responsible



3%

≤4% Amber n/a 4.1% 4.2% 4.2% 4.2%




Improved reporting through health roster has led to increases in

sickness absence figures

Additional training and coaching support for line managers in

managing sickness

Additional reporting for directorates on formal sickness employee relations cases

Nov 2018

In Progress

(Update)

Difficulties in reporting short term and long term absences

Introduction of ESR in November 2018 will improve reporting

for services on long term and short term absence and

reasons for absence enabling managers and HR to work

together to resolve issues

Nov 2018

In Progress

(No Update)


Encourage proactive management of sickness absence in all areas


to attend and managers are allocated slots. Sickness

absence is discussed at these and training needs or support

required for managers is identified and put in place.

Ongoing

Ensure all managers are adequately trained in the absence

management process

Roll out of sickness absence management workshops across

the trust with new managers invited as part of their induction.

These commenced in October 2018 and the aim is to have

run these in all areas by end of March 2019.

March 2019

Raise awareness of current sickness issues in each area.

Monthly report of sickness absence and Bradford scores

provided to managers who are required to confirm actions

taken to address.

Ongoing



Objective 7 We will have a sustainable financial model October 2018

Strategic

Issue

Metric Description

CQC Domain

Target

Cu

rren

t

RA

P P

g

Year to

Date

Reporting

Frequency

Jul 18

Aug 18

Sep 18

Oct 18

13 Month

Trend

vs

. L

as

t

Annual Surplus

Delivery

Distance from Financial Plan (Current in Trust Metric : Trust Underlying

Overall Position - Surplus / Deficit)

Use of

Resources

1

G

1

Monthly

1

1

1

1

Overall financial performance (In Month Var. £m) Use of

Resources

≥0

R

-0.02

Monthly

0.11

0.26

-0.52

-0.22

NHS Performance (In Month Var. £m) Use of

Resources

≥0

G

0.26

Monthly

-0.12

0.28

-0.12

-0.07

Efficiency Scheme Performance (YTD Percentage) Use of

Resources

100%

G

100%

Monthly

113%

125%

100%

100%

Efficiency Scheme Performance (YTD Var. £m) Use of

Resources

≥0

G

0.60

Monthly

0.20

0.50

0.48

0.60

Liquidity

Liquidity (days) Use of

Resources 1 G

1

Monthly 1 1 1 1

Cash Flow (In Month Variation) Use of

Resources ≥0 G

43.60

Monthly 48.70 44.30 42.20 43.60

Outstanding debtors (Total £m) Use of

Resources ≤ Plan G

9.6

Monthly 10.2 10.7 11.3 9.6



Objective 7 We will have a sustainable financial model October 2018

Strategic

Issue

Metric Description

CQC Domain

Target

Cu

rren

t

RA

P P

g

Year to

Date

Reporting

Frequency

Jul 18

Aug 18

Sep 18

Oct 18

13 Month

Trend

vs

. L

as

t

Use Of

Resources

Metrics

Use of resources risk rating - combines all of above measures Use of

Resources

1

G

1

Monthly

1

1

1

1

Top 10 Medicines (Cost Reduction) Use of

Resources

None Set

Monthly

In Development

Estate Cost per square metre Use of

Resources

None Set

Monthly

In Development

Overall cost per test Use of

Resources

None Set

Monthly

In Development

HR cost per £100 million turnover Use of

Resources

None Set

Monthly

In Development

Finance cost per £100 million turnover Use of

Resources

None Set

Monthly

In Development

Procurement Process Efficiency and Price Performance Score Use of

Resources

None Set

Monthly

In Development

Please note there are no Remedial Action Plan generated for Strategic Objective 7. For commentary, please refer to the Finance Report presented to board



Objective 8 We will be enterprising to support and fund our ambitions October 2018

Strategic

Issue

Metric Description

CQC Domain

Target

Cu

rren

t

RA

P P

g

Year to

Date

Reporting

Frequency

Jul 18

Aug 18

Sep 18

Oct 18

13 Month

Trend

vs

. L

as

t

Contribution To

ROI

I&E Margin (Current in Trust Metric : Overall Position) Use of

Resources 1 G

1

Monthly 1 1 1 1

Research & Development Position (In Month Var. £m) Use of

Resources ≥0 R

-0.10

Monthly -0.07 -0.03 0.01 0.00

Commercial Trading Unit Position (In Month Var. £m) Use of

Resources ≥0 R

-0.18

Monthly 0.30 0.00 -0.41 -0.15

Please note there are no Remedial Action Plan generated for Strategic Objective 8. For commentary, please refer to the Finance Report presented to board

AGENDA ITEM 07 – FINANCE REPORT

BOARD OF DIRECTORS 22 NOVEMBER 2018

Report title Monthly Financial Performance for Month 07 – October 2018

Report from Jonathan Wilson, Chief Financial Officer

Prepared by Jenny Greenshields, Deputy Chief Financial Officer

Jit Patel, Interim Head of Financial Management

Assad Choudry, Financial Controller

Previously discussedat None

Attachments None

Link to Strategic Objectives Deliver financial sustainability as a Trust

Executive summary:

• The Trust reported a surplus position in October of £1.44m; this is adverse to plan by £0.22m. The YTD position is a surplus of £3.02m, this is adverse to plan by of £0.02m;

• At present the forecast position for 2018/19 is achievement of the £6.70m surplus, in line with the agreed NHS Improvement (NHSI) revised control total. This includes profit on the sale of the long lease for 92 Britannia Walk (£1.80m) and associated Provider Sustainability Funding (PSF) incentive monies (£3.60m); and

• Efficiency scheme YTD achievement stands at £3.48m, against a target of £2.84m, an over-delivery of £0.64m. Non-Recurrent schemes account for £1.13m (32%) of the quantum. Efficiency schemes are currently forecast to under-deliver by £0.99m.

Quality implications:

Patient safety has been considered in the allocation of budgets.

Financial implications:

Delivery of the control total will possibly result in the Trust being eligible for additional benefits.

Page 1 of 18

Month Income & Expenditure

YTD Forecast

Plan

£m

Act

£m

Var

£m

Plan

£m

Act

£m

Var

£m

Plan

£m

Act

£m

Var

£m

16.48 16.86 0.38 NHS Income 107.69 109.65 1.96 182.95 188.35 5.40

14.97 15.42 (0.45) Expenditure 102.20 103.98 (1.78) 178.38 178.32 0.06

1.51 1.44 (0.07) EBITDA 5.49 5.67 0.18 4.57 10.03 5.46

0.65 0.65 - ITDA 5.33 5.25 0.08 9.77 9.83 (0.06)

0.86 0.79 (0.07) NHS Surplus/ (Deficit) 0.16 0.42 0.26 (5.20) 0.20 5.40

0.13 0.13 - R&D Surplus/ (Deficit) 0.25 0.15 (0.10) 0.88 0.88 -

0.67 0.52 (0.15) Commercial Surplus/ (Deficit) 2.63 2.45 (0.18) 5.62 5.62 -

1.66 1.44 (0.22) Trust Surplus/ (Deficit) 3.04 3.02 (0.02) 1.30 6.70 5.40

Risk implications:

Risks and opportunities are reported on and assessed within the report.

Action Required/Recommendation:

The board is asked to consider and discuss the attachedreport.

For Assurance For decision For discussion X To note

Monthly Finance Report For

October 2018

Prepared by:

Jit Patel

Head of Financial Management (Interim)

Assad Choudry

Financial Controller

Jenny Greenshields Deputy Chief Financial Officer

Presented By:

Jonathan Wilson Chief Financial Officer

Board of Directors Meeting 22 November 2018

Date produced 13 November 2018

Page 3 of 18

For information

For consideration

For decision

Action for Board:

4

Contents of Main Report

Page Number

Key Messages 4

Risk and Opportunities 5

Appendices

Appendix 1 - Executive Financial Summary 6

Appendix 2 - Detailed Income and Expenditure Position 7

Appendix 3 - Expenditure Run Rate 8

Appendix 4 - NHS Income Run Rate 9

Appendix 5 - Efficiency Scheme Performance 10

Appendix 6 - Research & Development and Commercial Trading Position 11

Appendix 7 - Cash Flow 12

Appendix 8 - Capital Expenditure 13

Appendix 9 - Better payment practice code and Debtors Management 14-15

Appendix 10 - Divisional Financial Performance 16

Appendix 11 - Divisional Financial Performance – Trend 17

Financial Position – Surplus/ (Deficit) YTD

(Appendix 2)

The Trust is reporting a YTD surplus of £3.02m.

This position is driven by surpluses in Commercial

of £2.45m, NHS, £0.42m and R&D, £0.15m.

Financial Position – Variance Against Plan YTD

(Appendix 2)

The Trust is reporting an adverse £0.02m

variance YTD position against a plan of £3.04m.

This is driven by NHS performance reporting a

favourable £0.26m; this is offset by adverse

positions in R&D, £0.10m and Commercial,

£0.18m.

Financial Position – Forecast (Appendix 2)

The forecast position for 2018/19 is a revised

surplus of £6.70m which delivers in line with the

agreed NHS Improvement (NHSI) revised Control

Total. This includes profit on the sale of the long

lease for 92 Britannia Walk (£1.80m) and

associated Provider Sustainability Funding (PSF)

incentive monies (£3.60m). Risks of delivery are

highlighted below under Risk and Opportunities.

Income – NHS (Appendix 4)

Clinical Income is over-achieving against plan by

£0.88m. This over-achievement is mainly within

Outpatients activity, £1.84m (an increase of

22,604 appointments compared to 17/18) and

offset by under-achievement in Inpatients,

£0.60m.

R&D (Appendix 6)

R&D is reporting a break-even position in month

but remains behind plan YTD by £0.10m. Under-

delivery on Income is offset with underspends

across Pay and Non-Pay.

Commercial Ventures (Appendix 6)

Commercial ventures are reporting a surplus YTD

of £2.45m which is £0.18m behind plan. Private

Patents Income in month, delivered on plan, with

UAE Income behind plan. YTD, Private

Patients remains behind plan by £0.7m (an income

shortfall of £0.58m), with UAE reporting £0.57m

ahead of plan (an income over-achievement of

£0.60m)

Efficiency Programme (Appendix 5)

The Trust is reporting an over-delivery YTD on

Efficiency Programme of £0.64m; this is supported

by Non-Recurrent schemes. The current forecast

outturn is adverse performance of £0.99m, which is

subject to internal challenge and assurance. Risks of

delivery are highlighted below under Risk and

Opportunities.

Use of Resources

The Use of Resources rating YTD is 1; this is in line

with the plan. There is an expectationthat at year –

end the rating will be 1.

Cash (Appendix 7)

The Trust reported a cash balance of £43.6m at the

end of October, higher than previous month. There

is an expectation that there will be a cash balance of

£43.3m at year-end. This takes into account

additional cash for both asset disposal and PSF

incentive monies.

Capital Programmes (Appendix 8)

The Capital Programmes are reporting a YTD spend

of £4.7m. At year-end, the Capital Programmes are

forecasted to spend £15.4m against plan of £15.0m.

Debtors (Appendix 9)

Debt has decreased by £1.8m to £13.3m; this is

mainly within NHS Debt. Overdue Debt (>30 Days)

has decreased by £1.6m to £9.6m.

Creditors (appendix 9)

Payment of invoices is at 88% by volume, against a

threshold of 95%.

Page 5 of 18

Key Messages

Risk/

Opportunity

Description Mitigations Direction Impact Likelihood Likely

financial

impact

£'000

Best-case

impact

£'000

Worst-

case

impact

£'000

Risk Cost improvement programmes

If the trust fails to achieve cost improvement targets then this leads to pressure on budgets.

Currently the trust has over-achieved against the YTD plan although there remains an

unidentified target and a significant non-recurrent CIP.

In 2018/19 trust reserves will be used to mitigate the impact of poor CIP performance

however moving into future years this will become more difficult. The trust has also

purchased project management software to enable swifter reporting against live projects, helping to identify blockages and gaps.

5

4

-1,560

0

-2,000

Risk AfC/ Medical and dental pay award/ Clinical Excellence Awards

The trust has received £1.3m income from DoH to fund the Agenda for Change pay award but

the cost impact of the award is £2.0. It is anticipated that the medical and dental pay award

and changes to CEAs will be unfunded from central government.

During the 2018/19 annual planning process the trust planned for a 2% AfC pay award and is

therefore partly able to mitigate the shortfall in central government funding. Trust reserves

will help to limit the impact of the medical and dental pay award and CEA changes.

5

3

-1,234

0

-1,603

Risk Income risk during EMR changeover

During the switch to EMR there is a risk that patient level activity information is not captured

in a timely fashion to enable accurate billing to commissioners.

In depth testing and the early assessment of billing information will identify issues with

patient level data to the contracts and income team, meaning a material impact to the trusts

income position will be avoided.

4

2

0

0

-880

Opportunity Chile profit

The trust has undertaken a learning and support project in Chile with a pre-agreed profit-

margin, that does not form part of the trusts annual plan.

There is an opportunity being explored to develop the project further towards 'phase 3'

which would lead to increased profit, and cash, for the trust.

4

2

0

320

0

Opportunity Surplus from lease sale

The trust is considering selling the lease to 92 Britannia Walk. This would lead to a profit

which would increase the trusts year-end forecast financial position and increase the cash

balance.

A paper making the case to sell the lease to 92 Britannia Walk has now been approved by the

Strategy and Investment committee. The trust is changing its forecast at M06 with NHSI to

reflect the profit from this sale in March 2019.

5

5

1,800

1,800

0

Opportunity Additional Provider Sustainability Funding (PSF)

As a result of the above profit on disposal, and by declaring an improved forecast at M06,

NHSI has committed to awarding the trust £2 for each £1 the trust overachieves against its

original forecast.

The trust has reforecast its year-end financial position to include an additional £1.8m from

the sale of the lease to 92 Britannia Walk. The forecast has also been amended to include an

additional £3.6m PSF monies; thereby improving the year-end I&E forecast, and cash position,

by a total £5.4m.

5

4

3,600

3,600

0

Risk Income loss from lease sale

Further to above the trust currently receives annual rental income of £0.22m from 92

Britannia Walk.

The loss of income will be partly mitigated by a reduction in the trusts annual PDC (public

dividend capital) payment by £0.12m. Therefore the net adverse impact to the trusts I&E

position is £0.10m.

2

5

-55

0

-110

Risk Oriel

The trust has planned to spend ~£6m to get Project Oriel to OBC. ~£4m of this was planned

to be capitalised. However until the trust owns the land it cannot capitalise any costs

associated with Oriel. If all costs are charged to I&E it will put pressure on the trusts financial

forecast.

The trust is ensuring tight control of Oriel expenditure and where possible move expenditure

to 2019/20, without causing a detrimental effect with regards reaching OBC. The trust is also

in discussions with its external auditors over the correct accounting treatment relating to

Project Oriel expenditure.

5

3

2,400

1,200

3,350

Page 6 of 18

Risk and Opportunities

7

NHS (exc. R&D)

Income

Expenditure

Overall Position

Research &

Development Position

Commercial Trading

Unit Position

Efficiency Scheme

Performance

Overdue Debts 6 Mths +

(£M)

3-5 Mths

(£M)

2 Mths

(£M)

1 Mth

(£M)

NHS Contract Debts 2.05 1.19 0.86 0.61

Commercial Debts 0.27 0.46 0.19 0.28

Other 1.85 0.36 0.12 1.39

TOTAL 4.17 2.01 1.17 2.28

Debtors

Capital Expenditure (£M)

Annual Plan Exp YTD Annual Forecast Var to Plan

Forecast

15.00 4.70 15.40 (0.40)

Capital Expenditure

Cash Balance (£M) Actual and Forecast 2017/18 Year End

Sep-18 Oct-18 Dec-18 Mar-18

42.50 42.20 43.60 40.20 43.30

Cash Flow

Year to Date

Plan (£M) Actual (£M) Var (£M)

3.04 3.02 (0.02)

In Month

Plan (£M) Actual (£M) Var (£M)

1.66 1.44 (0.22)

Trust Underlying Overall

Position - Surplus /

(Deficit)

Appendix 1 - Executive Financial Summary

Use of Resources Rating

19%

0.65 3.48 2.84

182.95 188.35 5.40

188.15 188.15 0.00

(5.20) 0.20 5.40

0.88 0.88 0.00

5.62 5.62 0.00

Full Year Forecast Key Risks and Actions Required Plan (£M) Actual (£M) Var (£M)

Income and Expenditure • In month, the Trust is reporting a surplus of

£1.44m, resulting in an YTD surplus of £3.02m. • Against plan, the Trust is reporting an adverse

variance in month of £0.22m and an adverse YTD variance of £0.02m.

