King’s College Hospital Board of Directors PUBLIC AGENDA Time of meeting 14:30 -17.00 Date of meeting Tuesday, 26 February 2013 Venue Dulwich Committee Room, King’s College Hospital Members: Prof. Sir George Alberti (GA) Trust Chair Graham Meek (GM) Non-Executive Director, Vice Chair Marc Meryon (MM1) Non-Executive Director Christopher Stooke (CS) Non-Executive Director Faith Boardman (FB) Non-Executive Director Prof. Ghulam Mufti (GM1) Non-Executive Director Tim Smart (TS) Chief Executive Angela Huxham (AH) Director of Workforce Development Dr. Michael Marrinan (MM) Medical Director Roland Sinker (RS) Chief Operating Officer Simon Taylor (ST) Chief Financial Officer Dr. Geraldine Walters (GW) Director of Nursing & Midwifery Jane Walters (JW) - Non-voting Director Director of Corporate Affairs Jacob West (JW1) - Non-voting Director Director of Strategy In attendance: Prof. Sir Robert Lechler (RL) Executive Director (KHP) Sally Lingard (SL) Associate Director of Communications Tamara Cowan (TC) Board Secretary (Minutes) Apologies: Sue Slipman (SS) Non-Executive Director Circulation to: Board of Directors Circulation List
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King’s College Hospital Board of Directors
PUBLIC AGENDA
Time of meeting 14:30 -17.00
Date of meeting Tuesday, 26 February 2013
Venue Dulwich Committee Room, King’s College Hospital
Members: Prof. Sir George Alberti (GA) Trust Chair Graham Meek (GM) Non-Executive Director, Vice Chair Marc Meryon (MM1) Non-Executive Director Christopher Stooke (CS) Non-Executive Director Faith Boardman (FB) Non-Executive Director Prof. Ghulam Mufti (GM1) Non-Executive Director Tim Smart (TS) Chief Executive Angela Huxham (AH) Director of Workforce Development Dr. Michael Marrinan (MM) Medical Director Roland Sinker (RS) Chief Operating Officer Simon Taylor (ST) Chief Financial Officer Dr. Geraldine Walters (GW) Director of Nursing & Midwifery Jane Walters (JW) - Non-voting Director Director of Corporate Affairs Jacob West (JW1) - Non-voting Director Director of Strategy
In attendance: Prof. Sir Robert Lechler (RL) Executive Director (KHP) Sally Lingard (SL) Associate Director of Communications Tamara Cowan (TC) Board Secretary (Minutes)
Apologies:
Sue Slipman (SS) Non-Executive Director
Circulation to: Board of Directors Circulation List
Enclosure Lead Time
1. STANDING ITEMS G Alberti 14:30
1.1. Apologies
1.2. Declarations of Interest – to receive
1.3. Chair’s Action
1.4. Minutes of Previous Meeting – 29/01/2013 Enc 1.4
1.5. Matters Arising/Action Tracking Enc 1.5
2. FOR REPORT/DISCUSSION
2.1. KHP Update Verbal A. R Lechler 14:35
2.2. Chair’s and Non-Executive Directors’ Report Enc. 2.1 G Alberti 14:50
2.3. Update on Council of Governors’ Activities Verbal G Alberti 14:55
2.4. Chief Executive’s Report Enc. 2.4 T Smart 15:00
2.5. Finance Report – Month 10 Enc. 2.5 S Taylor 15:10
2.7.2. Quarterly DIPC Report Enc. 2.7.2 G Walters 15:40
2.7.3. Quality Priorities 2012-13 & Report –
2013-14 Enc. 2.7.3 G Walters 15:50
3. FOR INFORMATION 16:00
3.1. Confirmed Board Committee Minutes
3.1.1. Equality & Diversity Committee –
29/11/2013 Enc. 3.1.1
4. ANY OTHER BUSINESS 16:05
5. DATE OF NEXT MEETING Tuesday, 26 March 2013 at 14:30 in the Dulwich Committee Room
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King’s College Hospital NHS Foundation Trust Board of Directors - PUBLIC
Minutes of the meeting of the Board of Directors held at 14:30 on Tuesday, 29 January 2013 in the Dulwich Committee Room, King’s College Hospital.
Members: Prof Sir George Alberti (GA) Trust Chair Graham Meek (GM) Non-Executive Director, Vice Chair Chris Stooke (CS) Non-Executive Director Faith Boardman (FB) Non-Executive Director Sue Slipman (SS) Non-Executive Director Prof. Ghulam Mufti (GM1) Non-Executive Director Tim Smart (TS) Chief Executive Roland Sinker (RS) Chief Operating Officer Simon Taylor (ST) Chief Financial Officer Dr. Michael Marrinan (MM) Medical Director Dr. Geraldine Walters (GW) Director of Nursing & Midwifery Angela Huxham (AH) Director of Workforce Development Jane Walters (JW) – Non-voting Director Director of Corporate Affairs Jacob West (JW1) - Non-voting Director Director of Strategy In attendance: Anne Greenough (AG)
Jill Locket (JL) Director of Education and Training, KHP Director of Performance and Delivery, KHP
Sally Lingard (SL) Associate Director of Communications Rita Chakraborty (RC) Assistant Board Secretary (Minutes) James Eales NHS Graduate Management Trainee Marion Mackay
Fiona Clark KCH Charity Governor
Stuart Owen
Governor
Apologies: Marc Meryon (MM1) Non-Executive Director
Item Subject Action
013/01 Apologies The Chair welcomed all public attendees. Apologies for absence were noted.
013/02 Declarations of Interest There were no declarations of interest.
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Item Subject Action
013/03 Chair’s Action There were no chair’s actions
013/04 Minutes of previous meetings – 18 December 2012
The minutes of the meeting held on 18 December 2012 were approved as a correct record.
013/05 Action Tracking/Matters Arising The Francis Enquiry was due to publish its report on 6 February and the recommendations could be far reaching.
013/06 Chair’s and Non-Executive Directors’ (NED) Report
The report on the activities of the Chairman and non-executive directors for the period was noted. Correction: GA did not chair Finance and Performance Committee on 18 Dec.
013/07 Update on Council of Governors Activities
The Chair provided an update on Council of Governor activities:
The recent Governor Development Day was very informative;
The Membership and Community Engagement Committee had discussed the membership strategy and the Trust centenary plans; and
Patient Experience and Safety Committee had received presentations on quality priorities, A&E survey results and improving the patient experience in the Acute Medical Assessment Units.
013/08 Chief Executive’s Report The Board noted the Chief Executive’s report for the period. TS highlighted the following key points:
King’s was the only London FT to be rated ‘green’ for finance and governance at present;
William McKee has been appointed Director of Transition and Transformation. There was some delay with the KHP full business case due to the awaited announcement by the Secretary of State for Health on the future of SLHT but this was expected imminently. Support was expected for the TSA’s recommendation;
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Item Subject Action
The final decision on the Trust’s acquisition of PRUH will be subject to
concluding terms of agreement that the FT regulator and the Trust are content with. Throughout negotiations, the Trust has made it clear that it must maintain its existing financial risk rating from Monitor and that the outcome must be in the best interests of patients at King’s and PRUH; and
There was discussion about recent developments in the Integrated Care strategy. A 24/7 geriatrician hotline was operational. The programme was seeing a change in behaviours with referrals to assessment units, which are GP-led multi-disciplinary teams. A new programme director had been appointed. Fiona Clark commented that there was some anxiety amongst older members of the community that the message about integrated care has not been sufficiently publicised. JW1 responded that a website has been set up, there are more materials being distributed in the community and a public Board has been established including local users. SL offered to take the issues raised to the integrated care communications group.
013/09 Finance Report – Month 9 ST presented the finance report for month 9.
It was noted that the Finance and Performance Committee had conducted an extensive review and discussion around the finance report earlier.
The Board noted the report and the following key points:
Winter pressures were resourced by the local commissioners;
The figures show a £2.4m deficit position after assets impairment but the Trust still remains in operating surplus with a financial risk rating of 3 and this is projected to continue to year end;
2013/14 initial tariffs suggest a 1.5% reduction in income. The Trust is likely to have to implement 2.3% savings. Education and training income will also be tight next year;
CIP targets in tertiary specialties, emergency and diagnostics were the most challenging at present;
In order to reduce the outstanding money from private patients, a more thorough check of each patient’s entitlement should be undertaken before treatment commences. The downward trend in income from some countries was likely to continue; and
Agency spending was high during winter as more temporary medical staff were hired to cope with the increase in patient activity.
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013/10 Performance Report – Month 9 RS presented the performance report for month 9.
It was noted that the Finance and Performance Committee had conducted an extensive review and discussion around the performance report earlier. The Board noted the report and the following key points:
Month 9 performance against core Monitor targets was strong with all access, referral to treatment (with the exception of 62 day cancer wait) and infection control targets achieved;
Performance challenges included A&E with some elective operations cancelled as the result of continuing high levels of emergency admissions. The referral to treatment target was unlikely to be met in Q4;
Five other areas of concern are slips, trips and falls, complaints response times, Mixed Sex Accommodation (MSA) and Maternity and Day Surgery. Actions are in place to manage these; and
Pressures on ED remains a major issue. Despite investment in A&E services and a 24/7 Acute Assessment Unit, the Trust was dealing with unprecedented levels of activity ;
The Board made the following observations:
The criteria for relocating patients involves identifying appropriate patients to move and network collaboration;
The corporate dashboard is reviewed annually to ensure a balance of indicators that: i) provide an early alert, such as data on training and line audits for infection control; and ii) provide assurance on data accuracy, such as KPMG’s scrutiny of 3 indicators and mock CQC inspections.
A more explicit presentation of weak indicators was suggested. Despite the Trust’s comparative good performance, a self-critical approach was welcomed; and
It was noted that if the Trust acquires the PRUH and is able to improve standards there, this will have a positive effect on care and finances at King’s also.
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Item Subject Action
013/11 Quarterly Patient Outcome Report The Board noted and discussed the Quarterly Patient Outcome Report. The report summarised the work of the Public Health Committee and its Health Improvement Groups.
There are high rates of lifestyle related illness and lower than average life expectancy in the local population;
The Trust is encouraging patients to make healthier lifestyle choices; however it is acknowledged that acute hospitals have a limited impact in this area;
Areas that the Committee and its feeder groups are focussing on are smoking, alcohol, obesity and healthy eating, physical activity, mental health, sexual health, oral health, occupational health, maternity and teenage pregnancy, sexual health and HIV, and older people’s health;
Some improvements have been identified in breastfeeding, teenage pregnancy rates and smoking in pregnancy;
A national audit of King’s health promotion showed the Trust was significantly better than the national average for assessing health risk factors but not for providing the appropriate interventions; and
CQUIN targets were being achieved.
The Board offered the following comments:
Given the size of the combined KHP workforce, there were opportunities to change attitudes of staff and their families. The Global Corporate Challenge generated interest at all levels of the organisation;
The proposed PRUH acquisition offered wider geographical reach across south east England;
Hospital visits can be an effective trigger for behaviour change because of patient trust in hospital doctors; and
Programmes run by local councils focus on targeting the population as a whole.
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Item Subject Action
013/12 KHP Update
Prof Anne Greenough presented a comprehensive update on the education and training workstream. Areas covered included:
- Innovative technology and teaching – KCL has adopted the quality mark; a learning hub provides all lectures on video via the website;
- Inter-professional education and training – patient safety is being developed as a vertical strand in the MBBS;
- Increasing research capacity – the quality of trainees is very good;
- Careers management – the model will be rolled out across all disciplines
- Global health education and training – a busy year including research on learning outcomes from electives in low and middle income countries;
- State of the art simulation suite and learning centre;
- CAG education and training leads and metrics – KCL teaching database has now been extended to all NHS consultants; firm survey results mirror the National Student Survey questions and can be split by campus, CAGs, department and individual teachers; there are currently 30 MScs programmes available;
- GMC review – communication needs improvement; the KCH campus needs a state of the art education facility;
- “You said – we did”; and
- South London HIEC – this project has brought together a large number of diverse organisations. An event on 15 March will explore SLHIEC solutions for the future.
