Trust Board Meeting: Wednesday 22nd January 2014 TB2014.13 ...

TB2014.13 Review of progress in delivering 2013/14 Trust Business Plan Page 1 of 37

Trust Board Meeting: Wednesday 22nd January 2014 TB2014.13

Title Review of progress in delivering 2013/14 Trust Business Plan

Status For information

History The Trust Business Plan for 2013/14 was approved by the Trust Board on 10 July 2013 (TB2013.85)

Board Lead(s) Mr Andrew Stevens, Director of Planning and Information

Key purpose Strategy Assurance Policy Performance

Oxford University Hospitals TB2014.13


Executive Summary 1. This paper summarises the progress against the corporate objectives set out in the

2013/14 Trust Business Plan.

2. The Business Plan contained some short term and long term objectives.

3. Overall good progress has been made.

4. Key areas for more attention in the coming months include:

• Achievement of performance standards

• Continued focus on safety, including infection control

• Reduction of turnover and sickness

• Achievement of planned CIP when activity levels are higher than commissioned

• Optimising the configuration of clinical services and the use of the Trust’s estate

• Improving the response rate for the Friends and Family Test

• Increasing the screening of patients for dementia

Plans for addressing these areas are included in other Board papers and will be incorporated into the Trust’s Business Plan for 2014/15.

5. Recommendation

The Trust Board is asked to note this report.



ABBREVIATIONS

AGM Acute General Medicine AHSC Academic Health Science Centre AHSN Academic Health Science Network BRC/U Biomedical Research Centre/Unit CCG Clinical Commissioning Group CIP Cost Improvement Programme CQC Care Quality Commission CQUIN Commissioning for Quality and Innovation CSW Care Support Worker ED Emergency Department EDD Estimated Date of Discharge EMU Emergency Medical Unit EoL End of Life ERAS Enhanced Recovery After Surgery FT Foundation Trust GET Gastroenterology, Endoscopy and Churchill Theatres GI Gastrointestinal GMC General Medical Council GUM Genitourinary Medicine HDR High Dose Rate HDU High Dependency Unit HGH Horton General Hospital IM&T Information Management and Technology IMRT Intensity Modulated Radiotherapy IOFM Intra Operative Fluid Management ITU Intensive Therapy Unit JR John Radcliffe KPI Key Performance Indicator LiA Listening into Action MDT Multi-Disciplinary Team MRI Magnetic Resonance Imaging MRSA Methicillin-resistant Staphylococcus aureus MTC Major Trauma Centre NHSLA National Health Service Litigation Authority NICE National Institute for Health and Care Excellence NOC Nuffield Orthopaedic Centre NSPCC National Society for the Prevention of Cruelty to Children NTSS Neurosciences, Trauma and Specialist Surgery (now NOTSS - Neurosciences,

Orthopaedics, Trauma and Specialist Surgery) OBC Outline Business Case PALS Patient Advice and Liaison Service PLICS Patient Level Information and Costing System Q Quarter QA Quality Assurance QIPP Quality, Innovation, Productivity and Prevention SHDS Supported Home Discharge Service



SLR Service Line Reporting SOC Strategic Outline Case SOP Standard Operating Procedure S&O Surgery & Oncology TDA Trust Development Authority TME Trust Management Executive ToR Terms of Reference VBI Value Based Interviewing VTE Venous thromboembolism



Review of progress in delivering 2013/14 Trust Business Plan

1. Purpose 1.1. This paper provides an update on the delivery of the corporate objectives set

out in the Trust’s 2013/14 Trust Business Plan. The plan was approved by the Trust Board on 10 July 2013 (TB2013.85)

2. Background 2.1. Each objective has been reviewed in conjunction with the director accountable

for its delivery. More detail has been added to some of the actions, milestones and measures.

2.2. Progress as at the end of December 2013 is provided in the table below.



Ref Objective Accountable

Director Key Actions Milestones/Measures Progress year to date as at end of

December

SO1 To be a patient-centred organisation, providing high quality, compassionate care with integrity and respect for patients and staff – “delivering compassionate excellence”

1.1 Respond to the recommendations of the Public Inquiry into the Mid Staffordshire NHS Foundation Trust (the Francis Report)

Medical Director Agree actions that the Trust should take in response to the report and implement

• Agreed action plan • Report on

implementation

Reports of the Mid-Staffordshire NHS Foundation Trust Public Inquiry (Francis 2), Professor Don Berwick’s review of arrangements for patient safety and Professor Sir Bruce Keogh’s examination of 14 NHS Trusts with higher than expected mortality have been thoroughly examined by the Trust. They have been considered by the Clinical Governance Committee, Trust management Executive and Trust Board on a number of occasions. A paper outlining the Trust’s overarching response was considered and accepted by TME in August 2013. The paper outlined 21 actions and initiatives that will over time further strengthen systems, processes and culture within the OUH in response to the issues identified in the wider NHS. Together, these actions and initiatives represent a blueprint for the Trust. However, it is recognised that the necessary work will need to take place over years and that individual initiatives and



Ref Objective Accountable Director

Key Actions Milestones/Measures Progress year to date as at end of December workstreams should only be commenced if they can be completed. From the initiatives outlined, the Trust prioritised a series of peer review visits and risk summits. These are on-going and progress of each has been, and continues to be, reported to TME and the Trust Board.

