GROUP TRUST BOARD MEETING IN PUBLIC1 A G E N D As3-eu-west-1.amazonaws.com/files.royalfree.nhs.uk/Trust... · 2018-10-22 · GROUP TRUST BOARD MEETING IN PUBLIC1 The next meeting

GROUP TRUST BOARD MEETING IN PUBLIC1

The next meeting of the group trust board will take place on Wednesday 24 October 2018 at 1.00pm in the boardroom, 2nd floor, Royal Free Hospital.

Dominic Dodd Chairman

A G E N D A ITEM LEAD PAPER

ADMINISTRATIVE ITEMS

2018/137 Apologies for absence – – group deputy chief executive, chief executive Royal Free Hospital, group director of workforce and OD

Chairman

2018/138 Declaration of interests Chairman 1.

2018/139 Minutes of meeting held on 26 September 2018 Chairman 2.

2018/140 Matters arising report Chairman 3.

2018/141 Record of items discussed at the Part II board meeting on 26 September 2018

Chairman 4.

QUALITY, PATIENT SAFETY AND EXPERIENCE

2018/142 Patients’ voices Lead governor Verbal

2018/143 QI/CPG presentation – childhood wheeze Group chief medical officer

Verbal

2018/144 Go see visits Director of public affairs and comms

5.

2018/145 Learning from deaths review – quarterly report Group chief medical officer

6.

2018/146 Director of infection prevention and control quarterly

report

Group chief nurse 7.

2018/147 North London Partners in Health and Care North Central

London sustainability and transformation programme (STP)

quarterly update

Group chief executive

8.

FINANCE AND PERFORMANCE

2018/148 Financial performance report Group chief finance and compliance officer

9.

2018/149 Operational performance report Group chief finance and compliance officer

10.

GOVERNANCE AND REGULATION: REPORTS FROM BOARD COMMITTEES – DISCUSSION BY EXCEPTION ONLY

2018/150 Chair’s and chief executive’s report Chairman/chief executive

11.

2018/151 Audit committee (21 September 2018) Committee chair 12.

2018/152 People and population health committee (27 September 2018)

Committee chair 13.

2018/153 Clinical standards and innovation committee ( 17

September 2018)

Committee chair 14.

1 In accordance with the Health & Social Care Act 2012, all Trust Board meetings must be held in public. All decisions which require the board’s collective approval can only be made at a Trust Board (or a Part II meeting held in closed session to discuss confidential matters).

ITEM LEAD PAPER

2018/154 Group services and investment committee (11 October

2018)

Committee chair 15.

OTHER BUSINESS

2018/155 Questions from the public Chairman

2018/156 Any other business Chairman

2018/157 Date of next meeting – 28 November 2018 Chairman

Paper 1

Register of interests – trust board 24 October 2018 1

REGISTER OF INTERESTS OF MEMBERS OF THE BOARD OF DIRECTORS

Executive summary

The trust constitution requires trust board members to declare interests which are relevant and material to the NHS board of which they are a member. The register of interests is presented at each board meeting.

There have been no changes since the last meeting.

Action required

Board members are asked to provide an update if they have any changes in interests since the last meeting.

Board members are asked to declare any interests which are relevant to matters on the board agenda.

The board is asked to ratify the register, subject to any further changes made.

Public Patient and Carer involvement

The register will be made available to the public.

Report From Dominic Dodd, chairman Author(s) Alison Macdonald, board secretary Date 18 October 2018

Report to Date of meeting Attachment number

Trust Board 24 October 2018 Paper 1

Version 25 Updated 13/9/18

Declaration of interests – board members are requested to highlight any changes to the register of interests at each board meeting held in public.

REGISTER OF THE INTERESTS OF MEMBERS OF THE TRUST BOARD

Board Member and position

Directorships, including non-executive directorships held in private companies or PLCs (with the exception of those of dormant companies)

Ownership or part-ownership of private companies, business or consultancies likely or possibly seeking to do business with the NHS

Majority or controlling share holdings in organisations likely or possibly seeking to do business with the NHS

A position of authority in a charity or voluntary organisation in the field of health and social care

Any connection with a voluntary or other organisation contracting for NHS services

Research funding/grants that may be received by an individual or their department

Interests in pooled funds that are under separate management (any relevant company included in this fund that has a potential relationship with the Trust must be declared)

Dominic Dodd, Chair

Director of UCLPartners

1

Member of NHSI’s Chairs’ Advisory Group. Unpaid position.

Nil Nil Trustee, The King’s Fund. Unpaid position

Nil Nil

Non-executive directors

Stephen Ainger Non-executive director 5/1/16

Chair Downshire Hill Residents’ Association.

Director of ATL trust fund.

Nil Nil Nil Nil Nil Nil

Mary Basterfield Non-executive director 8/3/18

Flatberg Ltd (property management)

Chief finance officer, UKTV

Trustee, National Cancer Research Institute and UCL Union.

1 The Company’s constitutional documents have been drafted in accordance with charity law and Charity Commission guidance, so that the Company can apply for charitable status in the

future as and when its Board of Directors considers this appropriate.











Wanda GoldwagNon-executive director

• Chair of the Office of Legal Complaints (OLC)

• Lay Member QC Appointments Panel

• Advisor SmedvigVenture Capital

Director, Goldwag Consultancy Ltd

Nil Nil Adopted sister is chief pharmacist of Barnet Enfield and Haringey Mental Health Trust

Nil I have a shareholding via Smedvig Capital in Antidote Technologies Ltd the clinical trial matching platform

Akta Raja Non-executive director

• Director RFL Property Services Company Ltd

• Enhabit Ltd • Geneff Ltd • Thornriver

Management Ltd • Riverside Homes

Ltd • Ansor Ltd (not

currently trading)












Professor Anthony Schapira Non-executive director

Upper Hampstead Walk Residents’ Association. AHV Schapira Ltd

Non-executive director, Ministry of Justice

Nil Nil Parkinson’s Disease Society Research Strategy Group

Nil Medical Research Council, Wellcome Trust, Parkinson’s Disease Society and other charitable sources of research funding

Nil

James Tugendhat

Non-executive director

Director of BHFS One Ltd and BHFS Two Ltd




Executive directors









Caroline Clarke Deputy group chief executive

Director RFL Property Services Company

Nil Nil Director

Royal Free Charity (1/4/16)

Trustee, Overcoming MS

Trustee, Healthcare Finance Managers Association

Nil Nil

Peter Ridley

Group chief

finance and

compliance

officer

Nil Nil Nil Nil Nil Nil Nil

Deborah Sanders Group chief nurse

Nil Nil Nil Board member, The Royal Free Hospital Nurses’ Home of Rest Trust

Trustee, Royal Hospital for Neuro-disability

Nil Nil Nil

Kate Slemeck, RFH chief executive

Nil Nil Nil Chair of NHS Elect Advisory Committee Chair of NHS Providers COO Network

Husband works for Canon who provide the trust’s managed print service.

Nil Nil





State when directorship commenced

Ownership or part-ownership of private companies, business or consultancies likely or possibly seeking to do business with the NHS State when interest acquired

Majority or controlling share holdings in organisations likely or possibly seeking to do business with the NHS State when interest acquired


State when position accepted




State when funding/grant commenced


State when interest acquired

Chris Streather

Group chief

medical officer

Nil Nil Nil Trustee of

Healthcare

Management

Trust (HMT) a

not for profit

organisation

which provides

care home

facilities and

healthcare in

Lincolnshire and

Swansea.

Unpaid advice to

ZPB on e-

rostering which

will contribute to

a report

commissioned

from them by

Allocate. It

involved two

meetings and

reviewing a

document and

Health Education

England (HEE)

also were

involved. The

trust has a

contract with

Allocate, but not

ZPB, for whom

this work was

done.

Nil Nil





State when directorship commenced

Ownership or part-ownership of private companies, business or consultancies likely or possibly seeking to do business with the NHS State when interest acquired

Majority or controlling share holdings in organisations likely or possibly seeking to do business with the NHS State when interest acquired






State when funding/grant commenced


State when interest acquired

David Sloman Group chief executive

Director, UCLPartners2

Nil Nil London Procurement Partnership board member.

Relative who works for Haringey CCG

Provider SROfor NCL STP and chair of digital programme board

Member of London health and social care strategic partnership board

Nil Nil

2 The Company’s constitutional documents have been drafted in accordance with charity law and Charity Commission guidance, so that the Company can apply for charitable status in the

future as and when its Board of Directors considers this appropriate.



Non-voting directors









David Grantham

Group director of

Workforce and

OD

Nil Nil Nil Board Member

and Treasurer

London

Healthcare

People

Management

Academy –

March 2013

Chair of NHS

Employers

Medical

Workforce

Forum – August

2010

Board Member Health Education North and East London (HENCEL) – July 2014 Board Member and Treasurer London Streamlining Programme(s) – March 2014

Nil Nil

Emma Kearney

Group director of

public affairs and

communications

Director, EK

Consulting Ltd


Steve Shaw

Chief executive

BH

Nil

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MINUTES OF THE TRUST BOARD

HELD ON 26 SEPTEMBER 2018

Present

Mr D Dodd Mr S Ainger Ms M Basterfield Ms C Clarke Ms W Goldwag Ms A Raja Mr P Ridley Ms D Sanders Prof A Schapira Ms K Slemeck Sir David Sloman Mr J Tugendhat

Chairman Non-executive director Non-executive director Group deputy chief executive Non-executive director Non-executive director Group chief finance and compliance officer Group chief nurse Non-executive director Chief executive – Royal Free Hospital Group chief executive Non-executive director

Invited to attendMr D Grantham Dr J Hawdon Ms E Kearney Mrs J Dewinter Miss A Macdonald

Group director of workforce and organisational development Responsible officer (attending on behalf of group chief medical officer) Group director of public affairs and communications Lead governor Board secretary (minutes)

Others in attendance

Mr S Ali Ms K Kalirai Miss E Kirk Ms N Skivington

Deputy CPG Chair Women’s and Children’s (for item 2018/124) Associate director – transformation (for item 2018/124) Consultant gynaecologist and pathway lead (for item 2018/124) -Enfield Healthwatch

2018/118 APOLOGIES FOR ABSENCE AND WELCOME Action

Apologies were received from:

Dr C Streather Group chief medical officer Dr S Shaw Chief executive, Barnet Hospital

The chairman welcomed those present to the meeting.

2018/119 DECLARATION OF INTERESTS

The responsible officer declared an interest as a member of two West London clinical commissioning group (CCG) governing bodies.

There were no further changes advised and the report on the register of interests was noted.

2018/120 MINUTES OF MEETING HELD ON 25 JULY 2018

The minutes were accepted as an accurate record of the meeting.

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2018/121 MATTERS ARISING REPORT

The matters arising report was noted.

2018/122 RECORD OF ITEMS DISCUSSED AT PART II BOARD MEETING ON 25 JULY2018

The report was noted.

2018/123 EARLY PREGNANCY UNIT (EPU) CLINICAL PRACTICE GROUP (CPG) PRESENTATION

Mr S Ali, deputy CPG chair women’s and children’s, Ms K Kalirai, associate director – transformation and Miss E Kirk, consultant gynaecologist and pathway lead, were in attendance for this item.

Mr Ali introduced Miss Kirk, who had joined the trust relatively recently and had led the work to improve the service for women experiencing problems in early pregnancy. Miss Kirk explained that the majority of acute gynaecology emergencies occurred during early pregnancy and more than 20% of pregnancies ended in miscarriage. 2% of the women attending the EPU would have an ectopic pregnancy – a potentially life threatening condition. As a consequence she and the team had to break bad news more regularly than in any other specialty. The previous pathway had been complex and meant that women had often spent a long time in the emergency department prior to referral to the gynaecology specialty team. The main changes made to the pathway had been to stream women from the emergency department (ED) direct to EPU, using a newly designed referral form which standardised the clinical information available to the team, and to introduce a self-assessment form to be completed by the woman. The service was heavily reliant on ultrasound scanning – which would ideally be done by a nurse sonographer which would mean that the scan could be done and the results discussed there and then with the woman. The service’s aspiration was for this to be done by a small number of sonographers who were expert and interested in this area of work. One of the challenges was therefore to either recruit nurse sonographers or to develop sonographers further to perform this enhanced role. Mr Ali echoed that having nurse sonographers would be the gold standard. Having put the new pathway into place, which was working six days a week, outcomes were generally much improved.

Ms Kalirai noted that this work had been done using quality improvement methodology and there had been a lot of positive feedback from the ED team.

Ms Goldwag, non-executive director, was pleased to hear about this very positive piece of work which was helping women through a traumatic experience. She suggested that some women might need additional time to adjust to the news that they were given, and that therefore reduced total time spent in the department was not necessarily the right performance indicator in all cases.

The chief executive of the Royal Free Hospital commented that the new pathway had made a huge difference to patients, redirecting them to the right place to see the right clinical staff really quickly.

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Mr Ainger, non-executive director, asked about the cost implications. Ms Kalirai responded that this should be cost neutral or cost saving as there were potential savings from fewer pregnancy tests, repeat scans and follow up attendances.

The group chief nurse asked about the emotional toll on the team in regularly having to break bad news and support women through a very difficult experience. Miss Kirk advised that there was a lot of peer support but nevertheless the team would benefit from having some form of psychological support. The group chief nurse undertook to follow this up.

The chairman thanked the team for attending and sharing this excellent piece of improvement work.

Group chief nurse

2018/124 PATIENTS’VOICES

The chief executive, Royal Free Hospital, read out a complaint from a patient about the application of criteria to requests for hospital transport which meant that they were not eligible to receive transport. As a result, they had to come to the hospital by taxi. However on arrival the parking attendant did not permit the taxi to park by the main entrance and the patient was faced with a long walk with severely limited mobility. The taxi driver was very kind and assisted the patient otherwise they might not have been able to manage this and the receptionist, also very kindly then wheeled the patient to their outpatient appointment. The patient made the point that it was not just the transport to the hospital that was needed but assistance to and from their actual appointment and suggested that this would be a role for volunteers. The chief executive noted that there was a concierge service at the front of the hospital but this complaint highlighted that this needed to have a higher profile and the patient had been thanked for their comments and apologies given for their poor experience.