The Board offered the following comments:
The NSS undergraduate survey results, GMC review and external review results all need to be taken on board. The expansion of the medical school made it much more challenging for staff to know each student. Prof Greenough responded that this was the case in phases 1 and 2 but that Firms should know their students in the later stage of the course as the numbers are the same as when we were KCH Medical School; and
Real time feedback was available to identify non-attendance of teachers at large lectures.
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Jill Locket, KHP Director of Performance and Delivery, updated the Board on the following:
AHSN licencing will be announced shortly and KHP was hopeful of securing £10m over 5 years;
Tariq Sethi has been appointed CAG Leader for Respiratory, Allergies and Critical Care;
An event will be held on 16 April for the top 250 people to celebrate KHP’s success; and
The re-accreditation process will begin in October 2013.
013/13 Monitor Submission Quarter 3 2012/13 The Board approved the Quarter 3 submission to Monitor.
013/14 Any Other Business
There were no other items of any other business raised for discussion.
013/15 Date of Next Meeting
Tuesday, 26 February 2013 at 14:30 in the Dulwich Committee Room.
Board of Directors – Public Meeting Action Tracker Enc 1.5
Board of Directors Meeting – 26 March 2013 1 of 1
Meeting Date
Item Action Who Due Date Notes
Not Due
30/10/2012 012/149 PE would return in six months to give an update on progress to implement the cancer patient experience action plan.
PE/LM 30/04/2013
30/10/2012 012/149 JW would undertake some research into the demographics of the cancer survey respondents and report back to the Board in due course.
JW Early 2013
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Report to: Board of Directors Date of meeting: 26 February 2013 By: Tim Smart, Chief Executive Subject: Chief Executive’s Board Report 1. Executive Summary
This has been a very difficult month on a number of fronts, both locally and nationally. We are very pressurised by the volume and acuity of emergency patients, and this is impacting on our ability to meet access targets. Unlike other organisations in the news, we have not yet had to make any really difficult decisions that compromise our ability to meet targets, and we have absolutely no intention of doing anything that compromises patient safety. New capacity is being brought into service, and this will make a difference to patient flows. We were all shocked by the distressing circumstances described by the Francis Report. The Board is digesting what it means for our assurance processes, and will report in due course. We are also starting a series of staff listening events, because one of our values is ‘Inspiring Confidence in Our Care’, and reassuring staff about our focus on patients, and listening to their concerns, is an important leadership process. We are also reviewing any Compromise Agreements which we have with ex staff, and are reviewing everything we do in this area to ensure that we encourage staff to identify concerns where they have them. And we continue to work with vigour and professionalism on the PRUH acquisition, and on the early stages of the KHP full business case. I would like to thank all staff, and the governors, for their engagement in these vital strategic matters. The Trust has been operating under significant financial strain this year, but we are in a position where we expect to breakeven at the close of the financial year. In Monitor’s eyes, we are the highest performing Trust in London, which is a considerable achievement and I appreciate the hard work and commitment that has gone into attaining this. 2. Finance – month 10
At the end of month 10 (January) the Trust has a deficit position of £3.071m, against a year to date planned deficit position of £624k. This is a variance from plan of £2.447m and a positive movement in month of £47k. The Trust’s overall Monitor financial risk rating at month 10 remains at 3. This is in line with the overall risk rating in the annual plan.
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3. Performance – month 10
As expected, January was a very challenging month for performance, with emergency admissions being even higher than expected. Despite this, the Trust achieved the required performance standard of 95% for treatment of all types of accident and emergency attendances within four hours. As planned, the Trust has not achieved the target of 90% for 18 week referral to treatment for admitted patients as the treatment of longer-waiting patients has been prioritised. At the end of the month the patients who remained on the waiting list were within the required targets. Cancer wait access targets have been under pressure in January and there has been a marginal underperformance. However, the Trust remains confident that this can be managed throughout the rest of the quarter in order to achieve the required levels for these indicators. The Trust has had another successful month with regard to hospital acquired infection rates. There have been no reported MRSA bacteraemia in month 10 and it is now over 300 days since our last reported post 48 hour bacteraemia. There have been two reportable C-difficile cases in month 10, resulting in a year to date performance of 47 compared with our quota of 63 cases. The start of month 11 has provided further challenge as emergency attendances remain higher than expected. 4. South London Healthcare Trust and King’s Health Partners
Following submission of the Trust Special Administrator’s final report on the 08 January 2013, the Secretary of State announced his decision on the recommendations on the 31 January 2013. With the exception of the University Hospital Lewisham (UHL) service reconfigurations, all the recommendations were accepted in full. The UHL service reconfigurations will be subject to a review by the NHS Medical Director, Professor Sir Bruce Keogh. The King's team are continuing to prepare a full business case in relation to this transaction. There is now broad agreement that should the transaction proceed, although this is unlikely to happen before 01 July 2013 and, on this basis, the Board will review the business case in early April. If the Board decides to proceed, the business case will be submitted to Monitor for review in mid-April. Work continues within King’s Health Partners on planning the next steps towards creation of a full business case for the potential merger of the three NHS Trusts and closer integration with King’s College London. Following his appointment as Director of Transition and Transformation, William McKee is now beginning to assemble his team and progress development of the business case. However, due to the on-going focus on South London Healthcare Trust this work has of necessity slowed down. The team that has been developing plans for the south London Academic Health Sciences Network (AHSN) held a formal panel interview on 24 January, with the national lead, Sir Ian Carruthers, Sir John Bell, Russell Hamilton from the National Institute for Health Research, and senior industry representatives. We expect to hear by the end of February whether or not the AHSN will be licensed to operate from 01 April 2013. Good progress is being made, in particular with the first of the clinical themes: diabetes. On 01 February a large number of clinicians, academics, patients and other stakeholders from across the network area came together to discuss the needs across the 12 south London boroughs, and began to explore potential solutions.
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5. Integrated Care
There are now 52 GP practices signed up to deliver integrated care across Lambeth and Southwark and 7 Community Multi-Disciplinary Teams (CMDTs) regularly meeting to discuss and action care for older people with complex needs. Work is on-going to simplify the hospital discharge process including looking at assessment and referrals from the acute sector, electronic information sharing, a single point of access for community services and a more responsive community service. The Programme Board has approved the proposals to use a small number of ICT products that support the sharing of patient information across the health and social care settings and work has begun to implement these. 6. Dignity Month
This is Dignity Month, which involves all Board members and governors visiting wards in a programmed and organised way to promote patient dignity. Treating patients with dignity is a fundamental principle which runs through all of the King’s Values. The Innovation in Dignity Care awards on 11 March will celebrate and promote innovation and will be the culmination of a programme of ward visits and masterclasses which champion the importance of dignified care. Ward visits represent an opportunity for interaction across the organisation and for patients, nurses, therapists, housekeeping staff, volunteers, governors and directors to share ideas about how to improve the experience of patients. 7. Capital, Estates & Facilities
Critical Care Unit – Enabling works are to commence in early March for this new purpose built critical care facility with capacity for 60 patients over two floors. Staff are invited to view architectural plans and to gain an understanding of the building process at drop-in events this month. Helideck – Detailed design is underway and a works methodology has been developed in parallel with the Critical Care Unit scheme. Cheyne Wing Ground Floor – Refurbishment of the corridors on the ground floor of Cheyne Wing will commence in early March and take 12 weeks to complete. The works will refurbish floors, walls ceiling, doors and lighting from Renal Outpatients to the central bear pit area. Solar Panel Installation – During February the Estates team will install solar panels on two roof pitches of the Day Surgery Unit. By generating electricity to be used within the estate these solar panels will provide the Trust’s first renewable source of energy. Golden Jubilee Wing Lifts – Works have commenced to upgrade the lifts in the GJW. All lifts will be completed by the end of May 2013.
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8. Media & Events (17 January – 15 February)
Press and broadcast coverage
23 January - King’s Consultant Hepatologist Dr Varuna Aluvihare provided expert comment for a BBC Online article about the UK’s first altruistic liver donation. Dr Aluvihare discussed the risks involved in donating part of your liver. 29 January - Dr Varuna Aluvihare was also interviewed on BBC Radio 4’s Inside Health. Dr Aluvihare provided expert comment on the number of alcohol related deaths in 2012. 9 February - Dr Emer Sutherland, A&E Head of Nursing Tricia Fitzgerald and social worker John Poynton were the focus of an in-depth article in The Sunday Times about how the work of our Emergency Department helps victims of gang violence. In the first scheme of its kind in the UK, youth workers are based in the Emergency Department at King’s so they can talk to victims of gang violence when they are in a “teachable moment”. This work is sponsored not only by the Trust but also by the charities across KHP. 17 January-15 February - There has been extensive media coverage about the Trust Special Administrator’s recommendations to break up South London Healthcare NHS Trust, and make changes to Lewisham’s A&E and maternity services. There has been coverage – albeit on a smaller scale - about the Secretary of State for Health’s decision to recommend King’s acquisition of the Princess Royal University Hospital. However, most of the media attention has been focused on changes to Lewisham, and the potential impact this could have on King’s maternity and A&E services, as well as other hospitals in south east London. Events 31 January – The Minister for Civil Society, Nick Hurd MP officially opened a new volunteers area at King’s, located at the entrance of Hambleden Wing. During his visit, Mr Hurd MP was introduced to some volunteers and heard about what they do, why they do it, and their experience of King’s. Mr Hurd was also given a tour of the Cardiac Catheter Lab, general surgery and our urology outpatient area. Upcoming 21 February – King’s staff and governors will be meeting with key stakeholders from Bromley to discuss the proposed acquisition of the Princess Royal University Hospital. 9. Consultant Appointments
Following Advisory Appointment Committees in the past month, there have been three consultant appointments.
Specialty New/Existing Appointee Start date
Medical Microbiology New Surabhi Taori 01/03/2013
Anaesthetics (Major Surgery)
Existing Derek Amoko
01/03/2013
Anaesthetics (Major Surgery)
Existing Tim Hughes 01/04/2013
10. Chief Executive’s Brief
The CEO Brief for February is attached.
CHIEF EXECUTIVE’S BRIEF February 2013 Issue 77
An update from the Chief Executive to all staff at King’s College Hospital
‘Mid Staffs’ will forever be synonymous with the lowest quality of care that the NHS is capable of
delivering. ‘Francis’ hopefully will be synonymous with a turning point for the culture of the NHS.
Compassionate and kind care at the centre of everything we do. I think that is what our values
mean, and in particular ‘Inspiring Confidence in Our Care’. I hope there won’t be any knee-jerk
reactions to the report, and we at King’s will definitely want to look carefully at its findings and at
the way the Board is connected to the ward. I will keep you informed of our plans, and I hope
anyone in Team King’s who is concerned about quality issues will let us know.
As we come towards the end of another challenging year for the NHS, King’s is in a relatively good
place. Although our finances are as challenged as ever, we have had a very good year in terms of
patient safety, and in terms of strategic development. We have a very strong team, and we are
grateful to everyone for their commitment. At the beginning of last year I remember saying that our
Values would help sustain us, and it seems that is the case, even though we still have financial and
operational performance issues that need to be resolved.
If we acquire the Princess Royal University Hospital in Bromley, it will be the most significant
development at King’s for many years. We will be able to improve healthcare for the populations in
outer southeast London, and this will in turn improve our capacity constraints here on Denmark Hill.
I know that all of us will want to embrace our colleagues in Bromley and welcome them to the
culture that makes King’s great.