Chief Nurse Clarify and refresh reporting of nurse sensitive indicators from “Ward to Board”

Indicators and reporting

Ward sensitive indicators are being reviewed as part of a review of staffing capacity and capability. This has been reported to TME and Trust Board.

1.2 Sustain and improve staff engagement and empowerment

Director of Workforce Create alignment of individual, team and Trust objectives

Year on year improvement in staff survey results

Implementation of new eAppraisal system will provide an enabler supported by management development and HR Business Partners and consultants

Director of Workforce Listening into Action (LiA) methodology adopted at Divisional, directorate and departmental level

Demonstrable service and quality improvement from LiA

LiA second wave project teams making progress with some LiA events occurring in Divisions with plans to use to support embedding new Divisional structure Q4 and beyond.

Director of Workforce Complete implementation of value based recruitment, appraisal and customer care training

Staff receiving regular feedback about behaviours and performance

Value Based Interviewing (VBI) project is now entering “spread and embed” phase. Divisional leadership briefings workshops commenced in Q3. To date 200 VBI interviews undertaken including those for Director of Workforce. 50 individuals




Key Actions Milestones/Measures Progress year to date as at end of December recruited.

Chief Nurse Identify value based interviewing implications for ward leadership

Implications identified VBI methodology being used for senior level recruitment and being piloted for care support workers.

Chief Nurse Align the “6Cs”1 into Trust values work

Document indicating alignment

Existing Delivering Compassionate Excellence programme reflects the 6Cs. This work will be developed as part of a new Nursing Strategy in 2014. The 6Cs are being incorporated into new Band 5-9 job descriptions.

1.3 Improve Quality Medical Director & Chief Nurse

Deliver agreed quality priorities across 3 quality domains

As per Quality Account

For 2013/14 local quality priorities were set across the 3 quality domains. Progress in delivering Divisional priorities is reported to Divisional Governance forums and monthly to the Clinical Governance Committee.

a) Domain 1: Safety Minimise Healthcare

Associated Infection Medical Director Ensure a Post Infection

Review is carried out for all MRSA infections

Incidence of MRSA and Clostridium difficile infections

As at the end of November there had been 3 cases of MRSA against a standard of 0 and 37 cases of Clostridium difficile against a standard maximum of 70 cases for the financial year.

Increase percentage of patients free from harm as assessed by NHS Safety Thermometer

Chief Nurse Reduce harm from pressure ulcers

Achieve NHS “Safety Thermometer” CQUIN

Not currently achieving target reduction due to reporting methodologies in 12/13.

1 Care, Compassion, Competence, Communication, Courage, Commitment




Key Actions Milestones/Measures Progress year to date as at end of December

Minimise venous thromboembolism (VTE)

Medical Director/Director of Clinical Services

Continue to improve VTE assessment

Achieve CQUIN Achieved

b) Domain 2: Patient Experience Introduce Friends and

Family Test

Chief Nurse • Introduce test for: - All inpatients and

ED patients from Apr 13

- Women who have used maternity services from Oct 13

• Complete procurement for wider patient feedback system

Achieve CQUIN

Friends and Family test introduced for inpatients and in ED and maternity services. Results analysed and reported through Divisional structures and to the Quality Committee. Overall response rate for Q3 was 16% against a CQUIN target of 20%. Work is in place to increase performance.

Improve Dementia Care

• Medical Director • Chief Nurse

• Improve screening for dementia

• Improve referral to specialist services of identified patients

• Clinical leadership and training

• Support to carers

Achieve CQUIN

• Although there has been some improvement in the number of patients being screened for dementia, the Trust’s performance is still considerably below target. Local feedback to areas (Trauma and AGM) has begun in order to enable local engagement. This will be expanded in Q4.

• To date 428 staff have been funded to attend dementia training facilitated by Oxford Brookes University, 18 staff have attended the Dementia





Leaders programme and 18 staff the ward level programme facilitated by Oxford Health NHS FT.

• All new CSWs receive a one hour session on dementia awareness (128 staff since Apr 13).

• Dementia café rolled out. • Capital project being progressed

for Dementia friendly ward. Improve service to

patients requiring a wheelchair

Director of Clinical Services

Develop an action plan to improve processes for timely referral and assessment of children requiring wheelchair equipment

Meet requirements of ‘Child in a Chair in a Day’ (specialist wheelchairs) CQUIN prequalification (5 week wait from referral to assessment)

Q2 performance 94 – 98%. There is no formal target. Work continuing to review and identify problem areas e.g. home visits. Q3 performance currently being analysed but verbal feedback of no new issues

c) Domain 3: Effectiveness and Outcomes Develop/extend the

use of intra-operative fluid management (IOFM) technologies for patients during and after surgery


Meet requirements of CQUIN prequalification (Use IOFM - 80% for agreed procedures. Q3 target = 50 per month / total 150)

On target.

