King’s College Hospital Council of Governors - 365.1 - cog agenda and papers ma… · CV Praveen Staff - Medical and Dentistry Carolyn Campbell-Cole Staff – Nurses and Midwives

King’s College Hospital Council of Governors

PUBLIC AGENDA

Time of meeting 15:00 – 16:45

Date of meeting Wednesday, 05 March 2014

Venue Large Hall, 4th Floor, Bromley Central Library, High Street, Bromley, BR1 1EX

Marc Meryon NED/Senior Independent Director – Chair of Meeting

Elected: Anoushka de Almeida-Carragher Bromley Eniko Benfield Bromley Paul Corben Bromley Penny Dale Bromley Michael Robinson Lambeth Central Godwin Ubiaro Lambeth Central

Fiona Clark Lambeth North Chris North Lambeth North Nanda Ratnavel Lambeth South vacancy Lambeth South Alan Hall Lewisham Tom Duffy Patient Patti Kachidza Patient Derek Cookson Patient vacancy Patient Jan Thomas Patient David Sullivan Patient Barbara Pattinson Southwark Central Pam Cohen Southwark Central Andrew McCall Southwark North Joe Onabaworin Southwark North Stuart Owen Southwark South Michelle Pearce Southwark South Phyllis Barnett Staff – Allied Health Professionals CV Praveen Staff - Medical and Dentistry Carolyn Campbell-Cole Staff – Nurses and Midwives Nicky Hayes Staff – Nurses and Midwives Helen Mencia Staff – Nurses and Midwives vacancy Staff – Admin, Clerical and Management

Nominated/Partnership Organisations: Cllr Robert Evans Bromley Council Diane Summers Guy’s & St Thomas’ NHS Foundation Trust Phidelma Lisowska Joint Staff Committee Chris Mottershead King’s College London Cllr. Jim Dickson Lambeth Council Sue Gallagher Lambeth Clinical Commissioning Group Warren Turner London South Bank University Richard Gibbs Southwark Clinical Commissioning Group Madeliene Long South London and Maudsley NHS Foundation Trust Cllr. Catherine McDonald Southwark Council

In attendance: Tim Smart Chief Executive Officer Jane Walters Director of Corporate Affairs Simon Taylor Chief Financial Officer Roland Sinker Chief Operating Officer Geraldine Walters Director of Nursing & Midwifery Michael Marrinan Medical Director Pedro Castro Interim Director of Strategy Sally Lingard Associate Director of Communications Tamara Cowan Board Secretary (Minutes)

Apologies:

George Alberti Trust Chair Rachel Burman Staff – Medical and Dentistry

Circulation to: Council of Governors and Board of Directors

Enclosure Lead Time

1. STANDING ITEMS M Meryon 15:00

1.1. Apologies

1.2. Declarations of interest

1.3. Chair’s action

1.4. Minutes of previous meetings Enc. 1.4

1.5. Matters Arising/Action Tracking Enc. 1.5

2. FOR REPORT

2.1. Election Results & Introduction of New Governors Verbal M Meryon/ New Govs.

15:05

2.2. Governor Engagement and Involvement & Development Day Feedback

Enc. 2.2 N Hayes 15:05

2.3. Sub-Committees Reports & Action Summaries

2.3.1. Membership & Community Engagement & Transport Feeder Group

Enc. 2.3.1 A McCall 15:15

2.3.2. Strategy Enc. 2.3.2 C North 15:25

2.3.3. Patient Experience & Safety Enc. 2.3.3 T Duffy 15:35

3. FOR REPORT/DISCUSSION

3.1. Board Report to the Council of Governors, including KHP Update

Enc. 3.1 T Smart 15:45

3.2. Trust Finance Report Enc. 3.2 S Taylor 15:55

3.3. Trust Performance Reports Enc. 3.3 R Sinker 16:05

3.4. Strategic Planning for Change Enc. 3.4 P Castro 16:15

3.5. Quality Focus 3.5.1. Quality Priorities 2014/15 and Quality

Account 2013/14 3.5.2. Quarterly Patient Safety Report

Enc. 3.5.1

Enc. 3.5.2

G Walters

M Marrinan

16:25

16:35

4. FOR INFORMATION 16:45

4.1. Register of Governor Attendance Enc. 4.1 4.2. Quarter 3 - Monitor Submission Enc. 4.2 4.3. Sub-Committees Confirmed Minutes 4.3.1. Membership & Community Engagement Enc. 4.3.1 4.3.2. Strategy Enc. 4.3.2 4.3.3. Patient Experience & Safety Enc. 4.3.3