The compliment was from the family of a patient with TB and lung cancer who had suffered a heart attack at home. He was brought to the Royal Free by ambulance and the ambulance team had performed resuscitation on the journey. The Royal Free heart attack team were awaiting the patient and had attempted to insert a stent. However this had not been successful and when it was clear that he only had a short time to live, he was admitted to the intensive therapy unit where the staff supported the patient so that he had utmost care and dignity in his final hours, and the family had a chance to say their goodbyes. The family were deeply appreciative of the care the patient received and the support provided to the family.

The lead governor would present the patients’ stories item next time. Lead governor

2018/125 GO SEE VISITS

Then group director of workforce and OD reported back on his visit to the pharmacy – he had now visited the service twice on all three sites. The staff had been keen to demonstrate the business model and value but wanted to know more about the long term strategy for the wholly owned subsidiary and were not quite clear about how their department fitted into the group/hospital/divisional structures. However overall, the staff were very positive.

The group chief executive then noted that the new Chase Farm Hospital had now been open for four weeks. The opening had gone extremely well and

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although there had been some minor issues these had been quickly resolved. Services for patients had been maintained throughout. The urgent care centre had closed one night in its old location and reopened the next morning in its new home with no problems. This was all a great testament to the huge commitment and hard work of the Chase Farm team. The next major milestone was the implementation of the new electronic patient record (EPR). He and colleagues had visited the hospital a number of times in the last few weeks to support the leadership team and to personally thank staff for all they were doing.

The group deputy chief executive commented that the concierge service was working very well. The programme board would continue to meet and maintain oversight of the commissioning and decommissioning programme.

Mr Tugendhat, non-executive director, noted that there would be a different culture in the new hospital and asked whether this would have other benefits for example on bullying and harassment. The group director of workforce responded that this could be measured by the quarterly temperature checks and the staff survey which was currently underway.

Mr Ainger, non-executive director, asked about the implementation of the EPR. The group chief executive responded that no decision had yet been made on go live and a gateway process was being followed to inform that decision. It was inevitable that there would be issues to resolve when go live occurred; the challenge was to plan and prepare to limit both the scale and duration. The mitigations would include phasing the implementation, scaling down activity for the first four weeks, training and floorwalkers to support staff. There would be a cost to all this and a report would be brought back to the October board on this.

The board noted the report.

Group chief medical officer

2018/126 NURSING AND MIDWIFERY ESTABLISHMENT REVIEW

The group chief nurse explained that this was the annual establishment review. The Allocate electronic staff rostering system enabled data to be collected twice a day regarding patient acuity and nurse establishment which could then be used to check that the correct establishments were in place. The establishment review was a bottom up process involving ward managers, matrons and hospital directors of nurses, using professional judgment to assess the Allocate data. The results had been compared with the current budgeted establishment and then recommendations had been made. Most were in support of the current establishments. There were two wards where changes were recommended and these had been accepted by the hospital local executive committees. This work should serve to assure the board that the current establishments were correct, but day to day it was possible that there would be shortages due to staff absence and these were dealt with by the ward managers and matrons.

The group chief nurse reported that staff were feeling that staffing was more stretched. She noted that the vacancy rate had increased by 2.4% for qualified staff, there was increased demand for temporary staff (20,000 hours in August) and the fill rate had reduced. There was a meeting each morning led by the hospital directors of nursing to review patient acuity versus the nurses available and nurses were reallocated between wards if necessary. There were nearly 300 nurses in the recruitment pipeline and 50 more nurses due to start with the trust having qualified through local conversion or back to nursing schemes. In terms of retention, the answer was in providing greater opportunity for flexible

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working and this was being pursued. Mr Tugendhat, non-executive director, noted that there were capacity and capability challenges to flexibility. The group chief nurse was confident that this could be done and the challenge was persuading people of the benefits.

The board agreed that the report provided sufficient assurance that the establishments for the inpatient wards were meeting the needs of patients and providing safe care.

2018/127 RESPONSIBLE OFFICER’S ANNUAL REPORT ON REVALIDATION

The responsible officer presented the report which showed an overall appraisal rate of 77% with 173 doctors not having completed an appraisal.

Ms Goldwag, non-executive director, was concerned about the levels of compliance and that the trust did not perform well against its peers. She found it difficult to understand that 85 doctors could have a valid reason for not having completed their appraisal. The responsible officer acknowledged the points she had made, and said that this was the responsibility of the medical leadership who needed to hold doctors to account for this. Valid reasons for not having been appraised included maternity leave, long term sickness absence and working abroad.

The group chief executive suggested that the board accept the responsible officer’s advice regarding the validity of reasons for not having had an appraisal. The overall position had improved significantly under her leadership but it might be necessary to consider incentives and penalties to improve compliance, for example linking appraisals to eligibility for clinical excellence awards.

It was agreed that revalidation and appraisals came within the remit of the clinical services and innovation committee and it was agreed that the committee would review proposals for making the next step change in compliance and the consequences of non-compliance.

The board:

• Accepted the report, which would be shared with the higher level responsible officer.

• Approved the ‘statement of Compliance’ confirming that the organisation, as a designated body, is in compliance with the regulations


2018/128 FINANCIAL PERFORMANCE REPORT

The group chief finance and compliance officer presented this report, noting that at the end of month 5 the trust was reporting an actual year to date (YTD) deficit of £33.6m which was £2.6m worse than plan. The key drivers for this were the clinical income upside of £2.8m driven predominantly by non-elective activity, phasing of the financial improvement programme (FIP) target in equal 12ths, overspends relating to global digital exemplar (GDE) funds and a loss in private patients unit (PPU) contribution.

He then reported on the 2018/19 financial plan which included delivery of £45.3m FIP savings. Current and imminent plans exceeded this, however

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£22.9m of this remained non-recurrent. The cash balance was strong, at the end of August it was better than plan by £90m due to rephasing of cash receipts with North Central London (NCL) and the earlier than expected payment of 2017/18 sustainability and transformation fund (STF) cash. However it would probably be necessary to draw loans down from February or March 2019.

The board noted the current financial position of the trust.

2018/129 OPERATIONAL PERFORMANCE REPORT

The group chief finance and compliance officer presented this report. He noted that at the end of August the submitted referral to treatment time (RTT) data was 78% compared with the 92% standard, with 46 patients waiting over 52 weeks. This represented a deterioration on the July position.

The A&E performance had shown an improvement in August, but had dipped in September and was 87.1% month to date against a 95% standard.

The board noted the current operational performance of the trust.

2018/130 CHAIR’S AND CHIEF EXECUTIVE’S REPORT

The chairman congratulated Ms Basterfield on her appointment as vice chair of the board and senior independent director. He also highlighted the new governor assignments detailed in the report.

The chief executive report then read out the following statement, which was endorsed by the board:

Following a meeting with local residents on the 24 September 2018, the board supports the agreement to develop an action plan to reduce littering and reduce smoking around the front of the hospital. The action plan is to be tabled at the environment liaison group meeting on the 18 October and will be subsequently monitored through this group.

The board noted the report.

2018/131 QUALITY IMPROVEMENT AND LEADERSHIP COMMITTEE

The board noted the report from the committee.

2018/132 CLINICAL STANDARDS AND INNOVATION COMMITTEE

Prof Schapira, chair of the committee, noted that the recent meeting had received a presentation, and discussed reports on serious incidents and never events. A written report would be provided to the next board meeting.


2018/133 GROUP SERVICES AND INVESTMENT COMMITTEE


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2018/134 QUESTIONS FROM THE PUBLIC

Noelle Skivington, Enfield Healthwatch, asked about the future of the Highlands Wing at Chase Farm Hospital. The group deputy chief executive responded that it would be refurbished as much as possible and retained for future use.

Ms Skivington then asked about the future of Capetown ward at Chase Farm Hospital. The group chief finance and compliance officer responded that this was a rehabilitation ward and the trust had been negotiating with the clinical commissioning group and Barnet Enfield and Haringey Mental Health Trust for the management of the ward to be transferred to the mental health trust. This matter was likely to be concluded by the end of the current financial year.

A member of the public asked why the trust’s financial strategy had not been published. He expressed the strong view that it was in the public interest for the financial strategy to be in the public domain.

The chairman responded that there were commercial and other strategic choices to be made which made it confidential for the time being. The group chief finance and compliance officer added that the strategy had not yet been completed and presented to the board.

The member of the public then suggested that the trust’s overall financial position was being propped up by spending less on staff.

The group chief finance and compliance officer responded that the trust was successfully managing the temporary staff position and the group chief nurse added that the nursing data indicated that the planned nursing levels were being achieved almost all of the time.

The member of the public then asked about the financial position of the property services company and the group chief finance officer responded that because the property services company had been established in year, budgets had been adjusted in year and there was a broadly neutral effect.

The member of the public then asked what was going to be done to reduce smoking outside the hospital.

The chief executive, Royal Free Hospital, referred to the statement the group chief executive had read out earlier and added that a detailed action plan was being developed for this in partnership with the environmental liaison group. However there were no easy solutions to this problem.

The chairman suggested that, if the member of the public had any further questions to ask, he put them in writing and the chairman would arrange for them to be responded to outside the meeting.

2018/135 ANY OTHER BUSINESS

There was no other business.

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2018/136 DATE OF NEXT MEETING

The next trust board meeting would be on 24 October 2018 at 1300 in the boardroom, 2nd floor, Royal Free Hospital.

Agreed as a correct record

Signature …………………………………..date 24 October 2018……………………………. Dominic Dodd, chairman

Paper 3

Matters arising – trust board 24 October 2018

Trust Board Matters arising report as at 24 October 2018

Actions completed since last meeting of the Trust Board

MinuteNo

Action Lead Complete Board date/agenda item

Outstanding

FROM TRUST BOARD HELD ON 26 SEPTEMBER 20182018/123 Early pregnancy unit (EPU) clinical practice

group (CPG) presentation The group chief nurse asked about the emotional toll on the team in regularly having to break bad news and support women through a very difficult experience. Miss Kirk advised that there was a lot of peer support but nevertheless the team would benefit from having some form of psychological support. The group chief nurse undertook to follow this up.

Group chief nurse

The EPU lead consultant has been put in touch with the consultant occupational psychologist to discuss what support can be provided to the team

2018/127 Responsible officer’s annual report on revalidation It was agreed that revalidation and appraisals came within the remit of the clinical services and innovation committee and it was agreed that the committee would review proposals for making the next step change in compliance and the consequences of non-compliance.


The committee chair and group CMO will discuss this when they plan the agenda. A verbal update will be provided to the board.

2018/125 Go see visitsReport on EPR implementation including cost – to be brought to trust board.


On Part II (confidential) board agenda

Paper 3

Matters arising – trust board 24 October 2018

FROM TRUST BOARD HELD ON 25 JULY 20182018/102 Director of infection prevention and control

report The chairman asked if the report could include clearer information on hand hygiene next time.

Group chief nurse

Included in report 2018/146

2018/106 Workforce race equality standardThere was discussion about the board having further unconscious bias training and it was noted that the previous training had identified that more work might need to be done on disability.

Group director of workforce and OD

To further address promoting a work environment where all staff are able to achieve their potential especially in the area of disability, a series of one hour disability confidence sessions is being organised where managers and staff members including those from staff disability networks around the trust can tell their stories share their experiences of being a staff with disability, both positive and negative, and how can all work together to make improvements. In addition, we are currently awaiting the final NHS England guidance on the implementation of Workforce Disability Equality Standards to inform SERP action plan.

2018/106 Gender pay gap reviewThe board noted the report and requested quarterly updates.

Group director of workforce and OD

Data not available for October 2018; an update is provided in the chair and CEO report and a a detailed report will be incorporated in equality update planned for December 2018.

Paper 4

Confidential trust board meeting update – trust board October 2018

ITEMS DISCUSSED AT THE CONFIDENTIAL BOARD MEETING HELD ON 26 SEPTEMBER2018

Executive summary

Decisions taken at a confidential trust board are reported where appropriate at the next trust board held in public. Those issues of note and decisions taken at the trust board’s confidential meeting held on 26 September 2018 are outlined below. The board discussed the trust’s financial position and performance report, although a detailed discussion also took place within the public part of the meeting. The following matters were also discussed at the meeting:

• Referral to treatment time (RTT) update – the trust is currently dealing with data quality issues which are impacting on management of waiting lists and ability to meet the waiting time standards. This is reported to the board every month in the public operational performance report.

• Fire compliance update – an update is provided in the chairman and chief executive’s report this month.

• Care Quality Commission (CQC) unannounced inspection – the board approved the trust’s provider information request (PIR) submission. An update on the CQC inspection is provided in the chair and chief executive’s report.

• Queen Mary’s House – this remains confidential for commercial reasons. • Update on group membership - an update is provided in the chairman and chief

executive’s report this month. • Pharmacy wholly owned subsidiary - the board noted the creation of the wholly owned

subsidiary. • Revised board committee structure and terms of reference – these were approved. The

committees report to the public trust board meeting after each meeting. • RFL group and wholly owned subsidiaries – governance and oversight – the board agreed

not to establish a holding company and that the group services and investment committee could adequately perform investor oversight of the subsidiaries.

Action required

For the board to note.

Report From

D Dodd, chairman

Author(s)Date

A Macdonald, board secretary 15 October 2018



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1

GO SEE VISITS

Executive summary

The board agreed to a new approach to go see visits at its December 2017 meeting, building on the previous programme of go see visits designed to increase visibility and engagement between trust leaders and governors with staff. Go see visits are open to all group directors, including site chief executives, non-executive directors and governors. They take place monthly and ‘visit’ all areas of the trust, including corporate support services. Prior to the visits, a fact sheet is provided giving some key information about the areas. This includes information on staffing and where appropriate, patient or client feedback. Visits are not designed to be inspections, but opportunities to listen to staff and, where appropriate, meet patients. Non-executives are paired with governors and executive directors visit a separate set of areas.

Three key questions are asked: what is working, what is not working and what would you like to change?

This information is fed back verbally at the following trust board meeting.

Since the last meeting the following visits have taken place. In additional group executive directors are visiting the hospital sites to talk to staff about the forthcoming Care Quality Commission (CQC) inspection. Dates for the next phases of go see visits are in diaries.

Area Director

CFH – general walkabout Deborah Sanders RFH – general walkabout Deborah Sanders BH – general walkabout Deborah Sanders CFH – general walkabout Sir David Sloman RFH – Imaging department Sir David Sloman (shadowing allied health

professional) RFH –ward 10 East Deborah Sanders(shadowing allied health

professional)

Action requiredThe board is asked to note the report.