Improve medical outreach to older people with complex needs who are patients


Achieve CQUIN Achieving CQUIN. A Senior House Officer and Consultant have been employed to focus on this.





in surgical areas Build capacity in the

organisation for clients with learning disabilities, dementia and vulnerabilities

Chief Nurse/Director of Clinical Services

Increase neurologist involvement in management of people with learning disabilities who present with seizures

• Number of Learning Disability champions who have attended training

• Achieve CQUIN • Improved outcomes

for vulnerable patients

CQUIN target met (relates to improved outcomes for patients with Learning disability who present with seizures). A report was presented to the Dec 13 Quality Committee meeting which identified a range of improvements, including those listed below.

Identify champions

The identification of learning disability champions across the Trust is on-going, with a particular focus on Emergency Medicine.

Training

Training on the provision of healthcare to patients with learning disabilities is embedded within current training frameworks for Safeguarding, Equality and Diversity, the Preceptorship course for nurses, CSW and overseas nurses’ induction. Specific training is delivered to CSWs in Neurosciences and individualised training to learning disability champions. Training for medical staff and Allied Health Professionals is in the process of being developed. A learning disability awareness training DVD has been developed.





The Trust has an established Learning Disability Working Group. Other improvements include: • A good range of easy to read

information is available throughout the organisation, including procedures and consent, PALS and complaints, treatment options and appointments.

• An established Trust Tracking and Flagging group which is developing a system to identify people with learning disabilities who use the Trust’s services.

• Audit by the Learning Disability Acute Liaison nurse of reasonable adjustments required by and provided to individuals

• Promotion of the community Learning Disability Teams to Trust staff and monitoring of referrals made to them.

1.4 Maintain/deliver national and local performance standards (figures marked with a * represent year to date performance) Referral to treatment

waiting times for non-urgent consultant-led treatment


• Delivery of theatres workforce plans

≥ 90% admitted patients to start treatment within 18 weeks

91.1%*

≥ 95% non-admitted patients to start treatment within 18 weeks

96.6%*





≥ 92% incomplete pathways within 18 weeks

92.9%*

No referral to treatment times >52 weeks

32 to the end of November

Diagnostic test waiting times


• Introduce 6 day working in endoscopy

• Review ultrasound and musculoskeletal MRI provision

<1% of patients waiting 6 weeks or more for a diagnostic test

Although the year to date figure is 8.1%, as at the end of December this had been reduced to 1.4%.

A&E waits and Ambulance Handovers


• Agree and implement action plan to support delivery

• Respond fully to recommendations of Emergency Care Intensive Support Team

• Ensure all patient pathways are clearly defined and effective

• Ensure all Divisions are engaged

• Establish Therapies Rapid Response Service, working with SHDS to avoid admissions

• Ensure there is a process in place to escalate potential

≥ 95% patients admitted, transferred or discharged within 4 hours of their arrival in ED

94.2%*

Maximum 12 hour trolley wait in ED

No waits over 12 hours

Handovers between ambulances and ED Department within 15 minutes (standard 95%)

81.9%* (performance for November was 89.84%)

Achieve CQUIN (“Emergency Care Intensive Support Team Action Plan”)

Currently on target against action plan. Additional practitioners are in place in the ED.





breaches to the appropriate level of management

• Consolidate and develop Children’s Urgent Care Pathway

Cancer Waits Director of Clinical Services

• Introduce 7 day working on linear accelerators

• Achieve agreement for the Outline Business cases to expand radiotherapy capacity

93% of patients seen within 2 weeks of an urgent GP referral for suspected cancer

95.3%*

96% of patients receiving 1st definitive treatment within 1 month of cancer diagnosis

97.5%*

85% of patients receiving 1st definitive treatment for cancer within 62 days of an urgent GP referral for suspected cancer

82.5%*

Where subsequent treatment is radiotherapy 94% of patients receiving treatment within 31 days

95.4%*

Cancelled operations Director of Clinical Services

Review theatre utilisation and list management/planning

All patients who have operations cancelled, on or after the day of admission (including the day of surgery),

Although the year-to-date figure as at the end of November was 14.6% not rebooked within 28 days, this figure is likely to be overstated due to incomplete validation of Q1 data.





for non-clinical reasons to be offered another binding date within 28 days, or the patient’s treatment to be funded at the time and hospital of their choice

The percentage who had not been rebooked at the end of November was 2.22%.

No patient to be cancelled for a second time for an urgent operation

No patients cancelled a second time.

1.5 Strengthen nursing care (linked to recommendations of Francis report)

Chief Nurse Evaluate and benchmark ward based nurse staffing levels at least annually

Evaluation and benchmarking

Q3 have used Safer Nursing Care tool to determine the levels of staff required in adult ward areas and reported this to Trust Board. This will be done bi-annually to determine safe levels of staff. This incorporates patient acuity and dependency. This data can be benchmarked against the Shelford Group.

Progress Modernising Nursing Careers plan in relation to Band 8 nurses and midwives

Agreed Competency framework

This work in on-going.

Review and relaunch Band 7 Leadership Programme

At least 2 cohorts of the programme run

In total 48 staff have now completed the leadership programme (3 cohorts). The next cohort is due to start in February with 18 staff already booked onto it from ward and critical care areas.





