Louise Barnett, Chief Executive, to present
Minutes:
Louise Barnett, Chief Executive, Rotherham Foundation Trust, gave a powerpoint presentation illustrating the progress made on the 5 year strategic plan as follows:-
Option 1 – the preferred Option
- There was overwhelming support from the lead commissioner to retain locally run services for the population of Rotherham led and managed by the Trust
- There was a significant number of potential opportunities that would be realised through closer working and collaboration with other providers without recourse to merger
Option 1 – Financial Challenge and Progress
- Final Cost Improvement Programme for 2014/15 agreed in 5 year plan was £10.9M
- As at 30th November, 2014, Month 8, the Trust had delivered c£6.3M in-year against £6.1M plan
- Year end forecast at Month 8 was £10.1M and full year effect was £12.1M
- Month 9 on track and on target to achieve the full Cost Improvement Programme in-year of £10.9M including significant full year effect to support 2015/16
- All schemes were approved subject to Quality Impact Assessments with sign off by the Chief Nurse and Medical Director
- The Cost Improvement Programme for 2015/16 was currently £12.9M as stated in 2014/15 5 year plan for year 2
- This would be refreshed in line with sector business planning requirements
- Over performance in 2014/15 would support delivery of this requirement
- Capital spend was slightly ahead of plan in Month 8 but was being monitored and where possible consideration was being given to advancing schemes for next year
- Aims was to ensure a robust planned programme of capital expenditure to support Service delivery
- Reserves were being access to support delivery of the plan for 2014/15
Progress against Key Areas
- Clinical Speciality Reviews had been completed and the outcome would be shared with the Trust Board in January
- Emergency Centre Business Case agreed and expected to open in 2017
- Further work would be progressed during 2015/16 and the outer years to support the Trust’s strategic direction to be a standalone Trust with collaboration
- Local context was compatible with national context – “Five Year Forward View” and the “Dalton Review” which supported local services and strived to achieve clinical and financial sustainability more broadly
- Benchmarking exercise undertaken with external input
- Identified opportunities for efficiencies compared with peer group
- Used to inform the cost improvement and transformation programmes for 2015/15 and beyond
- Importance of implementing Service Line Reporting and Patient Level Costing (PLiCS) to enable detailed understanding of cost base in 2015/16
Other Key Areas
- Monitor enforcement/undertakings
Electronic Patient Record enforcement lifted
Submitted documentation regarding Board Governance enforcement
Financial enforcement remained in place
- Board Director appointment since the last formal meeting
Simon Shepherd, Director of Finance
Chris Holt, Chief Operating Officer
Lynne Waters, Executive Director of Human Resources
Donal O’Donaghue, Interim Medical Director
- Winter pressures
A&E performance
Support from health and social care partners
Choose Well Campaign
- Sickness absence
- Recruitment and retention
Our Strategy and Goals
- Our Vision
To ensure patients are at the heart of what we do, providing excellent clinical outcomes and a safe and first class experience
- Our Mission
To improve the Health and Wellbeing of the population we serve, building a healthier future together
- Our Values
Respect, Compassion, Responsible, Together, Right First Time and Safe
- Our Strategic Objectives
Patients - Excellence in healthcare
Putting our patients at the heart of what we do
Care and compassion
Every patient and their family is special
Always ensuring we meet essential standards of care
Embracing the future and leading the way
Colleagues - Engaged, accountable colleagues
Amazing colleagues delivering patient care every single day
Ensuring that is a really great place to work
Listening to you and supporting you to make decisions
Developing you to be the best you can be
Facing our challenges together
Governance - Trusted, open governance
Being open and transparent about what we do
Being responsible and accountable
Learning when things do not go well
Supported by clear policies and structures
Always compliant giving patient’s confidence in all we do
Finance - Strong financial foundations
Using our money and resources wisely
Better understanding the costs of delivering services
Making savings safely and becoming more efficient
Investing in quality and improving our facilities
Value for money and planning for the future
Partners - Securing the future together
Understanding the needs of our community
Working with others to improve the health and wellbeing of our community
Looking ahead
Building partnerships to achieve clinical and financial sustainability
Embracing innovation
Next Steps
- 2015-16 business planning process
Refresh of strategic plan to reflect newly introduced strategic objectives and aims for 2015/16 and beyond
Quality priorities, workforce, operational governance and financial elements
Build on feedback from partners, patients and colleagues
High level draft operational plan – 27th February, 2015
Final detailed operational plan – 10th April, 2015
- Achieve 2014/15 plan requirements for year 1