• Despite the over-delivery YTD, CIP performance remains high risk, with an unidentified value of £1.3m, with forecast under-delivery of £0.99m. It is important to note that the £3.48m achieved YTD represents just 44% of the full year target.

• The current forecast for the Trust continues to reflect achievement of the revised Control Total.

Use of Resources Rating • Use of resources rating for the Trust is 1 year to

date.

Cash flow and Balance Sheet • Cash balance was £43.60m at the end of October. • Capital expenditure is £4.7m year to date. • Overdue debt has decreased by £1.64m to £9.63.

1.29 6.69 5.40

7.83

7.83

0.00

100%

Total

Last Month

(£M) (£M)

4.71 5.88

1.20 1.78

3.72 3.61

9.63 11.27

16.48 16.86 0.38

15.62 16.07 (0.45)

0.86 0.79 (0.07)

107.69 109.65 1.96

107.53 109.23 (1.70)

0.16 0.42 0.26

0.13 0.13 0.00

0.25 0.15 (0.10)

0.67 0.52 (0.15)

2.63 2.45 (0.18)

Indicator YTD YE Forecast

Capital Service Cover 1 1

Liquidity 1 1

I&E Margin 1 1

I&E Margin Variance 1 1

Agency Spend 1 1

Use of Resources Rating 1 1

8

Budget

£m

In Month

Actual

£m

Variance

£m

Budget

£m

Year To Date

Actual

£m

Variance

£m

Full Year Forecast

Budget Actual Variance

£m £m £m

Prior Year YTD

Actual Variance

YTD Actual £m £m

15.52

15.68

0.16

101.38

102.26

0.88

171.86 175.46 3.60

88.23

14.03

0.96 1.18 0.22 6.31 7.39 1.08 11.09 12.89 1.80 15.30 (7.91)

2.83 2.41 (0.42) 16.80 16.85 0.05 30.23 30.23 - 15.56 1.29

1.07 1.00 (0.07) 6.98 5.99 (0.99) 12.30 12.30 - 6.55 (0.56)

20.38 20.27 (0.11) 131.47 132.49 1.02 225.48 230.88 5.40 125.64 6.85

2.99

2.77

0.22

19.33

19.28

0.05

33.12 33.12 -

18.51

(0.77)

2.12 2.21 (0.09) 15.00 15.35 (0.35) 25.60 25.60 - 14.29 (1.06)

1.15 1.21 (0.06) 8.28 8.22 0.06 14.48 14.48 - 7.42 (0.80)

2.59 2.73 (0.14) 17.98 18.33 (0.35) 30.33 30.33 - 16.81 (1.52)

0.18 0.15 0.03 1.25 1.11 0.14 2.04 2.04 - 1.26 0.15

0.94 0.83 0.11 6.30 6.26 0.04 10.88 10.88 - 4.73 (1.53)

0.62 0.58 0.04 4.42 4.16 0.26 7.53 7.53 - 4.12 (0.04)

10.59 10.48 0.11 72.56 72.71 (0.15) 123.98 123.98 - 67.14 (5.57)

2.56

2.70

(0.14)

17.52

17.48

0.04

29.85 29.85 -

16.09

(1.39)

1.30 1.48 (0.18) 9.42 10.12 (0.70) 16.01 16.01 - 9.33 (0.79)

1.06 0.86 0.20 6.71 6.03 0.68 11.18 11.18 - 5.65 (0.38)

1.02 1.31 (0.29) 6.71 8.06 (1.35) 15.77 15.71 0.06 8.00 (0.06)

1.19 1.01 0.18 7.67 7.93 (0.26) 13.37 13.37 - 7.85 (0.08) 0.32 0.29 0.03 2.31 1.68 0.63 3.89 3.89 - 2.03 0.35

7.45 7.65 (0.20) 50.34 51.30 (0.96) 90.07 90.01 0.06 48.94 (2.35)

18.04 18.13 (0.09) 122.90 124.01 (1.11) 214.05 213.99 0.06 116.08 (7.92)

2.34 2.14 (0.20) 8.57 8.48 (0.09) 11.43 16.89 5.46 9.56 (1.07) 11% 11% 7% 6% 5% 7% 8%

0.65 0.65 - 5.33 5.25 0.08 9.77 9.83 (0.06) 5.44 0.19

0.03 0.05 (0.02) 0.20 0.21 (0.01) 0.36 0.36 - 0.74 0.53

1.66 1.44 (0.22) 3.04 3.02 (0.02) 1.30 6.70 5.40 3.37 (0.35)

NHS EBITDA 1.51 1.44 (0.07) 5.49 5.67 0.18 4.58 10.04 5.46 6.17 (0.50)

NHS EBITDA Margin % 9% 9% 5% 5% 2% 5% 6%

NHS Surplus / (Deficit) 0.86 0.79 (0.07) 0.16 0.42 0.26 (5.20) 0.20 5.40 0.80 (0.38)

Commercial Trading Unit EBITDA 0.70 0.57 (0.13) 2.83 2.66 (0.17) 5.98 5.98 - 2.98 (0.32)

Commercial Trading Unit EBITDA Margin % 25% 24% 45% 16% 54% 46% 19%

Commercial Trading Unit Surplus / (Deficit) 0.67 0.52 (0.15) 2.63 2.45 (0.18) 5.62 5.62 - 2.24 0.21

Research & Development EBITDA 0.13 0.13 - 0.25 0.15 (0.10) 0.88 0.88 - 0.41 (0.26)

Research & Development EBITDA Margin % 12% 13% 4% 3% 7% 7% 6%

Research & Development Surplus / (Deficit) 0.13 0.13 - 0.25 0.15 (0.10) 0.88 0.88 - 0.34 (0.19)

Appendix 2 - Detailed Income and Expenditure Position - Surplus / (Deficit)

Overall Trust I&E Summary

Income

NHS Clinical Income

Other Income

Commercial Trading Units

Research & Development

Total Income

NHS Expenditure

Pay Expenditure

Medical

Nursing

Scientific, Professional & Technical

Admin and Clerical

Ancillary Services

Commercial Trading Unit Costs


Total Pay Expenditure

Non-Pay Expenditure

Drugs

Clinical Supplies and Services

Premises

Other Expenditure

Commercial Trading Unit Costs


Total Non-Pay Expenditure

Total Expenditure

EBITDA

EBITDA Margin % NHS Interest, Dividends, Depreciation & Profit/Loss on Disposals Trading Unit Interest, Depreciation, Dividends & Profit/Loss on Joint Ventures

Surplus / (Deficit)

9

Appendix 3 - Expenditure Run Rate (NHS)

Pay YTD for thecurrent financial year, Total Pay costs are overspent by £0.45m, with in-month reporting an overspend of £0.04m.

• Employed costs (substantive). Compared to 17/18,

costs haveincreased by £1.2m, anaveragemonthly increase of £0.17m.

• Locum costs. Compared to 17/18, costs have increased by £0.27m, an averagemonthly increase of £0.04m.

• Bank Costs. Compared to 17/18, costs have increased by £0.08m, an averagemonthly increase of £0.01m.

• Agency Costs. Compared to 17/18, costs have increased by £0.23m, an average of £0.03m.

Non Pay YTD for thecurrent financial year, Total Non-Pay costs is overspent by £1.33m. • Clinical Supplies. Compared to 17/18, costs have

increased by £0.52m, an averagemonthly increase of £0.07m.

• Drugs. Compared to 17/18, costs have increase by £0.74m, an average monthly increase of £0.11m.

Note: Impairments incurred in March 18 have been removed, approx. £2.5m

10

Appendix 4 - NHS Income Activity

Commentary • NHS Income YTD has over-achieved by £0.88m, with an in-month over—

achievementof £0.16m. The YTD position is driven by continued over-performance in Outpatients - £1.84m. Offset by under performance in:

• Non-Elective - £0.46m; and • Elective - £0.14m.

Outpatients – Continues to over-deliver on both planandfor thesame period last (an increase of 22,604 appointments) Elective/Day-case – Compared to thesameperiodlastyear, thereis consistently higher levels of activity (an increase of 1,206), but remains behind plan for the last two months. High Cost Drugs – Compared to thesameperiod last year, thereareconsistentlyhigher levels of activity(an increaseof 1,805), but remains 629 behind plan for the current year.

11

Appendix 5 - Efficiency Schemes Performance

Gap £1.0m

As at month 7, the Trust is reporting an YTD over- achievementof £0.65m (23%) against a plan of £2.84 m.

Withinthe identified schemes, therearea number of non- recurrent schemes which equate to £1.3m (17%) of the total forecasted delivery.

Unidentified schemes have increased to £1.32m, with further red rated schemes of £0.62m. Forecast outturn performance is £0.99madverse, and is subject to further internal challenge.

RAG Status of Plans Identified

Blue Green Amber Red Unidentified

Total

Plans

YTD Delivery

Plan Actuals Variance

Forecast

Recurrent Non-

Total Recurrent

Slippage &

Un-

indentified

Division

City Road 1,489 1,232 100 80 827 3,728 1,181 1,423 242 2,483 367 2,850 (878)

North 746 225 86 50 175 1,282 522 732 210 1,114 192 1,306 24

South 165 373 220 45 139 942 380 395 15 711 219 930 (12)

Access 29 0 0 191 0 220 17 17 (0) 220 0 220 (0)

Estates & Facilites 378 0 0 250 64 692 243 445 202 201 491 692 0

Corporate 802 55 0 0 119 976 492 471 (21) 812 44 856 (120)

Total 3,611 1,885 406 616 1,322 7,840 2,835 3,482 647 5,541 1,313 6,854 (986) 46% 24% 5% 8% 17% 23% 71% 17% 13%

12

Research and Development

Budget

£m

In Month Actual

£m

Variance

£m

Budget

£m

Year to Date Actual

£m

Variance

£m

Budget

£m

Full Year Forecast

£m

Variance

£m

Prior Year Actual

£m

Variance

£m

Total Income 1.07 1.00 (0.07) 6.98 5.99 (0.99) 12.30 12.30 - 6.55 (0.56)

Expenditure

Pay Costs

Non-Pay Costs

0.62 0.32

0.58 0.29

0.04 0.03

4.42 2.31

4.16 1.68

0.26 0.63

7.53 3.89

7.53 3.89

- -

4.12 2.03

0.04

(0.35)

Total Expenditure 0.94 0.87 0.07 6.73 5.84 0.89 11.42 11.42 - 6.15 (0.30)

Interest, Dividends, Depreciation - - - - - - - - - 0.07 (0.07)

Total Contribution to overhead 0.13 0.13 - 0.25 0.15 (0.10) 0.88 0.88 - 0.33

The R&D position is reporting a marginal surplus in-monthand YTD, £0.13mand£0.15mrespectively. Againstplan, R&D, in month, is reporting a break-even position and behind

plan YTD, £0.10m.

R&D is forecasting to deliver on plan for the year-end.

Budget

In Month

Actual

Variance

Budget

Year to Date

Actual

Variance

Full Year Forecast

Budget Forecast

Variance

Prior Year YTD

Actual Variance £m £m £m £m £m £m £m £m £m £m £m

2.83 2.41 (0.42) 16.80 16.85 0.05 30.23 30.23 - 15.56 1.29

0.94

0.83

0.11

6.30

6.26

0.04

10.88

10.88

-

4.73

(1.53)

1.19 1.01 0.18 7.67 7.93 (0.26) 13.37 13.37 - 7.85 (0.08)

2.13 1.84 0.29 13.97 14.19 (0.22) 24.25 24.25 - 12.58 (1.61)

0.70 0.57 (0.13) 2.83 2.66 (0.17) 5.98 5.98 - 2.98 (0.32)

24.7% 23.7% 16.8% 15.8% 19.8% 19.8% 19.2%

0.03 0.05 (0.02) 0.20 0.21 (0.01) 0.36 0.36 - 0.65 0.44

0.67 0.52 (0.15) 2.63 2.45 (0.18) 5.62 5.62 - 2.33 0.12

Commercial Trading Units

Total Income - including Internal Sales

Expenditure

Pay Costs Non-Pay Costs

Total Expenditure

Commercial Trading Unit EBITDA Commercial Trading Unit EBITDA Margin %

Interest, Dividends, Depreciation and interests in joint ventures

Commercial Trading Unit Surplus / (Deficit)

Appendix 6 - Research and Development Position

Appendix 6 - Commercial Trading Unit Position

• Commercial units are reporting a surplus both in month, £0.52m, and YTD, £2.45 m. Against plan, both in-month and YTD are behind, £0.15m and £0.18m respectively. • Private Patient income has delivered on plan with UAE behind plan. • The underspend in month on expenditure is mirrored by the low activity and income in the UAE and a neutral position in-month in this business unit.

13

Increasedueto

settlementof CCG

performance debt.

Variance from plan is

dueto assetsale

proceeds; additional

PSF and no loan draw

down.

Assetsaleproceeds expected in

November.

Appendix 7 - Cash Flow

• Cash balancewas £43.6mattheend of October and is forecast to be£43.3matyear-end. Theforecastvariance from planis dueto factoring inproceeds of asset disposal and additional PSF partially offset by the impact of no loan draw down for Project Oriel.

• Assetdisposalproceeds of £5.2m arecurrentlyforecast to bereceived in November. £2.3mof £3.6madditional PSF fundingis expected to bereceived inthecurrent financial

year.

• Forecast cash outlay for project Oriel is estimated to be £3.7m against initially planned assumptionof £6.5m. This expenditureis now planned to be funded i nternallyand not

through a loan draw down.

14

Capital Expenditure and Forecast £M Schemes over £0.1m shown individually

Initial Budget

Changes Revised Budget

YTD Exp Year End Forecast

Var to Plan Forecast

PP - Theatres and Admissions Suite 2.9 0.3 3.1 1.6 3.1 -

City Road/RDCEC - External/Internal Backlog 0.4 - 0.4 - 0.4 -

City Road/RDCEC - Fire Review Remedial 0.3 - 0.3 0.0 0.3 -

Kemp House /City Road/RDCEC - BMS Controls 0.3 -0.2 0.1 0.0 0.1 -

City Road/RDCEC - General/Relocations 0.1 - 0.1 0.1 0.1 -

Kemp House - Electrical Distribution Systems 0.1 - 0.1 0.0 0.1 -

City Road/RDCEC - Access Control 0.1 - 0.1 - 0.1 -

Other - individually less than £0.1m 0.6 - 0.6 0.1 0.6 -

Estates sub-total 4.8 0.1 4.9 1.7 4.9 -

Operating System Replacement & Upgrade - 0.5 0.5 - 0.5 -

Haag-Streit Slit Lamps and Upgrades 0.4 -0.1 0.3 0.1 0.3 -

Darent Valley Expansion 0.3 - 0.3 0.3 0.3 -0.0

Retinal Camera 0.2 -0.0 0.2 0.2 0.2 -0.0

Floor Standing Op Microscope 0.2 - 0.2 0.2 0.2 -0.0

SGH Widefield Camera - 0.1 0.1 0.1 0.1 0.0

Other - individually less than £0.1m 0.6 -0.0 0.6 0.3 0.6 -

Medical Equipment sub-total 1.7 0.5 2.1 1.2 2.1 -0.0

EMR Development 2.8 -0.4 2.4 0.9 2.4 -

Wireless Access Points 0.2 - 0.2 0.0 0.2 0.0

Electronic Document Management 1.7 -1.5 0.2 - 0.2 -

PC Refresh 0.2 - 0.2 0.2 0.2 -0.0

SAN Upgrade 0.4 -0.2 0.2 0.2 0.2 -0.0

Cisco Switches - Core & Edge 0.1 0.1 0.2 - 0.2 -0.0

NHSmail migration or Egress upgrade 0.1 -0.0 0.1 0.1 0.1 -

Kiosks - 0.1 0.1 0.1 0.1 0.0

NHS Digital WiFi - 0.1 0.1 0.0 0.1 -

Intranet - 0.1 0.1 - 0.1 -

Other - individually less than £0.1m 0.7 0.0 0.7 0.1 0.6 0.2

Information Technology sub-total 6.2 -1.6 4.6 1.6 4.4 0.2

Project Oriel* 6.5 -3.3 3.2 - 3.2 -

Moorfields Dubai 0.4 - 0.4 0.2 0.4 -

Other 0.1 0.0 0.1 0.0 0.1 0.0

Contingency 1.0 -0.7 0.3 - 0.3 -

Carry forward -2.3 1.7 -0.6 - - -0.6

Total 18.3 -3.3 15.0 4.7 15.4 -0.4

*Project Oriel budget has been adjusted by £3.3m to reflect updated expenditure profile.