However, there are difficulties associated with last week’s announcement by the Secretary of State.
There is a lack of clarity about emergency care at Lewisham, and that will have knock-on effects for
all of King’s Health Partners, as will the downgrading of the maternity provisions at Lewisham. We
will need to invest in more capacity on Denmark Hill, and we will have to work ever more closely
with our colleagues at GSTT to ensure that we can accommodate the increased workload. The
implications for the KHP journey, and the potential merger of the three FTs, are still being assessed.
We are busy planning the events to commemorate the centenary on Denmark Hill, and I am quite
excited about them. We have been making a contribution to the communities around this location
for 100 years, and we are looking forward to the next 100 years. Who would care to imagine what
healthcare will be like in 100 years. We certainly have to navigate some still very tricky waters in the
next few years, but I am optimistic that we will do so.
Last week we received a visit from Nick Hurd MP, the Minister for Civil Society in formal recognition
that our volunteers programme is exemplary and could be used as a model to help improve the
quality of care across the NHS. We have over 700 volunteers now, and they are very representative
of the communities we serve. They undoubtedly improve the quality of care we provide, and I thank
them all. I also thank staff across the hospital for helping them integrate into Team King’s.
Tim Smart
Chief Executive
An update from the Chief Executive to all staff at King’s College Hospital
Find out more about new Critical Care Unit
As many of you will know, the Trust is in the
advanced planning stages for a new, cutting edge
critical care facility here on the King’s site.
With capacity for 60 patients, accommodated over 2
floors, the new facility will enhance King’s ability to
care for our sickest patients. It will be equipped with
state of the art assessment and monitoring
equipment, and provide a more appropriate
environment for staff to work in, and patients to be
treated in.
The Trust is holding two drop-in sessions during
February so that staff within the hospital can view
and comment upon the proposals, time line and work
plan. They are as follows:
At these sessions there will be a chance to meet the
architects, review the architectural designs and
drawings, understand how the building process may
impact upon the hospital, and how the new unit will
change the environment we provide to care for
critically ill patients.
Staff Appraisals
Appraisals are a key way for managers to monitor
how their staff are progressing, and an opportunity
for staff to identify ways for them to improve and
progress in their careers. Everyone in the Trust needs
to be appraised, and the details need to be
completed on the Electronic Knowledge and Skills
Framework (e-KSF) by 31 March. If you need a
refresher course on how to use e-KSF, please contact
The annual capital budget is £19.244m as at month 10, an increase of £282k on month 9. The additional budget is covered by funding from the
Foundation Trust Financing Facility for the Critical Care Unit of which £3m is expected to be utilised in 2012/13.
Capital Expenditure YTD
Capital expenditure to month 10 was £17.283m against a reforecast year-to-date budget of £16.513m, a YTD overspend of £770k.
The overspend against YTD budget is primarily due to the overspends on the Endoscopy Unit and Units 4 & 6 (below).
Capital Scheme Projected Variances
The forecast overspend to year-end is £3.7m (19% of current capital budget) against the revised plan.
The Trust is exploring measures to reduce the forecast overspend at year end. These will include a review of IT schemes and Minor Works
schemes to potentially defer projects which are not critical or have not been started.
Page 25
Month 10 Capital Summary
Capital SchemeOverspend
£'000Comments
Endoscopy 865
Additional costs due to decontamination equipment requirements, unforeseen works, changes to specification and
contract programme delayed by 3 months caused by work stoppages due to noise (site located in main site with
adjacent clinical services). Provision of a further X-ray room.
AAU move to old Endoscopy area 300 Additional costs due to design requirements and fees. £50k Accelerator fees included.
Units 4 & 6 420Unit 6 change of use of 1st Floor to clinical area (Assisted Conception Unit) and Unit 4 additional cost to include
transformer for power supply.
Emergency Department 100 Additional external works required to install transformers.
Transfer of Renal Services to Dulwich 200 No budget allocated as this is a new project required for Winter Bed Pressure Capacity Planning
Brunel Ward 250No budget allocated. Reconfiguration of Brunel Ward to accommodate additional Winter pressure capacity
requirements.
MRI Building Works 177 Delays due to equipment specifications leading to contract extensions and additional design fees.
PET CT Scanner Design Fees & Enabling Works 100 No budget allocated as this was a new project required to accommodate the purchase of the PET CT Scanner.
Other Major / Minor Work Schemes 369 Overspends due to unplanned essential capital maintenance works.
Medical Equipment Purchases 905Purchase of urgent medical equipment or equipment to support income generating schemes approved through
Working Capital Facility - represents a sum of money reserved by the relevant bank for potential use by
the Foundation Trust
Asset - An asset is a resource controlled by the enterprise as a result of past events and from which future
economic benefits are expected to flow to the enterprise Liability - an entity's present obligation arising from a past event, the settlement of which will result in an
outflow of economic benefits from the entity
Equity - the residual interest in the entity's assets after deducting its liabilities
EBITDA – Earnings before Interest, Taxation, Depreciation and Amortisation
EBITDA Achieved (% of Plan) – measures the achievement of earnings against plan
EBITDA Margin (%) – Measures Earnings as a percentage of total income indicating underlying
performance
Return on Assets excluding Dividends – Net surplus before Dividends as a percentage of average assets
indicating financial efficiency
I & E Surplus margin net of dividends – Net surplus as a percentage of total income indicating financial
efficiency
Liquidity Ratio (days) - The liquidity ratio (days) indicates the number of days that net liquid assets can
cover operating expenses without further cash coming from cash sales of fixed or long-term assets.
Enc. 2.5
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Finance and Performance
Committee
2012-13 Month 10
Performance
Roland Sinker
Chief Operating Officer
Enc. 2.6
Report to: Board of Directors Meeting
Date of meeting: 26 February 2013
Subject: Performance Report, Month 10 2012/2013
Author(s): Peter Fry, Assistant Director of Performance and Contracts
Presented by: Roland Sinker
Sponsor: Roland Sinker
History:
Status: For Information
2
1. Background/Purpose This report provides the details of performance achieved against the governance indicators defined in the
Monitor Compliance framework for the interim Quarter 4 position based on performance reported for January
2013. It also contains an update on the Trust’s contractual position at Q3 in relation to its CQUIN performance.
2. Action required Alongside the Monitor Quarter 4 2012/13 report, the Board is asked to approve the performance reported
against the governance indicators defined in the Monitor Compliance framework for Quarter 4 as detailed within
this Month 10 Performance Report.
Enc. 2.6
3
Legal: Statutory reporting to Monitor and the DH.
Financial: Trust reports financial performance against published plan.
Assurance: The summary report provides assurance that the Trust has met all targets as defined
within the Monitor compliance framework for the interim Q4 position in 2012/13
based on January 2013 performance, with the exception of 2 cancer waiting time
targets and the RTT Admitted target. The Trust can only achieve an Amber-Green
governance rating for Q4 due to the RTT Admitted target not being achieved in
January 2013.
Clinical: There is no direct impact on clinical issues.
Equality & Diversity: There is no impact on equality & diversity issues.
Performance: The summary report demonstrates that the Trust has achieved all performance
indicators for the interim Q4 position based on January 2013 performance as defined
in the Monitor compliance framework, with the exception of 2 cancer waiting time
targets and the RTT Admitted target.
Strategy: Performance against the Trust’s annual plan forecasts and key objectives.
Workforce: None.
Estates: There is no direct impact on Estates.
Reputation: Trust’s quarterly and monthly results will be published by Monitor and the DH.
Other:(please specify) None.
3. Key implications
Enc. 2.6
4
Contents
•Executive Summary
•Trust Performance Summary
•Divisional Performance Summary
•Regulatory/Contractual Performance
• Monitor 2012-13 Q4 position
• CQUIN 2012/13 Q4 update
• Care Quality Commission (CQC) – Quality Risk Profile Update
•Specific Performance Reports
• Emergency Care Action Plan Update
• RTT Q4 Performance Update
• Infection Control Update
Enc. 2.6
5
Executive Summary (1/5)
1. Trust Wide 2012-13 Performance for Month 10:
Good Performance
The Trust achieved the 4-hour waiting time standard for January at 95.1% despite the sustained pressure
experienced in the A&E department over the current winter period. RTT waiting time targets were achieved
for Non-admitted and Incomplete pathways in January. However, the Trust did not achieve the RTT
Admitted target of 90% as planned, with 88.8% of patients seen within 18 weeks. Cancer waiting time
targets were achieved in January with the exception of the 2-week wait and 31 day subsequent treatment
for surgery standards.
No further MRSA cases were attributed to the Trust during January so the Trust has 1 case YTD which is
lower than our quota of 4 cases for the YTD position. It is now over 300 days since the first case was
reported this year. 2 further c-difficile cases were reported during January, so the Trust has declared 47
cases to date, lower than our quota of 63 cases for the same period. This compares favourably to the 85
cases that were reported at this point last year.
Performance challenges
ED - Delivery of the 4-hour A&E waiting time standard in Q4 remains a concern, given the continued high
levels of bed occupancy experienced into February on general/acute wards and the critical care units.
The Trust has reported two 12-hour trolley wait breaches for the first week in February predominantly due
to patients waiting for side-rooms, but patient safety was not compromised.
RTT – The Trust continues to utilise off-site capacity from a range of providers to ensure that it can treat its
long-wait and 52-week wait patients, as this is also one of the key areas of focus for the commissioners.
Delivery of the RTT admitted target therefore remains a risk for remainder of Q4 which is in line with our
plan submitted to Monitor. As this indicator has not been achieved in January, Monitor will assess the
Trust as not meeting this standard for Q4 as the target must be achieved for each month in the quarter.
Tertiary transfers – Repatriation bedday delays increased to effectively 9 beds on average per day during
January compared to 7 beds in December due to bed pressures and remains a strategic and clinical risk
as reported last month.
Enc. 2.6
6
Executive Summary (2/5)
Diagnostic Waits - There were 218 breaches of the 6-week diagnostic waiting time standard at the end of
January compared to 147 breaches at the end of December. The increase was largely due to 49
breaches in non-Obstetric ultrasound and 84 breaches in endoscopy. Over 4.4% of patients are waiting
over 6 weeks for diagnostic assessment compared to the national 1% target. Current performance
represents a significant risk to the Trust that the backlog will not be cleared by the end of March, as this
indicator is included in the draft Monitor proposals for its 2013-14 Risk Assessment Framework.
Actions
Emergency Access Targets: Additional emergency medical beds have now come on-line as planned.
The outcome of the Root Cause Analysis into the two 12 hour trolley breaches will be reported to the
Finance & Performance and Quality & Governance Committees. To support the delivery of the agreed
divisional actions which form part of the Trust’s Winter Resilience Plan, daily meetings including all
divisional managers continue, chaired by the Assistant Director of Performance & Contracts.
Waiting List Access Targets: Additional on-site capacity for a short-stay elective ward became
operational at the end of January to provide ring-fenced elective activity. Additional off-site capacity
continues to be utilised, and additional lists have been secured at The Lister Hospital for General Surgery
and T&O, and Harley Street for Neurosurgery. The internal audit that has been agreed with our
commissioners to review our RTT monitoring processes has commenced which KPMG are leading on. EY
are supporting the Trust on work around restricting access for out of area care and longer-term off-site
moves.
Tertiary transfers: The Trust plans to provide additional capacity with the proposed Infill 4 and 5
developments will mitigate concerns being raised by other hospitals in relation to the current delays
experienced in transferring tertiary patients to the Trust.