Review and expand Healthcare Assistant Academy

Run monthly programmes

Patient feedback has highly commended the Trust’s CSW training. The Academy is a pilot site for the NSPCC project supporting the introduction of VBI. Initial anecdotal feedback clearly demonstrates the value of this recruitment system and the team has noted how these values are being exhibited within the Induction programme. A programme of education of existing support workers is due to commence in Jan 14 following consultation over the summer with senior nurses and CSWs. A pilot project to support a small cohort of Young Apprentices was launched in September 2012. 6 Young Apprentices were successfully recruited into geratology as well as microbiology, business development and OUH IM&T Services.

1.6 Optimise Configuration of Patient Services


Consult on future delivery of emergency surgery across the Trust, develop plan and implement

This has been delayed due to CCG wishing to undertake a broader public engagement exercise to cover a wider service strategy, rather than a single focus on the Horton. Director of Clinical

Services Maximise the use of the Horton General Hospital to improve services in the north of Oxfordshire

Undertake public consultation with CCG on the future of the Horton General





Hospital Director of Clinical Services

Resolve mixed sex accommodation issues

Mixed sex accommodation breaches

There have been 4 breaches as at the end of Q3.


• Relocate respiratory inpatients and Cystic Fibrosis service to the JR site

• Relocate and reorganise respiratory day case and outpatient service on Churchill site

• Agreement of business case (Summer 2013)

• Relocation by end of March 2014

Delayed as alternative proposals for the reconfiguration of services between the JR and Churchill sites are under consideration.


Relocate Clinical Genetics to NOC site

Agreement of business case (Summer 2013)

Aim to relocate service in Q4.


Review outpatient capacity on the Churchill site with objective of vacating old estate

• Identify clinic requirements

• Relocate services

Exercise to establish clinic requirement completed. Options now being considered for service locations.

SO2 To be a well-governed organisation with high standards of assurance, responsive to members and stakeholders in transforming services to meet future needs – “ a well-governed and adaptable organisation”

2.1 Achieve NHS Foundation Trust Status

Director of Planning and Information

Progress application • Submit updated Integrated Business Plan and Long Term Financial Model

• TDA support • Monitor

assessment

All milestones met in line with timetable agreed with TDA. (Timescale paused nationally pending development of new CQC inspection regime). New timetable for next phase of application agreed.





2.2 Continue to improve Governance and Assurance systems a) Implement changes

from the review of the Trust’s governance framework as part of the development of the application for Foundation Trust status

Director of Assurance

Revised Committee arrangements designed and implemented

SOPs in place and published / communicated to relevant staff (Aug 13)

Completed –Committee Handbook published on Trust intranet, Aug 13.

SOPs embedded and used effectively (March 2014)

In progress. Timescales being monitored and exceptions addressed or escalated as required.

Implement the changes from the reviews of committee effectiveness

Implement and communicate new suite of templates to support meeting effectiveness (Sept 13)

Completed – Report template issued and published on the intranet. Feedback being used to enhance templates as and when received, Sept 13.

Cycles of business revised for Board and sub-committees (Sept 13)

Completed – All cycles of business revised, Sept 13.

Review ToR for the TME and sub-committees (Jan 2014)

Completed. Review of ToR for TME and sub-committees completed and due to be reported to TME on 23 Jan 14.

Support the development of effective paperwork for the Board and sub-committees

Guidance written and issued (Sept 2013)

Completed – Guide to writing and presenting an effective Board paper published on the intranet, Sept 13.

Training sessions held for key report authors (Mar 14)

In progress - External provider identified and budget being negotiated. Training for Directors to be scheduled.

b) Ensure the continued provision of a legal


Undertake a review of the legal services

Review to be completed by

In progress / behind schedule – Field work including interviews with





services department which meets the needs of the Trust

department

31 Dec 13

key stakeholders completed. Review to be completed Jan 14.

Present a proposal to TME on proposed changes

Results of review reported to TME where necessary (Jan 14)

In progress - Report to be produced Jan 14.

Implement changes as identified through the review

All changes to be implemented by 1 Apr 14

Not started – Any necessary changes will be made following the review of the formal report.

c) Review and implement changes to the policy management framework


Use LiA methodology to support the review

LiA event to be held in July 2013

Completed – LiA events held in Jul and Aug 13.

Seek approval from the Trust Board to implement changes

Trust committee to consider revised approach Nov 13

Completed – Revised approach agreed by TME Dec 13.

Convene Policy Coordination Group

Group in place by Nov 13

Completed – Corporate Policy Coordinators identified and group convened, Nov 13.

Review all Corporate Policies to check all corporate policies are current, and compliant

Completed by end Jan 14

In progress – Due to be completed by 31 Jan 14

d) Continue to implement and embed the Assurance and Risk Management Strategies


Review achievement of initial Implementation Plans for both strategies

Review of strategies and presentation of results to Trust Board by Nov 13

Completed – Risk Management Strategy implementation plan formally reviewed and presented to the Board Sept 13. Assurance Strategy implementation plan reviewed and results presented to Trust Board Nov 13.

Further embed the Risk and Assurance Strategies into the Trust

Update risk training and run across the Trust (March 14)

In Progress – Risk Management training updated and currently being delivered





at: • Divisional level and, • Corporate directorate

level

Develop assurance map process (March 14)

In Progress – Data quality assurance map presented to Quality Committee Dec 14, further developments in progress.