Report From Emma Kearney, group director of public affairs and communications

Author(s) Alison Macdonald, board secretary Date 15 October 2018



Paper 6

Page 1 of 6

Learning from deaths 2017/18: Q4

Executive summary

From April 2017, we have been developing our review process to meet the national learning from deaths (LfD) guidance. We have identified those patient deaths that meet the key criteria and we launched our learning from deaths (LfD) policy in September 2017.

On average there are 171 deaths per month across the Royal Free London (RFL); 47% of these at the Royal Free RFH) and 53% at Barnet Hospital (BH). For 2017/18 we plan to review 9.4% of patient deaths. The planned reviews include those patient deaths that meet the key criteria and other patient deaths that have been selected at random (3%).

Data are provided for all information gathered and validated to date, which includes updates for Q1, Q2 and Q3 and data for Q4.

Q4 summary:

566 patient deaths 1 stillbirth 27 patient deaths that meet the review criteria 24 patient deaths selected for random review 52 patient deaths listed for review 24 patient deaths still under review 28 patient deaths reviewed 9 patient deaths considered likely to be avoidable > 50% (Likert 1-3) 5 patients who died who had learning disabilities (LD) 1 LD patient deaths considered likely to be avoidable > 50% (Likert 1-3) 10 patient deaths reported as serious incidents

In Q4, there were 9 patient deaths considered likely to be avoidable identified. These were identified as incidents prior to the Learning from deaths (LfD) process.

Action required/recommendation (to note, for information, to agree, to consider)• To note report • To agree the National submission on Learning from deaths (LfD).

Trust strategic priorities and business planning objectives supported by this paper Delete those that do not apply

Board assurance risk number(s) if you do not know risk number, please leave blank , or mark relevant cell with an X

1. Excellent outcomes – to be in the top 10% of our peers on outcomes

Yes

2. Excellent user experience – to be in the top 10% Yes

Report to Date of meeting Attachment numberTrust board 24 October 2018 Paper 6

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of relevant peers on patient, GP and staff experience

3. Excellent financial performance – to be in the top 10% of relevant peers on financial performance

Yes

4. Excellent compliance with our external duties – to meet our external obligations effectively and efficiently

Yes

5. A strong organisation for the future – to strengthen the organisation for the future

yes

CQC Regulations supported by this paper Please delete those that do not applyRegulation 4 Requirements where the service provider is an individual or partnership Regulation 5 ⃰ Fit and proper persons: directors Regulation 6 Requirement where the service provider is a body other than a partnership Regulation 7 Requirements relating to registered managers Regulation 8 ⃰ General Regulation 9 Person-centred care Yes Regulation 10 Dignity and respect Yes Regulation 11 Need for consent Yes Regulation 12 Safe care and treatment Yes Regulation 13 Safeguarding service users from abuse and improper treatment Regulation 14 Meeting nutritional and hydration needs Regulation 15 Premises and equipment Yes Regulation 16 Receiving and acting on complaints Yes Regulation 17 Good governance Yes Regulation 18 Staffing Regulation 19 Fit and proper persons employed Regulation 20⃰ Duty of candour Yes Regulation 20A⃰ Requirement as to display of performance assessments Care Quality Commission (Registration) Regulations 2009 (Part 4)Regulation 12 Statement of purpose Regulation 13 Financial position Regulation 14 Notice of absence Regulation 15 Notice of changes Regulation 16 Notification of death of a service user Regulation 17 Notification of death or unauthorised absence of a service user who is detained or liable

to be detained under the Mental Health Act 1983 Regulation 18 Notification of other incidents Regulation 19 Fees Regulation 20⃰ Requirements relating to termination of pregnancies Regulation 22A⃰ Form of notifications to the Commission

Risks attached to this project/initiative and how these will be managed (assurance)• Failure to review all relevant deaths – triangulation of data sets from SIRP, stillbirths,

Dr Foster and complaints against all trust deaths • Increased numbers of avoidable deaths identified – provides opportunities for more

learning • Delay of at least 4 months to identify deaths 30 days post discharge from Dr Foster

could lead to family distress if incidents are identified – update bereavement literature to inform families

• There are no dedicated resources to manage or undertake the Learning from deaths (LfD) process, so time delays will probably occur – this process will be fitted into current job roles.

Equality analysis Please choose one • No identified negative impact on equality and diversity • Positive evidence that proposal has considered equality and diversity • Any adverse impact on equality and diversity has been remedied or escalated

Report from Deborah Sanders, Group Chief Nurse Chris Streather, Group Chief Medical Officer

Author(s) Hester Wain, Deputy Director of Patient Safety and Risk Date 15/08/18

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Contents 1. Introduction .................................................................................................................... 3

2. Learning from deaths (LfD) data summary ..................................................................... 3

3. Learning from deaths (LfD) Quarter 4 of 2017/18 data review ........................................ 4

1. Introduction Hundreds of patients come through our doors on a daily basis. Most patients receive

treatment, get better and are able to return home, or go to other care settings. Sadly and

inevitably, some patients will die here (approximately 1% of all admissions). While most

deaths are unavoidable and would be considered to be “expected”, there will be cases where

sub-optimal care in hospital may have contributed to the patient’s death. We are keen to take

every opportunity to learn lessons to improve the quality of care for future patients and their

families.

This report provides an update on the patient deaths reviewed to date and the learning we

have gained from this process.

2. Learning from deaths (LfD) data summary

Please note that because the Learning from deaths (LfD) reviews are a continuing process, the data are dynamic, and there have been updates to the data since the last report.

Q1 Q2 Q3 Q4 201718 Total

Number of patient deaths 479 459 552 566 2056

Number of stillbirths 9 4 0 1 14

Number of patient deaths that meet the review criteria

30 36 30 27 123

Number of patient deaths selected for random review

5 11 22 24 62

Number of patient deaths listed for review 35 48 57 52 192

Number of patient deaths still under review 5 13 15 24 57

Number of patient deaths reviewed 30 35 42 28 135

Number of patient deaths considered likely to be avoidable > 50% (Likert 1-3)

2 2 3 9 16

Number of patients who died who had learning disabilities

2 3 4 5 14

Number of LD patient deaths considered likely to be avoidable > 50% (Likert 1-3)

0 0 0 1 1

Number of patient deaths reported as serious incidents

4 2 4 10 20

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3. Learning from deaths (LfD) Quarter 4 of 2017/18 data review

On average there are 171 deaths per month across RFL; 47% RFH: 53%BH. For 2017/18 we plan to review 9.4% of patient deaths. The planned reviews include those patient deaths that meet the key criteria and other patient deaths that have been selected at random (3%), with a 50:50 location split RFH/BH and other.

In Q4, 9 patient deaths were identified that were considered likely to be avoidable. These were identified as incidents prior to the learning from deaths (LfD) process, and 8 were reported as serious incidents. The 9th death (IN70714) was reviewed at the serious incident review panel (SIRP) which determined that the level of harm caused was moderate and scored a Likert of 3 for avoidability and the panel agreed that a divisional root cause analysis would be undertaken with the findings reported back to the mortality review group (MRG) for learning, which occurred in May 2018.

Datix/SI ID Patient Group/Category Likert AvoidabilityIN68057 2018/1325 Stillbirth 3. Probably avoidable, more than 50/50

IN67382 2018/4182 Serious incident 2. Strong evidence of avoidability


IN69690 2018/3607 Serious incident 3. Probably avoidable, more than 50/50



IN70714 Incident 3. Probably avoidable, more than 50/50

IN71404 2018/6737 Patient with learning disabilities 2. Strong evidence of avoidability


It should be noted that we do not yet have enough data to determine a baseline of how many deaths on average are likely to be avoidable. Thus any comparison of the quarterly data at this time may be misleading. However, due to the apparent increase of deaths likely to be avoidable in Q4, to nine, these will all be re-reviewed at the Mortality review group (MRG) to determine whether the Likert scoring was appropriate and whether it was related to the death, or to the incident being investigated.

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Executive summaryThis is the trust report from the director of infection prevention and control for the Royal Free London NHS Foundation Trust.

In line with the revised Health and Social Care Act (2008) trusts are required to have appropriate management and clinical governance systems in place to deliver effective infection control. Included at appendix A are the ten compliance criteria from the Health and Social Care Act to assist the board in assessing the information provided.

In line with the Health and Social Care Act (2008, rev 2015) Code of Practice on the prevention and control of infections and related guidance, trusts are required to have appropriate management and clinical governance systems in place to deliver effective infection control. Within criterion 1 of the Code of Practice is a requirement that there is a programme of activity and planned development for IPC within the organisation to keep to a minimum the risk for infection and the general means by which it plans to control such risks.

Equality impact assessment• Positive impact which supports equity of service


Trust board 24 October 2018 Paper 7

Director of infection prevention and control (DIPC) quarterly report

Action required The board is asked to confirm that the report provides sufficient information to provide assurance of sustained compliance with the Hygiene Code.

Trust strategic priorities and business planning objectives supported by this paper

Board assurance risk number(s)

1 Improving clinical effectiveness R1 2 Enhancing the patient experience

CQC outcomes supported by this paperOutcome 8 Cleanliness and infection control QCQ Compliance (regulation 12 (2) h)

Risks attached to this project / initiative and how these will be managed (assurance)The revised Hygiene Code Risk matrix will be monitored at the Infection Control Committee. The risks associated with the Hygiene Code have been included in the Board Assurance Framework

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Report From D Sanders, group chief nurse and director of infection prevention and control. Author(s) D Mack, microbiology consultant, IPC doctor

Anand Sivaramakrishnan, consultant microbiologist, IPC doctor Dianne Irish, consultant virologist Y Carter, head of IPC nursing IPC team

Date 8.10.18

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Introduction

The Health and Social Care Act (2008) Code of Practice on the prevention and control of infections and related guidance outlines the actions NHS Trusts in England must take to ensure a clean environment for the care of patients, in which the risk of infection is kept as low as possible. The 10 compliance criteria are attached at appendix A. The criteria have been revised for the 2015 edition, including a larger focus on antimicrobial stewardship

Monitoring Progress against the Health and Social Care Act, including internal audit. Hygiene code compliance will continue to be monitored through the Infection Prevention and Control Committee and through hospital unit divisional lead monthly meetings. The trust’s internal auditors annually assess trust arrangements and ensure robust evidence of compliance in all criteria. The most recent comprehensive CQC inspection identified no specific ‘infection prevention and control’ improvement recommendation, but the IPC team will support clinical divisions and services to make improvements in the infection prevention and control elements raised in the divisional and service reports.

1. Infection report

1.1 Meticillin-sensitive and Meticillin-resistant Staphylococcus aureus bacteraemia. (MRSA and MSSA) Reduction of hospital acquired Staphylococcus aureus bacteraemias including those due to MRSA continue to be an important infection control priority for the trust. The MRSA target for 2018/19 is zero for all organisations.

From April 2018, post infection reviews are only required for CCGs with a rate of 1.6 or more community onset MRSA blood stream infections per 100,000 population and trusts with a hospital onset MRSA blood stream infection rate of 1.7 per 100,000 bed-days or more. Any CCG or trust with a rolling rate that breaches this threshold within year will also have to formally undertake and report post infection reviews. Royal Free London NHS FT is not on the list of trusts required to carry out reviews.

Since April 1st, there have been six cases of MRSA bacteraemia. The first three cases have been presented at the July 2018 Board, two of which were attributed to the trust with learning across Maternity pathways relating to patient screening for infections prior to surgery. The latest three from July 2018 are community acquired, with no obvious learning for the trust.

The learning from any lapses is shared at the divisional leads IPC meetings.

1.2 MRSA colonization trust acquisitions. The trust MRSA colonization acquisition rate remains low across all sites, (an acquisition is defined as any patient not previously known to be MRSA positive but has been swabbed whilst in the RFLNHSFT after the first 48 hours of admission and found to be positive). Although the national requirement has reduced, the Trust screening process remains inclusive of in-patient admissions as it is felt to be integral in reducing acquisition rates and contributes to safer patient care.

1.3 Clostridium difficile (C.diff) The threshold for the trust for 2018/19 set by Public Health England (PHE) is 65 cases of acquired C.diff, a reduction of one from last year. Following revisions to its risk framework NHS Improvement, confirmed that for the purposes of its governance risk ratings of foundation trusts’ with effect from quarter one 2015/16 national performance against the C. difficile indicator will include only those infections that result from a lapse in care. Infections which result from a lapse in care are determined by the local clinical team applying a checklist based assessment developed by PHE with outcomes reviewed and agreed by local commissioners.

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Since April 1st there have been 35 cases of attributable C.diff, two above threshold. There have been no lapses in care so far identified. A larger than expected number of cases has been identified at Barnet, with one lapse of care identified with a transmission between 2 cases of the same ‘ribotype’ (see section 5). The deep cleanng programme has been a challenge at Barnet in the last couple of months but the programme is now moving forward and identified cases have reduced.

April 18

May 18

June 18

July 18

Aug 18

Sept 18

Royal Free hospital 4 2 4 3 2 1

Barnet hospital 0 2 2 4 5 6

Chase Farm hospital 0 0 0 0 0 0

Cumulative cases 4 8 14 21 28 35

Cumulative objective 6 12 17 23 28 33

2017/2018 Cases 4 9 18 27 32 40

2016/17 cases 6 8 14 23 29 38

2015/16 cases 7 16 20 29 32 39

The deep clean and vapourised hydrogen peroxide (VHP) programme is mostly embedded and along with antibiotic stewardship improvements are key actions for the trust for the next year.

The actions which will be also be focused on for the next year include: • Continue the deep clean programme across all sites, particular focus on Barnet site. • Review of all cleaning audit reports at monthly divisional lead meetings • Complete actions and recommendations from external expert review of C.diff reduction strategies

as part of the annual IPC action programme.

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• The group executive committee approved a business case to provide additional phamrmacy, microbiologist and nursing support to achieve the antimicrobial CQUIN

• IT integration: stool chart/algorithm, antibiotic stewardship,patient tracking and isolation • Clinical audit programme – Perfect Ward roll-out • Clinical team engagement in RCA process • ‘Board to Ward’ support • Consideration of the the documentation of infection prevention and control responsibilities and

delivery in annual appraisals, as recommended by the external expert report.

There have been further reductions in piperacillin-tazobactam, carbapenam, and total antibiotic usage in 2017/18 and this remains a focus of antimicrobial stewardship activities.