Appendix 8 - Capital Expenditure

• Total capital expenditure year to date is £4.7m.

• Revised capital budget for the year is

£15.0m, a £3.3m reduction on initial budget of £18.3m. This change reflects updated expenditure profile for project Oriel.

• Capital plan incorporates investment

in Trust clinical estate, medical equipment, IT and project Oriel.

• Year-end forecast expenditure is £15.4m, £0.4m above budget of £15.0m.

• Forecast overspend of £0.4m is due to

the carryforward assumption of £0.6m partially offset by underspend on some projects. To reduce the risk of overspending against the overall budget, forecast expenditure needs to be reviewed to identify projects that can be deferred into 19/20 and/or scaled back.

15

Type of Debt

Welsh Debts only

NHS Commissioner Income

Total Contract Debts

Private Patients

Sundry Debtors

TOTAL

Type of Debt

Welsh Debts only


Total Contract Debts

Private Patients

Sundry Debtors

TOTAL

Please note: Valuesshown in the above tables are for the stated types of debt only, and exclude UAE.

Additional items not included above comprise overall debt for the Trust, including provisions and accruals.

Appendix 9 - Better Payment Practice Code

Appendix 9 - Debtors Management and Credit Control

• Overall debt has decreased by £1.8m in October to £13.3m (£15.1m September) primarily due to settlement by NELC group following 2017/18 Q4 reconciliation exercise.

• Total overdue debt has decreased by £1.6m in October to £9.6m (£11.2m September) mainly due to, as above, settlement by NELC group following 2017/18 Q4 reconciliation exercise.

Key debtors over 4 months overdue

NELC Group £0.8m

SWL Group £0.3m

Welsh £0.3m

Key debtors 1-3 months overdue

NHSE £0.7m

NELC Group £0.5m

SWL £0.3m

• 88% of invoices by volume and 82% by value were paid within 30 days in October.

• A proportion of NHS invoices are queried with NHS organisations which take more than 30 days to resolve.

% of bills paid within target - Volume Target Act YTD Var YTD Apr May Jun Jul Aug Sep Oct

NHS 95% 70% -25% 72% 62% 63% 73% 84% 51% 78%

Non-NHS 95% 88% -7% 86% 87% 89% 90% 92% 86% 88%

Total 95% 88% -7% 86% 86% 88% 89% 92% 85% 88%

% of bills paid within target - Value Target Act YTD Var YTD Apr May Jun Jul Aug Sep Oct

NHS 95% 59% -36% 33% 49% 68% 50% 92% 54% 91%

Non-NHS 95% 86% -9% 81% 86% 89% 81% 93% 90% 89%

Total 95% 82% -13% 75% 82% 87% 75% 93% 83% 89%

6 Mths +

Apr 18

5 Mths

May 18

4 Mths

Jun 18

3 Mths

Jul 18

2 Mths

Aug 18

1 Mth

Sep 18

309

1,743

14

47

15

286

10

819

9

846

13

594

2,052 61 301 829 855 607

274

1,852

63

12

171

91

223

257

191

121

281

1,386

4,178 136 563 1,309 1,167 2,274

Overdue

Oct 18

Current

Oct 18

Total

Oct 18

370 19 389

4,335 1,713 6,048

4,705 1,732 6,437

1,203 614 1,817

3,719 1,334 5,053

9,627 3,680 13,307

Overdue

Oct 18

Current

Oct 18

Total

Oct 18

370 19 389

4,335 1,713 6,048

4,705 1,732 6,437

1,203 614 1,817

3,719 1,334 5,053

9,627 3,680 13,307

Overdue Current

Sep 18 Sep 18

Total

Sep 18

360 13

5,511 913

373

6,424

5,871 926 6,797

1,773 489

3,594 2,421

2,262

6,015

11,238 3,836 15,074

% Var

Overdue

% Var

Current

% Var

Total

3% 46% 4%

(21%) 88% (6%)

(20%) 87% (5%)

(32%) 26% (20%)

3% (45%) (16%)

(14%) (4%) (12%)

16

Overdue CCG debt

NEL, NWL and SWL CCG groups collectively account for £2.0m (59%) of

overdue English contract debt of £3.4m.

NCA (Non-Contract Activity) overdue debt includes Kent & Sussex Area

CCGs at £0.5m, 60% of the total overdue balance of £0.8m. As is the case

with all NCA debts, an individual targeted approach is made for each

debtor (112 in total).

Overdue Sundry debt

Overdue sundry debt has increased by £0.1m in October to £3.7m (£3.6m

September). Sundry debt includes NHS provider to provider charges. Key

overdue debtors are as follows:

Health Education England £0.9m (settled in November)

Barts Trust £0.4m

SGH Trust £0.1m

UCLH Trust £0.1m

Other Trusts £0.6m

University College London (R&D) £0.1m

Health Intelligence Ltd (R&D) £0.1m

PP consultants service charges £0.7m

Overseas patients £0.4m

Note: Standard NHS payment terms are 30 days from the invoice date.

SLA payments are mostly made on the 15th of each month and tend to run

smoothly.

Delays in payment occur when data is delayed or disputed, or queries

arise which require investigation.

£1,167

Total £13,307

5 Mths

4 Mths

3 Mths

2 Mths

1 Mth

Current £136

£563 £1,309

£2,274

£4,178 £3,680

6 Mths +

Total Debt by Age £'000

Total £13,307 £1,203

Current £3,719

Sundry Debtors


Private Patients

£4,335 £3,680

Welsh Debts only

Total Debt by Type £'000

£370

17

City Road

Description Budget

Mth (£k)

Actuals

Mth (£k)

Variance

Mth (£k)

Budget

YTD (£k)

Actuals

YTD (£k)

Variance

YTD (£k)

City Road is behind plan both in-month and YTD, £0.40m and £0.21m respectively.

Income is favourable position for both in-month and YTD, Outpatients (£1.78m), Elective (£0.49m) and High Cost Drugs (£0.13m). This is offset

by under-performance primarily within Non-Elective, £0.41m.

Overspend in Non Pay is partially due to increased activity, but also reflects Unidentified CIPs of £0.5m YTD.

Income 8,904 9,127 224 58,625 59,988 1,362

Pay Costs 4,572 4,573 -1 31,168 31,174 -6

Non Pay Costs 1,853 2,472 -619 14,178 15,746 -1,568

Below the line 0 0 -0 0 0 -0

Contribution/ Deficit 2,479 2,082 -396 13,280 13,067 -212

Access

Description Budget

Mth (£k)

Actuals

Mth (£k)

Variance

Mth (£k)

Budget

YTD (£k)

Actuals

YTD (£k)

Variance

YTD (£k)

Access is behind plan both in-month, £0.12m, and YTD, £0.38m.

The drivers behind the over-spend are as in previous months:

1) Unfunded posts within Pay; and

2) Overspend on Hybrid Mail

Income 0 0 0 0 2 2

Pay Costs 362 444 -82 2,536 2,755 -219

Non Pay Costs 133 171 -38 256 423 -167

Below the line 0 0 0 0 0 0

Contribution/ Deficit -495 -614 -119 -2,792 -3,176 -384

Moorfields

North

Description Budget

Mth (£k)

Actuals

Mth (£k)

Variance

Mth (£k)

Budget

YTD (£k)

Actuals

YTD (£k)

Variance

YTD (£k)

North is behind plan for both in-month and YTD, £0.02 and £0.10m respectively.

Income is behind plan YTD, £0.35m and is reflective of under-performance in High Cost Drugs (0.42m) and Bedford Activity (£0.11m)

Pay is reporting over-spend in month due to additional sessions worked and remains under spent YTD, whilst Non Pay is reporting an underspend

mainly within Clinical Supplies and Drugs (£0.47m).

Income 4,065 3,895 -170 26,504 26,153 -351

Pay Costs 1,384 1,400 -16 9,418 9,302 115

Non Pay Costs 1,476 1,312 165 10,263 10,129 134


Contribution/ Deficit 1,205 1,183 -22 6,823 6,722 -101

Moorfields

South

Description Budget

Mth (£k)

Actuals

Mth (£k)

Variance

Mth (£k)

Budget

YTD (£k)

Actuals

YTD (£k)

Variance

YTD (£k)

South is ahead of plan YTD but is behind in-month.

YTD Income position is £0.22m adverse, is primarily driven by Elective, £0.39m adverse, offset by a favourable High Cost Drugs position of

£0.15m.

Expenditure position continues to improve with Pay overspend at £0.5m and Non Pay continuing to remain under budget, YTD £0.4m under. Non

Pay has benefitted from a YTD budget transfer to cover additional cost at St Anthony's'.

Income 2,557 2,455 -103 16,544 16,322 -222

Pay Costs 1,078 1,117 -39 7,331 7,476 -146

Non Pay Costs 890 787 102 5,665 5,270 395


Contribution/ Deficit 590 551 -39 3,548 3,576 28

Estates &

Facilities

Description Budget

Mth (£k)

Actuals

Mth (£k)

Variance

Mth (£k)

Budget

YTD (£k)

Actuals

YTD (£k)

Variance

YTD (£k)

E&F is reporting favourable positions for both in-month, £0.07m, and YTD, £1.29m.

Income is over-performing mainly due to Transport (recharged to Commissioners).

Pay is under-spent primarily through holding of vacancies.

Non pay is under-spent YTD (£0.83m) primarily within Minor Works, this position is likely to be maintained through remaining months of the year.

Income 248 340 91 1,643 2,003 360

Pay Costs 310 301 9 2,116 2,031 85

Non Pay Costs 869 903 -34 6,684 5,851 832

Below the line 0 -2 2 0 -9 9

Contribution/ Deficit -931 -862 69 -7,157 -5,870 1,287

Corporate

Description Budget

Mth (£k)

Actuals

Mth (£k)

Variance

Mth (£k)

Budget

YTD (£k)

Actuals

YTD (£k)

Variance

YTD (£k)

Corporate areas are reporting a favourable YTD positions of £0.1m.

Income over-achievement is offset by Non Pay over spend, mainly due to Chilean Project Income 307 469 162 2,102 3,074 971

Pay Costs 1,320 1,466 -145 9,276 9,556 -279

Non Pay Costs 705 747 -42 3,213 3,836 -623


Contribution/ Deficit -1,718 -1,743 -25 -10,387 -10,319 68

Corp. Inc. Contribution/ Deficit -273 190 463 -3,152 -3,570 -418

R&D Contribution/ Deficit 125 136 11 253 147 -106 R&D is £0.11m behind plan YTD due to unachieved income of £0.99m is offset by underspends on Pay and Non Pay, £0.26m and £0.63m

respectively.

Commercial Contribution/ Deficit

662

519

-143

2,627

2,457

-170

Commercial is £0.18m behind plan YTD.

UAE is reporting surplus YTD of £0.30m, this is better than plan by £0.53m.

Private Patients is reporting a surplus YTD of £2.15m, this is behind plan by £0.70m.

Trust Contribution/ Deficit 1,644 1,442 -202 3,043 3,035 -9

Appendix 10 - Divisional Financial Performance

18

Trust Trend

Description Nov-17

(£k)

Dec-17

(£k)

Jan-18

(£k)

Feb-18

(£k)

Mar-18

(£k)

Apr-18

(£k)

May-18

(£k)

Jun-18

(£k)

Jul-18

(£k)

Aug-18

(£k)

Sep-18

(£k)

Oct-18

(£k)

A&E Contract 898 748 865 834 1,009 926 970 983 977 961 929 1,023

Bedford Activity 540 633 901 559 558 644 698 876 696 748 815 612

Community Contracts 38 37 29 29 27 19 16 20 17 19 16 15

Cquin'S 133 133 133 133 133 150 150 150 150 150 150 413

Diagnostic Tests 124 111 107 118 121 108 95 106 109 87 77 80

Education & Training 280 479 611 173 294 301 297 340 292 407 345 408

Elective Income 3,257 2,715 3,373 3,183 3,169 3,119 3,284 3,386 3,397 3,296 3,164 3,398

High Cost Drug Income 2,774 2,389 2,889 2,444 2,757 2,672 2,879 2,898 2,823 3,247 2,811 3,163

Income Cip 0 0 0 0 0 0 0 0 0 0 0 0

Laser 180 144 179 163 182 140 121 168 169 140 150 167

Meh Ventures Contribution 0 0 0 0 0 0 0 0 0 0 0 0

Moorfields Dubai 840 712 907 867 933 741 1,066 1,066 977 724 850 707

Moorfields Pharmaceuticals 0 0 0 0 0 0 0 0 0 0 0 0

Non-Elective Income 685 657 74 373 488 442 458 430 556 488 540 495

Other Contracts 10 6 12 12 5 10 11 11 11 9 9 9

Other Income & Recharges 675 594 615 679 6,153 571 480 548 1,120 696 823 768

Other Main Sla Income 163 127 165 546 642 134 118 137 120 40 129 130

Outpatient 5,793 4,259 5,519 5,015 5,086 5,206 5,341 5,500 5,262 5,374 5,361 5,994

Transport Commissioners 211 157 184 174 239 178 205 211 204 206 209 178

Private Patient Income 1,582 1,171 1,635 1,291 1,626 1,429 1,467 1,532 1,822 1,374 1,388 1,704

Research & Development 850 907 1,545 915 514 853 893 704 885 866 785 1,003

Income 19,034 15,982 19,743 17,507 23,936 17,644 18,550 19,067 19,589 18,831 18,550 20,266

Admin & Clerical 3,327 3,300 3,437 3,089 3,563 3,279 3,323 3,413 3,659 3,362 3,394 3,401

Ancillary Services 171 146 166 187 115 157 170 185 171 128 180 160

Medical 2,938 2,810 2,753 2,802 2,777 2,898 2,874 2,863 2,981 2,979 3,093 2,960

Nursing 2,256 2,257 2,236 2,207 2,494 2,441 2,439 2,512 2,704 2,544 2,571 2,590

Other Pay 11 3 315 33 146 20 13 26 20 31 63 51

Pay Cip 0 0 0 0 0 0 0 0 0 0 0 0

Sci Tech & Ther 1,235 1,268 1,228 1,216 1,215 1,242 1,272 1,264 1,379 1,290 1,290 1,320

Pay Costs 9,938 9,785 10,134 9,532 10,310 10,037 10,092 10,262 10,914 10,334 10,591 10,482

Clinical Supplies & Services 1,755 1,555 1,510 1,247 1,649 1,576 1,462 2,004 1,752 1,672 1,275 1,672

Drugs And Medical Gases 2,855 2,256 2,680 2,312 2,588 2,646 2,560 2,744 2,448 2,864 2,607 2,827

NHS LA 22 21 21 0 0 26 26 26 26 26 0 53

Non Pay Cip 0 0 0 0 0 0 0 0 0 0 0 0

Other Costs 1,928 2,148 1,865 2,372 5,972 1,746 2,171 1,725 1,956 2,079 2,170 2,071

Premises 1,174 1,005 939 1,046 754 985 1,192 851 1,011 1,052 973 1,018

Non Pay Costs 7,734 6,985 7,015 6,976 10,963 6,979 7,411 7,351 7,193 7,693 7,025 7,641

Depreciation 701 709 845 863 877 793 790 577 565 570 556 537

Dividends Payable 32 26 49 49 -71 72 72 72 72 72 27 64

Share Of Joint Venture P/L 45 31 25 29 31 12 5 5 -5 10 21 29

Exceptional Items -2 1 -2 -3 -178 -0 0 1 -1 1 2 1

Interest Payable 97 100 100 90 98 94 98 94 98 98 95 93

Interest Receivable -5 -15 -26 -15 -14 0 -30 -13 0 -32 -34 -23

Below the line 867 851 992 1,013 743 971 934 736 728 719 667 701

Surplus/ Deficit 495 -1,639 1,602 -13 1,920 -343 113 718 753 85 268 1,442

Cumulative Surplus/ Deficit -343 -231 487 1,240 1,325 1,593 3,035

Appendix 11 - Divisional Financial Performance - Trend

AGENDA ITEM 08 – WORKFORCE REPORT


Report title Workforce report

Report from Sandi Drewett Director of Workforce and Organisation

Development

Prepared by Sandi Drewett Director of Workforce and Organisation Development Rick Witham, Workforce Information Manager

Previously discussedat People Committee

Link to strategic objectives We will attract, retainanddevelop great people


The report provides headline progress against strategic workforce objectives and KPIs not covered in performance report as at the end of 2018-19 Quarter Two (Sep 2018), covering:

Sickness absence Staff Turnover & Stability Vacancyrate Training & Appraisal compliance Staff Engagement

Information is depicted in both quantitative and graphical format, along with supporting narrative

Action Required/Recommendation.