Discussion ensued with the following issues raised/clarified:-
· Patients had not been surveyed specifically in relation to the quality of service since the start of the Strategic Plan but there were regular surveys as well as the Friends and Family Test so as to provide a line of sight year on year
· There was £10M in the Trust’s recurrent funding. The Trust did carry out non-recurrent activities and the commissioners did give non-recurrent funding every year. Winter pressures were an example of that funding although that issue may be dealt with differently going forward. A more detailed understanding of the cost base was required so Service line reporting and patient reporting had been implemented so exact costings would be known for particular procedures and make it easier to manage the funding. At the moment there was still an underlying deficit of £6-8M which needed to be added and was masked by a whole raft of things that the Trust did
· A&E had the accommodation/ability to cater for 55,000 attendances a year – it was actually seeing around 75,000 therefore working in a constrained environment. The new Emergency Centre was critical and would open in 2017 although there had been an assurance that by the Winter of 2016 the environment would be sufficiently developed. Work was taking place on the possibility of more space for the Winter 2015 to try and cope more effectively
· The 4 hour access target was a metric giving line of sight on performance in the Emergency pathway because patients needed to be seen, treated, admitted or discharged within 4 hours. Currently the Trust was not consistently achieving the 95% target and would be the subject of discussions with their Regulator who was fully aware of performance. The Trust had achieved Q1 and Q2 but not Q3. Although there was a commitment to achieve Q4, the Trust could no longer achieve the target for the year but was not alone in the wider national context. Actions had been put into place internally to improve the way it worked which should make a significant difference the benefit of which was already being seen. There were now days where the Trust was achieving above 95% but there were difficult days. That would remain the focus throughout the year
· Work was underway on the financial planning and would be submitted to Monitor on 27th February. Discussions would then take place and the plan submitted on 10th April
· The Trust had a deficit but not a debt. There was an underlying deficit but because the Trust was in surplus it continued as it was, however, there was a need to be mindful that whilst it appeared to be fine, once it had been stripped back, the Trust was actually living over its means. Continued monitoring would take place whilst still aiming to be in a position of surplus
· It was incumbent upon the Trust and a statutory requirement to deliver services to the population of Rotherham as a community provider. In light of budget cuts, the services had to be continued but in a more efficient manner. Currently there were a number of long stay patients in hospital but if there was more effective multi-disciplinary working with partners then the length of stay should be able to be reduced, relocating them into the correct setting quickly and thereby reducing the resources of organisations and capacity to provide the care. It was also hoped that the transformation of Community Services would avoid people coming into hospital as often people were in hospital because there was no other alternative at the time of admission
· The Trust recognised the national challenges around the financial position but it was not planning to cease providing particular services as it had an obligation to provide them
· As part of the development of the Emergency Centre there had been a commitment to provide additional car parking and work was ongoing with bus companies with regard to routing. Work would also take place with the workforce and ensuring staff were flexible in terms of how they worked as the Trust increasingly moved to 7 days working. Other forms of transport would be encouraged e.g. car sharing and cycling. The Trust agreed to provide further information
· The Enforcement had been extremely challenging over recent times and there were still things that could be done to improve performance particularly A&E performance. The Emergency Centre would help take the Trust in a significant direction
· There had been intensive support from Health and Social Care partners during the Winter so far. The Rotherham Clinical Commissioning Group had assisted when the Trust had raised concerns regarding the Walk in Centre and the ability for extra capacity had been provided to prevent people going to A&E which had made a real difference in managing the high spikes. GPs went into the Hospital 3 times a week to work as part of the multi-disciplinary teams to support long term patients to ensure the best possible care in the right place. With the assistance of the Hospital Consultants, senior GP, Head of Nursing in Communities Services, Social Services and Therapeutic Services, there was the ability to carry out focussed work and individual patient service which ensured the patient received the care needed very quickly. The Trust had also been provided with additional Social Workers and was really pleased with the package of support that had been available and felt very fortunate to have that level of co-operation from the local Health and Social Care economy