1.4 E.coli bacteraemias. From April 2017 a government initiative extended the surveillance of bacteraemias caused by Gram-negative organisms to include Klebsiella species and P. aeruginosa in addition to the existing E. coli collection with the intention of reducing such infections by 50% by 2021. The reporting of these cases will be driven through the hospital unit divisional leads group and the Infection Prevention and Control Committee. A report will be provided once cases are reviewed according to PHE guidance. The reduction in these infections is one of the stated aims in the Quality Account for 2018/19.

It is recognised that the trust rates are above the England average and further work is essential to reduce Gram negative bacteraemias. .

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1.5 Carbapenemase producing enterobacteriaceae (CPE) and other non-fermenting (CP-NF) organisms. There have been sporadic cases of CPE and CP-NF identified through admission screening and individual cases of transmission, but no outbreaks. Full IPC measures were instigated in all instances with no further cases. A CPE management group has been established at Barnet to manage preventative actions and respond in a timely manner to any newly ientifed cases, whether from admission screen or sampling later in an in-patient stay. Each sporadic case now identified is investigated, with ‘contacts’ screened and full IPC measures instituted.

1.6 Influenza The winter of 2017/18 identified more patients than previous years with both Flu A and Flu B as reported in the last quarterly report. The staff vaccination rate reached 72% which was the highest achieved by the trust. The programme to increase to 75% in preparation for winter 2018/19 has been implemented using a Quality Improvement methodology (QI):

Cases of influenza have been reported within the trust in the last month and staff vaccination has now commenced.

1.7. Quality Improvement The IPC team is using a quality improvement initiative to identify drivers for improvement in all infection indicators. The overall aim has four elements, as detailed in the previous quarterly report.

1. Reduce Gram negative bacteraemias as per national (PHE) 50% reduction target by 2021. This is equal to 10% reduction per year.

2. Reduce C.diff to below threshold of 65 attributable cases from April 2018 to March 31st 2019

3. Zero MRSA BSIs by March 31st 2019

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4. Undertake mandatory surgical site infection surveillance for 2018/19 and maintain orthopaedic SSIs within national parameters

The trust is participating in the national NHSI collaborative to reduce catheter associated urinary tract infections (CAUTI), along with associated commissioning support unit and primary care partners. The collaborative will be active until January 2019 and activity and improvements reported at the January Board meeting.

2 Orthopaedic surgical site infection reportThe mandatory requirements from DH for surveillance is one category of orthopaedic surgery for one quarter within each financial year as a group requirement. Chase Farm and Royal Free hospitals have received notice from Public Health England that infection rates were outside the national 90th percentile, however, this is based on data that was submitted two years ago. PHE have been contacted and the latest rates are within benchmarked normal ranges.

The surgical site infection surveillance (SSIS) committee drives the SSI programme within orthopaedic surgery across all the group hospitals. RCA’s from all infections are reported to the orthopaedic specialty team and surgery and associated services divisional board and reported to the SSI committee for learning and dissemination of best practice.

The theatre environment at the new Chase Farm hospital is designed and running to be compliant with healthcare building ventilation regulations, enabling more robust ventilation management designed to reduce infection transmission.

3. Viral infections

252 laboratory-confirmed viral infections were identified by the Virology Laboratory at Royal Free Hospital (RFH) site between April and September 2018, which required IPC interventions from the Virology doctors at Royal Free Hospital. The Microbiology Consultants at BCF site were telephoned or emailed with all positive results for that site. (See Figure 1).

Virology IPC Activity from April 2018 - September 2018

84% of the infections were due to respiratory viruses, 9% of the infections were gastrointestinal infections and 4% of the infections were rash illnesses. There were 10 cases of varicella zoster virus infections and 1 cases of measles identified during this period at the Royal Free hospital. There was also 1 case of acute mumps. Two cases of acute hepatitis E infection were recorded

RFHJul Aug Sept Total

Respiratory 40 38 75 153Gastro/Other 10 20 10 40Total 50 59 83 193

BarnetJul Aug Sept Total

Respiratory 21 14 23 58Gastro/Other 0 0 1 1Total 21 14 24 59

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Virology IPC Activity from October 2014 – September 2018

Respiratory Infections - Jul-Sept 18 Gastro/Other Infections – Jul-Sept 18

6.

4. Serious Incidents, outbreaks related to HCAIs There was a Clostridium difficile (C.diff) outbreak on Juniper ward at Barnet hospital. A period of increased incidence (PII) for was declared on 07/09/2018 when the ward was placed on supportive measures with weekly review meetings due to the identification of two cases of healthcare associated C.diff within 21 days of each other. Subsequently a third case was identified 29 days after the first case on 13/09/2018. Case one and two had different ribotypes’, 011 and 005 respectively and were therefore not linked by direct transmission. However case 2 and 3 ribotype were the same, resulting in a C diff outbreak being declared and PHE informed. At this stage the ward had been on supportive measures for three weeks and a deep clean had been completed. No further cases have been reported since the 13/09/2018.

On 12/09/2018 a period of increased incidence (PII) related to Carbapenemase producing enterobacteriaceae (CPE) was declared on Palm ward at Barnet hospital. Three cases of CPE were identified within a week. The index patient, nursed in a bay, was positive from a urine sample taken on 03/09/2018. The other patients’ in the bay were subsequently screened on 10/09/2018 and two further cases were identified with the same organism, CPE OXA-48 Klebsiella pneumonia. All positive cases were placed in strict contact isolation and the ward was placed on supportive measures with weekly meetings taking place. Once established that the cases were linked in time and place an outbreak was declared. Although the affected bay was terminally cleaned and VHP fogged, deep cleaning of the ward is pending.

RFH BarnetAdenovirus – NPS/BAL 11 1Coronavirus 8 2Enterovirus/Rhinovirus 97 44Human metapneumovirus 4 3Influenza A 3 3Influenza B 0 1Parainfluenza 27 3Parechovirus 2 0RSV 1 1Total 153 58

RFH BarnetAdenovirus - FAE

4 0

Astrovirus 1 0Hepatitis A 2 0Hepatitis E 2 0Measles 1 0Norovirus 12 1Rotavirus 4 0Sapovirus 3 0VZV 10 1Total 39 1

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The Royal Free hospital and Chase Farm hospital have no outbreaks or PII incidents in the last quarter.

5. IPC team activity The team continue to work with the quality improvement (QI) programme related to reducing catheter associated urinary tract infections (CAUTI). This has been a priority as part of the Gram negative bacteraemia reduction programme and to improve patient safety.

The IPC team is supporting the Chase Farm new hospital build with site visits and IPC advice. An IPC clinical lead nurse in now in post full time to work at Chase Farm.

The team has participated in the working party to develop a unified personal protective ensemble/clothing protocol for high consequence infectious diseases, now published at : https://www.journalofinfection.com/article/S0163-4453(18)30261-5/fulltext

The team continue to train staff flu vaccinators, train staff in the management of multi-drug resistant infections and roll out clinical audits in patient areas

6. Hand hygieneHand hygiene is audited by staff within clinical areas and data entered on the Perfect Ward App. Verification audits are undertaken by the IPCNs and individual training and feedback provided within the clinical area directly to the staff.

The Perfect Ward programme has recently been rolled-out and a full breakdown by ward will be presented next quarterly report.

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7. Serious Incidents. There have been no SIs this quarter relating to infection risks.

8. Antibiotic stewardship There have been incidents related to Teicoplanin in surgical antibiotic prophylaxis at the Royal Free

hospital. A revised prophylaxis policy has been agreed with vascular surgery and at the antiobiotic

stewardship committee (ASC). A revised prophylaxis policy for orthopaedic surgery has been agreed with

theanaesthetists and orthopaedic surgeons at the Royal Free hospital with discussion on-going to

harmonise at Barnet hospital.

Medical assessment unit antibiotic stewardship ward rounds are being undertaken by microbiologists using

resources made available through CQUIN.

Paediatric surgical prophylaxis has been agreed with ENT, orthopaedics, gynaecology and anaesthetists

and has been approved at ASC and is awaiting ratification b the drugs and therapeutics committee

Paediatric Gentamicin Dosing is in discussion with RNOH regarding the best equation for CrCl calculation

9. Decontamination

The endoscopy unit at Chase Farm continues to operate inside the requirements of the health technical

momorandas.

The refurbishment of the unit at Chalkmill Drive, Enfield continues to progress. There is a slight delay to the programme due to drainage issues that are outside of the trusts control with an expected date for opening of June 2019. The internal fit out is to plan and the washers/ sterilisers / endo washers have started to be fitted. The procurement programme to increase instrument and scope stocks has begun and will run alongside other medical equipment purchasing in the trust .

10. Validation The trust has declared compliance to the Care Quality Commission in relation to IPC aspects of the Health and Social Care Act (2008) Hygiene Code. The CQC has agreed unconditional compliance. The Trust also collaborates with the CCG CSU advisors in the PIRs and RCAs for infections to ensure open and transparent reporting, learning from the outcomes and sharing learning from other organisations.

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Appendix A

Page 1 of 2 Final

North London Partners in Health and Care North Central London sustainability and

transformation programme (STP) quarterly update

Executive summary

The North Central London (NCL) sustainability and transformation programme (STP) is now known as North London Partners in Health and Care. This is a partnership of health and care organisations from the five London boroughs of Barnet, Camden, Enfield, Haringey and Islington.

It includes:

• Barnet, Camden, Enfield, Haringey and Islington CCGs • Barnet, Camden, Enfield, Haringey and Islington Councils • Barnet, Enfield and Haringey Mental Health NHS Trust • Camden and Islington NHS Foundation Trust • Central and North West London NHS Foundation Trust • Central London Community Healthcare NHS Trust • Moorfields Eye Hospital NHS Foundation Trust • North Middlesex University Hospital • Royal Free London NHS Foundation Trust • Royal National Orthopaedic Hospital NHS Trust • The Tavistock and Portman NHS Foundation Trust • University College London Hospitals NHS Foundation Trust • Whittington Health NHS Trust

The STP sets out how local health and care services will transform and become sustainable over the next five years, building and strengthening local relationships and ultimately delivering the Five Year Forward View vision.

A quarterly update is attached which includes examples of progress made so far.

Action requiredThe board is asked to note this report.




x

2. Excellent user experience – to be in the top 10% of relevant peers on patient, GP and staff experience

x


4. Excellent compliance with our external duties – to meet our x



Page 2 of 2 Final

external obligations effectively and efficiently 5. A strong organisation for the future – to strengthen the

organisation for the future x

CQC Regulations supported by this paperRegulation 17 Good governance

Risks attached to this project/initiative and how these will be managed (assurance)Any risks would be outlined in the report.

Equality analysis• No identified negative impact on equality and diversity

Report from Sir David Sloman, group chief executive Author(s)Date 16 October 2018

North London Partners in Health and CareNorth Central London STPQuarterly provider update 20 September 2018

Ambition for the STP is built on existing CCGs, Local Authorities

and Providers values and strategy

Improve the health and wellbeing of the local

population

Reduce health inequalities

Maximise out of hospital care and build resilient well

supported communities

Ambitions of the STP

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.

Prevention Planned care Mental Health Maternity Urgent and

Emergency Care Health and care closer to home

Children and young people

Cancer

Dr Julie Billet(Camden and

Islington)

Prof. Marcel Levi

(UCLH)

Paul Jenkins(TAVI)

Rachel Lissauer(Haringey)

Sarah Mansuralli(Camden)

Tony Hoolaghan(H&I)

Charlotte Pomery

(Haringey LA)

Kathy Pritchard Jones UCLH

Dr Clare Stephens(Barnet)

Clin

ical

wo

rkst

ream

sSR

Os

Dr Karen Sennett

(Islington)

Dr Richard Jennings,

(Whittington)

Dr Vincent Kirchner

(C&I)

Professor Donald Peebles

Dr Shakil Alam(Haringey)

Dr Katie Coleman, (Islington)

Dr Oliver Anglin

(Camden)

Professor Geoff Bellingan

(UCLH)

Clin

ical

lead

s

Dr Tom Aslan (Camden)

Dr Jonathan Bindman

(BEH)

Dr Alex Warner (Camden)

Mai Buckley(Royal Free)

Dr Chris Laing(UCLH)

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

Clinical and senior leadership in place across North London Partners

NCL Programme Board and Advisory Board

Dr Debbie Frost (Barnet)

Borough based leads for each

CCG

Social Care

Dawn Wakeling (Barnet)

North London Councils Adult

Social Care group

NCL Health and Care Cabinet: Richard Jennings and Jo Sauvage STP Clinical Leads and Co-Chairs

Case 1 Case 2

Examples of progress so far

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 carry out these operations is coordinating the development of how this kind of care could be delivered in the future.

We are currently engaging with ourstakeholders on the draft case for change before considering next steps.

Case 3

New specialist perinatal mental health service for north central London

The service provides specialist treatment and support 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.

Opening of two new maternity community hubs

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

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

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

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.

Headlines from across the programme

Health and

Care Closer

to Home

SRO: Tony

Hoolaghan

Overall workstream objective

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 planned for next reporting period (Q3 2018)• Launch of Quality Improvement network • Full population coverage of neighbourhoods

• Commence procurement process for online consultations provider

Priority project Impact* Major Independencies Key Care Settings Partner involvement

CHIN/Neighbourhood C Workforce, Estates, Digital GP practices, social care, community Partners involved:• CCGs, GP, community pharm , Mental Health & Social CarePotential 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 interdependencies

Planned

Care

SRO:

Marcel Levi


Deliver better value planned care through new models of care and reducing unwarranted variation across providers.

Notable progress made this reporting period (Q2 2018) Notable progress planned for 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, GPsPotential 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

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, promotes 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 discharge 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 related to Discharge approved;

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

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


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

Care HomesPotential 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

Health and

Prevention

SRO: Julie

Billet


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

Notable progress made this reporting period (Q2 2018) Notable progress planned for next reporting period (Q3 2018)• Agree a consistent and coordinated approach to NCL wide MECC training

• Submitted bid to DWP funded Challenger Fund for improving workforce

retention for people with mental health needs

• Working with Cancer workstream to support delivery of awareness and early diagnosis

programme in NCL.


Workforce for prevention E, P Workforce, Estates, Digital Acute, MH Trusts, Community Partners involved:• GP practices Potential future commitments:• Working to towards healthier workplaces • Alignment of organisational strategies • Commitment to prevention (primary and secondary)

Healthier environment O Workforce Acute, MH Trusts, Community

Healthier choices C, Q Workforce

Mental

Health

SRO: Paul

Jenkins


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

Notable progress made this reporting period (Q2 2018) Notable progress planned for next reporting period (Q3 2018)• 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, HEEPotential 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.