Develop and implement phase 3 HealthAssure action plan

Phase 3 Plan developed (July 13)

Completed – Plan developed July 13

Risk register reporting developed (Nov 13)

Completed –Reporting developed and updated user guide completed Dec 13

Quality review of risk registers (March 2014)

In progress – Due to be completed by 31 Mar 14

e) Continue to implement action plans to ensure continued compliance with CQC outcomes and other regulations


Ensure evidence is populated on Health Assure at clinical service level

All evidence sets to be populated (Sept 13)

Completed - CQCAssure in place and running across the Trust. All assessments completed Sept 13.

Quality assess the evidence and make recommendations for improvements

QA process to be 80% completed by 31 Jan 14

In progress – initial reports to TME Sept 13 and Quality Committee Oct 13, on-going reports from Jan 14 (80% of QA on track for completion by due date)

Implement internal peer review process

Full review of each division to be completed by Mar 14

In progress –Review of all divisions to be completed end of Feb 14

Develop an on-going programme of Peer Review (Mar 14)

In progress – Due to be completed by 31 Mar 14

Assist with the Trust NHSLA accreditation processes

In line with inspection timeframes

Completed – Maternity NHSLA Level 2 assessment completed Nov 13.

2.3 Continue to realise Director of Planning Agree future • Agree future roll- • Maternity relaunch successfully





the benefits of the introduction of the Electronic Patient Record

and Information development path out plan • Agree

reprocurement approach

implemented • Roll-out plan agreed at

November Trust Board meeting • Reprocurement approach

agreed at May Trust Board meeting. Reprocurement timetable remains on target.

2.4 Develop and support OUH leadership community to deliver

Director of Workforce Create a Leadership Strategy (Framework) and Plan which supports the on-going development of leaders

Strategy and Plan developed

Draft Plan tabled at the last 2 Workforce Committees – scheduled for January Board

Director of Workforce Introduce a 360º feedback process into appraisals to support personal development planning

360º feedback mechanism in place

Integrated into leadership strategy – new NHS Leadership 360º tool to be launched in Feb 2014 – Initial introduction to the new model made at the OUH leaders Conference in Dec 13

Director of Workforce Commence a training needs analysis of leaders on a phased basis

Training needs analysis completed for ward sisters and other priority groups

Integrated into the leadership development strategy

2.5 Carry out Trust’s legal obligations with regard to Medical Revalidation

Medical Director Ensure each doctor has a quality-assured annual appraisal.

All doctors have quality-assured annual appraisal

The medical appraisal window runs from 1st Oct 13 to 31st Mar 14. At the end of Q3 all doctors with a prescribed connection for medical revalidation had been assigned an appraiser, advice had been updated and circulated and a small number of completed appraisals had been received by the Medical Director’s




Key Actions Milestones/Measures Progress year to date as at end of December Office. Every doctor is being tracked individually and each appraisal received is checked against basic quality standards to enable full compliance to be reported.

For those doctors who have revalidation dates within 2013/14 make revalidation recommendation

Revalidation recommendations made for the 20% of doctors with revalidation dates Apr 13-Mar14

All revalidation recommendations due to date have been made on time and in accordance with GMC guidelines.

SO3 To meet the challenges of the current economic climate and changes in the NHS by providing efficient and cost-effective services and better value healthcare – “delivering better value healthcare”

3.1 Increase productivity and delivery of CIPs year on year in line with the agreed financial strategy and within the agreed performance framework/compacts

Director of Finance and Procurement supported by Director of Clinical Services

Deliver agreed Financial Plan

Financial plan The Trust is on plan to generate the agreed break even surplus after the first eight months of the year.

Deliver Cost Improvement Programme

Cost Improvement Programme

The Trust forecasts it will deliver £42.7m in savings in 2013/14, with the high levels of activity making the delivery of savings through ward closures not currently possible and with some slippage on the workforce initiatives.

Downsize commensurate with commissioner QIPP delivery

QIPP delivery The delivery of savings through ward closures is not considered possible. Commissioned activity is ahead of plan and delayed transfers of care are also above target.

3.2 Maximise the utilisation of resources through


Business case for 23 hour day surgery unit

Business case in development





extending hours and increasing 6 and 7 day working

Develop weekend gynaecology scanning and Saturday theatre sessions

Weekend scanning on-going. Saturday theatre sessions have been run when justified by demand.

Pilot 7 day radiotherapy service

Pilot has commenced

Review scope to extend working hours in theatres

Extended hours are in operation in some theatres, with plans to extend this further.

3.3 Develop workforce plans that respond flexibly to activity levels within the affordable financial envelope whilst maintaining quality standards

Director of Clinical Services/Director of Workforce

Improve workforce and capacity business planning capability to reduce reliance on temporary workers during peak periods of activity

Workforce expenditure in line with agreed budgets

Expenditure is above agreed budget levels due to continued use of agency and higher than forecast activity levels for specialised commissioners.

Director of Clinical Services/ Director of Workforce

• Align job plans, shift arrangements and rotas to service requirements

• Improve staff retention and reduce turnover and sickness absence

Achieve agreed turnover, sickness absence and recruitment KPIs

Turnover and sickness absence KPIs were above the agreed standard as at the end of Nov 13 (11.35% and 3.24% respectively) Retention plan to be agreed with TME in Feb 14. “First care” being rolled out across the Trust, will be fully utilised from 1 Apr 14

Director of Workforce Improve the effectiveness of the recruitment process to avoid pressures

Recruitment process has been reviewed using Lean methodology. “TRAC” candidate tracking system has been introduced. Time to hire





associated with high vacancy rates

has been reduced.