The board is invited to discuss the report.

For Assurance

For decision

For discussion X To note

1

1.1 Workforce strategy and plans

The framework and contexts for the workforce strategy have been discussed at People Committee. Workforce planning is to be undertaken in line with the Business Planning process and guidance has been issued to services supported by the Human Resources Business Partners.

1.2 ESR and Payroll

The Electronic Staff Record system has been introduced to replace the existing workforce system, Route 66. This will enable improved reporting and data to enable workforce planning and other workforce decisions. The system went live on 1st November. Implementation and benefit realisation will continue until q1 next year.

1.3 Equalities The Management Executive has agreed a set of recommendations to revise the Equality Objectives for patients and staff, improve the governance and oversight and strengthen the staff networks.

1.4 WRES

Further to the board workshop in May 2018, work continues to capture staff experiences of inclusion and leadership to inform action and interventions to improve their experience and opportunities for progression of BAME staff. The Trust is delighted to be one of 6 pilot trusts working with Birmingham Race Action Partnership as part of a national scheme to address inequality in the NHS.

1.5 EU staff

The Home Office has announced plans to afford health workers rights to gain status through the EU settlement scheme. From 29 November 2018, EU citizens working in the health and social care sector will have the opportunity to access the scheme early and apply for settled status before it is opened up to the general population from March 2019. Moorfields is supporting its EU staff by providing legal advice, access to the employee assistance scheme and reimbursing the registration costs associated with applying for settled status.

1.6 Key Workforce Metrics: Headlines

The dashboard provides an overview of current workforce KPIs.

The rolling annual sickness rate has increased over the past 12 months to 4.2%, although it has remained steady over the past quarter. Staff group hot spots for sickness absence are Clinical Support and Registered Nursing staff.

Stress, Anxiety & Depression accounted for the most calendar days lost due to sickness over the past year.

Workforce Report

2

The rolling annual turnover rate for permanent staff is currently 13%. The Stability (retention) rate is just below 89%, which remains well above our target threshold rate. Turnover rates remain highest for Administrative staff.

The vacancy rate is currently 15.8%.

The Appraisal rate has slipped below target, currently at 79%. Meanwhile the Statutory/Mandatory Training compliance rate remains above target at 86%

76% of staff would recommend Moorfields as a place to work, and 97% would recommend

Moorfields as a provider of care (based on Q1 2018-19 results).

1.7 Key workforce metrics: Summary view

KPI

Target Q3

2017-18 Q4

2017- 18

Q1 2018-

19

Q2 2018-

19

Trend

RAG

Full Time Equivalent

N/A 1,905 1,907 1,918 1,945

Headcount N/A 2,119 2,124 2,134 2,176

Vacancy Rate 10% 13.4% 13.8% 16.8% 15.8%

Turnover (annual) 15% 13.4% 13.6% 13.4% 12.8%

Stability (annual) 80% 87.7% 87.4% 88.1% 88.5%

Sickness (annual) 4% 4.0% 4.1% 4.2% 4.2%

Appraisal compliance

80% 84% 79% 80% 79%

Training compliance

80% 88% 85% 87% 86%

Staff Engagement N/A 73% 73% 76% -

2. Key workforce metrics: By KPI

2.1 Sickness Absence

The rolling annual sickness rate has seen a small increase over the past year, from 4.0% to 4.2%,

although it has remained level over the past quarter. However this is still above our target threshold

level of 4%.

3

The capturing of sickness absence informaton has been facilitated by the implementation of the e-

Rostering solution, enabling us to identify sickness absence hotspots with greater accuracy. Two

particular hotspots are Clinical Support staff and Registered Nursing staff. Both have remained

consistently high compared to their position a year ago. Further analysis has revealed that the

majority of sickness episodes that make up the high rate for Clinical Support staff are short-term

ones, whereas the rate for Registered Nursing staff is split more equally between short- and long-

term episodes. Actions to address are outlined in the performance report.

The above chart shows the top ten recorded reasons for absence (where known) in terms of the

total calendar days lost between October 2017 and September 2018. The three biggest reasons,

accounting for as many days lost as the next seven combined, were Stress, Anxiety and Depression

followed by Cold, Cough, Flu then Musculoskeletal problems. According to findings by the Chartered

Medical Prof / Sci / Reg. Nursing Tech

Estates / Ancillary

Clinical Support

AHPs Admin / Clerical

7.0%

6.0%

5.0%

4.0%

3.0%

2.0%

1.0%

0.0%

Rolling annual Sickness rate by Staff Group

Headache / migraine 2220 1653

Back Problems

Chest & respiratory

1560

Tumours, cancers 2659

Heart, cardiac & circulatory 1021

Injury, fracture

Gastrointestinal

1017

Musculoskeletal 980

Cold, Cough, Flu 3104

698 731

Anxiety/stress/depression

Top 10 Reasons for Absence (by calendar days lost, year to Sep 2018)

Calendar days lost

4

Institute of Personnel and Development the amount of days lost across the NHS due to Stress and

Mental Health issues doubled between 2010 – 2014, which provides some context to the fact that it

is currently the biggest cause of sickness days lost at Moorfields. The workforce strategy will have a

specific worksteam on staff engagement which will see a focus on health and wellbeing.

2.2 Retention and Attrition

Turnover for permanent staff has remained steady over the past year, currently at just below 13%

which is well below London benchmarks.

Our biggest retention hotspot is Admin and Clerical staff, with a permaent staff turnover rate of

18%. Clinical Support staff were also a hotspot this time last year, but this is no longer the case as

can be seen from the chart above. Plans to address administrative and clerical staff turnover were

considered by the People Committee.

2.3 Staff Engagement

Whilst there is no single measurement that can fully capture the concept of ‘Staff Engagement’, the

most-commonly used standard in the NHS is the percentage of staff who say that they would

recommend their organisation to friends and family as a place to work, measured via the quarterly

Staff Friends & Family Test [FFT].

Prof / Sci / Reg. Nursing Tech

Medical Estates / Ancillary

Clinical Support

AHPs Admin / Clerical

0%

5%

10%

15%

20%

25%

Turnover rate by Staff Group (permanent employees only)

5

The quarter 2 Staff FFT results had not been published by NHS England at the time of producing this

report, hence the chart above shows our results for each of the four quarters up to Quarter One

2018-19. 76% of respondents agreed that they would recommend Moorfields to friends and family

as a place to work, which represents a positive increase compared to the figure of 67% seen in Sept

2017. The percentage of staff who say they would recommend Moorfields to friends and family as a

provider of care remains consistently above 90%, and as at Sept 2018 had risen to a high of 97%

3.0 Action being requested

3.1 The Board is asked to RECEIVE and DISCUSS the report

Sep. 2017 Dec. 2017 Mar. 2018 Jun. 2018

As a place to work

As a provider of care

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

Recommendations from Moorfields' own staff

6

Workforce Metrics: Definitions/Calculations

Sickness

Absence

Sickness Absence is calculated based on the number of hours lost as a percentage

of the hours available within the specified period – either a month or a rolling year.

Rolling Annual Sickness is a standard NHS-wide measure that looks at total absence

over the past 12 months rather than just the current month. This provides a more

informed view of absence rates within the organisation because seasonal and

other fluctuations are ironed out.

Turnover

Turnover is calculated by taking the number of Leavers (headcount) in the specified

period divided by the average Staff in Post in that period.

Stability Stability is calculated as the percentage of employees who were with us 12 months

ago who are still with us today.

Vacancy Rate The vacancy rate is calculated based on filled posts compared to the budgeted

estbalishment. This information is currently held within the Finance system.

Employee

definition

The figures provided in this report include all paid substantive Employees, but exclude Bank, Contractors, unpaid Honorary contract holders and Volunteers.

AGENDA ITEM 09 – LEARNING FROM DEATHS (Q1&2 2018/19)


Report title Learning from deaths – quarterly update (Q4 2017/18)

Report from Nick Strouthidis, Medical Director

Prepared by Julie Nott, Headof Risk and Safety

Previously discussedat Ongoing responsibility of Clinical Governance Committee

Attachments None

Link to strategic objectives We will pioneer patient-centredcare with exceptional clinical outcomes

and excellent patient experience

Executive summary

This report provides the trust board with a quarterlyupdate regarding how we learn from deaths that

occur within Moorfields defined by criteria (see Annex below) as set out in trust policy. It is a

requirement for all trusts to have a similar policy.

The trust has identified 1 patient deaths in Q1&2 2018/19 that fall within the scope of the learning from

deaths policy.

Quality implications

The board needs to be assured that the trust is able to learnlessons from serious incidents in order to prevent repeat mistakes and minimise patient harm.

Financial implications

There are no direct financial implications from this paper.

Risk implications

If the trust fails to learn from deaths there is clinical risk in relation to our ability toprovide safe care to patients, reputational risk, financial risk of potential litigation and legal risk to directors.

Action required/recommendation.

The board is asked to receive the quarterly report for assurance.

For assurance For decision For discussion To note

2

Learning from deaths Board paper

This report satisfies the requirement to provide the trust board with an update regarding compliance with,

and learning from, the NHS Improvement learning from deaths agenda.

The data in relation to Q1 and Q2 2018/19, as at 9 November 2018, is shown in table 1 below. Q2 data will

be refreshed and re-presented with Q3 data in January 2019. The one death of which the trust became

aware of in Q1 did not involve a patient with a learning disability or a mental health needs and it was not a

child.

Indicator Q1

2018/19 Q2

2018/19

Summary Hospital Mortality Indicator (as reported in the IPR) 0 0

Number of deaths that fall within the scope of the learning from deaths policy (see annex 1)

1 0

% of cases reviewedunder the structuredjudgement review (SJR) methodology/reviewed by the Serious Incident panel

100 0

Deathsconsidered likely to have been avoidable 0 0

Table 1

To date, the trust has become aware of one death that has occurred within Q3 2018/19, however this does

not fall within the scope of the policy and a SJR will not be undertaken.

Learning and improvement opportunities identified

Following the review of one case, no learning and improvement opportunities have been identified.

3

Annex 1

Included withinthe scope of this Policy:

All in-patient deaths;

Patients who die within 30 days of discharge from inpatient services (where the Trust becomes

aware of the death);

Mandatedpatient groups identified by the NQB Learning from Deathsguidance including individuals

with a learning disability, mental health needs or an infant or child;

The deathof any patient who is transferredfrom a Moorfields site and who dies following admission

to another provider hospital;

The deathof any patient, of which the Trust is made aware, within 48 hours of surgery;

All deaths where bereaved families and carers, or staff, have raised a significant concern about the

quality of care provision by Moorfields;

Deathsof which the Trust becomes aware following notification, and a request for information, by

HM Coroner;

Persons who sustain injury as a result of an accident (e.g. a fall down stairs) whilst on Trust premises

and who subsequently die;

Individual deaths identified by the Medical Examiner or through incident reporting or complaints or

as a result of the Inquest process;

Excluded from the scope of this Policy:

People who are not patients who become unwell whilst on Trust premises and subsequently die;

AGENDA ITEM 10 – ANNUAL NURSING REVALIDATION REPORT BOARD OF DIRECTORS 22 NOVEMBER 2018

Report title Annual report on Nurse Revalidation 17/18

Report from Tracy Luckett, Director of Nursing and Allied Health Professions

Prepared by Carmel Brookes, Lead Nurse for Revalidation

Previously discussedat Management executive, 6 November

Attachments

Link to strategic objectives We will attract, retainanddevelop great people

Executive summary

Revalidation is the process that all nurses and midwives in the UK need to follow to maintain their registration with the NMC. The paper outlines the revalidation activity within the year April 17 to March 18

Quality implications

Nurses receiving feedback and reflecting on practice increases self-awareness and is a stimulus to improve the quality of the care they deliver.

Financial implications

Nil

Risk implications

Reputational risk if the trust does not comply with professional regulationcompliance.

Action Required/Recommendation

The board is asked to receive the report for assurance

For Assurance √ For decision For discussion To note

Annual Report on Nurse Revalidation

April 2017 – March 2018

1 Produced by:

2 Carmel Brookes, Lead Nurse for Clinical Innovation and Safety and Revalidation Lead.

Emral Jarrold, Deputy Director of Human Resources.

September 2018

Executive Summary

Revalidation is the process that all nurses and midwives in the UK need to adhere to in order to maintain their

registration with the Nursing and Midwifery Council (NMC).

Introduced in April 2016, revalidation helps nurses and midwives demonstrate that they practise safely and

effectively in line with the NMC Code: Professional standards of practice and behaviour for nurses and midwives

(2015).

Revalidation occurs every three years and the process for revalidation is outlined in more detail in the following

pages.

Four hundred and twenty nine nurses (429) were employed by the trust as of the 1st April 2017. This is a slightly

lower figure than in April 2016 when four hundred and thirty three nurses (433) were employed.

From April 2017 to March 2018 (129) nurses were successfully revalidated by the NMC.

There were no issues raised regulatory issues raised during this reporting period.

Purpose ofthe Paper

The purpose of this paper is to provide assurance that qualified nurses working across the trust are meeting all the

requirements to revalidate with the NMC and are registered and fit to practice.

Background

Through the process of Revalidation nurses are able to maintain their registration with the NMC by demonstrating

their constant ability to practise safely and effectively. Revalidation is a continuous process designed to engage each

nurse throughout their career.

Revalidation is not an assessment of a nurse’s fitness to practise or a way to raise fitness to practise concerns or an

assessment against the requirements of their current or former employment.

Being fit to practise requires a nurse or midwife to have the skills, knowledge, good health and good character to do

their job safely and effectively. All qualified nurses and midwives must adhere to The Code: Professional standards

of practice and behaviour for nurses and midwives.

The ‘Code’ launched in 2015 confers the professional standards and behaviours that nurses and midwives must

uphold in order to be registered to practise in the UK.

It is designed around four themes

Prioritise people

Practise effectively

Preserve safety

Promote professionalism and trust

https://www.nmc.org.uk/standards/code/

https://www.nmc.org.uk/standards/code/

One of the main strengths of revalidation is that it encourages the individual to use the Code in their day-to-day

practice and professional development.

It requires the nurse to consider the role of the Code in their practice by encouraging a culture of sharing, reflection

and improvement.

When nurses collect feedback from patients or colleagues they need to identify which theme of the Code supports

their evidence consequently demonstrating to their confirmer (line manager) that they are using the code every day.

Revalidation will strengthen the NMC renewal process by introducing new requirements that focus on:

Confirming up-to-date practice and continuing professional development

Reflection on the professional standards of practice and behaviour as set out in the Code

Engagement in professional discussions with other registered nurses to discuss their written reflective

accounts and portfolio of evidence.

Revalidation provides nurses with the opportunity to reflect on their practice against the standards as set out in the

Code and confirm that they are using these standards in their everyday practice.

Revalidation is built on existing arrangements and adds requirements which encourage nurses to seek feedback from

patients and colleagues, reflect upon the Code by having a professional discussion with another NMC registrant and

to seek confirmation that they have met these requirements from a third party.

It is the responsibility of each individual nurse to ensure that they have revalidated and that they manage the

process.

The NMC in their annual data report ‘Year 2 April 2017 – March 2018 ‘(August 2018) commented that “Nurses are

preparing earlier for Revalidation and using the Code more. Increasing numbers are reporting the positive input

revalidation is having on practice, with the reflective element of Revalidation playing the biggest role”.