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

Maternity

SRO: Rachel

Lissauer


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

Notable progress made this reporting period (Q2 2018) Notable progress planned for next reporting period (Q3 2018)• Earlier this year, the team opened 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

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

Personalisation & choice Q Digital Acute, community

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

Community services dvt Q HCCH Community settings

NCL collaborative working £, Q Workforce Acute, community


* 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 sustainability; reduced variation.

Notable progress made this reporting period (Q2 2018) Notable progress planned for next reporting period (Q3 2018)• Findings from annual review – 1-year survival rate better than England average

• % people in NCL diagnosed at early stage good relative to England average

• Workforce modelling re: radiology gaps in employment • System work on 62 day target


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

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

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

Social Care

SRO: Dawn

Wakeling

Overall workstream objectiveWorking to address care inequalities in provision and improving longer term strategic approach to workforce and care market.

Notable progress made this reporting period (Q2 2018) Notable progress planned for next reporting period (Q3 2018)• 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 providersPotential future commitments: Joint commissioning strategy

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

Digital

SRO: David

Sloman

Notable progress made this reporting period (Q2 2018) Notable progress planned for 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:• Acute Trusts, Primary Care, Commissioners, Pharmacy, Public

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

Pop Health Management Q, £ Clinical Workstreams All

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

Children

and Young

People

SRO:

Charlotte

Pommery


‘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 planned for next reporting period (Q3 2018)• 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


Paediatric surgery Q Workforce, digital Acute trusts (GDH & Tertiary) Partners involved: Acute Trusts, Primary Care, Commissioners, Pharmacy, Public Health, Local AuthorityPotential future commitments:System approach to managing & preventing asthma in C&YP• Developing surgical network across NCL• Preventative approach to care & support for CYP & families

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

Workforce

SRO:

Siobhan

Harrington

Overall workstream objectiveTo attract people to live and work in NCL so we have the best possible workforce to deliver high quality services to our community

Notable progress made this reporting period (Q2 2018) Notable progress planned for next reporting period (Q3 2018)• 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 Potential future commitments:• Standardisation of mandatory training to aid portability • Standardisation of employment contracts to aid portability

Portability (including passports, MAST)

P, Q, £ Prevention, HCCH Acute, Community, Primary care

Temporary Staffing £, Q, C - Acute and Community trusts

Social & Primary C/Community/Place based

£, P, Q UEC Community, Primary care

Analytics (WF planning) £ All

Estates

SRO: Simon

Goodwin

Overall workstream objectiveTo 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 planned for 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 TrustsPotential future commitments:Partnership working on NCL estates strategy iteration

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

Reducing void spaces £, Q All All STP partners

Provider

Productivity

SRO: Tim

Jaggard

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

Notable progress made this reporting period (Q2 2018) Notable progress planned for next reporting period (Q3 2018)• 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


Workforce £ Workforce NHS Trusts Partners involved:• ProvidersPotential future commitments:• Consideration of collaborative bank option • Ongoing engagement in modelling, scoping and emerging

programme of work

Procurement £ - NHS Trusts

Facilities management £ - NHS Trusts

Diagnostics £, Q Planned Care NHS Trusts


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]

Appendix 1: Capacity to delivery change

Page 1 of 2

Financial performance report for month 6 (September 2018)

Executive summary

At end of month 6 the trust reported an actual year to date (YTD) deficit of £40.4m which is

£3.1m worse than plan.

The 2018/19 financial plan includes delivery of £45.3m financial improvement plan (FIP)

savings. The trust delivered £16.1m of FIP YTD compared to a target of £13.7m. The trust is

currently forecasting to deliver £43.1m of FIP on plans identified for FY19. This is £2.3m

below its target for 2018-19.

The cash balance on 30 September was £68.1m. Cash at the end of September was

significantly better than plan by £62.7m due to re phasing of cash receipts with NCL and prior

year settlements with CCGs. Cash profiles for the remainder of the year were updated in

July and the cash balances remain as per this revised profiling. Loan drawdowns will not be

required until February 2019, later than plan due to the re phasing of cash receipts from

NCL.

Action required

For information

Trust strategic priorities and business planning objectives

supported by this paper

Board assurance risk

number(s)

1. Excellent outcomes – to be in the top 10% of our peers on

outcomes

2. Excellent user experience – to be in the top 10% of relevant

peers on patient, GP and staff experience

3. Excellent financial performance – to be in the top 10% of

relevant peers on financial performance

x

4. Excellent compliance with our external duties – to meet our

external obligations effectively and efficiently

5. A strong organisation for the future – to strengthen the

organisation for the future

CQC Regulations supported by this paper

Regulation 4 Requirements where the service provider is an individual or partnership

Regulation 5 ⃰ Fit and proper persons: directors

Regulation 6 Requirement where the service provider is a body other than a partnership

Regulation 7 Requirements relating to registered managers

Regulation 8 ⃰ General


Trust Board Part I 24 October 2018 Paper 9

Page 2 of 2

Regulation 9 Person-centred care

Regulation 10 Dignity and respect

Regulation 11 Need for consent

Regulation 12 Safe care and treatment

Regulation 13 Safeguarding service users from abuse and improper treatment

Regulation 14 Meeting nutritional and hydration needs

Regulation 15 Premises and equipment

Regulation 16 Receiving and acting on complaints

Regulation 17 Good governance

Regulation 18 Staffing

Regulation 19 Fit and proper persons employed

Regulation 20⃰ Duty of candour

Regulation 20A⃰ Requirement as to display of performance assessments

Care Quality Commission (Registration) Regulations 2009 (Part 4)

Regulation 12 Statement of purpose

Regulation 13 Financial position x

Regulation 14 Notice of absence

Regulation 15 Notice of changes

Regulation 16 Notification of death of a service user

Regulation 17 Notification of death or unauthorised absence of a service user who is

detained or liable to be detained under the Mental Health Act 1983

Regulation 18 Notification of other incidents

Regulation 19 Fees

Regulation 20⃰ Requirements relating to termination of pregnancies

Regulation 22A⃰ Form of notifications to the Commission

Risks attached to this project/initiative and how these will be managed (assurance)

Equality analysis

• No identified negative impact on equality and diversity

Report from: Peter Ridley, group chief finance and compliance officer

Author(s): Senior Finance Team

Date: 17th October 2018

The Royal Free London

Finance Report M6 TB Part 1

1

YTD Performance at M6 – Headlines

2

Performance against Plan

In Year Performance - FY18

Agency Spend Vs. Last year

Cash Flow forecast

• YTD performance against plan - £2.7m adverse predominantly due to impact of FIP phasing

FIP Performance

• YTD FIP delivery of £16.1m

Better Payment Performance Code Capital Expenditure

Agency spend for the month was £2m. Agency spend is £0.8m above ceiling at end of M6

Number Value £'m Number Value £'m % Number % Value

NHS 1,608 £29.67 477 £14.51 30% 49%

Non NHS 88,143 £303.15 71,601 £219.63 81% 72%

Total 89,751 £332.82 72,078 £234.14 80% 70%

within 30 days Total YTD Forecast

Plan Actual Variance Plan Actual Variance

£m £m £m £m £m £m

47.6 46.3 1.2 82.4 82.4 0.0

CFO Message

Delivered an actual deficit of £40.4m at

end of M6; £3.1m

worse than plan

1 At end of September, the Trust delivered an actual deficit of £40.4m. This was £3.1m worse than plan. Adverse variance

predominantly relates to the impact of phasing the FIP income target in equal twelfths in the financial plan whilst delivery is

expected in Q4

Key drivers for year to date performance are

• Clinical income upside of £2.6m driven predominantly by non-elective activity

• Phasing of the FIP target in equal 12ths - £3.7m

• Overspends relating to GDE

• Loss in PPU contribution

Delivered £16.1m of

FIP at end of

September

2 The Trust delivered £16.1m of FIP at end of September. The Trust is currently forecasting to deliver £43.1m of FIP on plans

identified for FY19. This is £2.3m below its target for 2018-19.

Recurrent forecast FIP delivery for FY19 including full year effects is currently at £29m. The Trust is committed to identifying £40m of recurrent FIP schemes by the end of this financial year.

Reliance on non-recurrent FIP will have an adverse impact on the underlying financial position.

Cash position –

£68.1m at end of September

3 The cash balance on the 30thth of September was £68.1m Cash at the end of September was significantly better than plan by £62.7m due to re phasing of cash receipts with NCL and prior year settlements with CCGs. Cash profiles for the remainder of the year were updated in July and the cash balances remain as per this revised profiling. Loan draw downs will not be required until February 2019, later than plan due to the re phasing of cash receipts from NCL.

Emerging risks that will impact delivery

of FY19 plan

4 At end of September there are emerging risks that will impact on the delivery of FY19 plan. Some of the emerging risks are • Above than planned expenditure relating to GDE • Income risks as contracts are performing to a level above what is affordable to CCGs. • Slippage against FIP plans identified • Impact of winter pressure in light of no additional funding from the CCG • Continuing underperformance relating to PPU contribution

3

September Performance FY19

M6 Overview September Performance FY19

4

Plan Actual Variance Plan Actual Variance

£ '000s £ '000s £ '000s £ '000s £ '000s £ '000s

NHS Clinical Income 56,968 56,806 (163) 343,353 345,964 2,612

TEDD Income 16,472 17,653 1,181 98,840 93,956 (4,884)

Non NHS Clinical Income 3,167 2,637 (529) 18,543 16,165 (2,377)

Other Operating Income 9,030 8,147 (883) 55,190 50,028 (5,162)

Property Services Income 246 246 1,509 1,509

Total Income 85,637 85,488 (148) 515,926 507,623 (8,303)

Pay (45,419) (45,456) (38) (273,241) (270,535) 2,706

Other Pay (Apprentice Levy) (218) (200) 18 (1,196) (1,196) (0)

Non-Pay Expenditure (Excl. TEDD) (25,515) (25,148) 368 (154,685) (156,902) (2,218)

Property Services Expenses (214) (214) (1,395) (1,395)

TEDD Expenditure (15,857) (16,538) (681) (95,457) (89,820) 5,637

Total Operating Expenditure (87,010) (87,556) (546) (524,579) (519,848) 4,731

SLR 0 (0) (0) (0) (0) (0)

EBITDA (1,373) (2,068) (695) (8,653) (12,225) (3,572)

Interest, Dividends & Depreciation (4,942) (4,711) 231 (28,641) (28,178) 463

P/L Disposal of Fixed Assets

Investment In Joint Ventures

Surplus/Deficit (6,315) (6,778) (463) (37,294) (40,403) (3,109)

In Month YTD

Page 1 of 1

Operational performance report

Action required/recommendation

The board is asked to review the current performance of RFL against the key cancer, A&E

and RTT operational performance standards

Trust strategic priorities and business planning objectives

supported by this paper

Board assurance risk

number(s)

1. Excellent outcomes – to be in the top 10% of our peers on

outcomes

X

2. Excellent user experience – to be in the top 10% of relevant

peers on patient, GP and staff experience

X

3. Excellent financial performance – to be in the top 10% of

relevant peers on financial performance

4. Excellent compliance with our external duties – to meet our

external obligations effectively and efficiently

X

5. A strong organisation for the future – to strengthen the

organisation for the future

CQC Regulations supported by this paper

Regulation 8 ⃰ General

Regulation 9 Person-centred care

Regulation 10 Dignity and respect

Regulation 12 Safe care and treatment

Regulation 17 Good governance

Regulation 18 Staffing

Regulation 20A⃰ Requirement as to display of performance assessments


Failure to achieve and maintain compliance against Monitor risk assessment framework

standards and targets.

Equality analysis


Report from Peter Ridley

Group chief finance and compliance officer

Authors Sally Dootson, chief executive (Barnet), Sarah Dobbing, chief executive

(RFH) Senita Robinson, performance lead

Date 18 October 2018


Part 1 Trust board meeting 24 October 2018 Paper 10

Royal Free London –operational performance

October 2018

2

Operational performance summary report

Where we are Predictions Key Risks

Cancer –August 2018

• Performance in August was reported at 81.8%

• The majority of breaches were in the Prostate, lower GI and HPB tumour sites

• The largest backlog volumes are in Lower GI (53), Prostate (18) and Gynaecology (13) tumour sites

• Un-validated September performance is 73.50%

• The backlog is currently152 overall with 52 diagnosed over 62 days

• The overall PTL size has risen in conjunction with the backlog

• Clearing lower GI backlog whilst implementing STT pathway

• Endoscopy capacity issues raised in deep dive which will affect a number of tumour sites

• Lower GI, plastics and renal and furthest from target on their backlog trajectories

RTT –August2018

• Performance in August was 78% - third consecutive negative outlier against new control limits (set by negative shift in March 2018

• 45 >52 week waiters, compared to 34 in June and 40 in July

• Draft specialty-specific recovery plans are being written.

• Continued drop in performance whilst validation effort is focused on OPWL pending release of MBI PTL.

• Validation of September performance is near complete and is showing a significant increase in >52 week waiters at 73.

• Continued increase in >52 week waiters, particularly tip-ins.

• No current visibility of what performance will look like with new PTL

• Mitigations – 10 validation posts have been approved and are in the process of being advertised to manage the load

A&E –September 2018

• Overall performance in September is 86.8%

• Below trajectory but above 2017/18 performance at this time

• Further 15 AAU beds at RFH to be opened.

• Performance problems at other trusts, leading to redirections of ambulance and walk-in activity at RFH site.

• Capacity and staffing at BH site.

3

62 Day Cancer – Performance Summary

Current Period August: comparable with 2017/18 performance, below trajectory and standard at both site and Trust level

Relative position Aug 2018: 3rd quartile at trust level

% cancer patients waiting < 62 days from GP referral to first treatment

Source: NHS England, August 2018

4

In August, 5 out of 13 tumour sites accounted for 38.5% of the trust’s total breaches:

● Prostate cross-site – 9 breaches (performance 63.3%)

● HPB RFH – 4 breaches (performance 41.7%)

● Lower GI – 4 breaches (performance 81.6%)

● Renal – 2 breaches (performance 85.2%)

62 Day Cancer – Sources of Current Performance

August Performance by Tumour site Observations

Number of excess patient breaches*

* Actual breaches minus breaches that would have been incurred if the tumour site were exactly at 85% standard

38.5% of total RFL breaches

5

62 Day Cancer – Diagnosis and Actions

What is our diagnosis of what is driving current performance and future risks?