Diagnostic Access Targets: There is a further 2 week delay before the new MRI scanner becomes
operational. Medinet will continue to run lists at the weekend, and will run additional lists during week-
days to fill unused capacity that cannot be run due to the difficulties in recruiting nursing staff for the new
Endoscopy unit. An additional weekend list will be run by KCH staff from 18 February 2013. Additional
weekend lists are being planned to help reduce the level of non-obstetric ultrasound breaches that were
Enc. 2.6
7
Executive Summary (3/5)
reported at the end of January. The position deteriorated due to the loss of one scanner which could
not be replaced by the manufacturer, and the department is attempting to source an additional
scanner. Additional clinics have been run in February to reduce the echocardiography backlog and
has more than halved the number of breaches. Additional room capacity is being sought in order to
manage the demand and breach position from March onwards.
Health Care Acquired Infection (HCAI): C-difficile remains a risk due to the low trajectory that has
been set for this year. Enhanced actions from the 2011-12 HCAI Action Plan continue into the new
financial year, and additional measures have been incorporated into the Trust’s Winter Resilience
Plan.
Francis Report actions: The final report into the care provided by Mid Staffordshire NHS Foundation
Trust was published on 6 February 2013. An internal working group has been convened with non-
executive and Governor representation as well as senior leadership within the Trust. The group will
provide an initial review of the recommendations within the Francis Report and assessment of key
areas of reporting and Board Assurance that require improvement. An interim report will be taken to
the Finance & Performance Committee in March.
Other areas of concern:
Day Surgery Unit (DSU): Detailed investigations are on-going and a full report on the DSU Action
Plan following the ‘mock’ CQC inspection will be taken to the Finance & Performance Committee in
March.
Mixed Sex Accommodation: There were 27 Single Sex accommodation breaches reported in
January 2012, which represents a slight increase compared to the 23 cases reported in December. All
breaches were delayed discharge patients from surgical and medical critical care units.
Safety indicators: Red shifts, and slips, trips and falls remain high and above target.
A never event due to a retained swab was reported in a Neurosurgery patient. Preliminary findings
have been presented to the Serious Incident committee in February, with the aim of the formal findings
being reported to the March committee meeting.
Enc. 2.6
8
Executive Summary (4/5)
Supplies of meat products: In light of recent events, Medirest have contacted the Trust to confirm that they
have taken a decision to use only processed beef products where it has been sourced and processed in the
UK and Ireland for the foreseeable future. Medirest has also commenced its own independent DNA testing
programme across all of their processed meat products.
2. Regulatory
• Monitor Q4 position
The Trust achieved all performance indicators in January with the exception of 2 cancer waiting time targets
(31-day subsequent surgery and the 2 week wait for all cancers, and the RTT Admitted target. Although
delivery of the cancer waiting time targets remains a risk, we expect to achieve the targets for Q4 overall.
The Trust is therefore rating itself a provisional score of 2.5 in the Monitor Compliance Framework based on
the January 2013 position, which would give the Trust a governance risk rating of Amber-Red. Due to the
RTT Admitted target not being achieved in January, the best rating for Q4 would be Amber-Green.
• Care Quality Commission (CQC) Quality Risk Profile (QRP)
February 2012 QRP report showing 5 outcomes rated better than expected (previously 6) and 11 outcomes
rated similar to expected (previously 10).
3. Contractual
The Trust is being proactive in working with our lead commissioners who have expressed concerns over our
current RTT and diagnostic waiting performance and the recent 12 hour trolley breaches in A&E, as well as
some issues in relation to incident reporting and A&E exception reporting.
• CQUIN 2012/13
The Trust has submitted Q3 CQUIN evidence and expects to achieve 100% of the CQUIN scheme
standards, with an associated financial value of £2.7m. The Trust has achieved the National Inpatient
CQUIN for this year based on the Inpatient survey and scored 6.85 compared to the 6.70 target, securing
£241k income for Q4. Other CQUIN areas are on track for Q4 and work is on-going to finalise data
collection and reporting functions for the dementia pathway.
Enc. 2.6
9
Executive Summary (5/5)
• CQUIN 2013/14
The Trust is awaiting feedback from the Clinical Commissioning Group on the first round of proposals for
CQUIN schemes in 2013-14. In order to release CQUIN funding for 2013-14, the Trust is required to report
to commissioners on five DoH ‘High Impact Innovations’. Information is being collated on Trust plans to
participate in telehealth/telecare, intraoperative fluid management, international and commercial activity, use
of digital technology to reduce unnecessary face to face contacts and supporting carers for people with
dementia. Details of the Specialised Commissioning CQUINs is outstanding but due imminently.
4. Specific Performance Reports
• Emergency Care Action Plan Update
Medicine have continued to use the Cotton (surgical) ward until the middle of February and the additional 12
medical beds have now come on-line as planned. Despite the challenging performance issues that the A&E
department is experiencing into February, the Trust has held off significant steps around restricting access.
Further details on the priority actions can be found in the update later in this report.
RTT Q4 Performance Update
The Trust did not achieve the RTT Admitted target in January 2013 with 88.8% of patients seen within 18
weeks compared to the 90% target. Despite severe bed pressures impacting on elective activity and a 57%
increase in the number of patients cancelled within 7 days of their admission during January compared to
December, the Trust has managed to maintain its backlog position. The number of 52-week wait patients
has reduced from 129 in December to 118 in January, and the plan is to have less than 50 patients waiting
by the end of March.
The Trust continues to utilise significant capacity from a wide range of providers to mitigate against the on-
site bed pressures and improve its long-wait position. Additional list capacity has been secured in February
and March at The Lister Hospital for General Surgery and Harley Street for Neurosurgery.
Infection Control
Further details on the enhanced actions for 2012-13 can be found in the HCAI Action Plan, provided later in
this report.
Enc. 2.6
10
Contents
•Executive Summary
•Trust Performance Summary
•Divisional Performance Summary
•Regulatory/Contractual Performance
• Monitor 2012-13 Q4 position
• CQUIN 2012/13 Q4 update
• Care Quality Commission (CQC) – Quality Risk Profile Update
•Specific Performance Reports
• Emergency Care Action Plan Update
• RTT Q4 Performance Update
• Infection Control Update
Enc. 2.6
Trust Month 10 Performance
Summary
Domain* Key Highlights Key Actions
• Adverse financial moves from the projected year-end position to be discussed at the Month 10 divisional performance review meetings. •CCTD division are undertaking a 6-month theatre program which includes looking at improving the pre-assessment pathway to reduce cancellations and improve patient experience/care.
10 5
Clinical
Effectiveness
8
Safety
8 2
Patient
Experience
7
Finance & Operational
Efficiency
2 1
Staffing measures
3
7
Staff Vacancy rate is at 7.1% in January – within the 5-8% target tolerance. Key concerns:
Mandatory & Statutory Training – overall training index score has increased by 2% in Jan to 65 but remains below target Appraisals – 36.1% of staff have had their appraisal performed in-year compared to the 75% target.
*Number of red/green indicators by domain from Trust scorecard
• Focus on staff appraisals to be conducted for the end of March
11
Patient access targets for Emergency care 4-hour performance, Referral to Treatment (RTT) Non-Admitted and Incomplete measures, and all Cancer Waiting Times except for 31 Day Wait for 2nd Treatment (Surgery) have been achieved this month. Elective ALOS has increased to 5.9 days, 1.2 days above the 4.7 day stretch target. Repatriation bedday delays increased from 217 to 265 - effectively 9 beds per day on average for January compared to 7 beds per day last month. Key concerns are: • RTT pathway targets – whilst the 95% Non-Admitted target and 92% Incomplete target were both achieved in January, 88.8% of patients were admitted within 18 weeks in January, therefore not achieving the 90% RTT Admitted target. • Emergency Care – 95.1% of patients were seen in A&E within 4 hours, achieving the 95% target for January Leading indicators for efficiency: Recording of Expected date of discharge (EDD) has decreased to 51.3% across all divisions and the 90% internal target was only achieved by Haematology (95.0%) and Cardiovascular (92.2%) this month.
No new MRSA cases were attributed to the Trust during January and it is now over 300 days since our last reported case. Key concerns are: • HCAI – 1 new VRE case reported this month in Haematology on Davidson Ward. 24 cases have been reported to date which is higher than the internal target of 14 cases, and higher than the 17 cases reported at this point last year. 2 CDT cases were reported during January – 1 in TEAM on Twining and 1 in Surgery on Lister - which means 47 cases have been reported to date compared to the trajectory of 63 cases. • Red AIs and red shifts – 4 Red AIs were reported in January: 1 in Acute Medicine, 1 in Neuro-Imaging, 1 in Neurosurgery and 1 in AAU attributed to another Trust. 43 red shifts were reported in Jan: 17 in TEAM and 26 spread over 6 other Divisions. Leading indicators of safety:
MRSA Screening - 99.4% of elective patients and 97.2% of emergency patients were screened. Hand Hygiene – audit compliance dropped to 85.3% overall in January (compliance was 89.3% for actual audits performed)
Overall HRWD score has dropped by 1% to 85% in January, not achieving the 86% target. Although patient complaints increased slightly to 54, the response rate to complaints continues to improve with just under 50% replied to within 25 days. Key concerns are: 28 Day Cancellation Standard – 4 breaches of this standard in January (2 breaches were due to over running lists, 1 to an
emergency taking priority and 1 for an unknown reason). Single Sex Accommodation – 27 ICU delayed discharge breaches were reported in January compared to 23 last month. Outpatient Cancellations – 8392 hospital-initiated cancellations in January, an increase of nearly 2000 above target.
At Month 10, the Trust has a net variance from plan of -£2.449m. Further details can be found in the Finance part of this paper. Key concerns are: Theatre Utilisation Rate – despite dropping by 1% to 80% in January, the overall rate is still achieving the 80% target. Main
Theatre utilisation dropped by 3.4% to 81.4% in January, still achieving the target. Although DSU Utilisation rose by 5.1% to 78.1%, it is still not achieving the 80% target. Weekend discharges – under 19% of patients were discharged over the weekend in January compared to 25% in December. DNA Rate increased by 0.5% from 12.3% in December to 12.8% in January, and is not achieving the 12.2% target.
• Latest actions and divisional plans can be found in the specific performance update reports in this paper for Emergency Care and RTT performance • Daily meetings continue to be held with the COO to review breaches in A&E • Weekly RTT meetings continue to take place to track longer-waiting patients • Weekly Cancer waiting list meetings continue to take place to track individual patients.
• Continued focus on managing MRSA infection and screening. • Critical Care has been red-rated for January. • Weekly CDT meetings continue to review locally reported cases , and distinguish between true or colonised cases. • Ongoing implementation of an action plan to ensure compliance with the DH document “Start Smart, then Focus” for antimicrobial stewardship.
• Continued focus on patient experience through Energising for Excellence, Safety Express and Ward 20/20 initiatives. • Developing a Trust-wide plan for HRWD
Enc. 2.6
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Enc. 2.6
13
Contents
•Executive Summary
•Trust Performance Summary
•Divisional Performance Summary
•Regulatory/Contractual Performance
• Monitor 2012-13 Q4 position
• CQUIN 2012/13 Q4 update
• Care Quality Commission (CQC) – Quality Risk Profile Update
•Specific Performance Reports
• Emergency Care Action Plan Update
• RTT Q4 Performance Update
• Infection Control Update
Enc. 2.6
14
Division Areas of Concern
Womens & Children • Finance position
• Ante-natal booking within 12+6 weeks (Obstetrics)
• Discharge Date Compliance (Child Health and Gynaecology)
In order to release CQUIN funding for 13/14 the Trust is required to report to Commissioners on five DoH
High Impact Innovations. Information is being collated on the Trust plans to participate in telehealth/telecare,
intraoperative fluid management, international and commercial activity, as well as the use of digital
technology to reduce unnecessary face to face contacts and supporting carers for people with dementia.
Detail of local Specialised Commissioning CQUINs is outstanding but is due to be released shortly.
Actions: Submit a CQUIN prequalification report to commissioners by end of February and finalise CQUINs
in time for sign off by 1 April 2013. Further detail to be included in future reports to the Board.