The NMC will not make any changes to the model of Revalidation until they fully understand the impact of the

existing model and all nurses and midwives have been through revalidation for the first time.

Carmel Brookes, Lead Nurse for Clinical Innovation and Safety is the trust’s Revalidation lead and is supported by the

Deputy Director of HR and the HR team in all aspects of revalidation.

Revalidation Requirements

The requirements for Revalidation are:-

Practice Hours Nurses need to evidence they have worked a minimum of 450

practice hours

Continuing professional development (CPD) Nurses need to evidence they have undertaken 35 hours of CPD

with 20 of those hours being participatory leaning

Practice related feedback Five pieces of feedback are required from a variety of sources

demonstrating how they have used it to improve their practice

Written reflective accounts Nurses need to reflect on either CPD, and event or experience or

feedback. Five pieces are required.

Nurses must show how each reflection relates to the Code.

Health and character Nurses need to self-declare that their health and character are

sufficiently good to enable them to practice safely and

effectively

Professional Indemnity Nurses need to self-declare that they have sufficient cover to

practise

Reflective discussion

A discussion must be undertaken with another NMC registrant (usually line manager) discussing five reflective

accounts these could be based on CPD, an event or experience that the nurse has had or practice related feedback.

During these discussions the nurse can demonstrate that they are practising safely and are upholding the standards

of the Code.

Confirmation

The NMC and the trust advise that the person acting in the confirming role should be a line manager wherever

possible however this person does not have to be an NMC registered nurse.

This is the final requirement and is undertaken to provide assurance, increase support and engagement between

nurses and their confirmers (line manager), and make nurses more accountable for their own practice and continued

improvement.

The nurse arranges to meet their confirmer in advance of the revalidation application date. The nurse needs to

demonstrate to their confirmer that they have met all the requirements (except health and character and

professional indemnity – as these are self-declarations).

If this is not the case the nurse should be allowed time to correct any areas of deficit and then meet with their

confirmer again to ensure that all requirements have been met. Feedback from managers acting as confirmers can

be found in appendix 1.

Revalidation and appraisal

Revalidation and appraisal are two distinct processes, however during the appraisal having a discussion about how

the nurse has met the revalidation requirements is recommended. Revalidation forces nurses to reflect on their

practice in a formalised way which would not have taken place before. It allows nurses to recall training that has

been undertaken and so refreshes their practice.

During the appraisal nurses can discuss with their line managers their professional approach to nursing rather than

just their performance

Numbers ofstaff who have revalidated

In April 2017 there were four hundred and twenty nine qualified nurses (429) working across the Trust.

In total from April 2017 – March 2018 we have had 129 nurses completed the Revalidation process. (See graph 1.0).

Our highest numbers of nurses revalidating successfully were found to be in September 2017 twenty (20) and March

2018 fifteen (15). This is dictated by the first date that the nurse was registered with the NMC.

Graph 1.0

Nov Dec Jan-18 Feb March Apr-17 May June July August Sept Oct

0

4 5

7

11

6

10 9

10 10

12 12 13

15 15

20 20

Nurses who have successfully revalidated by month 25

Graph 2.0

Issues arising from Practice

The lead nurse for revalidation continues to support staff and manage the revalidation process through one to one

meetings.

One staff member did not submit their revalidation application by their revalidation application date. After

discussion with human resources department and the director of nursing and allied health professions the staff

member was suspended from work until the NMC had processed their application for readmission to the register. A

full internal investigation took place. On return to the workplace the individual had a professional discussion with

the director of nursing and allied health professions regarding their conduct.

Issues raised by the Nursing and Midwifery Council

During this reporting period the regulatory body have not raised any concerns to the trust in relation to individual

registrant’s revalidation nor have they raised any issues regarding compliance with the trust’s revalidation process.

Next steps

Following successful implementation of the first full year of revalidation an internal audit to review if the current

process is fit for purpose or if there are any training needs is scheduled to be undertaken by the lead nurse for

revalidation with support from human resources.

Revalidation awareness training sessions will continue in addition to bespoke learning sessions for those who require

advice and support.

0

4 4 5

7 6 6

9 10

11

9 1010

9 10

13 12 12 11 12

15 14

15

17 17

20 20

23 22

Number of Nurses who have successfully revalidated per month by year

2016 25

Conclusion

The process of meeting the revalidation requirements has encouraged nurses to stay up to date, reflect on their

professional practice and use the standards within the Code day to day.

Overall there has been a very positive response from nurses across the trust to meet the NMC requirements to

revalidate without any concerns, using support and resources offered internally and by the NMC.

References

Revalidation NMC (2015) How to revalidate with the NMC - Requirements for renewing your registration.

Revalidation NMC (2015) Information for confirmers

Revalidatio0n NMC (2015) Employers’ guide to revalidation

The Code NMC ( 2015) Professional standards of practice and behaviour for nurses and midwives

Revalidation: Annual data report year 2 April 2017 – March 2018. NMC (2018).

Moorfields Nursing Revalidation Policy

Appendix 1

Personal reflections from line managers who have taken on the role of the confirmer (2017- 2018)

The nurses are treating the revalidation process very diligently and putting lots of effort to get it right in

collecting relevant evidence.

The reflective discussions have been extremely beneficial for both the staff that need to revalidate and also

the confirmer who sometimes has to think about the issues that are being reflected upon. The reflective

discussion has been the best part of the revalidation process because two professionals have to make time

and sit down and go through the practice reflections. Nurses don’t always have time to share personal

reflections on their own practices, own behaviours or own experiences with another nurse or another

professional colleague, but this mandatory process has provided nurses with the opportunity to do just that.

Focusing on reflection as a core component of revalidation can only enhance a registrant’s practice and in

turn this will benefit patients. I have witnessed subtle changes in behaviour as a direct result of a reflective

practice discussion.

Having to demonstrate CPD hours to the confirmer is important. It acknowledges the benefits of learning

beyond the clinical environment and introduces new thinking to practice.

So far I have been a confirmer for approximately 6 staff. Staff who are notified by NMC that they are due to

revalidate ask me in the months prior to their revalidation date to confirm that they are fit to practice.

I ensure that they have achieved 35 hours of professional development, evidenced by attendance

certificates, written reflections of self-directed study or verbal feedback of study related to the NMC code.

The nurse should have evidence of 450 hours of clinical practice, 5 pieces of reflection related to practice

and learning from these reflections, these should again be related to NMC code of practice.

Finally the nurse should have 5 pieces of feedback, this can be sourced from colleagues, patients, students, I

always give a copy of student evaluation to the mentor and co-mentor as evidence and I give copies of

friends and family feedback if the whole team is referenced, or to individuals if there are named on the

feedback.

If staff don’t meet the requirements, I suggest what more is required and make a further appointment with

them within the timescale for their submission to the NMC.

After the confirmation, I suggest to the nurse that they start collecting evidence for the following

revalidation, even though it is 3 years away so that they are keeping an ongoing record of update learning.

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AGENDA ITEM 11 – REPORT OF THE AUDIT & RISK COMMITTEE


Report title Report of the audit and risk committee

Report from Nick Hardie, chairman, audit and risk committee

Prepared by Helen Essex, company secretary

Previously discussedat N/A

Attachments N/A

Link to strategic objectives We will have aninfrastructure and culture that supports innovation

We are able to deliver a sustainable financial model


Attachedis a brief summary of the audit and risk committee meeting that took place on 16 October 2018.


Boardis asked to note the report of the audit and risk committee and gain assurance from it.

For Assurance For decision For discussion To note

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AUDIT AND RISK COMMITTEE SUMMARY REPORT – 16 OCTOBER 2018 Committee Governance (for date of meeting)

Quorate – Yes

Attendance (membership) - 100%

Agenda completed – Yes

Current activity (as at date of meeting)

Matters arising

In relation to job planning it was agreed to await the outcome of the internal audit prior to agreeing an action. However, the committee asked for some verbal assurance prior to the next meeting.

Internal audit progress report

Core financial systems – amber/green

This audit was focused on payroll and treasury systems. The key underlying themes relate to procedural documentation and whether

responsibility sits with workforce or finance/payroll.

It was acknowledged that it was important for the audit to be done prior to ESR going live.

The core task schedule has been developed and rotated so that it is reviewed regularly.

Recommendations tracker

Two reviews are nearing completion (RTT and booking system).

The recommendations to be cleared by the end of November relate to equality and diversity which is now in the portfolio of the director of workforce & OD.

Counter Fraud progress report

Collusion is hard to detect and early detection of previous fraud appears to be due to the control environment which suggests there is a good system of internal control.

Counter fraud training is part of the induction when people join the organisation but it is not part of statutory and mandatory training.

An e-learning module is in place.

An update was provided on specific counter fraud cases going through the system.

Assurance was sought on how individuals spot collusion.

Waiver reporting provides the ability to see patterns in terms of where suppliers are being procured.

The position has been strengthened so that three quotes or a waiver is required for any amount over £5k.The last step is that the trust needs to make sure everything goes through a purchase order process.

Board assurance framework

The committee will review one risk in depth per meeting.

The audit committee will look at gaps in assurance and direct other committees to review.

As well as Brexit, the committee flagged the ability to be flexible in the face of change, either expected or unexpected, as a potential risk.

Clinical impact of each risk and how it relates to patient care to be added prior to the next meeting.

Corporate governance review

The committee identified four potential gap areas:

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Research governance

IT and digital, data management – this is going through capital scrutiny committee for scrutiny over project management and capital planning.

Health and safety as it relates to construction of buildings, etc. – this area sits within the quality & safety team but assurance needs to be provided for this specific purpose.

Education – for clarification as to whether this sits within the people committee or strategy committee

SFI Waivers

The list of waivers has increased as procedures have been strengthened.

The next step is to look at trends for the future and undertake some analysis as to those can be addressed.

A large number of waivers come through EBME. This shows that we need to better leverage our buying power, develop a medical devices strategy, provide a more standardised approach, etc.

Other

The committee noted an update on the risk management system roll out and minor changesto the SFIs.

Key concerns There is a lack of discipline in people taking responsibility for the procedural notes (core financial systems audit).

Key learning SFI waivers – undertake some analysis for the next committee and what changes

the trust might make as a result.

Escalations Counter fraud briefing to form part of the board briefing schedule

Items for discussion outside of committee

The January committee will review the BAF in full and then issue a directive to other committeesto deep dive into specific risks.

It was agreed to address the points arising from the corporate governance review via the management executive and conduct an annual review.

Date of next meeting

22 January 2019

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AGENDA ITEM 12 – REPORT OF THE FINANCE COMMITTEE BOARD OF DIRECTORS 22 NOVEMBER 2018

Report title Report of the finance committee

Report from Nick Hardie, chairman, audit and risk committee


Previously discussed at N/A

Attachments N/A

Link to strategic objectives We will have an infrastructure and culture that supports innovation

We are able to deliver a sustainable financial model


Attached is a brief summary of the finance committee meeting that took place on 16 October 2018.


Board is asked to note the report of the audit and risk committee and gain assurance from it.

For Assurance For decision

For discussion

To note

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FINANCE COMMITTEE SUMMARY REPORT – 16 OCTOBER 2018 Committee Governance (for date of meeting)

Quorate – Yes

Attendance (membership) - 100%

Agenda completed – Yes

Current activity (as at date of meeting)

Cost improvement programmes

The committee received a presentation on the Project Management tool (PM3) recently acquired by the Trust, initially for the management of the Cost Improvement Programme (CIP). The system provides:

- Standardised reporting; and - Assurance and governance.

The ambition is to utilise PM3 for service improvement, IT projects and Estates. The committee asked how quality was managed in the clinical divisions. This is

largely through the Quality Impact Assessment (QIA) process, which reviews all schemes that have a financial value greater than £25k.

The committee was keen to understand how if a scheme is fine at first, what happens if it has a negative impact on quality thereafter and how is this identified?

This is reviewed with Divisions at bi-weekly meetings, with an onus on project managers as well as at monthly Divisional performance reviews.

iSLR

iSLR will enable financial performance to be reported split by site, sub-speciality and division

The information within iSLR should drive improved productivity.

The processing of information and governance is through the steering group, and this would be controlled to ensure the production of outputs is manageable.

iSLR is iterative and will improve with better data quality, but this needs to be bottom-up rather than top-down.

Risk and opportunities

The risk and opportunities register was presented.

Bad debt should be included although it was noted that this is accounted for in 2017/18.

CEAs do not present a financial risk to the trust as the process for awarding points is fixed.

BHRUT governance

The committee received an update on progress to date in implementing the recommendation of the BHR financial governance report.

Reasonable progress has been made despite only five of the 24 recommendations being complete; a number were close to completion and were waiting for final sign-off.

The main area of concern related to debtor and creditor policy and procedure.

Capital report

The updated capital report was presented and accepted to/by the group, although

Key concerns Deadlines missed as part of the BHRUT governance plan Only 25% of the capital budget had been spent in the first half of the year.

Date of next meeting

22 January 2019

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AGENDA ITEM 13 – MEMBERSHIP COUNCIL MEETING REPORT BOARD OF DIRECTORS 22 NOVEMBER 2018

Report title Report of the Membership Council meeting

Report from Tessa Green, chairman


Previously discussed at N/A

Attachments N/A


To provide an update for the Board on the meeting of the Membership Council held on Thursday 18 October 2018.


The Board is asked to note the report.

For Assurance

For decision

For discussion

To note

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REPORT FROM THE MEMBERSHIP COUNCIL MEETING – 18 OCTOBER 2018

1. Matters arising from the minutes

Governors were provided with an update on the telephone system at St George’s. There are now only four vacancies out of 27 with changes in roles that staff are feeling positive about. The new Netcall system will be installed within the next four weeks and will require a period of embedding.

2. Executive reports

Governors were informed about the well led CQC inspection, the new digital leads for innovation, the financial position, St Pancras option agreement and potential impact of Brexit.

Integrated performance report

Governors sought assurance on the robustness of the data and were advised that both internal and external audit test the quality and robustness of data throughout the year and provide their reports to the audit committee, which is satisfied that there is sufficient assurance.

It was noted that serious incidents are not reported in public if they refer to patients or staff. The SI in SGH refers to an unmonitored inbox and following a clinical harm review it was confirmed that there was no harm caused to patients.

A discussion took place about DNA rates and journey times and the need to audit when the journey time starts for the patient.

Governors asked how the relationship with the host trust has impacted the works at SGH and were advised that the trust is located in hospitals that have continuing challenges that might take their focus. Host trusts are responsive but there is clearly a need for MEH to get involved in wider estates issues at an earlier stage.

Project Oriel patient participation strategy

Governors were informed about the establishment of an Oriel patient advisory group that would comprise around 15 – 20 flexible and diverse members.

In parallel to this the trust will be running patient experience surveys and hospital interviews to better understand the patient journey. The PCF had a concern that there had been previous participation but then nothing had happened. It was agreed that people need to be informed when there isn’t a great deal going on.

Governors felt that the trust should be ambitious in that we will undertake engagement that will be an exemplar in terms of accessibility and inclusivity. A robust equality impact assessment needs to be conducted. Any factors arising from that would need to be addressed by this group and assurance on that issue would be helpful. It was agreed to recirculate the patient engagement pledge to the group.

The trust needs to understand best practice in terms of logistics for disabled and visually impaired people and make sure those issues are included at the right points.

3. Chair’s board reports

The governors will receive a presentation on the ECLO service at their next meeting.

4. Capital scrutiny committee briefing

Governors received a presentation on the committee and its purpose, as well as the work it has done so far.

The committee will review and gain assurance that project management and delivery of capital works is being undertaken in an acceptable way. This includes the introduction of project gateways, risks, delivery of individual projects, delivery on budget and that appropriate management is in

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place. The committee will also look at procurement strategy in order to understand how we buy and how to we make sure we are protecting the trust position and public money.

Assurance has been received on the project oriel master programme and a schedule is in place that takes the trust from the start to the opening of the new facility.

The membership council discussed how Network Rail and London Underground have detailed processes, standards and expertise in relation to visually impaired passengers.

5. Quality & safety report

Governors received the bi-annual quality and safety report which provides updates on serious incidents and never events, duty of candour, CQC action planning and PALS and complaints.

6. Lead role election results

The membership council offered congratulations to all those who were successful and who nominated themselves. Individuals will start in their roles on 1 January.

Allan MacCarthy – vice chair

Paul Murphy – lead governor

Rob Jones – chair of the governor remuneration and nominations committee.