What are our action priorities and what is our status on them?

1. Persistent backlog in prostate tumour site

2. Increase in backlog for Lower GI at Barnet Hospital

3. Endoscopy capacity issues

1. Providing training to NMUH doctors, handover now pushed back to mid-November. The aim is to hand this work back and thereby double capacity for RFL patients. Operational management are also reviewing patients who fall outside of the one-stop shop to identify causes.

2. Expanded STT service started 10th

September. There were some initial issues but is now working well. Patients who enter the pathway now are being seen quickly and mostly within timelines but there is a backlog in the middle of the PTL to be managed.

3. Raised in recent deep dive. Outsourcing options are being explored and workforce plan being devised to ensure adequate staffing.

6

RTT – Performance Summary

Current Period August 2018: declining, below standard and 2017/18 performance

Relative position August 2018: 4th quartile in London

% patients waiting < 18 weeks from referral to treatment

Source: NHS England, June 2018

September data not submitted at time of writing report

7

RTT – Sources of Current PerformanceCurrent Period Performance by Specialty/Hospital Combination

* Actual breaches minus breaches if achieving 85% standard

Barnet Hospital Royal Free Hospital

Current Period > 52 week waiters

Introduction of new patient tracking list

August 2017August = 45

8

RTT – Diagnosis and Actions

What is our diagnosis of what is driving current performance?


1. The Patient Tracking List (the waiting list) continues to suffer from unexpected ‘pop-on’ long-waiting patients, and there are a continual rise of “tip-ins”

2. The full suite of waiting list and performance reports is not yet available to operational and clinical teams to enable them to monitor their performance and act on early warnings.

3. Need for productivity improvements in outpatients and theatres.

4. Data quality/logic issues mean we are less aware of genuine operational issues.

1. When handed over, MBI PTL should eliminate “pop-ons”. TEAM meetings have moved to weekly in addition to sit reps to ensure we minimise patients who are visible and “tip-in” to the >52 week category.

2. The OPWL and ASI list have been constructed and validation is almost complete on the former. Daily PTL emails are now being sent to operational teams and a list of confirmed >52 week breaches is distributed monthly to operations to ensure we only submit genuine patients.

3. The outpatients productivity programme has started and we are refreshing our theatres productivity programme. This will include a re-designed theatres productivity dashboard.

4. Specialties are completing RTT recovery plans; key areas have already submitted a draft to DDOs.

9

A&E – Performance Summary

Current Period September: above 2017/18 performance, below trajectory and standard at both site and Trust level

Relative position Sep 2018: 3rd quartile at trust level

% patients waiting < 4 hours in A&E

10

A&E – Barnet Sources of Current Performance

Current Period Performance

Performance against 4 hour standard

DTOC and MOs

Total DTOC and MO bed days – August 2018 DTOC by borough – August 2018

September ED performance is below trajectory. DTOC and stranded patients variable and not consistently at target.

The improvement plans continue. A MADE event is planned for 18th OctoberUpgraded space & new model for same day emergency care, TREAT & AAU being developed and planned for implementing in December.

11

A&E – Barnet Diagnosis and Actions



1. ED and ambulances have increased and in-patient flow is becoming challenging

2. We currently have variable and now (October) high DTOC & stranded patient numbers

3. ED workforce vacancies cause inconsistent staffing levels & skill mix

1. Reviewing ambulance flow and acuity. Performance of attendance avoidance schemes flagged to the CCG

2. Daily & weekly reviews. MADE event 18th

October

3. Workforce plan in place & reviewed weekly but the divisional team.

12

A&E – Royal Free Sources of Current Performance

Current Period Performance

Performance against 4 hour standard

DTOC and MOs

Total DTOC and MO bed days – August 2018 DTOC by borough – August 2018

Performance dipped in mid-September, with increase in minors breaches and an increase in bed occupancy causing delays in dischargeCurrent actions• Working on UCC redesign, the UCC

moved to be co-located with the Treatment unit from October

• Improved streaming and ambulance handover times

13

A&E – Royal Free Diagnosis and Actions



1. ED process delays. ED process delays contribute significantly to breaches

2. In-hospital flow – discharge delays and bed pressures are affecting ED performance

3. Out of hospital capacity. DTOCs and delays for complex patients with mental health and medical needs cause capacity constraints

1. Focusing on improving Streaming to UCC to reduce burden on ED. Working on redirecting ‘specialty expected patients’ to AAU.

2. The AAU has helped flow. Further work is being done with specialties to improve discharge processes. The bed model is being reviewed to ensure it meets current demand

3. Regular stranded patient reviews and Multi-agency discharge events with external partners to improve flow

Paper 11

1 X:\ Chair and CEO report 24 October 2018

CHAIRMAN’S AND CHIEF EXECUTIVE’S REPORT

Executive summary

This is a combined chairman’s and chief executive’s report containing items of interest / relevance to the board.

Action required

The board is asked to note the report.

Report From D Dodd, group chairman and D Sloman, group chief executive Author(s) Alison Macdonald, board secretary Date 15 October 2018



Paper 11


CHAIRMAN’S AND CHIEF EXECUTIVE’S REPORT

A TRUST DEVELOPMENTS

CHASE FARM HOSPITAL REDEVELOPMENT UPDATE

The opening of the new Chase Farm Hospital has continued to go smoothly. The next major event is the rolling out of the new electronic patient record (EPR)

The scheduled date for EPR go-live at BH, CFH and maternity at the RFH is over the weekend of 17-19 November. The RFH will go-live in 2019.

EPR is a single patient record that will cross the hospital sites and will replace paper records over the next two years. Staff will be able to enter documentation straight into EPR and patients will have the opportunity to access their records through a patient portal. If a patient’s observations and assessments are outside expected ranges, care plans will support clinical staff in giving the right treatment.

It will improve the quality of clinical services through supporting best practice, delivering excellent models of care and improved workflows. Integrated medical devices will reduce error and free up clinical time and a new infrastructure, including new PCs will support the implementation. The new EPR will use Cerner’s model experience content, which has been developed with UK partner trusts in line with national and local standards.

THE PEARS BUILDING

On 16 October there was a “bottoming out” ceremony to mark the reaching of the lowest point of the site and the beginning of the next phase, when the building will “rise out” of the ground.

The event will be marked with the deposit of a time capsule that will be embedded in the foundations, designed to be re-opened in 100 years’ time. Included will be items giving a snapshot of life today in the institute, the hospital, the charity and the wider community. Ideas from pupils of the Royal Free School are being included.

The good summer weather has meant excellent progress on the project, with removal of underground obstructions, construction of the external retaining walls, more work on the foundations and drainage and installation of a tower crane for handling building materials.

Over the next few weeks key work on the foundations and underground drainage will be completed and work on the external retaining walls and external drainage will continue. A new power substation will be installed.

The science display for the hoarding will be installed during the first week of November and displays of local art will be added before Christmas.

The construction working group continues to meet to provide information for neighbours and the local community and to address concerns. There have been a number of reports of damage to local property which have been investigated but so far none has been found to have been caused by the construction work.

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B REGULATION

INFORMATON COMMISSIONER’S OFFICE (ICO) UNDERTAKINGS

In August 2018 the trust confirmed to the ICO that all the items in the Linklater audit recommendations had been completed. The ICO’s assurance team wrote to request evidence to support this which was submitted in September. The ICO has now sent the trust a follow up report containing their review of the evidence and updates provided. The group chief information office has reviewed the report and is of the view that the trust can meet all of the ICO recommendations. An action plan with named individuals and completion dates is being drawn up.

CARE QUALITY COMMISSION (CQC) VISIT

The care quality commission (CQC) have informed the trust that they will be making an unannounced visit shortly.

CQC is the independent regulator of all health and social care services in England. They visit all hospitals in the country to check standards of quality, and to make sure they are providing safe, caring, effective and responsive care, and that they are well-led.

The visit could be to any of the trust’s hospitals, services or offices where trust staff deliver patient care.

It will give the trust the chance to discuss the areas in which the trust knows improvement is needed, the plans the trust is following to make sure that progress is being made and what the trust is proud of about the services delivered.

The inspection will use measures, evidence and engagement to assess services against five key questions:

• Are they safe? • Are they effective? • Are they caring? • Are they responsive to people’s needs? • Are they well-led?

To help staff prepare for the inspection, the trust is producing a staff handbook, creating a special managers’ briefing, updating the Freenet pages with FAQs and providing updates in the chief executive’s briefings.

A series of special staff briefings are taking place across the trust during October and November. The briefings are led by an RFL group director and a senior leader from BH, CFH or the RFH.

This is an opportunity for staff to hear all about the CQC inspection and ask any questions they may have.

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C BOARD AND COUNCIL MATTERS

ROYAL FREE LONDON GROUP

The Royal Free London NHS Foundation Trust (RFL) is one of four trusts across the NHS to be chosen to develop a group model, enabling the trust to share services and resources more effectively across hospitals in order to improve the experience of patients and staff.

Individual trusts are able to join the group under a range of membership options, from full membership to arrangements such as clinical partnerships and buddying. The RFL group is already delivering benefits – including reduced neonatal unit admissions and shorter length of stay for patients following knee operations. These are illustrated in an animation “The Royal Free London group: the best of the NHS for every patient” which has been published on YouTube.

North Middlesex University Hospitals NHS Trust (NMUH) joined the Royal Free London group as a clinical partner in September 2017 with a view to potentially joining as a full member at a later date.

At the trust’s most recent board meeting on 24 September, the board approved West Hertfordshire Hospitals NHS Trust (WHH) joining the RFL group as a clinical partner. This follows several months of close collaboration between the two trusts.

At the same meeting, the RFL board agreed that NMUH, would not be in a position in the near future to become a ‘full’ member of the RFL group.

COUNCIL OF GOVERNORS

A governors’ seminar on communications was held on 3 October; with 13 governors attending. The seminar covered understanding the governors’ role, the RFL media policy and a reminder to refer all press enquiries to the communications department. A further governors’ seminar is being held on 23 October to look at the role of the council of governors in raising concerns.

Two local members’ councils have been held; one for the Royal Free London Hospital and the second at Barnet Hospital. Chase Farm local members’ council is being held on Tuesday 30 October 2018 at 6 pm.

A medicine for members event is being held on 6 November 2018 in the Sir William Wells atrium of the Royal Free and the topic for this is “pathways to better health” focusing on the better birth pathway.

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D LOCAL NEWS AND DEVELOPMENTS

BLACK HISTORY MONTH

Dame Elizabeth N Anionwu, an eminent professor of nursing, spoke to staff at RFH and BH as part of Black History Month (October 2018). Introducing her to staff, RFL group director of workforce David Grantham, described her as a ‘trailblazer’ for the black and minority ethnicity community (BME) throughout her professional career. This included being part of the successful campaign for a Mary Seacole statue to be erected, and for her work around sickle cell disease and thalassemia.

The trust is marked Black History Month with a presentation and staff listening session with RFL group chairman and chief executive. Staff were encouraged to attend to hear about the importance of addressing the discrimination BME staff experience in the NHS and what the trust is doing about it, and to have an opportunity to express their views.

This was part of the trust’s commitment to achieving the NHS Workforce Race Equality Standards (WRES). Topics discussed in previous sessions have included fair recruitment processes, access to career progression and development, shadowing, secondment and mentoring opportunities.

GENDER PAY GAP UPDATE

This is an update on further work the trust has undertaken to address the gender pay gap (GPG) identified from analysing the pay data against gender and other protected characteristics including ethnicity.

The trust’s median GPG was 13.32% compared to the median public sector average of 13.10% and the median private sector average of 15.9%.

The key findings of the of the further work are that:

• The overall GPG is predominantly driven by consultant clinical excellence awards and incremental scale (which rewards long service and there are less female than male consultants with longer service, reflecting changes in the make-up of the profession over time).

• The overall pay gap between black and minority ethnic staff and white staff is 7.96%. This is predominantly driven by the proportions of BME/White staff and the bands they occupy, and the known under representation of BME staff in senior roles at Bands 8a and above.

Further pay gap analysis work on-going to be reported in the Trust’s equality annual report in December 2018.

The Trust GPG priorities are:

• Reform of the local clinical excellence award arrangements (in line with national changes).

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• Continuous reinforcement of local guidelines and process reviews of starting salaries managed via the trust’s recruitment service.

• Promote flexible working as a key staff benefit to encourage female staff to return to work following maternity leave.

• Monitor the impact of diverse panel on Trust’s talent management to improve the representation of women and BME staff in Bands 8a and above.

The government’s race disparity audit in 2017 showed that Asian, Black and other ethnic groups were disproportionately likely to be paid less while performing the same job as a white colleague. As a result, a consultation has been launched on whether to have a mandatory ethnicity pay gap reporting to address pay disparity at work. The consultation will end in January 2019, the objective of the plan is make sure the UK’s organisations, boardrooms and senior management teams are truly reflective of the workplaces they manage.

NHS England, KPMG and other private and public sector companies have signed up to the oncoming “Race at Work Charter”. The charter is a commitment to increase recruitment and career progression of ethnic minority employees in the UK. Further information is awaited and the board will be updated in the next report.

STAFF SURVEY 2018

The staff survey is underway and a number of steps are being taken to encourage staff to complete the survey and give their views on working at the trust. This includes “Take 15 on the 15th” when staff are being asked to take 15 minutes of work time on 15 October to complete their staff survey, with the active support of their line managers.

There are staff survey hubs – where PCs are available for staff to complete their survey – on all three sites. There are also three sessions a week at the RFH where assistance with completion of paper surveys is available.

FIRE COMPLIANCE UPDATE

The trust has a robust system of fire risk assessments, training, maintenance and capital investment. The trust’s capital programme contains a three year programme of fire compliance work with a value of £5m. This includes fire improvement works (such as planned replacement of fire alarm systems, changes and improvements to room layouts and fire compartmentation and planned replacement/upgrades of emergency lighting systems) as part of refurbishment of existing areas, which demonstrates the trust’s commitment to continued improvement in fire safety This is running to time and to budget.

Cladding has been examined across the trust’s estates and the trust has not identified any installations of concern, specifically no aluminium composite material (ACM) installations of the type used in the Grenfell Tower. Further surveys and testing of the cladding are taking place.

Fire training is being closely monitored.

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FAMILY AND FRIENDS TEST (FFT)

The NHS friends and family test (FFT) was introduced in 2013 to enable patients to feed back on their care and treatment to enable hospitals and other providers to improve services.