Enc. 2.6
Regulatory/Contractual Performance
2012/13 (3/3)
24
• Care Quality Commission (CQC) Quality Risk Profile (QRP):
The February 2013 QRP profile report was published in 6 February 2013. The report is currently
showing ‘better than expected’ across 5 outcomes (previously 6) and ‘similar to expected’ across 11
outcomes (previously 10).
The CQC has actioned a previous request and excluded Lewisham Hospital Endoscopy Global Rating
Scale data from King’s QRP. This led to adjustments to risk estimates for Outcomes 14: Supporting staff
and Outcome 16: Assessing and monitoring quality of service provision.
Marginal adverse movement from high green to low yellow for Outcome 21: Records due to ‘much
worse than expected’ results in refreshed National Bowel Cancer Audit Project data for patients
receiving a CT or MRI scan. Assurance has been received that this is a resource issue relating to
completion of data submission and that all CT and MRI scans are taken and reported in line with best
practice.
Enc. 2.6
QRP February 2013 position
25
Analysis of King’s QRP February 2013 (published 6 February 2013):
Overall Risk Estimates
Enc. 2.6
26
Contents
•Executive Summary
•Trust Performance Summary
•Divisional Performance Summary
•Regulatory/Contractual Performance
• Monitor 2012-13 Q4 position
• CQUIN 2012/13 Q4 update
• Care Quality Commission (CQC) – Quality Risk Profile Update
•Specific Performance Reports
• Emergency Care Action Plan Update
• RTT Q4 Performance Update
• Infection Control Update
Enc. 2.6
27
Continued Governance arrangements include:
• Winter Action plans for all divisions have now been signed-off and key actions being implemented
• The Emergency Care Board continues to meet monthly and the Emergency Care Board Operational Group
continues to meet weekly.
• The Emergency Care Action Plan continues to be tracked and developed.
• Daily breach review meetings continue and all divisional managers now attend these meetings held at 10am.
• Outcome metrics reflecting the delivery of the action plan are being devised.
Priority actions taken include:
• Focus on weekend discharges as part of TEAM winter plan workshop, a number of actions are now in place to
improve weekend discharges.
• Increased staff at weekends (within the Emergency Department, Wards, Pharmacy and Therapy services).
• Maximise bed availability on a Monday morning by increasing discharge planning on a Thursday/Friday/Saturday
and Sunday.
• Increase use of Medihome.
• 24/7 AAU model introduced.
• Increase nursing and medical staff within the Emergency Department and Acute Assessment Unit at times of peak
demand to manage surges of patients.
• E-vision now reporting real time ED Performance and Phase 2 reporting requirements have been reviewed and
are being developed.
• Additional capacity – Plans to move the existing Acute Assessment Unit from a ward location to a new facility in
the previous endoscopy unit have been escalated and the 12 additional medical beds have now come on-line.
The latest Emergency Care Action Plan can be found in the following pages:
Emergency Care Performance Action
Plan (1/13)
Enc. 2.6
28
Emergency Care Performance Action
Plan (2/13)
Enc. 2.6
29
Emergency Care Performance Action
Plan (3/13)
Enc. 2.6
30
Emergency Care Performance Action
Plan (4/13)
Enc. 2.6
31
Emergency Care Performance Action
Plan (5/13)
Enc. 2.6
32
Emergency Care Performance Action
Plan (6/13)
Enc. 2.6
33
Emergency Care Performance Action
Plan (7/13)
Enc. 2.6
34
Emergency Care Performance Action
Plan (8/13)
Enc. 2.6
35
Emergency Care Performance Action
Plan (9/13)
Enc. 2.6
36
Emergency Care Performance Action
Plan (10/13)
Enc. 2.6
37
Emergency Care Performance Action
Plan (11/13)
Enc. 2.6
38
Emergency Care Performance Action
Plan (12/13)
Enc. 2.6
39
Emergency Care Performance Action
Plan (13/13)
Enc. 2.6
RTT Q4 Performance Update (1/3)
40
1. Referral To Treatment (RTT) January 2013 Update
• The table below summarises the Trust performance since April 2012 against the 3 RTT waiting time
standards that Monitor assesses us against. In addition, the number of 52+ week waiters at the end of
January relative to December are outlined here.
Target Apr May Jun July Aug Sep Oct Nov Dec Jan
Admitted Complete
90% 91.0%
91.2%
85.7% 91.0% 90.1% 90.2% 91.4% 90.1% 90.1% 88.8%
Non-admitted Complete
95% 98.1%
98.2%
98.3% 98.1% 98.2% 97.7% 97.1% 97.1% 97.0% 96.7%
Incomplete 92% 90.1%
90.6%
92.2% 92.6% 92.3% 92.4% 92.8% 92.9% 92.7% 92.8%
52+ Week Waiters January December
General Surgery 83 90
Urology 1 1
T&O 14 13
Neurosurgery 4 8
Cardiothoracic Surgery 1 1
HpB 15 13
Cardiology 0 1
Other Specialities 0 2
Total 118 129
Enc. 2.6
RTT Q4 Performance Update (2/3)
41
• As planned with Commissioners, RTT Admitted Performance did not achieve the 90% target with 88.8% of patients seen within 18 weeks in January 2013. The Trust is planning not to achieve the admitted target in February and March, as part of a planned approach to treat long-wait patients.
•Specialties that failed to achieve the 90% target in January were:
• General Surgery (78.8%) • Urology (74.6%) • T&O (69.7%) • Neurosurgery (72.0%) • Cardiothoracic Surgery (69.0%)
• The number of 52+ Week waiters reduced from 129 in December to 118 in January. The Trust is planning to have less than fifty 52+ by the end of March.
• January was characterised by severe pressure on both general and critical care beds with a 57% increase in within-the-week hospital cancellations compared to December (the 409 admission cancellations in January was the highest monthly figure for the year to date). • Despite this pressure on elective activity, the Trust has managed to maintain its admitted backlog position while reducing the overall waiting list and the numbers of 52+ week waiters. This has partly been achieved by continuing to utilise weekend onsite and offsite capacity from other providers, wherever possible. • However, bed pressures are continuing into February which further increases the risk to achieving the target backlog trajectory. The Trust’s priority focus remains on using whatever capacity it has available to clearing all 52+ week waiters. • The Trust has continued to achieve its overall non-admitted performance target of 95% but two specialities did not achieve this threshold:
• Cardiology (90.1%) • Neurology (81.4%)
Enc. 2.6
RTT Q4 Performance Update (3/3)
42
3. Outsourcing Update
• The Trust continues to utilise significant off-site capacity from a wide range providers to help mitigate onsite bed pressures. There is a desire to do more off-site work and maximise utilisation still further, but the main constraint has been the inability of offsite providers to make further capacity available to the Trust. In addition, the Trust is finding it particularly challenging to secure appropriate capacity for patients whose care requires the presence of critical care facilities on-site, especially for HpB patients.
• Whilst off-site capacity is proving vital in maintaining the Trust’s backlog and improving long-wait position alongside current bed pressures – it is not proving effective in clearing historic backlogs.
• The Trust continues to rigorously explore possibilities for procuring more capacity from existing and alternative providers for February and March – and increased capacity has been secured from Lister Hospital for General Surgery and T&O, and from Harley Street for Neurosurgery.
• It is not anticipated that funding from commissioners for the same level of off-site work will continue into 2013/14 – hence future reductions in backlog will need to be achieved via increases in on-site capacity.
• In January the following KCH activity was managed offsite:
Provider Speciality Activity Levels
BMI Blackheath Neurosurgery 2 IP
BMI Chelsfield General Surgery 5 IP
BMI Fitzroy Place General Surgery
Colorectal
1 IP and 1 DC
6 DC
Lister Hospital T&O 4 DC
London Bridge HpB 2 IP
Sloane Hospital T&O 3 IP
Weymouth General Surgery 5 DC
Total 13 IP and 16 DC
Enc. 2.6
Infection Control: Trust position –
January 2013
43
1. MRSA (post 48 hour) bacteraemias – good performance:
One Trust attributable case reported in 2012-13
• One in Ambulatory (Apr 2012)
MRSA screening:
• 99.4% Elective (in January 2013)
• 97.2% Emergency (in January 2013)
2. VRE bacteraemias – improved performance:
1 case of VRE bacteraemia in January with a total of 23 cases YTD (trajectory of 14 cases for the same
period.)
3. C-difficile – still under DH trajectory for number of cases and have seen a reduction in Q3
compared to Q2:
47 CDT cases reported to DH (as per National Guidance) in 2012-13 (trajectory of 63 cases YTD):
• Surgery - 10 cases compared to 13 in 2011/12 (YTD January)
• TEAM - 6 cases compared to 15 in 2011/12 (YTD January)
• Critical Care - 5 cases compared to 10 in 2011/12 (YTD January)
• Cardiac - 3 case compared to 5 in 2011/12 (YTD January)
Trust attributable CDT Cases over the last 4 quarters:
• 2011-12 Q4 – 18 cases
• 2012-13 Q1 – 11 cases
• 2012-13 Q2 – 25 cases
• 2012-13 Q3 – 12 cases
A further 94 cases have been reported locally as per the April DH testing guidance. All of these cases
have been included in the Root Cause Analysis process and been managed as per Trust CDT guidance.
This continues to place additional pressure on isolation provision.
Enc. 2.6
C-difficile Action Plan Update
(1/1)
44
Key focus areas:
1. Antimicrobial stewardship
Monthly audits undertaken in all inpatient wards. Results are improving. Work completed to audit
prophylaxis prescribing and administration in theatres. Results shared at appropriate meetings,
highlighted a lack of prophylaxis guidelines in some surgical specialties. These are now being developed.
The Antibiotic Usage Steering Group is leading on the implementation of the “Start Smart then Focus”
action plan. Progress will be reported in the next quarterly report.
2. Hydrogen Peroxide Vapour (HPV) technology
HPV has been used in a number of areas where CDT or multi-resistant gram negative infections
occurred. Work is now underway to develop a proactive HPV programme to work in conjunction with the
reactive programme already in place.
3. CDT root cause analysis
The well established process for reviewing both DH and locally reportable CDT cases has been further
developed so that divisions ensure completion of mitigating actions identified through this process.
4. Multidrug resistant organisms – Child Health
The trust has had cases of children colonised with a multi resistant family of organisms. A working group
comprised of Capital, Estates and Facilities (CEF), Infection Control Prevention (IPC), Medirest and the
division, have been formed to manage this situation. External reviews have taken place over the last few
weeks and the Group is currently working towards completion of an action plan to address issues raised
by the external review.
5. Water management group
A group has been established with key stakeholders, including CEF, Infection Control and Medical
Microbiology, to manage the Trust’s response to new guidance on water quality.
Enc. 2.6
Enc 2.7.1
1
Report to: Board of Directors
Date of meeting: 26 February 2013
By: Jane Walters, Director of Corporate Affairs
Subject:
Quarterly Patient Experience Report
1. Executive Summary
Delivering a quality service to our patients is one of the Trust’s core strategic priorities - safe, kind and effective care. The publication in February of the Francis Report underlines the importance of our strategy. The Trust has established a group to review the report’s recommendations which will report to the Board in due course.
Preparations are well underway to implement the new Friends and Family Test, results of which are published nationally from April 2013.
Performance in the 2012 CQC National A&E Survey was improved since the 2008 survey. Performance against London peers and other national Major Trauma Centres was encouraging with King’s leading the MTCs in London.
The CQC National Inpatient Survey results 2012 are expected to be published nationally at the end of April/beginning May.
All CQUIN targets for both the national and local patient experience CQUINS were achieved for Quarter 3.
Positive HRWD results for inpatients continued in Quarter 3 and the numbers of patients responding to the outpatient survey is growing steadily.