3.4 Improve utilisation of Trust’s estate

Director of Development and the Estate

Reconfigure theatre and critical care facilities across sites, refurbishing facilities where required

• Feasibility paper for JR theatre and critical care facilities to be presented to Trust Management Executive in January 2014.

• Project underway for refurbishment of Women’s Centre theatres.

• 6 Facet survey expected completion 31 Dec 13.

• Proposals for configuration of clinical services across sites discussed at Board Seminar 8 Jan 14.

• Latter two documents will inform development of detailed Estates strategy

3.5 Use IM&T to improve quality and efficiency Reduce unnecessary

face-to-face contact between patients and healthcare professionals by incorporating technology into these interactions


Project to reduce antenatal visits for gestational diabetics

Meet requirements of “Digital First” CQUIN prequalification

Target was for 50 women to participate in satisfaction survey. 49 out of 52 women participated.

Project to improve physical outcomes post myocardial infarction

Recruited to all posts except one in December.

Work with Oxford Health NHS FT and Oxfordshire Social Services to increase the use of telemedicine


Agree plan for use of telehealth/telecare to support more accurate assessment of patients who have become

Meet requirements of “3millionlives” CQUIN prequalification

Information governance and procurement issues have led to a delay in the project.





to provide whole system care delivery close to home

acutely unwell in community settings

Extend ICE on-line ordering to radiology requesting/reporting


Roll out ICE to radiology requesting/ reporting

Meet requirements of “Digital First” CQUIN prequalification

Milestone achieved/CQUIN target met

Prepare for paperless referrals in NHS (target date March 2015)


Strengthen underpinning IT infrastructure

Update clinic templates to support Directly Bookable Services

• Direct booking implemented on NOC site

• Project plan for clinical profiling agreed

• Project on track 3.6 Develop initiatives to

reduce length of stay Director of Clinical Services

Extend Enhanced Recovery After Surgery (ERAS)

Extension of ERAS underway for additional elective clinical pathways and emergency clinical pathways. Recruitment problems to physiotherapy aide post has caused delay to this project.

Extend use of minimally invasive surgery

Widening of skill base and application of minimally invasive robot assisted surgical procedures in progress. First cystectomy completed in 13/14. Extension to colorectal surgery planned for 14/15 to enable participation in national clinical trial.

Improve provision of specialist support for medicine patients with GI bleeds

Initial discussions and scoping of a service model improving 7/7 provision of GI bleed service between GET Directorate and Medicine completed.

3.7 To change OUH from an expenditure-led

Director of Finance and Procurement

Promote the use of Patient Level Information

• SLR and Reference costs used in

Clinical Costing Advisory Development Group established.





service line reporting organisation to an income-led Service Line Management organisation with a focus on positive contribution

and Costing System (PLICS) and Service Line Reporting (SLR) information throughout the organisation, allowing the Divisions to more effectively manage services and costs

Divisional Performance reviews

• SLR analysis included in evidence within business case submissions and improvements in SLR performance included in criteria for approving change

SLR analysis must now be included in the evidence within business case submissions and improvements in SLR performance are to be included in the criteria for considering and approving change. The patient level costing system (PLICS) is used to support the negotiations with Commissioners for non-tariff service areas.

Encourage Divisions to improve accuracy of clinical coding and optimise clinical productivity, including job planning

The Trust has established the Information Governance & Data Quality Group which receives regular reports relating to data quality improvements including benchmarking, external audits and Divisional data audits. Job Planning Guidance has been issued and a review of medical on call rotas is also in progress. The PLICS and SLR models are updated with the up to date consultant job plans when they are made available.

Undertake specific work with NTSS and S&O Divisions to analyse factors driving

NTSS Division, supported by the central Costing Team, has used a “drill down” approach within the PLICS system to identify,





performance with objective of making recommendations for reducing costs and improving financial performance

investigate and address adverse cost variances. The S & O Division has undertaken in depth case studies for each of the 4 directorates, and in Surgery, Renal and Gastroenterology Operational Service Managers have been reviewing the costs attributed to their services within the model and improving and amending the activities used to allocate direct costs to patients.

3.8 Introduce internal trading for Radiology and Pathology


• Implement 1st Apr 13

• Monthly data distributed

• Quarterly review meetings in place for all Divisions

Radiology internal trading was put in place as of Month 3 with a backdate to 1st Apr 13. The data has been validated with the clinical divisions. There has been an over performance across all Divisions. A full review was undertaken after Q1 and the feedback from the clinical divisions was very positive. Regular on-going meetings have taken place at directorate level and queries have been dealt with as they have arisen. Pathology internal trading has taken longer to implement due to the volume of data that has required validation. This is now completed and monitoring has been in place since Month 9. Again there has been an over performance across all Divisions.