It asks patients whether they would recommend hospital wards, A&E departments, maternity services and out-patient clinics to their friends and family if they needed similar care or treatment. The September results are below.

Royal Free London combined data

% likely/extremely likely to recommend September 2018

(range: 0 – 100%)

Number of patient responses

In-patient 87% 574

A&E 84% 2548

Barnet Hospital % likely/extremely likely to recommend September 2018

(range: 0 – 100%)


In-patient 85% 214

A&E 79% 1247

Antenatal care 100% 2

Labour and birth 100% 18

Postnatal hospital ward 100% 18

Postnatal community care 100% 24

Out-patients 91% 220

Chase Farm Hospital % likely/extremely likely to recommend September 2018

(range: 0 – 100%)


In-patient 100% 4

Out-patients 98% 55

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Royal Free Hospital % likely/extremely likely to recommend – September 2018

(range: 0 – 100%)


In-patient 87% 410

A&E 89% 1560

Antenatal care 100% 4

Labour and birth 100% 11

Postnatal hospital ward 82% 11

Postnatal community care 100% 24

Out-patients 96% 429

*The postnatal community care question is only reported as a whole trust figure and not split

by site.

COMMUNICATIONS BOARD REPORT: SEPTEMBER 2018

Media coverage

Main positive story: The trust’s media coverage this month was dominated by three main stories. The death of It’ll Be Alright on The Night presenter Denis Norden at the Royal Free Hospital was covered in most media outlets (871 mentions). His family were very positive about the care he had received in his final weeks.

There was also widespread coverage for a story about former X Factor contestant, Chico, who had a stroke and was treated at Barnet Hospital, where he praised the ‘wonderful’ care he received. Coverage of monkeypox also contributed to the high overall figures because the first patient was treated at the Royal Free Hospital (arriving September 8).

The table below shows the sentiment of press mentions in September:

September Royal Free Hospital

Barnet Hospital Chase Farm Hospital

Total

Positive 1,149 147 3 1,299Neutral 704 9 31 744Negative 53 1 4 58Total 1,906 157 38 2,101

Digital communications

The total number of Facebook followers is 6,210 (+ 223); the number of posts was 102, reaching 142,312 people.

The total number of Twitter followers is 16,317 (+446); the number of tweets was 124, reaching 217,307 people.

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The top tweet for September was raising awareness about NHS Blood and Transplant’s campaign for new platelet donors to help cancer patients. The trust tweeted that people could donate at the Edgware Blood Donor Centre. The post received 11,502 impressions on Twitter.

Internal communications

Care Quality Commission (CQC) – the communications team has produced a 16-page CQC visit staff handbook, ‘Your time to shine’, which includes key information about the inspection. Regular updates have also been given in Freemail and Freepress and promoted the special CQC staff briefing sessions. The chief executive has told staff, ‘be proud of everything we do for patients’.

Electronic patient record (EPR) – Awareness of the new EPR has continued to be raised, with a particular focus on promoting the training available. A new countdown banner has gone live on Freenet, there are regular updates in Freemail, Freepress and on Freenet and the latest digital transformation newsletter has been published and distributed.

CFH – Awareness has continued to be raised of the opening of the new hospital with a popular social media campaign, Freepress articles and the summer redevelopment newsletter. There has also been an advertising campaign in local media/council publications.

Staff survey 2018 – This has been publicised with staff being encouraged to take 15 minutes to complete it. The staff survey has been advertised in Freepress and Freemail.

E NATIONAL NEWS AND DEVELOPMENTS

NURSING AND MIDWIFERY COUNCIL

The Care Quality Commission chief inspector of adult social care Andrea Sutcliffe has been appointed the new chief executive of the Nursing and Midwifery Council.

Ms Sutcliffe, who joined the CQC in October 2013, will take on the role at the nursing watchdog in January 2019.

She replaces former NMC chief Jackie Smith, who resigned from the NMC in May 2018.

NHS ENGLAND BOARD MEETING 26 SEPTEMBER 2018

Below is a summary of the main issues discussed at the board meeting.

Cancer Programme update

• The National Cancer Programme is now in the third year of implementing the Cancer Taskforce Strategy and has made significant progress towards increasing cancer survival and improving patient experience and quality of life.

• Cancer survival rates are at the highest they have ever been. The latest figures show one year survival at 72.3% in 2015; this is a 0.7% increase from 2014.

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• NHS England (NHSE) is investing £200m though Cancer Alliances in 17/18 to transform diagnostic services and care during and after treatment.

• Nineteen Cancer alliances were established in 2016, these brought together senior and clinical managerial leaders from across a geographical area to help drive forward the Cancer Taskforce’s ambitions.

• The taskforce has engaged with over 50 organisations to date in the development of the cancer section of the Long Term Plan for the NHS. The third annual report of progress in delivering the cancer strategy will be published this autumn.

Commissioning Committee Board Report

• Based on the report on the outcomes of the CCG 2017/18 improvement and assessment outcomes, the committee agreed that CCGs rated as ‘inadequate’ will go into special measures and that some CCGs that are rated as ‘requires improvement’ may also enter or remain in special measures.

• Report on the Integrated Care Systems (ICS) programme has noted that ICSs will continue to expand to include voluntary, community, social enterprise and other partners as they mature.

Specialised Services Commissioning Committee Report

• NHSE is updating its strategic priorities for specialised commissioning to provide a clearer focus for implementation and provide the basis for planning for 2019/20 as well as supporting delivery for 2018/19.

NHS BOARD MEETING 27 SEPTEMBER 2018

Below is a summary of the main issues discussed at the board meeting.

Chief Executive’s report

• NHS Improvement (NHSI) published its winter review for 2017/18, which outlines its priorities and key deliverables for this coming winter, including improving staff uptake of the flu vaccine.

• At the end of Q1, trusts were projecting to end 2018/19 £519m in deficit. NHSI has been working with NHS England (NHSE) to identify actions which will result in a balanced financial plan for the NHS. This is the first year that the £4.3bn ‘underlying deficit’ of the provider sector is being included in the report.

• Acute trusts continue to face high levels of bed occupancy, and there has been a significant increase in patients waiting more than 52 weeks for elective care. Trusts have reduced the number of long waiters.

• There are currently 21 providers in special measures; four providers are in special measures for both quality and finances, ten for reasons of quality only, and seven for reasons of finance only.

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• NHSI and NHSE have been developing a single operating model and are starting to appoint to the new senior national and regional director roles.

JOINT NHS ENGLAND AND NHS IMPROVEMENT BOARD MEETING 27 SEPTEMBER 2018

Winter 2018/19 planning update

• NHSI and NHSE will support trusts to deliver important progress for winter 2018/19 such as more effective flu vaccines for older people, and a new £145m capital upgrade for A&E departments. There is a national ambition to release a further 4,000 beds from length of stay reductions of long stay patients in hospital over 21 days. Trusts have been segmented based on current and projected performance, and will receive tailored support.

Financial and operational performance report

• This is the first time that NHSE and NHSI have produced a joint finance report. NHSE and NHSI have agreed a joint programme of actions designed to eliminate the £519m trust deficit.

• Demand for emergency and non-elective NHS services continues to rise but there is evidence that the strategy to ensure patients are treated in the most appropriate setting for their urgent care needs is having an impact on A&E attendance growth.

·

Development of the long term plan for the NHS

• The long term plan work streams have been asked to be clear about the workforce required to deliver their ambitions, how their proposals are deliverable within the agreed financial settlement, details on how their proposals will be implemented and the impact they will have on inequalities reduction.

• All work streams are working to identify opportunities to reduce variation in practice, improve outcomes and increase efficiency, by building on existing Carter and GIRFT programmes.

• The digital and technology work stream will articulate a new map for digital, data and technology.

• From November 2018 to March 2019, NHSI and NHSE will work with local and regional NHS bodies, including STPs, to map out implications of the national priorities for local services and people.

Integrated Care Systems programme (ICS) update

• All but one of the ten first wave ICSs performed above the national average for cancer waiting times in 2017/18. Eight performed above the national average for referral-to-treatment times and seven performed at or above national average for the A&E standard.

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• Six of the Wave 1 ICSs delivered a better financial position than they planned in 2017/18.

• All systems have made progress implementing primary care networks at the neighbourhood level. All report full or nearly full coverage, although networks are at different levels of maturity.

• Eight of the ten Wave 1 ICSs are now working under a new financial framework, in which the ICSs link some or all of their provider sustainability funding to the collective financial performance of the system.

• Memoranda of Understanding have been agreed for 2018/19 with each ICS, which include national expectations based on implementing priorities for the coming year.

• ICSs will be a foundational part of the future NHS system architecture, and NHSI/E are considering how to put them on a firm consistent footing across England, as well as how to clarify their essential functions and what support the most challenged systems need.

Next steps on delivering a single operating model and shared culture

• In designing the single operational model, NHSI and NHSE are committed to deliver 20% efficiency.

• The way NHSI and NHSE’s joint enterprise will work is described as follows:

• NHS system-level decisions will be made jointly between their constituent organisations, corporate and regional teams and through engagement with stakeholders via the input of the NHS Assembly.

• The locus of decision-making and resources will be centred more on the Regional Directors and their teams.

• Corporate Directors and their teams will provide strategy, support and services, such as improvement capability, run activities where those activities only need to be done once and benefit from scale, and deliver national regulation, guidance and support to the NHS as a whole.

• NHSI and NHSE state that this model will be adaptive, meaning that as local systems improve, the balance of activities that take place in regions and in the local health system may shift so that services, support, regulation and improvement are all located where they best deliver improved care.

• NHSI and NHSE are developing a shared narrative covering their purpose, identity and priorities which will soon be tested against the long term plan and with the new Joint Executive Group. They will also work to develop a shared culture and set of values and behaviours.

• NHSI and NHSI will undertake a single internal planning process and are aiming for a fully integrated approach for 2020/21.

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Governance model for joint working between NHSE & NHSI

• In terms of executive leadership, proposals include:

• The creation of a single NHS Executive Group, co-chaired by two CEOS and with membership from national directors from the two organisations and the new regional directors

• A set of single national director roles, reporting to the two CEOs, which include a single NHS Medical Director, a single NHS Nursing Director/Chief Nursing Officer for England, a single Chief Financial Officer and a single National Director for Transformation and Corporate Development

• Single regional teams bringing together NHSI & NHSE functions, led by regional directors with a single reporting line to the two CEOs, and with responsibility for the performance of all NHS organisations in their region in relation to quality, finance and operational performance

• Significant devolution of responsibility to regional directors and a different model of local leadership in the NHS. National teams will provide expertise, challenge, support and intervention

• Several committees in common, including strategy and delivery and performance.

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Final

Report from the audit committee meeting held 21 September 2018

Executive summary

To follow is an update from the audit committee meeting on 21 September 2018 on key discussion items and agreed actions.

Action required





x


x


x


x


x

CQC Regulations supported by this paperRegulation 8 ⃰ General Regulation 13 Financial position

Risks attached to this project/initiative and how these will be managed (assurance)Nil.

Equality analysis


Report from Mary Basterfield, non-executive director and chair of the audit committee

Author(s) Veronica Jackson, committee administrator

Date 16 October 2018



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SPEAKING UP (WHISTLEBLOWING)

The committee received its regular update on ‘speaking up’ and heard from the speaking up guardian and a speaking up champion who worked cross site on their experiences so far. The committee noted that work was underway to recruit more speaking up champions but appreciated that this role was voluntary and was in addition to the day-to-day job. It noted that October would be the trust’s second annual ‘speak up’ month.

Noting the amount of work undertaken and planned in respect of speaking up, the committee asked about markers of success. Although it was still too early in the process to clearly define those, it was noted that a spike in the number of incidents raised had coincided with a trust campaign to raise awareness on speaking up. Plus, the results from the staff survey, particularly in respect of bullying and harassment (B&H) would also provide insight into whether speaking up was having the desired outcomes.

HR felt that having a non-executive director (NED) lead for speaking up would be helpful. It was agreed that the group chairman would be asked to consider this as part of the NED assignments and in time for the Care Quality Commission inspection in October.

BULLYING AND HARASSMENT

The committee requested an update on how the trust’s improvement actions in respect of B&H was faring. It noted that a B&H group was meeting monthly, alongside a fortnightly sub-group and that November would be the trust’s dedicated B&H month. Speaking up champions were also being trained on dealing with B&H incidents coming through the speaking up route.

A discussion was had on the nature of B&H cases; it was noted that there were differing views of what constituted that and could cover staff’s perceived inequalities, work related performance matters and issues with poor line management. On the latter, the committee noted that processes and training, such as the trust’s Licence to Lead programme, was in place to help improve ineffective line management. However, it was noted that there were limits to increasing the number of managers able to undertake the training modules, such as funding and resource capability within the organisational development (OD) team. The committee considered there was a financial ask on the OD team to increase the training budget in order to ensure all staff were supported when moving into new managerial roles.

It was suggested that NEDs speak with staff about B&H when undertaking their go-see visits.

DATA QUALITY

The committee received a further update on the trust’s data quality (DQ). The chair considered the update to be the most comprehensive iteration of the report received by the committee so far but there remained unanswered questions in respect of understanding fully what the trust’s DQ issues and hotspots were, and what the trust’s sources of assurance were. A number of the committee’s requests also remained unactioned, e.g. the addition of a heatmap within the report. The chair requested a further update, addressing all of the concerns raised previously, be presented at the November audit committee meeting. The group chief finance and compliance officer agreed to this undertaking, noting that he would circulate a draft report to members for comment in advance of a final report being presented in November. However, he closed by stating that he was able to offer assurance that a number of DQ related issues had been / were being addressed; inconsistencies in A&E arrival / handover times, cancer 2 week waits and RTT which was subject to a lot of external review.

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The committee also agreed to establish whether a go-see visit to Enfield Civic Centre, which housed the DQ team, had been undertaken or was in the pipeline.

INTERNAL AUDIT – KPMG

Progress report: the committee approved the removal of two reviews in the 2018/19 internal audit plan – outsourced contracts and facilities management.

Recommendations follow up: robust effort had been made by KPMG in following up on the outstanding internal audit recommendations. There was still an issue in respect of the DQ recommendations but KPMG would continue to liaise with the senior operations manager – elective access in closing those off. The committee considered it would be helpful to raise awareness of internal audit, their role etc. across the organisation and to have the local / other committees accountable for the recommendations arising from internal audit reviews and involved in chasing outstanding actions.