The number of complaints received was slightly higher last quarter, but in line with previous years. Performance in responding to complaints continues to be below target but improving.
In December, a Quality Accounts Stakeholder Meeting gained valuable input from stakeholders about proposed quality priorities for next year.
Volunteer numbers continue to be upwards of 700. Highlights for the last quarter include invitations to 10 Downing Street and the Cabinet Office to discuss King's approach to volunteering, followed up by a visit from Nick Hurd, Minister for Civil Society in January 2013.
Enc 2.7.1
2
2. King’s Quality Accounts
2.1. 2012 /13 Quality Account
The quality priorities for patient experience for 2012/13 are :
2.2. National Patient Experience CQUIN This CQUIN is worth £800K this year. A further three wards were identified in Q3:
Kinnier Wilson (Neurosurgery)
David Marsden (Neurology)
Dawson (Liver) They will be putting actions in place to make improvements of 3% overall in 5 patient survey key question areas.
2.3. Local CQUIN: Improving outpatient experience This CQUIN is worth £1.4 million split evenly between development and roll-out of a trust How are we doing outpatient survey and targeted improvement in key aspects of outpatient experience. Q3 targets focussed on achieving responses to the How are doing survey. All targets were met. Suites 3 and 7 have been tasked with making improvements in five key question areas:
If you had to wait for your appointment, were you told how long you would have to wait?
How clean was the Outpatient Department you visited (including any toilets you may have used in the Outpatient Department)?
Did a member of staff explain the results of your test(s) in a way you could understand?
Were you involved as much as you wanted in decisions about your care and treatment?
Overall, how would you rate the care you received in the outpatient department? This quarter text reminders and i-Pads were introduced which have had a positive impact on the numbers of surveys completed by patients. All CQUIN targets to-date have been met.
2.4. Quality Priorities for 2013 – 2014 In December we held a Quality Accounts Stakeholder meeting. Attendance was good with representation across our stakeholders including Governors, Overview and Scrutiny teams, Local Involvement Networks and commissioning colleagues. The Trust presented detailed updates on progress against current priorities and shared potential areas on which to focus for next year’s priorities. For the patient experience metrics, stakeholders were positive about continuing work to embed the outpatient survey and to drive
Enc 2.7.1
3
improvements across the Trust. There was also interest in both information and support for patients on discharge and improvement work in the Medical Assessment Unit. The Patient Experience Committee considered the comments received and has recommended that the two areas of focus for 2013/14 are improving outpatient experience and improving information for patients on discharge. The draft report will go out for consultation to stakeholders in April.
The National A&E Survey results were published on the Care Quality Commission’s website on December 6th 2012.
King’s is rated amber for all sections of the survey – in the expected range
Results were positive with an increase of 3.7 points overall since 2008 and improvement in 4 out of 6 comparable sections, with significant improvement in care and treatment, environment and facilities and leaving the ED.
King’s was ranked 1st amongst the London Major Trauma Centres (MTCs) and 3rd for comparable MTCs nationally.
A number of initiatives are being implemented both to drive and measure improvements.
Friends and Family test is being introduced in the Emergency Department from March 2013.
A How are we doing survey is in development to supplement the Major Trauma survey which is providing useful information from patients to inform service improvement
The ED is continuing to work on improving younger people’s experience of the ED, for example, continuing work with local voluntary groups including Red Thread and the Loughborough Junction Youth Club.
A new collaboration with primary care partners has commenced which aims to improve the meet and greet function, improve communication with GPs, for example info on frequent attenders, addressing community health themes and an integrated IT system
4. External ‘Radar’ The trust regularly monitors a range of external sources of patient experience data from the CQC Quality Risk Profile on websites such as NHS Choices, Patient Opinion and social networking sites including Facebook and Twitter. The rating system on the NHS Choices website has now changed to a star rating system and King’s is currently rated as five star. Recent comments include:
“I had surgery and the team that looked after me was brilliant, they explained to me very
fully what the procedure would involve and they were very professional, kind and caring.
The surgery was successful and they have given me very thorough follow up care and
monitoring. I made a good recovery and returned to work.”
What I liked: My daughter was treated on Lion Ward. The staff were all committed and
very professional, but very caring and sympathetic.
What could have been improved: The car parking was very expensive, maybe if you have
a child in the hospital you should get some of this refunded?
Enc 2.7.1
4
5. The Friends and Family Test – update The Friends and Family Test has been included in the government’s mandate to the NHS Commissioning Board. Making sure that people have a positive experience of care is a key requirement in the Mandate, published on 13 November 2012. It means every patient will be able to give feedback on the quality of their care, even in hospitals which currently have no established patient survey programme. The rollout plan is:
acute hospital inpatients and accident and emergency patients from April 2013
for women who use maternity services from October 2013
as soon as possible after October, for all those using NHS services. The Friends and Family test is being widely trailed as one of the government’s responses to the Francis Report. Results will be publically available and will play a role in where patients choose to receive their care. It has been announced that the Friends and Family Test will be the only national Patient Experience CQUIN for 2013/14. The CQUIN will be structured with three separate elements:
30 per cent of the funding for phased expansion: NHS providers will need to deliver the nationally agreed roll-out plan to the national timetable. Missing any element of this will result in non-payment of the CQUIN.
40 per cent of the funding for increasing the response rate in the acute inpatient and A&E areas. Initial minimum response rates required are 15- 20%. This presents a particular challenge in A&E due to the high throughput. Going forward, achieving a response rate in the top 50 per cent which also improves on the Q1 response rate will be required.
30 per cent of the funding for increasing the score of the Friends and Family Test question within the 2013/14 staff survey compared with 2012/13 survey results.
King’s monthly Patient Experience Report presents integrated patient feedback from patient complaints, Patient Advice and Liaison Service (PALS), How Are We Doing and patient comments. It also monitors performance against CQUIN targets and Eliminating Single Sex Accommodation.
6.1. How are we doing?
Performance over the quarter has been very positive.
The overall HRWD score met the benchmark throughout Q2 and for 2 out of the 3 months in
Q3.
Scores for both patient engagement and care and treatment reached the benchmark of 87 for two months in Q3. Environment scores reached the benchmark in November, but dropped back one point for October and December.
The food rating has remained green for the last 12 months.
Patients rated their experience in Day Surgery green with a score of 92. Maternity scores fell back slightly from 83 to 82.
Response rates for HRWD were disappointing for the quarter at 37%. Rates will need to improve.
Within the Divisions, Cardiac and Children’s met the overall benchmark for all three months of the quarter and Haematology for two out of three months
The trust also continues to do well in meeting patient expectations for receiving their care in ‘single sex’ accommodation. The average satisfaction score for this quarter was rated green at 91.
In January a revised version of the HRWD inpatient survey was launched which includes the new Friends and Family question, as well as a question on whether a patient was admitted through a planned route or as an emergency. It also includes a question about volunteers to assess their impact on patient experience and a question on whether a patient has diabetes to support staff in improving the experience and care of patients with diabetes.
6.2. Complaints and Patient Advice and Liaison Service (PALS)
Complaints
79
56
80
54
7164 62 63
5358
74
51
20
30
40
50
60
70
80
90
Jan-1
2
Feb-1
2
Mar-
12
Apr-
12
May-1
2
Jun-1
2
Jul-12
Aug-1
2
Sep-1
2
Oct-
12
Nov-1
2
Dec-1
2
No. of Compl ai nts Compl ai nts T r end
There were 176 complaints this quarter. YTD there have been 500 complaints, against a target of 405. We will exceed our end of year stretch target (540), and expect an increase compared with 2011/12 (590). The trend in complaint numbers has remained similar since Q3 11/12, against a pattern of increasing activity.
47% of complaints for YTD were responded to within the target of 25 working days against a target of 70.
The profile of complaints has remained the same for the last two quarters. There was a notable reduction in concerns about inpatient cancellations in Q3 , although conversely PALS report an increase in this area, which suggests that issues remain, and are being picked up through different routes.
Neurosciences received the highest number of complaints during the quarter.
The highest proportion of PALS issues continue to be related to outpatients.
Enc 2.7.1
6
7. Volunteering King’s volunteers are continuing to play a key role in helping staff and patients. Numbers continue to be high with upwards of 700 volunteers from the local community actively involved in King’s. Highlights for last quarter include invitations to No 10 Downing Street and the Cabinet Office to discuss King's approach to volunteering, and a visit in January from Nick Hurd, Minister for Civil Society, and the Department of Health, to see King's volunteers in action, and as a possible model for wider rollout within the NHS.
8. King’s Patient Experience Transformation Programme We are continuing to drive improvement in patient experience through our Patient Experience Transformation Programme. To summarise progress:
8.1. Video Stories Good progress has been made in developing video patient stories as a method for gathering and using patient experience feedback to drive service improvement. This quarter saw the first four areas trained in the methodology and carrying out their first video stories. Both MAU wards, Mary Ray and Oliver have filmed patients as well as videos in Renal and in the Derek Mitchell Unit as part of the trust’s cancer improvement work. A second tranche of wards and outpatient areas will carry out their first video stories in the New Year and begin to use these to focus in on local areas for improvement. They are Cotton Ward, Elderly Medicine, Radiology and Suite 1 outpatients. Some Governors are involved in the project and receiving training so that they can both produce patient video stories and support staff to introduce video stories across the trust. 8.2. Improving Patient Experience in the Medical Admissions Unit (MAU) Work has begun on Mary Ray and Oliver to get a better understanding of how patients experience these two very busy wards. The diagnostic phase has looked closely at existing data on patient experience and is also gathering new information from patients. Two focus groups are planned as well as observations on the wards. Based on this, a set of actions will be put in place to improve the experience of patients admitted to the MAU which will then be monitored and measured through the How are we doing survey.
9. Recommendation
The Board is asked to note this report, and offer any comments.
Enc 2.7.2
1. Background/Purpose
A summary of the Infection Prevention and Control activity from October till December 2011
2. Action required
To note the content of the report.
3. Key Implications
Legal: The Trust has a statutory responsibility to ensure compliance under the Hygiene code. The submission of a quarterly report is part of the Code.
Financial: Poor infection control practices and increase in infection rates has a direct financial impact as a result of additional drug costs and increase in Length of Stay
Assurance: The infection Prevention and Control report provides an overview of Infection Control activity and identifying significant trends and developments. This report incorporates the risk register relating to infection control also.
Clinical: Good Infection Prevention and Control practices are key to providing high quality care to King’s patients
Equality & Diversity: The content of this report has no implications for equality and diversity
Performance: Infection rates have a direct impact on length of stay, our Monitor performance rating and our CQC registration status.
Strategy: None
Workforce: None
Estates: None
Reputation: Poor compliance in infection prevention and control standards could adversely affect the reputation of the organisation.
Other: (please specify)
Report to:
Board of Directors Meeting
Date of Meeting:
26 February 2013
Subject:
Infection Control Quarterly Report – Quarter 3; 2012/13
Author(s):
Erika Grobler; Deputy Director of Infection Prevention and Control
Presented by:
Dr Geraldine Walters, Director of Infection Prevention and Control
Sponsor:
Dr Geraldine Walters
History:
Quarterly DIPC report
Status:
For report.
1
Quarterly DIPC report
2012-13 Quarter 3
Geraldine Walters
Director of Nursing and Midwifery;
Director of Infection Prevention
and Control
Enc. 2.7.2
2
Contents
• Executive summary
•Trust Performance Summary
• Divisional Performance Summary
• Key focus areas
• Antimicrobial stewardship
• CDT Root Cause Analysis process
• Other areas of note
• ICE pod installation
• Consumables standardisation
• IV line insertion – role of the IV team
Enc. 2.7.2
3
Executive Summary (1/3)
1. MRSA (post 48 hour) bacteraemias – good performance:
One Trust attributable case reported in 2012-13
• One in Ambulatory (Apr 2012)
MRSA screening:
• 100% Elective (in December 2012)
• 96.6% Emergency (in December 2012)
2. VRE bacteraemias – improved performance:
1 case of VRE bacteraemia in December for a total of 22 cases YTD (trajectory of 13 cases for the same period.)