7. Membership development group

The main issue under discussion was about resourcing what governors do in terms of engagement with membership. The group asked about the possibility of additional funding although accepted that this would need to be part of the business planning round. It was acknowledged that Governors are effective and communicate with the membership more than many other organisations.

In relation to the magazine, the trust has brought in extra resource and this will go out to members prior to Xmas.

8. Governance development group

The group discussed some key issues including lead roles (each of which will have a term of office of three years up to a maximum of six years).

Future items for discussion will include training session topics, feedback from the NEDs, holding NEDs to account, assessment of membership council effectiveness, patient stories, reviews of induction pack and governor term limits.

9. Joint meeting of the governance and membership development groups

Topics covered include the trust magazine and a paper on the constituency review. It was concluded that it would be best to do nothing at this time. All governors represent both the public and patients.

There is still an issue to address around carers and a possible suggestion as to look at maybe developing a carer’s strategy.

More data is required on the rest of England patient constituency and this will be discussed further at the next meeting.

10. Member’s week report

This report is being considered by the board in November.

11. SIS update

Governors asked if targets were going to be increased now they have been achieved. The team needs to look at the optimum target and once this is achieved then it would not be reduced any further. This information will be benchmarked nationally and internationally.

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AGENDA ITEM 14 – MEMBERS WEEK REPORT AND RESPONSE BOARD OF DIRECTORS 22 NOVEMBER 2018

Report title Report from member’s week

Report from Tessa Green, chairman


Previously discussed at Membership council, 18 October 2018

Attachments Member’s week report and trust response

Link to strategic objectives We will pioneer patient-centred care with exceptional clinical outcomes and excellent patient experience


To provide an update for the Board on the work done by the Membership Council as part of Member’s Week in July 2018 and the subsequent response from the trust to the report on actions taken.


The Board is asked to note the report.

For Assurance

For decision

For discussion

To note

Page 1 of 24

Member’s Week

Feedback Report

9 – 13 July 2018

Page 2 of 24

1. Executive summary

Contents

a. Background and context 3

b. General governor comments 3

c. Other comments and reflections from patients and carers 4

d. Action points raised for consideration 4

e. Site-specific environmental action points 5

f. Conclusion 6

2. Appendices 7 – 24

Page 3 of 24

1. Executive summary

Background and context The purpose of Member’s Week is for governors to have a presence at Moorfields at City Road and other network sites in order to recruit members and engage and involve patients, carers and the public in trust activities. Governors get to explain first hand their own role and responsibilities and encourage those who are not already members to become such. Equally importantly governors get to engage with members, patients and staff and get their invaluable feedback as to how they feel the trust is performing. Compliments, improvement suggestions, concerns and complaints are noted allowing governors to provide feedback to the board on the themes coming from patients and carers, so that the trust can put in measures to continually improve services.

On recommendation from the membership development group that the week should have a slightly different format this year, the membership council agreed that governors should visit other network sites as well as City Road clinics during the week. However, the membership council also agreed that more frequent site visits over the coming year should be encouraged and the trust is developing a schedule to facilitate this.

Over the course of the week the following sites were visited:

City Road

St. Ann’s

St. Georges

Northwick Park

Nine governors took part in Member’s Week this year, and consequently fewer clinics (30 as opposed to 56 in 2017) were visited and fewer people (approx.120 as opposed to approx. 360) spoken to. An estimated 20 new members were recruited (60 in 2017). Although this was less comprehensive than in previous years, member’s week remains a useful exercise. The joint meeting of the membership and governance development group discussed engagement from governors and will look at options to allow more governors to take part for 2019. It is important for governors to participate in these engagement events and a great chance to experience the ‘front line’, providing us with a valuable learning tool.

It was also agreed that there should be less emphasis on data collection (checking customer care standards) this year as going forward the membership council will be relying on robust scrutiny of the trusts own metrics in this regard. However, some of the governor visits (see appendices) used last year’s questionnaire in order to try to provide some comparison on this issue (so as to evaluate if the required improvements highlighted in the conclusion of last years report have been attained). Approximately 20 clinics and 65 patients were surveyed using this method.

General governor comments As before, the vast majority of patients were highly complimentary about the standard of clinical care provided by the trust. Most sites were reasonably cool and comfortable, with most cold water machines functioning. Toilets and lifts were working and clean at most sites. Nearly all patients reported that the clerks were both friendly and courteous and this accorded with governors own observations. The few

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adverse comments typically centred on the length of wait times in clinics and the relative lack of information about those wait times as well as the perceived low standard of customer care for those waiting. Pharmacy was operating efficiently with waiting times averaging 15 minutes.

Other comments and reflections from patients and carers

The majority of patients and carers complimented their consultants and other staff, as well as the treatment they received. The environment was praised and people felt that they were treated ‘personally rather than being on a conveyor belt’. Patients also welcomed the multicultural feel of the trust and its staff. Staff are seen as professional and helpful and willing to discuss the services their departments provide when asked.

Patients felt that improvements could be made in the following areas:

Whiteboards showing the correct waiting times and clarification over how a ‘wait time’ is assessed (i.e. is it the time you wait to see a doctor or the time you wait to see a nurse or undergo tests prior to seeing a doctor)

Receptions should provide more information, such as the likely waiting time and information

about the tests that will be undertaken or the individuals you will see prior to seeing a doctor

Lessons could perhaps be learned from looking at pathways in other hospitals

Although clinical outcomes at St George’s are seen as very good, there are continuing capacity challenges that have an impact on the patient experience

The length of waiting times were raised as an issue at Northwick Park as well as a perceived lack of ‘proper’ communication

LED displays that show the patient’s name up on screen (as in many GP surgeries)

Action points raised for consideration

The step up to the clinic in Cayton Street is very high and could be difficult for patients with mobility or other physical problems. A review of this would be welcome.

Some challenges were raised at St George’s in relation to appointment bookings. Reported late cancellations by the trust mean that some patients are having extended periods without treatment, particularly injections, which will have a discomfort impact for many patients. It would be helpful for the board to know the number and percentage of patients subject to cancellations and the average time they have to wait for a re-appointment.

The ECLO Service at St George’s appears to be operating outside the trust service model, and more focused on the interests and priorities of the local society. Governors ask that the executive review how this should operate. Governors would be keen to understand more about the purpose and ambitions of the ECLO service within the MEH network and to be assured by the board that this fits with the patient participation strategy and member engagement plan, effectively supporting corporate objectives.

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Improvements on the site pathway, route guidance and signage at Northwick Park as well as provision of wifi for waiting patients.

There is still a lack of awareness amongst staff and patients about the potential for using buzzers. There is a standard operating procedure for this and we would ask that either the SOP be monitored for compliance with retraining available for staff or it be changed to say ‘buzzers provided on request’ with extra publicity/information provided for patients.

Screens are still often inaccurate (58% as per clinic survey results at appendix 1) so as per

previous recommendations this may require staff retraining/prompts, adequate back up and improved monitoring as well as quicker rectification of system problems and ownership by service managers.

Waiting times and communication appear worse than last year (taking into account the difference in methodology, numbers of patients interviewed, etc.) This is an issue that might be addressed through improved customer care training and monitoring of compliance with new systems.

The last three points are issues that have been raised previously and are being worked on by the service improvement and sustainability team, monitored through their reports and the integrated performance report.

Site-specific environmental action points (these points have been highlighted to the executive for immediate action)

Northwick Park

The lights in the two lifts had gone and that a repair had not happened as had been scheduled.

Downstairs water dispenser had been out of action for some weeks. Staff were pursuing rectification of both and providing bottled water.

Other environmental issues were raised with staff at the time of the visit and actioned by them:

St. Ann’s

Drinks vending machine was out of order, and the snacks vending machine was very low on stock. Veronica said that she had experienced problems in the past securing the restocking of the snacks machine. As the café is located at some distance from the clinic, there was a dependence on these machines, particularly in view of waiting time in the clinic without access to refreshments.

One of the toilets was blocked and needed repair.

City Road

Out of order vending machines and water dispenser.

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Conclusion

Members’ week, though more limited in scale than that of previous years, was once again a very successful and worthwhile exercise. It enabled governors to engage with members and got a feel for the day to day operation of outpatient clinics. We were able to observe first hand the complexities of delivering first class clinical eye care in sometimes challenging circumstances. The role of governors was explained to patients and carers and those not already members were encouraged to join. Members (staff included) were encouraged to participate in trust activities and reminded that the governors existed to represent their interests and therefore needed and prized their input.

The majority of feedback was very positive. Once again the core of what we do drew high praise. The membership council wishes to record it’s thanks to all the hard working staff that make this possible. The friendliness and professionalism of all MEH staff was evident.

There are still some areas of improvement that can be made as evidenced in the points above. The key issue that still requires focus from the executive team is how best to resolve the issue of proper and appropriate communication with waiting patients, which previous action plans and improvement programmes have so far failed to satisfactorily resolve.

The membership council recognises that the SIS team is working hard in this area and welcomes being kept informed of progress via quarterly SIS updates and the integrated performance report. The membership council is happy to continue to assist the board in identifying themes that are important to patients and looks forward to seeing progress made in these key areas. The membership council also welcomes the reduction in average total journey times.

I would like to thank all governors who gave up their time to attend and also the Friends of Moorfields, clinic staff and of course Helen and Jessica who helped facilitate the week.

Paul Murphy Lead Governor,

On behalf of the membership council

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1. APPENDICES – INDIVIDUAL SITE REPORTS

CLINIC SURVEY RESULTS – Paul Murphy and Jane Bush

Survey of 20 clinics (approx.65 patients surveyed) members week 2018.

Overall average compliance with customer care obligation was 50% (2017; 59%)

Screens were 58% inaccurate (2017; 57%)

Waiting times and communication (WTC) records the number of NO responses to questions about such (Q’s 1,6,8 (b and c),9,10.11 and 13) and this year’s figure was 67% (2017 ;62%)

Q’s 10,11 and 13 (patients asked if informed on arrival of process by reception, likely wait time and if updated if waiting beyond an hour ) some 77% answered NO

Q’s 2 & 3 – clerks feeling supported showed a welcome improvement to 100%. (84% 2017)

Q’s 4 & 5 (reception asked if had received any MEH customer service training or if they worked to any MEH customer service standards) 70% answered NO. (2017; 20%)

Average wait time shown on whiteboards (mostly legible and complete) was 2-3 hours. However such wait times were largely (78%) inaccurate.

Total Journey Times (TJT);

Trust data shows that the average TJT for all clinics in this week was 102.5 minutes, 8% better than that of 2017 which was 111.5 minutes, ( 2016; 104 minutes. 2015; 98 minutes, 2014; 97minutes). Although not over robust (as less than 50% of TJT’s are properly recorded) it is the only data available and is validly comparable year on year.

Above results show that overall performance was worse, screen accuracy was no worse but still poor. Most patients reported that they were not being informed nor updated re waiting times. Whiteboard wait times were 78% inaccurate.

There was a large increase in the % of receptionist who reported that they had not received MEH customer service training nor did they work to MEH customer service standards. There did however seem to be a higher than last year number of bank staff working in clinics surveyed.

Conversely there was a welcome increase (to 100%) of receptionists feeling supported in their work.

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Example of clinic questionnaire used

Visits to:- Clinic 1 Adnexal Clinic 4 External Disease Clinic 15 Medical Retina

Clinic 1 Adnexal

I spoke to four patients in this clinic and asked each patient four questions about their experience:-

On arrival today, were you given information by the receptionist about who you will see and what will happen to you, during your visit?

Patient 1 Answer: No Patient 2 Answer: Yes

Patient 3 Answer: No Patient 4 Answer: No

On arrival today, were you given information about how long you would have to wait?

Patient 1 Answer: No.

Patient 2 Answer: Yes. This patient had asked the receptionist how long they would have to wait and were informed that there were three patients ahead of her. The receptionist was not quite sure how long seeing them would take and hence how long this patient would have to wait.


Do you know where you can get refreshments and fresh drinking water?

Patient 1 to 4 -all yes

However, Patient 3 drew attention to the fact that the drinks dispensing machine was out of order in this clinic and it was a very hot day and very warm in the clinic.

If you have waited over one hour beyond your appointment time to see the doctor, have you been told why and how much longer it would take?

Patient 1 Answer: No, but this patient had not yet waited for an hour


Patient 4 Answer: No This patient had been waiting 1hour 20 minutes.

General comments of patients attending this clinic (Clinic 1 Adnexal)

Patient 1: This was a young female patient who when questioned felt that she had received enough information about her appointment, most of the information being covered in the letter with her appointment. In any event, this was not her first time in this clinic.

She had used the kiosk to register and found this to be an easy process.

I asked her if she had ever been given the Friends and Family Leaflet, and she said that she had never been given this to complete.

When asked if there was anything the clinic could improve, she said

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a) The waiting time could be improved. Her ideal would be a 20 minute wait to be seen by the

doctor.

b) She would like patients’ name to come up on the screen when called to see the doctor or nurse (as happens in many GP surgeries).

On the positive side, she commented that “the doctors are really good”

She expressed an interest in receiving information on the hospital’s fund raising events and was interested in becoming a Trust Member.

Patient 2:

This patient commented that on a previous appointment at Moorfields she had been told by the doctor that she had an infection in her eyes, but that this turned out to be an incorrect diagnosis, as the problem was subsequently found to be an allergy to the drops she had previously been prescribed.

However, on the whole she felt “the Moorfields organisation is excellent.”

One improvement she would like to see effected (like Patient 1) would be for patients’ names to be shown on the screen when called to see the doctor or nurse (as happens in many GP surgeries). In the absence of this provision, she would like doctors and nurses to call your name more loudly as it is hard to hear when you are called and that in any events many patients have hearing difficulties.

Husband of Patient 2 accompanying his wife; He would like waiting times to be shorter and thought it remiss that the drinks dispensing machine did not work, which was hard on the hot day it was. On the positive side, he said that the “treatment itself at Moorfields is fantastic.”

Patient 3:

This patient had only positive comments about Moorfields, stating that “It is a very calm environment. The staff don’t make you feel rushed even when they are busy. You feel that you are being treated personally rather being on a conveyor belt.” This patient’s husband commented that Moorfields is very much a multicultural Trust which he greatly welcomed and enquired as to whether the ethnicity of Governors was mixed.

Patient 4:

This young female patient said that she thought the doctors at Moorfields are good.

She queried whether PALS is independent, whether the staff are employed by the hospital and whether the PALS office should be located outside the hospital in the interest of being seen to be independently run.

Clinic 4 External Disease

I spoke to two patients in this clinic and asked each patient four questions :-


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Patient 1 Answer: No “The receptionist just took my name.”

Patient 2 Answer: No


Patient 1 Answer: No. Patient 2 Answer: No


Patient 1 Answer: yes “Only because I have been coming for 4-5 years now.”

Patient 2 Answer: yes

However, Patient 2 drew attention to the fact that the drinks dispensing machine was out of order and it was a very hot day and very warm in the clinic.


Patient 1 Answer: No This patient was from Worthing and had at the time of speaking been waiting without being seen for1 hour 10 minutes.

Patient 2 Answer: No This patient had been in clinic for one hour and had seen the nurse but not yet by the doctor.

General comments of patients attending this clinic (Clinic4 External Disease)

Patient 1:

This patient had not used the kiosk to register but had done so with the receptionist. They said that now they knew that a kiosk was available for this purpose, they would use it in the future.

They felt that waiting times in the clinic could improve and that a half hour wait would be acceptable.

On the positive side, they said that they were very happy with the doctors and treatment they had received, that Moorfields City Road was a first class hospital providing very good care. They said that the nurses could not have been nicer.

Patient 2:

This patient had checked in with the receptionist rather than registering at the kiosk as she was unaware that kiosks existed.

This lady had numerous different eye conditions and was being seen at several of Moorfield City Road clinics for the different conditions. She was worried about her raised eye pressure and in spite of it being diagnosed in a different clinic to today’s clinic, she had only been seen by a nurse and not a doctor to try and resolve the problem. She was concerned about the compartmentalization of treating conditions and was worried that her raised eye pressure, which whilst pressing would not be dealt with in the External Disease Clinic today as this condition was not the remit of today’s clinic. She felt that there wasn’t a cohesive approach to the treatment of her different co-existing conditions.