Internal audit reviews:

• Digital strategy and governance – KMPG had reached an overall assessment of significant assurance with minor improvements required (amber-green), which was in line with management’s anticipated assurance rating. There were five amber rated recommendations – three having been implemented as the report concluded which was positive. The chair considered staff should be encouraged to maintain the momentum made so far in order to close off the outstanding recommendations by their due dates.

• Hospital governance and risk management – KPMG has provided an assessment of significant assurance with minor improvement opportunities (amber-green) which was in line with management’s expectations. Overall, the findings were positive, e.g. consistency in governance arrangements having been seen, but greater controls were needed in respect of the hospital risk registers and ensuring all risks were scored appropriately. This was subject to a recommendation for follow up by the hospital medical directors and the chair stressed that she did not want to see progress fall behind on this important issue.

• General Data Protection Regulation (GDPR) post-implementation – KPMG had provided an overall assurance rating of partial assurance with improvements required (amber -red). It was noted that although the trust had a comprehensive action plan in place to evidence preparedness for new regulations, certain aspects of the execution of that plan required review to better manage the risks of perceived or actual non-compliance, and to better evidence readiness. The chair considered whether the trust board should have a progress update on this at a future meeting; the group chief finance and compliance officer agreed to speak with the chief information officer and information governance group on that point.

Internal audit effectiveness: the committee approved the process for the assessment of internal audit effectiveness 2018-19.

EXTERNAL AUDIT – PRICEWATERHOUSECOOPERS (PwC)

Progress report: PwC had undertaken their debrief of their end of year audit of the trust’s quality accounts (QA); although the process had been slightly rushed at the end, there had been a good plan in place, including testing in year, and that would be replicated in the 2018-19 QA audit. The chair highlighted that she was pleased to see that there had been

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continued dialogue between PwC and the trust on the financial audit and asked that this same approach be taken through the 2018-19 end of year audit.

External audit effectiveness: The committee approved the process for the assessment of external audit effectiveness 2018-19.

LOCAL COUNTER FRAUD SERVICE – RSM

The committee received an update on the proactive work undertaken by RSM since the last meeting. It noted that there was one outstanding recommendation in respect of conflict of interests and gifts and hospitality review but this was the subject of a report on the agenda later on in proceedings. The counter fraud team had also delivered a bespoke fraud and bribery session to the trust board.

In terms of referrals, the committee noted that these were up on last year but RSM saw that as a positive step particularly as many referrals were coming through directly from the wards and divisions, not just finance and HR.

CONFLICTS OF INTEREST

The committee received an update on the implementation of the trust’s conflict of interest’s policy and the process of validation currently underway. It noted that the RSM had reviewed the trust’s policy and has made some helpful comments and suggestions which would be reviewed and incorporated in a revised policy to be presented to the audit committee in November.

FINANCIAL

Cash position update: The chair and group chief finance and compliance officer had spoken on this in advance of the meeting. Given the conversation on going concern at the time of the 2017-18 financial audit, the committee’s understanding of the trust’s approach to operating within a cash constrained environment, in addition to the cash forecast, needed to be addressed. The chair suggested it would be also be helpful to have further details on the commissioning group landscape, particularly those CCGs that were most affected, on supplier payments and for the committee to be sighted on the cash position and whether it was deteriorating as soon as possible.

Tender waivers: The committee received its regular tender waiver report. Following the establishment of the RFL Property Services Ltd (RFLPS), clarification was needed on the audit committee’s role and level of control in respect of RFLPS and other newly created wholly owned subsidiaries. The group chief finance and compliance officer agreed to look into that and report back accordingly.

Losses and special payments: The committee received its regular report on losses and payments; the total to date this financial year was low but these would not be written off until later in the year.

End .

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Report from the people and population health committee (PPHC) held 27 September

2018

Executive summary

The first meeting of the PPHC was held on 27 September July 2018. The key items discussed and decisions taken are outlined below.

Governance PPHC reviewed its revised terms of reference with particular focus on its membership; it was agreed that the council of governor’s bullying and harassment (B&H) champion would become an attendee of the committee. It also undertook regular review of its group goals and board assurance framework risks. Following the disbandment of the quality improvement and leadership committee, the goal in respect of promoting equality and diversity had transferred to PPHC. It was noted that the board had agreed at its meeting the day before to amend the leading indicator for that goal to Workforce Race Equality Standard (WRES) 1: percentage of white and black and minority ethnic managers in bands 8-9.

Developing partnerships PPHC received an update in respect of the trust’s discussions on progressing clinical partnerships with West Hertfordshire Hospitals NHS Trust, North Middlesex University Hospital, Royal National Orthopaedic Hospital, and other NHS providers.

Clinical Practice Groups (CPGs) PPHC started discussions on how to extend CPGs out of hospital. The report provided a first view on the steps needed to build out a pathway and the trust’s current CPG in respect of childhood wheeze was suggested as a starting point for consideration. Childhood wheeze was a common condition nationally and locally and was closely linked to high levels of social deprivation, and it was noted that the current pathway had been redesigned and streamlined in order to reduce significant areas of variability and improve the patient experience. Views centred on engagement outside the NHS, e.g. with 3rd party providers, building relationships e.g. with GPs, the broader benefits to public health initiatives and how to measure success.

Mental health impact on the trust and the population health need PPHC received a report highlighting the impact of mental health on patients and services with the aim of starting a discussion on whether a clinical partnership, e.g. with a mental health trust, could deliver benefits to understanding and managing mental health across the population. Members noted that the trust’s maternity services had undertaken a lot of work in respect of perinatal mental health alongside the patient’s general health. Discussions covered looking at how to help build the population’s resilience to mental health, the mental health of staff and the development of a mental health strategy.

Musculoskeletal (MSK) lead provider for Barnet and Enfield PPHC noted that the trust had agreed not to continue as the lead provider for the MSK



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programme in Barnet and Enfield.

Integrated care systems (ICSs) in North Central London (NCL) PPHC received a paper providing information on the population health challenges across the NCL sector with the aim of seeking the committee’s views on whether it would want to work with a specific borough to develop an integrated care system (ICS). Following discussion, it was agreed that the trust would look to make an ICS plan with Barnet providers.

Workforce and organisational development goals update The PPHC received progress updates against each of the workforce and organisational development goals. A discussion was had on the future reporting of the goals into the committee; it was agreed that the group director of workforce and organisational development would strengthen the workforce annual planner to ascertain what needed to be be scheduled into the PPHC meetings and when. PPHC also considered that it should be tracking performance against the assigned goals, prioritising those goals and risks which were considered to be off-track. In terms of immediate themes, all agreed that the PPHC would focus its attention on B&H, increasing uptake of the annual staff survey, plus a monthly focus on WRES.

New people strategy The draft strategy outlined the initial thinking on the trust’s proposed structure and approach for attracting, engaging, developing and looking after its workforce over the next five to ten years. It was suggested that the trust board may wish to hold a specific board seminar on that topic.

Guardian of safe working reports PPHC received the quarter 4 2017-18 reports which highlighted a number of hotspots, such as recruitment issues, but which were already on the trust’s radar.

Action requiredThe committee is asked to note the report.




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CQC Regulations supported by this paperRegulation 17 Good governance

Risks attached to this project/initiative and how these will be managed (assurance)Any risks would be outlined in the report.


Report from James Tugendhat, non-executive director and chair of the PPHC Author(s) Veronica Jackson, committee administratorDate 16 October 2018

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Report from the clinical standards and innovation committee (CSIC) held

17 September 2018

Executive summary

The key issues discussed and actions agreed at the recent CSIC are outlined below.

Clinical practice group (CPG) pathway presentation – teledermatology The committee received a presentation on the CPG pathway – teledermatology. It was pleased to note that the project had met a number of its aims, i.e. a reduction in the numbers seen in clinic; greater efficiency in the pathway with patients being sent straight to surgery; an improved patient experience; and savings on prescriptions. A discussion was had on the financial elements of the pathway; the committee recognised that the service was financially beneficial for the wider healthcare economy but also noted savings to the group in regards to resource utilisation, prescriptions, use of the right clinic and right treatment from the outset and a reduction in unwarranted variation.

Reports from the site clinical performance and patient safety committees (CPPSCs) The site medical directors presented the first of their respective CPPSC’s updates in the new template agreed for reporting into CSIC. The chair considered this was a good step forward in terms of consistency but noted that the template would be improved further by way of additional sections on ‘key risks identified and how these would be managed’ and ‘new guidance from regulators considered and changes to practice made’.

The chair noted the number of apologies received at the RFH and CFH CPPSCs in July and August. He suggested the medical directors may want to review their committee memberships as these were large and could deter staff from attending.

Quality improvement The committee received a progress update on QI, noting that the greatest risks to the QI programme were around infrastructure and stability, specifically linked to the resourcing of QI experts with the RFL faculty. It was agreed that the committee would receive a QI presentation at every other meeting (alternated with the CPG presentations).

Learning from deaths report – quarter 4 2017-18 The summary of findings had identified nine deaths in quarter 4 2017-18 which were considered likely to be avoidable. The committee was pleased to note that no death had been picked up by the learning from deaths framework that had not already been identified by existing trust serious incidents (SI) processes, indicating that internal tracking processes appeared to be working well. The group chief information officer considered the numbers for the quarter were not indicative of any major concern, and that early indications showed numbers were down to normal levels for quarter 1 2018-19.

National hip fracture database (NHFD) alert, plus mortality update Based on data submitted to the NHFD, Barnet Hospital had reported a mortality rate above



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the 95% control limit for the 2017 data and this had registered as an ‘alert’ requiring further investigation and an examination of data quality. The medical director – Barnet Hospital confirmed that the hospital would undertake a number of actions in response to this notification and report progress to the Falls and Fragility Fracture Audit Programme accordingly.

The committee also received its regular mortality update; the chair noted that, overall, both the Barnet Hospital and Royal Free Hospital had a good mortality position which was better than the national average.

Serious incidents The committee noted that in August 2018 there had been a further 11 SIs. These were being reviewed at the regular safety huddles and the committee agreed to take stock of the position in November.

Never events (NEs) The committee was disappointed to note that there had been a further NE on the Barnet Hospital site. It recognised that there was external anxiety from commissioners around NEs but was assured that the trust had a comprehensive NEs action plan in place and efforts were being made to improve the position such as generating LoCCSIPS, holding safety huddles with the clinical leadership team etc. The group chief nurse and group chief medical officer were also meeting regularly with NHS Improvement to discuss improvement action. The chair reiterated his view that additional mechanisms for preventing NEs should be explored alongside the current plans and would probably involve learning from other industries. This subject would be discussed further at the next CSIC.

Clinical research • Recruitment into NIHR portfolio clinical research studies

The committee noted that the trust was on target to meet its recruitment trajectory. Efforts were ongoing to increase recruitment on the Barnet Hospital site but there were limitations such as space and lack of investment for recruitment.

• Measurement of board goal: Top 3 for research citation The committee recognised that this was an important goal and strategic aspiration. It was noted that RAND had successfully ranked trusts by their citations and the committee was pleased to see that the UCL library had been able to replicate the RAND methodology in order to measure the trusts citation performance.

Education workforce development committee report The committee noted that an improvement had been seen in the term 3 undergraduate medical feedback (good scores) on the Royal Free Hospital and Barnet Hospital sites. There were a greater number of red outliers seen in the trust’s General Medical Council survey results this year; actions were underway to resolve the issues identified at a local and trust-wide level. A comprehensive report on this would be presented at the November meeting.

Policy ratification The committee ratified the following policies: trust health and safety policy (subject to some minor amendments), trust risk policy, and the deceased organ and tissue donation policy (also subject to some minor amendments).

Revised terms of reference The committee approved its revised terms of reference subject to some minor amendments.

Any other business The committee noted that this would be Stephen Ainger’s last meeting. The chair thanked him for his services to the committee, particularly as he had chosen to become a member in

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a voluntary capacity, and for his helpful contributions and insight that he brought to the discussions.

Action required





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CQC Regulations supported by this paperRegulation 9 Person-centred care Regulation 10 Dignity and respect Regulation 11 Need for consent Regulation 12 Safe care and treatment Regulation 13 Safeguarding service users from abuse and improper treatment Regulation 14 Meeting nutritional and hydration needs Regulation 17 Good governance Regulation 18 Staffing Regulation 19 Fit and proper persons employed Regulation 20⃰ Duty of candour

Risks attached to this project/initiative and how these will be managed (assurance)N/A


Report from Prof Anthony Schapira, non-executive director and chair of CSIC Author(s) Veronica Jackson, committee secretaryDate 9 October 2018

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Report from group services and investment committee (GSIC) meeting held 11

October 2018

Executive summary

The GSIC met on 11 October 2018. The key agenda items are outlined below.

Health services laboratory – investor update

Draft accounts were discussed and a review of the financial recovery plan was requested for review at the November meeting.

Wholly owned subsidiaries updates - RFL property services ltd, decontamination and pharmacy

NHSI guidance on subsidiaries was discussed. Business plans for each subsidiary will be considered at the November meeting.

Land opportunities - Queen Mary’s House and plot D

A progress update was provided.

Financial strategy update

The committee found the financial strategy update helpful; particularly the differentiation between recurrent and non-recurrent savings which the committee endorsed.

Options for pricing and charging clinical partners

The committee agreed the principles for pricing and charging clinical partners.

Digital transformation business case 2018-20

Discussion on the business case was deferred; the committee noted that the implementation of digitisation at Chase Farm Hospital had been successful.

GSIC goals and Board Assurance Framework risks The committee undertook regular review of its group goals and received verbal updates on those goals not already covered by the agenda items;

• Efficiency leader on corporate services • CFH deficit eliminated • Double contribution of private patients

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QlikView metrics – GSIC goal measurement

This was deferred to the November meeting.

Action required





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CQC Regulations supported by this paperRegulation 15 Premises and equipment Regulation 17 Good governance Regulation 13 Financial position


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Equality analysis

No identified negative impact on equality and diversity

Report from Wanda Goldwag, non-executive director and chair of GSIC Author(s) Carolyn Cullen, interim trust secretaryDate 26 September 2018

GROUP TRUST BOARD MEETING IN PUBLIC1 A G E N D As3-eu-west-1.amazonaws.com/files.royalfree.nhs.uk/Trust... · 2018-10-22 · GROUP TRUST BOARD MEETING IN PUBLIC1 The next meeting

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