· Choose Well Campaign – need to keep getting the message out to the public
· The sickness absence rate was not good. Managers were being trained to manage this more effectively, strengthen the health and wellbeing offer to staff when not at work and take a very robust and supportive role. Sickness absence may impact on continuity of care and also leads to higher costs through the use of agency staff
· Recruitment and retention – there were national shortages in certain groups but the Trust continued to strive to recruit as many permanent staff as possible and was determined to ensure it had safe staffing levels. There were approximately 20,000 nursing vacancies across the country. Rotherham continued with their recruitment campaign both nationally and internationally
· The Trust had faced a shortage of nurses and had done all it could to attract them to Rotherham. As many as the Trust could accommodate were recruited and there had been some very good student nurses within the organisation. It was acknowledged that there was more that could be in terms of unregistered staff, Health Care Assistants for example, who could be trained and not rely on agency staff. The market meant that nurses could go to agencies and work at a higher premium outside of their ‘normal‘ working hours at another hospital. Successful investment schemes had been run attracting personnel to the organisation but ideally would like to reach a balanced position of staff working within the organisation consistently and able to do extra hours on the bank if they wished
· The Trust was very mindful and guided by NHS England in relation to whether it was appropriate and ethical to go abroad to recruit. The Spanish nurses were those that could not secure a job in Spain due to there not being sufficient positions, not because they were not competent. 2 of the Trust’s experienced nurses had gone to Spain to interview the applicants and ensure they were fit to work in England and the Trust. Many of the nurses wanted to be able to secure jobs in the NHS and Rotherham’s team had given assurance that the nurses were very impressive. They would start at the Hospital in the second week of February and would have a minimum of 2 weeks classroom induction to help them understand how the NHS worked and induct them into the process. The Trust was working with the Council to develop guides of local colloquialisms to help the nurses understand
· Every month the number of registered nursing vacancies were monitored and scrutinised at the Quality Committee. The Trust held between 30-50 registered nursing vacancies across the Trust per month and it knew that the local universities had an outturn twice a year so did its best to recruit new nurses to fill the vacancies. It had been identified that over the course of the next 6 months it would probably need to recruit 70 registered nurses to fill the vacancies and those that were likely to occur. A recruitment visit was to take place to Romania at the end of February as the Trust was led to believe from its recruitment agency that Spain would dry up in relation to surplus nurses shortly and it would be unethical to continue to recruit. It was hoped to recruit up to 30 nurses from Romania
· There was a NHS national staff survey which took place in the Autumn every year the results of which were anticipated in February/March. The Trust’s own survey was also conducted in the Autumn and, whilst there was room for improvement, it had done quite well compared to other organisations. There needed to be continued work with staff to ensure they were supported and had a good experience
· The Vision and Mission statements were reviewed annually. In terms of changes it was incumbent upon the Trust and others to work together and work through the Health and Wellbeing Board and outside that which all contributed to improving the health and wellbeing of Rotherham
· With regard to ex gratia payments i.e. small amounts of money claimed for compensation, the Trust took the stance that it was still public money and should not pay even small amounts without a full investigation. It was acknowledged that administratively it took time and cost for the investigation but it was still public money and if there were lessons to be learnt to avoid future costs that investigation should take place. The Ex Gratia Panel would consider whether an offer should be made and then would be reported to the Finance Committee and/or the Audit Committee.
· Patient litigation – the Trust contributed to the NHS Litigation Authority and was not out of line with other Trusts of its size in relation to litigation costs. It could be 6 years before the cost of a litigation was known. Rotherham’s premiums to the Litigation Authority was what might be expected to see in a Trust of its size. Trusts without the 3 specialisms that Rotherham had - obstetrics, orthopaedic and A&E – may have lower premium and claims history as they were known as the 3 highest risk areas
Louise was thanked for her presentation.
Resolved:- (1) That the Trust attend Health Select Commission meetings twice a year to provide updates.
(2) That the Trust provide additional information about future plans for car parking on site.