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She said that she had an appointment this morning at the External Disease Clinic and had been given a 17.00 hours appointment at a different clinic for an eye pressure reading (not to see a doctor about this). Hence she was obliged to wait around for hours between appointments and it would make it very late by the time she returned home by train to Kent. I invited Paul Murphy to also listen to her concerns and he advised her that in future she should contact the appointments booking department and request appointments which were closer together on account of travelling some distance to attend the clinics.

Clinic 15 Medical Retina

This was the last clinic visited and I saw one of the last remaining patients waiting in the clinic.

I asked this patient four questions about their experience:-

On arrival today, were you given information by the receptionist about who you will see and what will happen to you, during your visit? Answer: Yes

On arrival today, were you given information about how long you would have to wait? r: No.

Do you know where you can get refreshments and fresh drinking water? Yes

If you have waited over one hour beyond your appointment time to see the doctor, have you been told why and how much longer it would take? Answer: yes

General comments of patient attending this clinic (Clinic15 Medical Retina)

This older lady and her accompanying son and daughter said that had nothing bad to say about Moorfields. Their only comment was that waiting time to be seen was the only negative thing. This patient felt that the staff were very good and were very understanding. She and her family had found the leaflet on Age-Related Macular v. useful

Paul Murphy, Jane Bush, Emily Brothers and Allan MacCarthy, City Rd. 9 July (with Jane, Emily and Allan)

I spent the day at City rd. and twice visited clinics 1, 4, contact lens, 11, 12 and 15 I also visited clinics 2.,3 and pharmacy. On each visit I completed the customer care survey/questionnaire talking to receptionists, patients, carers and recording my own observations. The results of this (together with Jane’s additions) are recorded in the main report and my overall impressions coincide with the main thrust of the report. That is that patients really rate our clinical care, value the friendliness and professionalism of our staff but have concerns over wait times and being informed and updated re such.

I spoke to about 30 patients and recruited about 4 as members. Clinics were generally very quiet (doctors on leave) and running reasonably well.

The cold drink vending machines were not working (on a hot day!) However through informing matron we managed to get these repaired by the afternoon.

The cold water dispenser in clinic 4 was not working, had an out of order notice on and I was assured it had been reported BUT it was still not working on my Thursday visit.

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Paul Murphy, City Road 12 July

I visited clinics 1, 4 contact lens and 15 and again completed the customer care survey for each. I spoke to about 8 patients and recruited 2 as members.

No new action points. Impressions same as Mondays visit as reflected in survey results. Worth noting that of the many inaccurate screens some still had Mondays information and I watched whilst a receptionist repeatedly tried to update. Her screen showed correct information but patient screen would not update which suggests the screen problems shown in report (58% inaccurate) may be down to system problems as much as input neglect.

Screen inaccuracy together with lack of publicity about/, knowledge of, use of and receptions’ ignorance of Buzzer S.O.P. were raised as AP’s with Tracey at the time.

I met with Sean and his team (Lynsey and Naomi) for an update about their ongoing work in the area of customer care including input to refining the satisfaction questionnaire they will be using to measure improvement.

Paul Murphy, St. Ann’s 12 July

Not much to add to Janes report from that morning. I surveyed the 2 clinics running and spoke to about 10 patients (2 recruited as members). Survey results were sadly average i.e. clerk had received no customer care training or standards. Wait time inaccurate. Clerk said he informed patients (question 6) re wait but patients reported he had not. Patients complimentary, staff all very nice and professional, environment good, cool and not overcrowded (some infrastructure improvements since my last visit including privacy screening.)

Brenda Faulkner and Emily Brothers, St Georges Outpatients Department 10 July 2018

Met by: Christine Real, Clinic Sister/Adnexal NP, SGH Outreach

Clinics: 8.30 to 12.00 noon

Medical Retina - 35 patients

* 2 clinics

* 2 doctors per clinic

* 3 technicians

Glaucoma - 18 patients

* 1 doctor

* 1optometrist

* 1 nurse lead, plus 3 nurses RNs

External Diseases – 34 patients

* 2 doctors

* 1 optometrist

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* 3 technicians

Urgent care

* 8.30am start to 21.00 finish

* 1 consultant – Rathie Rajendram

* 1 nurse practitioner

* 2 senior nurses

* 1 senior manager -

* 1 full time receptionist – Meana

The waiting area for all MEH clinics was very busy, with only a few chairs available. The seating area was not divided into clinics. Without temporary volunteers providing assistance to staff and patients alike, capacity to provide adequate support would have been even more stretched.

At the time we visited (11.15am) 15 patients had checked in and 11 had been seen.

The waiting area was packed with little seating available. We were greeted by Christine Real and we introduced ourselves to the clerks. We met several members of staff who remembered us from our last visit.

There were two student volunteers there on 2 month placements from university; Zairi and Maricarmen (from the university of California). Maricarmen spent 50 percent at St George’s and 50% at City Road.

Patients

Patient 1

* Glaucoma clinic – 10.30 appointment

The patient was seen straight away for an initial examination.

Comments –

“- need to be patient” “staff do their best”

Patient 2

* Glaucoma Clinic – 10.30 appointment

The patient has been coming for a couple of years. Had vision done immediately.

Comments – The patient once waited 3 hours as her notes were lost. She was booked for a 6 month appointment which was cancelled the day before and had to wait a further 3 months for another appointment.

She was originally seen at Teddington by Miss Ray then referred to St George’s. She would prefer to go to Cobham Hospital where there is no Moorfields clinic. Not a happy patient.

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Patient 3

* Glaucoma clinic – 11.30 appointment

The patient has been coming to St Georges for 11 years.

She was very positive about everything and waited only 30 minutes for the first procedure. She wouldn’t leave clinic to get refreshments in case she missed her turn.

Asked if she would do so, if there had been a buzzer, she said she would do.

She gave positive feedback about surgery she had had at St Anthony’s on 28 June.

Patient 4

* Research retina – 10am appointment

Had drops and an x-ray. The patient was prepared to wait for up to 2 hours and would not leave for refreshments but would do so if there were a buzzer.

Had a blue badge and experienced no problem with parking.

An appointment was cancelled 2 months ago and she was told she would be sent another which did not receive. She went to clinic to ask why and she was told she would have to wait until the doctor said she should come – nothing happened. She went to her optician who had told her to come to Urgent Care

Patient 5

* Medical retina – 10.15 appointment

Had pressures done, wouldn’t leave for refreshment. Waited 1.5 hours before being seen.

I noticed a pile of flyers folded on the reception desk advertising “Moorfields St George’s low vision” day (8th August at 10am to 2.00pm). No one there seemed to be aware of it but we were informed that it was being organised by the ECLO, Samantha who we spent a short while with. She has organised the day with various companies (shown on the flyer). Emily, as SW London Governor, was not aware of the event and how this fits into our wider patient and member engagement.

Samantha has been an ECLO for 12 years employed by Merton Vision, but funded by MEH to carry out this work on Tuesday, Wednesday and Thursday.

Otherwise she works for the local authority. She deals with registration, has lots of phone calls and emails and she runs a macular support group (Merton Vision). She had no referrals today. We do not understand why she is not engaged with patients and why registration seems to take up so much of her resources.

She is leaving in September to go back to full time education. We believe this provides an opportunity to regularize working methods in line with MEH wider ECLO service.

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Conclusions and Recommendations

MEH at SGH continues to present capacity challenges, with consequential poor patient experience. More patients than previously appeared open to using a buzzer. Everyone continues to be pleased with clinical outcomes.

There would appear to be some difficulties with appointment bookings. Late cancellations by MEH mean that some patients are having extended periods without treatment, particularly injections which will have a discomfort impact for many patients. It would be helpful to know the number and percentage of patients subject to cancellations and the average time they have to wait for a re- appointment.

The ECLO Service at MEH appears to be operating outside our service model, more to the interests and priorities of the local society. We recommend that management review how this should operate. More strategically, it would be helpful for Governors to be briefed about the purpose and ambitions of the ECLO service across the MEH network and to be assured by the board this is fit for purpose and effectively support corporate objectives.

Allan MacCarthy, Feyi Onafowokan, Northwick Park 11 July 2018

1. Reaching the Eye Centre – signage and the path.

It was easy to reach the main hospital from the tube station, but not so to the Eye Centre when there. Signage was limited. We both, travelling separately, had to ask for directions.

This route was along an uneven path adjacent to parking areas which, in places, it veered around. Whilst many patients may arrive by other ways we considered that for those arriving as we did this route was unlikely to be easy especially, we thought, for those with visual impairment or for anyone attending for the first time.

2. At the Eye Centre

The MEH Eye Centre is on two floors with three waiting areas, one of which is downstairs. There are separate reception desks on each floor. We were met by Dee Clarke, manager, who kindly showed us around, neither of us having been there before. Clinics were busy.

We were told that the lights in the two lifts (no others) had gone and that a repair had not happened as had been scheduled. We saw people struggling up the stairs and with the lift. We also learned, as had been observed by Allan earlier, that the downstairs water dispenser had been out of action for some weeks. (Allan saw patients being told of this and noted the availability of bottled water.) We reported these, and another matter, to support MEH colleagues’ own work as soon as we could.

3. Our observations and engagement with patients/carers there

Allan’s observations:

I spoke with those on the ground floor. I noted that the seating in the downstairs waiting area was adequate for the number of people attending, with one “large” chair. There were few empty seats during the time I was there. and that it was quiet and air conditioned. I did not detect wi-fi on my own device, something I meant, but forgot, to ask. I noted that the reception staff re-directed a

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couple of people to the upstairs departments. This made me wonder how appointment letters made clear which area to attend.

I saw one wheelchair user having to wait near the main entrance door, the only space which could accommodate her chair. She complained that there was no table for her (others did not have these). Staff pointed out her place was by a fire escape route so nothing could be fixed in the area which could be an obstruction. This position meant that she had lots of people passing right by her, an experience that others waiting did not have. I also wondered what if two wheelchair users had to wait at the same time as there seemed only space for one?

Names were called clearly. There was no screen but there was a whiteboard. This indicated the number of doctors, of patients and estimated waiting time. Printed signage in the area was appropriate (albeit one out of date) and not cluttered. There was an F&F box on the counter; I did not see how patients were given the forms.

I spoke to all the patients and carers waiting and to one volunteer (about 20 people) about membership, handing each membership applications. One person was a member already. All those I spoke to had attended before and knew about waiting and registration arrangements. Detecting that patients wanted to be quiet I did not ask individuals much more. No one raised issues with me. I noted that a number of those to whom I spoke were carers.

Feyi’s observations (written up by Allan from Feyi’s notes); Engagement was with about 16 people. Comment was made by at least three that the waiting room was too warm. The air conditioning was said by one not to be working well. The same person indicated that there was not much light in it either. One of the two upstairs waiting areas had no natural light. Two people said that the waiting area they were in was too small.

Staff were said to be effective and friendly but one person commented that they hadn’t been informed by the receptionist where to get water or the location of the toilet. Another thought the receptionist had not been helpful. It was noted that there had been queues to the reception desk. One person said that this had been too long.

Comments were made about the length of waiting time and one person on the lack of what they called proper communication.

4. Our thanks – we would both like to thank all the Moorfields staff at Northwick Park that afternoon, but especially Dee Clarke for her warm welcome to us and for her time showing us around. Can we also thank the patients and carers to whom we spoke for their time talking to us and helping us in this way – and hopefully for becoming members.

Brian Watkins, Northwick Park 11 July 2018

There are two lifts from ground level to the first floor. Both were working but had no light other than a small advertisement. This was reported to the Estates Office at City Road last week, apparently fixed, and then reported again yesterday. I understand that the procedure is for City Road to then call in lift engineers but no-one had come by the time I left soon after mid-day today. Warning notices have been put on the lift doors and Moorfields staff are accompanying patients in the lifts if required.

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Refreshments are available from a machine and drinking water is available. The whole clinic is clean, well decorated and has adequate seating. However there is no wifi available.

The clerks on the reception desk were very friendly and new arrivals were made welcome without delay. The whiteboard at the reception desk listed six different clinics – medical retina, contact lens, low vision, kerataconus, pre-assessment and primary care, but no wait times. However when I was there mid-morning there were very few patients in the first waiting room, most having moved on to the internal area following their first tests.

I handed out a small number of membership application forms and also flyers for the AGM on the basis that they would be looked at later. There was no immediate positive reaction.

The two action points are lift lighting to be fixed, which is urgent, and installation of wifi, which is desirable although probably not absolutely essential.

Rob Jones, Brenda Faulkner, City Road Friday 13 July 2018

Visit 1 Met Andrew Whittington (volunteer) at check-in kiosks. He showed us how to use the machine. It was quiet at first – later became busy – 5 to 6 waiting to check in.

Visit 2 Visited the PALS office to talk to Nargis and Maria. Maria said how they organise appointments for braille patients when required and also large print.

Visit 3 – Cayton Street Met by Jonille (full-time clinic clerk) Clinics start from 08:00am

Met Vilma (technician) Met Lewis Jacobs (optometrist) who works there on Fridays. Introduced to two other optometrists.

Met Raj Das-Baumik (consultant Adnexal for eight years). Works in A&E on Fridays then in urgent care in Cayton Street.

Clinics Urgent care – 22 booked patients One consultant and four optometrists

Virtual glaucoma – 30 booked patients all day Technician-led

Glaucoma phasing – 3 patients spend all day in clinic

Water machine available, patients know where to get refreshments.

Patient 1 11:15 appointment Has been coming for 10 years. Normally goes to the glaucoma clinic. She missed her last appointment as she was in hospital. Re-booked for Cayton Street. Wanted to know why she was referred here – explained about the new venue.

Patient 2 Lives in Bromley. Has been to City Road 3 – 4 times in three years. Always comes to A&E when she has a problem. Referred from A&E to Cayton Street at 10am. First visit here, quite happy with her treatment at MEH. Was called in whilst we were there.

Visit 4 - Main reception Spoke to five staff (reception x 3, transport x2, porter x1) Vijay and Graham very helpful.

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Visit 5 – Switchboard Graham took us to switchboard to meet Kumar Sisupalan (team leader) who has been at MEH for 33 years in various posts. He is responsible for main reception which includes switchboard and transport.

He introduced us to Tracy and Patrick who work for FALCK, the transport company.

Then he took us to meet switchboard staff: * Cat who has been at MEH for over seven years

* Guy is bank staff and has been on the switchboard for five months

* Omi has been here for one month Asked about his induction which he said was good.As about call volume – between 12 midnight and 11:30am there were 301 calls. On a really busy day there could be 1000 to 1200.

Observation

The step up to the clinic in Cayton Street is very high and could be difficult for patients. Is there any way this could be rectified? A very good visit overall.

Richard Collins, St Ann’s [check date]

How did you find the environment for patients? This might include the following: General standard of maintenance and decoration, availability of refreshments/drinking water/wifi, seating, etc.

Generally good. Clearly staff had given thought to patient needs and wishes: for example, a ‘phone charger was available; telephone numbers for local taxis were displayed; staff had provided plants in the reception area and so on. However, the drinks vending machine was not working (staff explained that the contractor had been notified but that service support from the contractor was often slow and unsatisfactory) and the snacks machine had not been refilled meaning that there was a very limited choice of snacks available for purchase. However, the drinks machine in the discharge lounge was working. Wifi worked in the discharge lounge but not in the main reception area.

Ask patients/carers about their experience. This might include the following: Did patients feel they had enough information about their appointment and wait? Was the registration process easy for them? Are there things that could be improved? What did we do well?

The patients to whom I spoke (in reception and discharge lounges) were never less than satisfied with their experience and some were effusive in their gratitude and appreciation of Moorfields at St Anne’s.

However, though the information white board had patient numbers, clinic times, consultant’s name (only one consultant on the day of visit) etc. displayed there was no written information on the length of wait which patients could expect.

Please record any additional general observations below:

I was very favourably impressed by staff’s helpful, friendly and respectful engagement with patients. Further, staff were obviously familiar with each other and worked very effectively and constructively

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as a team. They reported that relations with the St Anne’s host worked well. In the discharge lounge patients were given full, clear and friendly information by desk staff and surgeon and pharmacist spoke to patients before they left after surgery.

Are there any actions that you would like to see following your session at member’s week?

Staff should be asked to show waiting times on the reception area white board. A notice about

availability of buzzers should be displayed (particularly because the patient café at St Anne’s is

distant)).