This does indicate an improvement on Q2 (13 cases in Q2; 6 cases in Q3)
3. C-difficile – still under DH trajectory but number of cases and have seen a reduction in Q3 compared to
Q2:
45 CDT cases reported to DH (as per National Guidance) in 2012-13 (trajectory of 56 cases YTD):
• Surgery - 9 cases compared to 12 in 2011/12 (YTD December)
• TEAM - 5 cases compared to 13 in 2011/12 (YTD December)
• Critical Care - 2 cases compared to 8 in 2011/12 (YTD December)
• Cardiac - 3 case compared to 5 in 2011/12 (YTD December)
Trust attributable CDT Cases over the last 4 quarters:
• 2011-12 Q3 – 22 cases
• 2011-12 Q4 – 18 cases
• 2012-13 Q1 – 11 cases
• 2012-13 Q2 – 25 cases 2012 – 13 Q3 – 12 cases
A further 88 cases have been reported locally as per the April DH testing guidance. All of these cases have been
included in the Root Cause Analysis process and been managed as per Trust CDT guidance. This continues to
The Trust has reported 20 post 48 hour cases of MSSA bacteraemia YTD for 2012/13
Key focus areas:
1. Antimicrobial stewardship
Monthly audits undertaken in all inpatient wards. Results are improving. Work underway to audit
prophylaxis prescribing and administration in theatres. Results to be available shortly. The Antibiotic
Usage Steering Group is leading on the implementation of the “Start Smart then Focus” action plan.
Progress will be reported in the next quarterly report.
2. Hydrogen Peroxide Vapour technology
HPV has been used in a number of areas where CDT or multi-resistant gram negative infections
occurred. Areas that have been treated, i.e. surgical and renal wards have shown a marked reduction in
CDT cases.
3. CDT root cause analysis
The well established process for reviewing both DH and locally reportable CDT cases has been further
developed so that divisions ensure completion of mitigating actions identified through this process.
4. Multidrug resistant organisms – Child Health
The trust has had cases of children colonised with a multi resistant family of organisms. A working group
comprised of CEF, IPC, medirest and the division, have been formed to manage this situation.
5. Water management group
A group has been established with key stakeholders, including CEF, Infection Control and Medical
Microbiology, to manage the Trust’s response to new guidance on water quality.
4
Enc. 2.7.2
5
Executive Summary (3/3)
Other areas of note:
1. ICE pod installation:
Two pods will be installed on Annie Zunz during the first week in December. A further 5 pods to be installed
once bed pressures allow.
2. Healthassure and the Infection Control Gap Analysis
The IPC team is working with others in the Trust to implement the Healthassure system. The Hygiene Code
model will provide a more accurate view of Trust compliance than the systems currently being used. Progress
will be reported as part of this report in the future.
3. Consumables standardisation: The Infection Prevention and Control team will take an active role in the newly established Product Selection Group by
co-opting the appropriate clinical leaders onto the group, i.e. the Continence Nursing team when decisions on
continence products are made.
4. European Directive – provision of safety engineered devices
The Lead IV practitioner is leading on the implementation of safety engineered devices. These are sharp devices that
pose a risk to staff of needlestick injuries. The Trust has implemented safety engineered peripheral cannulaes and
venepuncture equipment. Trials will take place over the next few months on other devices, i.e. hypodermic syringes and
needles and needles for intramuscular and subcutaneous injections.
Enc. 2.7.2
6
Contents
• Executive summary
•Trust Performance Summary
• Divisional Performance Summary
• Key focus areas
• Antimicrobial stewardship
• CDT Root Cause Analysis process
• Other areas of note
• ICE pod installation
• Consumables standardisation
• IV line insertion – role of the IV team
Enc. 2.7.2
MRSA bacteraemia
7
Enc. 2.7.2
VRE bacteraemia
8
Enc. 2.7.2
C.difficile – DH reportable
9
Enc. 2.7.2
C.difficile – locally reportable
10
Enc. 2.7.2
MSSA bacteraemia
11
Enc. 2.7.2
E.Coli bacteraemia
12
Enc. 2.7.2
IC scorecard – Dec 2012
13
Enc. 2.7.2
IC scorecard – Dec 2012
14
Enc. 2.7.2
IC scorecard – Sept 2012
15
Enc. 2.7.2
16
Contents
• Executive summary
•Trust Performance Summary
• Divisional Performance Summary
• Key focus areas
• Antimicrobial stewardship
• CDT Root Cause Analysis process
• Other areas of note
• ICE pod installation
• Consumables standardisation
• IV line insertion – role of the IV team
Enc. 2.7.2
Divisional performance
• Two divisions continue to be identified each month as requiring
additional scrutiny and input from the Infection Prevention and Control
(IPC) team
• The criteria on which this decision is based has been widened to include
the number of non-compliance assurance audits on the Infection Control
Scorecard, but also other potential areas of concern, i.e. any clusters or
outbreaks that have occurred.
• There is also an aim to ensure that all divisions meet with the IPC team
in this way at least once in the financial year.
• Turnaround meetings during Q3:
– October: Cardiac and Child Health
– November: Emergency Department and Liver
17
Enc. 2.7.2
2012/13 December
Infection Control heatmap (1/2)
18
Enc. 2.7.2
2012/13 December
Infection Control heatmap (2/2)
19
Enc. 2.7.2
20
Contents
• Executive summary
•Trust Performance Summary
• Divisional Performance Summary
• Key focus areas
• CRE
• Antimicrobial stewardship
• CDT Root Cause Analysis process
• Other areas of note
• ICE pod installation
• Consumables standardisation
• IV line insertion – role of the IV team
Enc. 2.7.2
CRE Carbapenemase Resistant Enterobacteraceae
• A group of organisms that normally live in the gut
• Organisms are very resistant to antibiotics, making the treatment of infections due to these
organisms very difficult.
• Prevention is important as treatment options are limited.
• Carbapenemase can be transferred between organisms.
• Infections caused by CRE is associated with high mortality
CRE at KCH
• August 2012 – KCH notified by a hospital in Dublin that three paediatric liver patients
transferred were found to be positive
• September 2012 – Weekly screening of all patients on Rays of Sunshine and Thomas Cook
introduced. Sixteen patients in Child Health have been have been identified in Child Health,
predominantly in Rays of Sunshine.
21
Enc. 2.7.2
Antimicrobial stewardship (1/3)
22
• The Trust continues to be the only Teaching hospital in London that
undertakes a monthly audit of antimicrobial stewardship; a process
coordinated and managed by the Medical Microbiology team.
• Results for November 2012:
– KPI1 compliance (is an indication recorded) = 96%
– KPI 2 compliance (stop / review date recorded)=79%
– KPI 3 compliance (IV / PO switch not overdue) = 96%
– KPI4 compliance (indication as per guideline) = 91%
Enc. 2.7.2
Antimicrobial stewardship – Nov data
(2/3)
23
Enc. 2.7.2
Antimicrobial Stewardship – Nov data
(3/3)
24
Enc. 2.7.2
CDT root cause analysis
process
Root cause analysis process:
• The weekly CDT review meetings is fully established and has become more
important in reviewing locally reported cases to distinguish true or colonised
cases.
• These review meetings have now been changed to strengthen local Divisional
and Speciality ownership and review.
25
Enc. 2.7.2
26
Contents
• Executive summary
•Trust Performance Summary
• Divisional Performance Summary
• Key focus areas
• Antimicrobial stewardship
• CDT Root Cause Analysis process
• Other areas of note
• ICE pod installation
• Consumables standardisation
• PICC line insertion – role of the IV team
Enc. 2.7.2
ICE pod installation
ICE (infection control enclosure)-pod isolation facilities
A product recently brought to the market by Bioquell. It is a semi-
permanent structure that is constructed bespoke for each bed
space. The Trust has ordered 7 (installation w/c 5th Dec) of these
pods to:
• Provide more flexibility in isolation room provision
• Increase the uptake of HPV usage by reducing the time required
to implement this technology.
The first two pods have been installed on Annie Zunz. The further
5 pods will be installed once bed pressures allow.
It is important to note that this technology is not a direct
replacement for increasing isolation room provision but does
provide more flexibility.
27
Enc. 2.7.2
Consumables standardisation
A group; the Product Selection Group, has been established under the
chairmanship of the Director of Procurement for KHP to work towards
standardisation of clinical consumables to:
• ensure that the quality of consumables used is of a sufficiently high
standard
• to increase patient safety
• to explore economies of scale through joint procurement across
KHP.
The first product range to be worked on will be urinary catheterisation
products.
28
Enc. 2.7.2
PICC line insertion
role of the IV team
• Peripherally inserted Central catheters (PICC) are used for patients
who require longer term intravenous therapy; i.e. IV antibiotic therapy
or TPN nutrition.
• The IV team are taking on more of a role in inserting PICC lines
(currently undertaken by interventional radiologists) in order to relieve
the pressure on PICC insertion waiting times.
• The team have also commenced pre-assessment of these patients to:
– Improve the consenting process
– Improve the information given to patients
– Improve the utilisation of PICC insertion lists in Radiology
• The team have been given authorisation by the Novel Procedures
Group to trial a new device for keeping PICC lines in place. Currently
around 25% of slots on the insertion lists are used for resiting lines that
have either accidentally been removed or have migrated. This trial will
commence in January 2013.
29
Enc. 2.7.2
Making King’s First Choice for patients and staff
Quality Priorities &
Accounts
Geraldine Walters
13 February 2013
Enc. 2.7.3
Quality priorities & accounts
1
The quality accounts keep
us...
Stakeholder involvement
ensures we...
Accountable for quality Match up to our aims
Focussed Focus on the right things
Transparent Stay in touch with those we
serve
Every year, we develop our Quality Priorities in collaboration with our stakeholders, and
publish Quality Accounts based on these.
Enc. 2.7.3
Our Priorities in context
2
Reduce infections
Achieve zero Never
Events
Reduce hospital
acquired infection
Reduce number of
incidents with high
degree of harm
Pa
tie
nt
Sa
fety
Reduce hospital acquired
infection
Improve patient
experience by using
inpatient feedback
results
Pa
tie
nt
Ex
peri
en
ce
Improve the consistency
of positive inpatient
experience
Improve patient
experience
Eliminate mixed sex
accommodation
Improve cleanliness of
the hospital environment
2009/10 2010/11 2011/12
Pa
tien
t O
utc
om
es
Enhance mortality
performance
Demonstrate best 20%
mortality benchmark
performance
Ensure at least 90% of
all inpatients are VTE
risk assessed before
discharge
Improve end of life care
Improve diabetes care
Reduce avoidable death,
disability, and chronic ill
health from venous
thromboembolism (VTE)
Improve medication safety
Improve identification
and escalation of acutely
ill patients
Minimise harm acquired
in the hospital
Improve end of life care
Improve diabetes care
Improve responsiveness
to inpatients personal
need
Improve outpatient
experience
2012/13
Enc. 2.7.3
Stakeholder Event 1
3
Explanation of the event & its purpose
Review of 2012/13 priorities & progress
Explanation of candidate priorities for 2013/14
Stakeholders invited to comment on candidate priorities & make suggestions
Enc. 2.7.3
4
Quality Priorities 2012/13
Priority Objective Target for first 6 months Results Status
Improve the
identification
and escalation
of acutely ill
patients
• To improve the identification and
escalation of acutely ill patients
by establishing a consistent
performance framework across
the organisation.