SO4 To provide high quality general acute healthcare to the people of Oxfordshire including more joined-up care across local health and social care services – “delivering integrated local healthcare”

4.1 Work with partners to reduce the number of system wide delayed transfers of care (DTOCs)


• Expand Supported Home Discharge Service (SHDS)

• Roll out joint pilot between Therapies team and SHDS in ED to help reduce admissions

• Develop a night care service to reduce admissions

• Expand service provided to Abingdon Community Hospital

• Joint audit with Oxford Health FT to identify how urgent care is used (April-June)

• Develop single point of access (availability of advice from expert nurse)

• 75% of patients to have an ‘estimated date of discharge’ (EDD) documented within 36 hours of admission

• Meet Local CQUIN payment criteria

Audit demonstrated 100% compliance with EDD 36 hour target. All actions required for CQUIN payment completed. Two audits undertaken jointly with Oxford Health FT demonstrate OUH compliance with agreed KPIs. However, system-wide delays at the end of Q3 show a year to date average of 142 delayed discharges.

4.2 Develop relationships with local GPs, both as commissioners through CCG and its localities and as providers


• Agree joint Work Programme

• Individual workstreams agree objectives and deliverables

• Joint work programme agreed • Individual objectives and

deliverables in process of being finalised

4.3 Continue implementation of


Develop model for Emergency Medical Unit

Agreed business case EMUs at JR and Horton are joint developments with Oxford Health





review of Acute and General Medicine

(EMU)/Acute Ambulatory Multidisciplinary Unit at the JR and Horton sites

NHS FT and will be fully operational in Jan 14.

Increase availability of intensive observation, treatment and nursing facilities within Trust

Develop business case for a Medical HDU on JR site

Feasibility study for the replacement of JRII theatres and integrated ITU and HDU considered by the TME in Jan14. Further work being undertaken and an update will be submitted to the TME in Mar 14.

4.4 Continue to improve psychiatric liaison and access to psychological support for the Trust’s patients


• Establishment and full integration of the new Psychological Medicine Service in Acute General Medicine and Geratology

• Consider the future requirements for psychological input into specialist services in line with NHS England draft service specifications

Meet CQUIN payment criteria

CQUIN requirements fully met. Psychiatric input is in place for medicine and old age (including Horton and weekends). A joint medicine/Women’s services psychiatric post will be advertised shortly. There is also psychiatric input in place for Children’s services and extension of this is being examined. Business cases are being developed for further psychiatric input into Cancer, Palliative Care and Neurology services. Work is underway to scope the need for psychology/psychiatric input in Transplant and Renal (some input already in place for donor assessment), ITU, Trauma and Pain services.

4.5 Prepare Genitourinary Medicine (GUM) services for a tender


• Review costs and provision of existing service

Tender submitted and OUH awarded contract for combined service which incorporates sexual health and contraception advice.





exercise for all GUM services under the new commissioning regime within the local authority

• Consider how to propose future service provision

• Submit tender return (Aug 13)

4.6 Improve the care of Diabetes patients


Develop multidisciplinary foot protection team and Diabetic Footcare Pathway

Meet criteria for local CQUIN payments

Criteria met

Improve care of inpatients with diabetes

• Reduced length of stay for inpatients with diabetes

• Compliance with NICE guidance

• Benchmarked performance in Diabetes inpatient audit

A risk summit was held in Oct 13 to examine processes and outcomes in relation to the care of adult inpatients with diabetes. The summit was attended by approximately 50 members of staff, along with representatives of both patients and commissioners with a follow up in Nov 13. A number of workstreams have been defined.

Improve support for young adults (16 -25 year olds) with diabetes

Meet criteria for local CQUIN payments

Criteria met

4.7 Improve the care of Stroke patients


80% spend 90% of stay on a Stroke Unit

90% (year to date)

85% of patients have direct admission to the Hyperacute Stroke Unit / Acute Stroke Unit within 4 hours of hospital arrival

Nov 13 – 100% at both the HGH and JR





100% of patients are scanned within 24 hours of arrival at hospital when judged clinically appropriate


95% screened for swallow problems

Nov 13 – 100% at the HGH and 96.67% at the JR

Assessment by the multi-disciplinary team within 72 hours of admission

Nov 13 – 100% at the HGH and 98.25% at the JR

Percentage of patients who have MDT Rehabilitation goals agreed within 5 days


4.8 Provide enhanced community-based palliative care service for Oxfordshire, in collaboration with Katharine House Hospice and Sue Ryder


• Establish “hospice at home” and a community respite/step down facility

• Agree model for retention of in-patient services, including widening of End of Life Care to non-oncology interventions

Initial meetings with Sobell House Hospice Trustees to establish common vision and strategy to develop step down facility. In discussion with CCG colleagues about Hospice at Home, though this has stalled following PCT/CCG reconfiguration. Inpatient service model for specialist palliative care confirmed but future model for EoL care provision included in outcomes based commissioning framework. Details not known.