Moorfields staff pointed out that there is no entertainment for patients (eg a television) in the reception area. The television is the staff area (donation from a grateful patient) did not work due to antenna/signal problems – this should be fixed. Wifi in the reception area should be improved.

What information would patients/carers/members like to hear from the trust?

No comments received.

Jane Bush, St Ann’s [check date]

Visits to:- Clinic : Glaucoma

When Richard and I arrived at the clinic, we were made very welcome by Veronica Brade, Team Leader and Anna Hitji. As Richard was a new governor, they gave us a guided tour of the unit and the one consultant on duty, Mr Richard Wormald also quickly greeted us. He apologized for not having time to speak with us, but his two fellow consultants were on leave, so he was the sole consultant on duty that day. We were also greeted by the nurse in charge, Mustafa who impressively recalled meeting me on a previous governor visit, and we were introduced to Alfonso Vasquez Perez who was carrying out the day’s cataract surgeries.

In discussion about the unit, Veronica Brade said that she would like to see a TV in the waiting area to provide a distraction for patients whilst waiting to be seen.

Veronica informed us that they expect to be getting self-check in kiosks soon.

When asked if they have a buzzer system for patients to avoid missing their place to be seen whilst visiting the toilet or café, she said that they do have such a system, but that she thought it would be helpful to patients if a sign could be put up informing them of/advertising the availability of buzzers. However, she made the point that the café is located quite far away from the clinic and most patients were reluctant to visit it whilst waiting, even using a buzzer in case they did not get back in time to be seen and would lose their place in the queue.

Unfortunately, the drinks vending machine was out of order, and the snacks vending machine was very low on stock. Veronica said that she had experienced problems in the past securing the restocking of the snacks machine. As the café is located at some distance from the clinic, there was a dependence on these machines, particularly in view of waiting time in the clinic without access to refreshments. There was a functioning water fountain.

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I noted that one of the toilets was blocked and needed repair. I mentioned this to Veronica and she said that she would ensure it was fixed.

At the end of my visit, I observed an older patient who had undergone cataract surgery that morning, extremely angry, upset and complaining loudly in the waiting area in front of other waiting patients that he had not been given as promised a date the following week for the other eye to undergo cataract surgery. He complained that his cataract surgery had been cancelled several times before.

I subsequently spoke to Veronica about the episode and it transpired that after speaking with him, she ascertained that his previously cancelled cataract operations were under Middlesex and The Royal Free. When he attended clinic on the day of our visit, he had had his first eye operated on and was upset because he was not listed for the second eye to be done a week later, which he was expecting.

Veronica invited him to discuss what had happened in a private room, but he declined and said he would not leave the clinic until this had been resolved to his satisfaction.

Veronica handled the situation very diplomatically and skilfully, listening to him without interruption to obtain an understanding of his complaint, allowing him to ventilate, whereupon he calmed down. She also contacted the admissions manager and arranged for the operation to take place the following week in accordance with the patients’ understanding of what he had been promised. The situation was resolved skilfully and with compassion.

All the patients I spoke to were unanimous in their praise of the doctors and nurses and the treatment they received.

Part one: speaking to the receptionist (Zaynah Burthum - permanent member of staff)

When patients arrive, do you tell them what will happen and who they will see during their visit? Answer: Yes – patients ask her

If you need extra support in the clinic, do you feel comfortable asking for it? Answer: Yes

If you have asked for support in the past did you get it? Answer: Yes

Have you received any customer service training? Answer: No

Do you have customer service standards you work to?

Answer: Yes – “good manners to patients, need to be a good listener, need to be helpful, supportive, because patients are mostly older.”

The receptionist said that she does tell patients how long the wait is, and the nurses put the information on the board.

I noticed that The Friends and Family leaflets were on the desk at Reception. I asked if and when these were given to patients and was told that they were given to patients when they leave.

Part two: my observations

Did you observe the receptionist explain to patients?

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a) What would happen and who they would see during their visit? Answer: No

b) Tell them how long they would need to wait? Answer: Yes, but the time was not accurate

c) Were they working to their customer service standards? Answer: Yes

Did the clinic receptionist appear friendly and welcoming to patients? Answer: Yes

Was the information on the white board behind the receptionist legible? Answer: Yes

b) Did it show the estimated waiting time?

The white board said “CLINIC APPOINTMENTS LAST 1 – 2 HOURS”, it did not say the estimated waiting time. Furthermore, some patients pointed out that clinic visits last much longer and that typically they were in clinic 2 - 4 hours.

Did the (TV) information screens display the estimated waiting time for this clinic? No

I spoke to five patients in this clinic and asked each patient four questions:-


Patient 1 Answer: No – she said she had to ask for this information

Patient 2 Answer: No – it was not necessary as this patient was a long standing patient.

Patient 3 Answer: No – “I have been a patient for nearly ten years so I know what will happen.” This lady was a nurse.

Patient 4 Answer: Yes



Patient 1 Answer: No.


Patient 3 Answer: No, but this patient said she didn’t mind how long she waits.

Patient 4 Answer: Yes

Patient 5Answer: No


Patient 1 Patient was called to see doctor and so answered no further questions


Patient 3 Answer: no


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* See comments above about vending machines


Patient 1 -

Patient 2 Answer: No. At the time of speaking to this patient it was 11.10 a.m. and their appointment was at 9 a.m. They had had a scan but were still waiting to see a doctor.

Patient 3 Answer: No - Not yet waited for an hour.

Patient 4 Answer: No - Not yet waited for an hour

Patient 5 No – had been waiting for an hour

General comments of patients attending this glaucoma clinic

Patient 2:

This patient felt that the best thing about the clinic was her consultant. She thought that Moorfields was very good and the treatment met her expectations. She had been attending the clinic for four years and had no negative comments about Moorfields. She reported that she completed The Friends and Family Test and was enthusiastic about becoming a Member of the Trust.

Patient 3:

As previously mentioned, this lady was an A&E nurse in another Trust.

When asked what could be improved, she said that from experience she expects to be in clinic for up to four hours. She commented that the white board did not show the correct waiting time, which is usually 2-4 hours in any event. Most times the clinic takes four hours in all. She further made the point that the “wait time” should be clarified as the time you wait to see a DOCTOR, and not refer to the time it takes to see the nurse and/or undergo tests prior to seeing the doctor.

She said that the receptionists do not tell you how long you will wait and you are not given information about the tests that will be undertaken and the people you will see before seeing the doctor.

Where she works (at Whipps Cross Hospital – Barts Trust), they have a more streamlined patient pathway through A&E and they manage to keep the waiting times down. She wondered if lessons could be learned from this and applied to this clinic. This patient believed that a total time of 1 – 2 hour in the glaucoma clinic for the whole journey could be achieved, and 15-20 minute per patient with the doctor was adequate and could cut down waiting times.

On the positive side, she was of the view that the doctors and nurses at St Ann’s were very good.

Patient 4:

Found it easy to register and said that “everything is very good – Moorfields is one of the best in the NHS”

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Patient 5:

This elderly female patient arrived with transport in a wheelchair from St Michael’s Hospital where she was an inpatient.

She was of the view that the letter she received about her appointment gave all the information she required about her appointment and the wait.

With regards to the waiting time, she said that ”waiting in clinic is inevitable because there are so many people to be seen.” She reported that she usually comes at 8.30 a.m. and is finished by 10 – 10.30 a.m. She observed that because she has come from another hospital, she came later today than usual and that there were many more people in the clinic as a result.

This patient had no complaints about Moorfields.

After talking to Patient 5, another female patient approached me and said that she had undergone her cataract operation and had been waiting for over an hour for transport home to arrive. She said that she had been in clinic since 6.30 a.m., had had her operation and just wanted to get home. At the time of speaking to me it was 12.10 noon.

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Personal reflections from patient governors on their experience (appointments held outside member’s week)

Rob Jones

Clinic 11. Arrived on time for a 9 am appointment; the waiting area (a corridor which is pretty grim) filled very quickly. Excellent clinical appointment as ever. Problem noted: The clinic did not start taking patients until 9.25, the doctors wandered in between 9.10 and 9.25. I mentioned the late start of the clinic to John Quinn in a Membership Council meeting with a view for requesting action on late clinic starts as if this is general practice, obviously there will be a serious adverse outcome for patient waiting times.

Appointment in Clinic 4: An excellent experience: appointment time 9 am; called into the clinic at 8.50 for the n nurse vision testing exercise; (I arrived at about 8.45) Called into the clinic at 9.05; excellent clinical appointment as ever, seen by the Fellow and Consultant. As ever the nurse input was not appropriate and in my case a waste of time; I think attention needs to be paid to the appropriateness of the nurse input as this is not necessarily "added value" in a significant number of cases, particularly given the quality of this part of the appointment. While waiting for a short time for my calls into the clinic I had the opportunity of talking with three other patients (one with a carer). All three said they thought the service was excellent and that they would not attend any other hospital. Neither receptionist offered me a FFT, in both clinics receptionists very helpful, positive and observed as very good interactions with other patients also.

Comment: When we are looking at audits for future governor choices, it might be appropriate to request an audit on clinic start times; another issue worth looking at would be the percentage of attendances where the nursing vision testing part of the appointment is added value.

Richard Collins

I was a patient in the afternoon City Road glaucoma clinic (clinic C3). The video screen was showing details for the morning session, not the afternoon; the large white on black placard identifying the clinic stated that the clinic was neuro-ophthalmology (not glaucoma) and the white board above the receptionist/clerk's desk correctly stated that the clinic was a glaucoma clinic but did not state a wait time (it did state a "duration" period - which may equate to wait time but if so is an unhelpful and possibly confusing message for patients).

All otherwise was tickety boo - staff were courteous and efficient, the place was clean, etc. I think all that's required is for someone to receive a gentle reminder about ensuring the information given to patients is up to date, unambiguous and accurate.

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Member’s Week

Response and actions

John Quinn (COO)

30th October 2018

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Background and context

The member’s week report has been shared with the divisional teams and discussed at the senior management team meeting. Also the divisional manager for the South and the director for service improvement attended the membership council to discuss specific issues raised.

Each point below is a response based on the discussions at the senior management team meeting. Comments in bold are those raised by the membership week report. A single response may relate to a number of different comments raised.

Whiteboards showing the correct waiting times and clarification over how a ‘wait time’ is assessed (i.e. is it the time you wait to see a doctor or the time you wait to see a nurse or undergo tests prior to seeing a doctor)

Receptions should provide more information, such as the likely waiting time and information about the tests that will be undertaken or the individuals you will see prior to seeing a doctor.

The length of waiting times were raised as an issue at Northwick Park as well as a

perceived lack of ‘proper’ communication

Response: The times that are presented to patients differ across the network. Some relate to the time it takes to make initial contact, for others it is the time it takes to see doctor and for some it relates to the total contact time. There is a need to standardise what information patients are given then put in systems to make sure this is communicated.

Action: Establish a working group with the divisions, service improvement and patient governor from the membership council to define what information patients would find most useful. From this develop a trust-wide SOP in order that staff can be trained and utilise a standard approach.

Lessons could perhaps be learned from looking at pathways in other hospitals.

Response: Other clinical subspecialties have been looked at in the past for learning. Unfortunately there are few equivalent pathways for ophthalmology to copy. A recent informal comparison of other eye hospitals by the World Association of Eye Hospitals (WAEH) showed that Moorfields has similar pathways and waiting times when looking at international comparisons.

Action: The director of service improvement is aiming to set up an international benchmarking process through the WAEH in order to compare against other centres and undertake improvement based on best practice.

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Although clinical outcomes at St George’s are seen as very good, there are continuing capacity challenges that have an impact on the patient experience.

Some challenges were raised at St George’s in relation to appointment bookings. Reported late cancellations by the trust mean that some patients are having extended periods without treatment, particularly injections, which will have a discomfort impact for many patients. It would be helpful for the board to know the number and percentage of patients subject to cancellations and the average time they have to wait for a re-appointment.

Response: The divisional management team has identified the capacity challenges and have set a plan to rectify these. This includes reviewing all clinic templates and comparing the demand and capacity of each. This process will take up to 6 months and clinic profiles will be adjusted throughout this timescale. In addition to this, the service improvement team is undertaking a review of flow and outpatient capacity which will feed into the demand and capacity work. This is also working over a six month period.

Action: Continue with existing plan.

LED displays that show the patient’s name up on screen (as in many GP surgeries)

Response: This has been looked at in the past and a view was taken not to pursue this for a number of reasons including placement where with many of our clinics patients would not be able to see them clearly, patient confidentiality would be an issue and patients would have the option of opting out and for some patient they would not be able to see them clearly due to sight issues.

Action: This will not be pursued further. It should be noted, however, that the trust does use Helping Hand stickers to ensure that clinic clerks are aware and to ensure names are called clearly.

The step up to the clinic in Cayton Street is very high and could be difficult for patients with mobility or other physical problems. A review of this would be welcome.

Response: This was a known issue when the clinic was being refurbished. There is a portable ramp on the right hand side inside the door if a patient requires this. Patients are preferentially taken through Moorfields Private and use the side entrance into the Cayton Street facility should they need this. The ramp is there is there were to be a problem taking the patient through private.

The ECLO Service at St George’s appears to be operating outside the trust service model, and more focused on the interests and priorities of the local society. Governors ask that the executive review how this should operate. Governors would be keen to understand more about the purpose and ambitions of the ECLO service within the MEH network and

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to be assured by the board that this fits with the patient participation strategy and member engagement plan, effectively supporting corporate objectives.

Response: ECLOs are managed by the Moorfields matrons at their local sights and the Matron oversees the priorities of their work and that it is required for the local patient groups. An ECLO coordinator is being appointed who will have an oversight of all ECLOS and will be able to ensure that there is a balance of standardisation of service with providing for local needs.

Action: Continue with ECLO coordinator appointment and set up ECLO network meetings.

Improvements on the site pathway, route guidance and signage at Northwick Park as well as provision of WiFi for waiting patients.

Response: The divisional management team has been working on WiFi at Northwick Park for a year. Routers have been installed and will be soon be operational. Signage is part of an ongoing conversation with our host organisation (this has been more difficult at London North West as there have been an number of changes in personnel who would normally action this).

Action: To continue with existing dialogue about signage with the local management teams.

There is still a lack of awareness amongst staff and patients about the potential for using buzzers. There is a standard operating procedure for this and we would ask that either the SOP be monitored for compliance with retraining available for staff or it be changed to say ‘buzzers provided on request’ with extra publicity/information provided for patients.

Response: A baseline audit has been completed so that we can measure awareness now and measure ongoing improvement. Large posters have been designed to be put in patient areas so that patients are aware of the buzzers and can ask where they need them.

Action: Continue with existing change plan.

Screens are still often inaccurate (58% as per clinic survey results at appendix 1) so as per previous recommendations this may require staff retraining/prompts, adequate back up and improved monitoring as well as quicker rectification of system problems and ownership by service managers.

Response: TV screens have been difficult to change due to the software they were based upon. This has now been amended and the IT team is undertaking a systematic review of each area and changing to a new software platform which will make it easier to change the TV screens to make them more responsive.

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Action: Continue with the existing roll out.

Waiting times and communication appear worse than last year (taking into account the difference in methodology, numbers of patients interviewed, etc.) This is an issue that might be addressed through improved customer care training and monitoring of compliance with new systems.

Response: This was discussed at the membership council that this had improved and that existing service improvement actions would continue.

Site-specific environmental action points (these points have been highlighted to the executive for immediate action)

Northwick Park

The lights in the two lifts had gone and that a repair had not happened as had been scheduled.

Response – this is now fixed.

Downstairs water dispenser had been out of action for some weeks. Staff were pursuing rectification of both and providing bottled water.

Response – this is now fixed

Other environmental issues were raised with staff at the time of the visit and actioned by them:

St. Ann’s

Drinks vending machine was out of order, and the snacks vending machine was very low on stock. Veronica said that she had experienced problems in the past securing the restocking of the snacks machine. As the café is located at some distance from the clinic, there was a dependence on these machines, particularly in view of waiting time in the clinic without access to refreshments.


One of the toilets was blocked and needed repair.

Response – this is now fixed

City Road

Out of order vending machines and water dispenser.


A MEETING OF THE BOARD OF DIRECTORS...Vishal Shah Moorfields medical staff 18/2199 Apologies for absence Apologies were received from: Steve Williams, vice chair and non-executive

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