- Launch Trust scorecard
- Consolidate Trust initatives /
committees
- Pilot root cause analysis process
-Implement ‘Wardware’ observations
tool
- On target
- On target – divisional
reporting system in place
- In place
- 9 wards
Minimise harm
acquired in
hospital
• Use & broaden the use of the
NHS Safety Thermometer &
Safety Express
- Maintain progress in falls/pressure
ulcers
- 90% venous thromboembolism
(VTE) assessed
- 90% appropriate prophylaxis
- 75% written information
- 6 wards with Safety surveys
- 10 wards on Safety Express
- 95.4%
- 94.7%
- 77%
- Yes
- Yes
Improve
diabetes care
• Build on existing work to meet
National Institute for Clinical
Excellence quality standards for
diabetes
- Increase specialist presence
- Link practitioner scheme
- Performance framework
- Progress towards e-insulin sheet &
associated blood glucose meter for
active decision making
- Improved insulin safety
- Dedicated consultant &
specialist nurse
- Scheme prepared to start in
2013
- Diabetes dashboard in place
- Manual electronic record of
blood glucose; no meter
- Improved 2010-2011 (error-
free insulin prescription rises
from 78.0% to 86.2%; error-
free insulin management
rises from 74.1% to 79.8%)
On target At risk Not on target
Enc. 2.7.3
Quality Priorities 2012/13
5
Priority Objective Target for first 6 months Results Status
Improve end of
life care
• To build on the work in 2011/12 to
improve the coordination of care we
give to patients as they approach
end of life and achieve the locally
agreed CQUIN1 target.
- 90% discharge letters in 2 days to
enable handover of end of life care
- Education and training on end of life
care
- ‘Amber care bundle’ in 5 areas
- 96.2%
- Weekly teaching,
- Reached 5 areas
Improve
responsiveness
to inpatients’
personal needs
• To use a similar framework to
2011/12 to achieve the locally
agreed CQUIN1 target for the
‘responsiveness to personal needs’
composite indicator.
- Identify 3 weakest wards & improve by
3% on basket of survey questions
- Identify further 3 wards to focus on
- 5% improvement
- Identified Kinnier
Wilson, David Marsden
& Dawson
Improve
outpatient
experience
• To roll out an Outpatient feedback
survey and achieve focused
improvement on key issues
identified from our National
Outpatient Survey results.
- Launch outpatient survey in Suites 1,
3, 5, 6 & 7
- Agree targets for future uptake
- Launched in these
areas
- Agreed
On target At risk Not on target
1CQUIN = ‘Commissioning for Quality and Innovation’, a payment framework by which a portion of income providers receive
from commissioners is dependent on achieving certain quality targets.
Enc. 2.7.3
Quality Priorities for 2013/14
Outcome of first stakeholder meeting
Enc. 2.7.3
Patient safety
7
Strong support for:
• Effective nursing and medical
assessment of inpatients
• Management of the acutely unwell
patient
Some interest in:
• Surgical safety checklist
Less support for:
• There may be overlap between nurse assessment and patient falls. Perhaps falls could be added into the
assessment priority if adopted?
• Diagnostic test result communication would be likely to be difficult to measure positively:
• Might be hard to get meaningful data
• Might be very expensive to measure
• There was little interest in putting forward VTE, because:
• Good historical performance
• Other avenues to measure
Enc. 2.7.3
Patient Outcome
8
Strong support for:
• Dementia: focus would be linked with
primary care; makes sense
• COPD: helps to support integrated
care and public health
• Alcohol: supports patient health and
wellbeing
Some interest in:
• Cancer staging: large numbers of
patients presenting acutely
• Mental Heal of adults with physical
illness: relates to effective
assessment
Less support for:
• Acute Kidney Injury (no comments)
• Glaucoma (no comments)
Enc. 2.7.3
Patient Experience
9
Strong support for:
• Outpatients: would impact on a large
number of patients
• Discharge: improving information to
patients families and carers
Some interest in:
• AMUs: good scope for improvement
Less support for:
• Diabetes: felt this would belong in patient outcomes
• National CQUIN priority questions (no comments)
Enc. 2.7.3
13/14 Priorities
10
Pa
tien
t S
afe
ty
Pa
tie
nt
Ex
pe
rie
nc
e
Pa
tien
t O
utc
om
es
Management of the acutely unwell patient
Surgical Safety Checklist
Dementia
COPD
Outpatient Experience
Discharge
Enc. 2.7.3
Enc. 3.1.1
Equality and Diversity Committee Minutes of the meeting of the Equality and Diversity Committee held at 12:00 on Thursday 29 November 2012 in the Dulwich Committee Room, King’s College Hospital
Present: Marc Meryon (MM) Non-Executive Director/Committee Chair Prof. Sir George Alberti (GA) Non-Executive Director/Trust Chair Faith Boardman Non-Executive Director Tim Smart (TS) Chief Executive Angela Huxham (AH) Executive Director of Workforce Development Dr Angela Grainger (AG) Disability Inclusivity Network Sally Lingard (SL) Associate Director of Communications Mark Preston (MP) Associate Director of Human Resources Frank Wood (FW) Joint Staff Committee Attendees: Ben Rhodes (BR) Chaplaincy Team Manager Chris Forster (CF) Head of Asset Management Leonie Mallows (LM) Corporate Governance Officer Apologies: Dr Geraldine Walters (GW) Director of Nursing and Midwifery David Lawson (DL) Director of Procurement Prof. Alan McGregor (AM) Non-Executive Director Lindsay Batty-Smith (LBS) LGBt Forum Carol Bell (CB) Cultural Diversity Network Mr Richard Gullan (RG) Consultants’ Committee Representative Item Subject Action
12/37 Apologies The apologies for absence were noted.
12/38 Declarations of Interest There were no declarations of interest.
12/39 Chair’s Action There had been no Chair’s action.
12/40 Minutes of the Previous Meeting The minutes of the meeting held on 24 July 2012 were approved as a correct record.
12/41 Matters Arising/Action Tracker The progress made on the action tracker was noted. Mapother House The Committee agreed to remove the action relating to Mapother
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House from the action tracker as it was no longer relevant to this committee. Younger FT Members SL reported that she and Jessica Bush would attend the next Volunteers’ Forum to encourage volunteers, many of whom fall into the 17-21 and 22-29 age categories, to become foundation trust members.
12/42 Equality Delivery System (EDS) Objectives Tracker MP presented the document tracking progress against each of the EDS objectives. He reported that all of the objectives due for completion by the 31 January 2013 were close to completion or complete. In response to comments and questions from Committee members, the following key points were made: It was confirmed that whilst it is possible to put some
measurements in place to analyse the impact of staff development and training on equality and diversity, there is no direct way of measuring the implementation of these strands operationally;
The Trust website is reviewed every six months and changes are
made to enhance this from a user’s perspective, although this is balanced against the resources available;
The Chair commended the progress made to date and suggested
that given the significant progress made to date, it might be appropriate to bring forward the objectives scheduled for completion by January 2014 and to identify action owners.
The Committee discussed the possible impact on implementation of the EDS arising from the potential acquisition of the Princess Royal University Hospital (PRUH) in Bromley. The following key points were noted: A different population would produce different inclusion issues, all of
which would need to be considered and reflected in all EDS documents;
The various integration work streams would need to consider how to embed the EDS and the wider equality agenda through their planning work;
The PRUH should have their own equality objectives and the
merging of the two sets would necessitate a baseline exercise with external benchmarking and guidance in order to produce a neutral view; and
In the event of the Trust acquiring the PRUH, a review of both
organisation’s EDS / equality objectives should be undertaken as soon as possible after the acquisition date.
The final report on the national evaluation of the EDS for the NHS is now available and will be circulated to committee members.
MP/LM
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12/43 Analysis of the Pension Scheme Membership AH presented analysis of the diversity profiles of staff who were and were not members of the NHS Pension Scheme. Key points included: 24% of staff have opted out of the pension scheme. This is
considered to be an unusually high proportion and is thought to be primarily due to domestic and financial reasons, and possibly related to recruitment from overseas;
The Department of Work and Pensions has introduced auto-
enrolment as part of a commitment to ensure that pensions are available to all workers. The Trust’s date for introducing auto-enrolment is April 2013;
Eligible staff will be auto-enrolled into the pension scheme and will
have to opt-out if they do not wish to remain in the scheme following auto-enrolment. The auto-enrolment process will take place on a three yearly basis.
In discussion the Committee made the following comments and observations: A communications plan will be rolled out, led by the finance team;
The trade union view is that an employer’s contribution to an
employee’s pension is a deferment of salary and therefore employees are encouraged to opt in;
A significant number of people not in the pension scheme are under
the age of 40; As employees contributions rise it is to be expected that an
increased number of people will opt out; and The pensionable age is also increasing and a national group has
been established to review the implications of this.
12/44 Diversity Theme: Faith
BR presented an overview of the work of the spiritual care team to address issues of equality and diversity both within the Trust and in partnership with KHP. Key points included:
There has been an increased rate of emergency call outs and an increase in adult contract funerals. The reasons for the increase in adult contract funerals are being explored;
The team works closely with the palliative care and organ donation teams and, more widely, with the NHS Blood and Transplant London group on barriers to donation due to culture and belief;
A range of spiritual and faith events have taken place this year to try to ensure that staff and patients see their faith represented;
The chaplaincy database record a diverse range of self-reported
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beliefs and seeks to cater for this range;
A group of volunteers work with the spiritual care team to enable a much greater reach across the Trust and to increase visibility;
As part of the Trust’s centenary, wholeness and healing will be celebrated, remembering in particular those who have benefitted from care at King’s and gone on to lead full lives;
Work with KHP partners includes a spiritual care response to the Liverpool Care Pathway audit and participation in a European project on spiritual assessment via KCL.
The Committee acknowledged the value of the contribution by the spiritual care team to patients, their families and to staff.
12/45 Estates and Facilities 3-year Plan CF presented an update on progress towards the access compliance requirements under the 2010 Equality Act. Key points included: Equality and diversity are part of the design stage when planning
capital projects;
Installations include an induction loop, handrails and a telephone for use by the visually and hearing impaired;
A feasibility study to install an external lift at the main entrance of
Golden Jubilee Wing will be completed by February 2013; and
A comprehensive risk assessment of surrounding roads, walkways and access to the main entrances of the hospital is being undertaken;
A working group has been established to review all main access
roads and walking pathways and traffic routes around the hospital to ensure suitable and safe circulation for disabled persons and public
Due to financial constraints, the previously reported 3-year plan is
likely to be executed over a 6-year period.
FW suggested placing capital project models in public areas to enable the public to engage with and share their views on the Trust’s capital plans. CF responded that on previous occasions models and plans have been available at the Trust Open Day. SL to contact the Transport Feeder Group regarding the availability of accessible information at Denmark Hill station. It was agreed that CF would return with an update towards the end of 2013.
SL/LM
CF/LM
12/46 Staff Diversity Networks Update AG gave a verbal update on the activities of the Disability Inclusivity
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Network (DIN). Key points included: There has been an increase in the number of people declaring a
disability;
Evaluation of the suitability of access to new buildings is being undertaken by DIN members;
DIN is working with the communications team and ICT to confirm if
it is possible to hold managed online discussions on specific topics via the Trust website in order to gather the views of staff and the local community to widen inclusivity;
A work experience day for children with severe disabilities took
place recently. Further visits are being planned.
In future, reports from the staff diversity networks will follow a pro-forma, which aligns with the Trust’s strategic objectives and equality and diversity strands.
12/47 Equality and Human Rights Update There were no updates Equality and Human Rights issues.
12/48 Any Other Business FW raised concern over the quality of local social care services and whether appropriate checks are carried out to ensure that discharged patients have care provision at home.
12/49 Date of Next Meeting Tuesday 29 January 2013 13:00-14:00 in the Dulwich Committee Room.