4.9 Develop the Trust’s role in preventing, as

Chief Nurse Participate in Maternity services pilot

• First ‘Train the Trainer’ session has taken place





well as treating, ill health in accordance with the “Every Contact Counts” initiative

• Presently sourcing digital images for the posters

• Meeting had been organised but needs to be re-scheduled due to sickness

SO5 To develop extended clinical networks that benefit our partners and the people they serve. This will support the delivery of safe and sustainable services throughout the network of care that we are part of and our provision of high quality specialist care for the people of Oxfordshire and beyond – “excellent secondary and specialist care through sustainable clinical networks”

5.1 Continue implementation of radiotherapy modernisation plan, including potential for satellite radiotherapy facilities


• Develop outline business case for increased radiotherapy capacity

• Expand use of IMRT in line with agreed business case

• Implement prostate brachytherapy

• Implement stereotactic body and brain radiotherapy

• Develop business case for High Dose Rate radiotherapy

• Trust Board and the TDA have approved the SOCs for satellite radiotherapy units. The first OBC will be considered by the Trust Board at its January meeting.

• The local developments (IMRT, brachytherapy, stereotactic radiotherapy and HDR) have all been implemented.

5.2 Expand satellite haemodialysis provision


Agree business case for Swindon

Implemented

5.3 Continue to deliver specific network service development initiatives: Complete the

expansion of neonatal services


• Completion of construction

• Commission building • Expanded service

operational

Completed and operational





Progress the plan for the regional provision of Vascular Surgery


• Agreement of protocols and guidelines

• Discuss proposals for development of Oxford as interventional radiology centre of excellence with neighbouring trusts and prepare business case

On-going

Continue to develop Oxford’s role as Major Trauma Centre (MTC)


• Review implementation of MTC business case

• Establish integrated Rehabilitation pathway

• Improve interventional radiology provision

Fully operational

Continue to develop South of England Strategic Children’s partnership for paediatric cardiac surgery, paediatric neurosurgery and paediatric critical care in association particularly with University Hospital


Implementation of a Health Information Exchange

Fully functioning paediatric network between OUH and University Hospitals Southampton FT covering neurosurgery and cardiac services





Southampton FT Continue to develop

relationships with surrounding Trusts, particularly through joint clinical appointments and the delivery of care locally


• Appoint to agreed Urology and lung clinical oncology posts

• Develop business cases for further joint posts

Posts appointed to

Review the service specifications published by NHS England and prioritise investment in response


Complete

Develop Transplantation Service


• Develop business case for Renal Medicine and Transplant Centre

• Consider extension of transplantation portfolio, (including proposals for islet autotransplantation and liver transplantation)

• Complete Full Business Cases

• Implement if agreed

• Renal SOC due to be submitted to Mar 14 Trust Board meeting.

• Have not progressed designation for liver transplantation.

Review intestinal failure service provision


• Await outcome of national assessment process

• Develop full business case for future provision of service

Peer review process successfully completed.





SO6 To lead the development of durable partnerships with academic, health and social care partners and the life sciences industry to facilitate discovery and implement its benefits – “delivering the benefits of research and innovation to patients”

6.1 Establish the Oxford Academic Health Science Network (AHSN) as an entity independent of the Oxford University Hospitals. The AHSN is currently hosted by OUH

Chief Executive (interim accountable officer and deputy chairman)

Advertise and appoint a qualified Chief Executive to direct the actions of the AHSN

• Advertisement in Mar/Apr 13

• Interview May 13 • Appointment

Jun 13

Chief Executive and Chief Operating Officer appointed

6.2 Publish an ‘innovation scorecard’ to show compliance with NICE guidance on new drugs and treatments or explain why there is a delay


Compile composite innovation scorecard of all NHS AHSN members regarding NICE compliance. Publish local formulary

• Confirm NHS membership of AHSN

• Agree standards for monitoring NICE compliance and returns and publication of local formularies

The AHSN is now established as an independent entity with its own Business Plan and objectives.

6.3 Pre-qualification High Impact Innovation for CQUIN under International & commercial activity


Demonstrate that clear plans are in place to exploit the value of commercial intellectual property – either standalone or in collaboration with Academic Health

• Assure that clear plans are in place

• Publish International & Commercial Activity strategy either as a Trust or AHSN joint strategy

• Agree standardised Intellectual





Property and Clinical Trials policy across NHS AHSN members

6.4 Apply for Academic Health Science Centre status

Chief Executive Submission of prequalifying questionnaire

31st May 2013 AHSC status awarded

6.5 Progress the shared agenda with the University of Oxford and Oxford Brookes University

Chief Executive Joint working agreement signed

6.6 Progress the strategies set out in the successful renewal bids for the Biomedical Research Centre and Unit (BRC/U)

Medical Director Make progress in strategic development of BRC, establishing appropriate priorities

2 yearly review of all themes and working groups

BRC work programme being progressed.



3. Conclusion 3.1. Overall good progress has been made. Areas for more attention in coming

months include:

• Achievement of performance standards

• Continued focus on safety, including infection control

• Reduction of turnover and sickness

• Achievement of planned CIP when activity levels are higher than commissioned

• Optimising the configuration of clinical services and the use of the Trust’s estate

• Improving the response rate for the Friends and Family Test

• Increasing the screening of patients for dementia

3.2. Plans for addressing these issues are included in other Board papers and will be incorporated into the Trust’s Business Plan for 2014/15.

4. Recommendation 4.1. The Board is asked to note this report.

Mr Andrew Stevens Director of Planning and Information Report Prepared By: Ailsa White Corporate Planning Manager January 2014

Trust Board Meeting: Wednesday 22nd January 2014 TB2014.13 ...

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