5. ANY OTHER BUSINESS 16:55

6. DATE OF NEXT MEETING

Wednesday 15 May 2014, 18:00 – Boardroom, Hambleden Wing, King’s College Hospital, Denmark Hill

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Council of Governors – Public Session Minutes of the meeting held on Wednesday, 11 December 2013 at 19:00 in the Dulwich Room, King’s College Hospital.

Marc Meryon Senior Independent Director – Chair of Meeting\ Elected: Michael Robinson Lambeth Central

Godwin Ubiaro Lambeth Central

Fiona Clark Lambeth North

Chris North Lambeth North

Nanda Ratnavel Lambeth South

Tom Duffy Patient

Patti Kachidza (part) Patient

Barbara Pattinson Southwark Central

Pam Cohen Southwark Central

Andrew McCall Southwark North

Joe Onabaworin Southwark North

Michelle Pearce Southwark South

Stuart Owen Southwark South

Brady Pohle Staff – Admin, Clerical and Management

Rachel Burman Staff – Medical and Dentistry

Nicky Hayes Staff – Nurses and Midwives

Carolyn Campbell-Cole Staff – Nurses and Midwives Nominated/Partnership Organisations Phidelma Lisowka Joint Staff Committee

Chris Mottershead King’s College London

Sue Gallagher Lambeth CCG

Richard Gibbs Southwark CCG

Warren Turner London South Bank University

Cllr. Robert Evans Bromley Council

Cllr. Catherine McDonald Southwark Council (part) In attendance: Tim Smart Chief Executive

Jane Walters Director of Corporate Affairs

Chris Stooke Non-Executive Director

Faith Boardman Non-Executive Director

Angela Huxham Director of Workforce and Development

Simon Taylor Chief Financial Officer

Roland Sinker Chief Operating Officer

Tamara Cowan Board Secretary (Minutes)

Tooba Ahmadi Corporate Governance Officer

Sally Lingard Associate Director of Communications

David Dawson Deputy Director of Strategy Apologies Cllr. Jim Dickson Lambeth Council

Christine Klaassen Patient

Derek Cookson Patient

Ahmad Toumadj Staff – Support Staff

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Diane Summers Guy’s & St Thomas’ NHS FT

Madeliene Long South London and Maudsley NHS FT

Vacant Lambeth South

David Sullivan Patient

Jan Thomas Patient

Phyllis Barnett Staff – Allied Health Professionals Vacancies:

Public Governor Lambeth South

Item Subject Action

13/67 Welcome & Apologies The apologies for absence were noted. The Chair advised that this is Brady Pohle’s last meeting as a governor of the Trust as he starts his new role as Head of Legal Services at the Royal Free Hospital in the new year. The Council and the Trust thanks him for his service and contribution to the Trust. The Council also welcomed new governor Cllr Robert Evans as the nominated governor from Bromley Council.

13/68 Declarations of Interest There were no declarations of interests raised.

13/69 Chair’s Action There was no chair’s action reported.

13/70 Minutes of Previous Meeting The minutes of the meeting held on 18 September 2013 and were approved as a correct record.

13/71 Matters Arising/Action Tracking The action tracker was noted.

13/72 Update on Integration Programme & Trust Performance Report The Council received the Trust’s performance report for month 7 and Roland Sinker (RS) presented an update on the integration programme. The following key points were noted: Integration Programme

RS and Simon Taylor are currently the senior responsible officers for the integration programme in the absence of Jacob West who is currently on secondment;

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Item Subject Action

Programme activity is being managed and monitored through the previously advised governance structure - by executives through the integrated steering group and King’s Executive weekly meetings, at board level through the Board Integration Committee and with continued support from Ernst & Young whilst the Trust fully implements its integration programme office;

There are four major overarching areas of work, clinical operations, workforce, governance and communications and corporate services;

In these broad areas sit a number of schemes and projects related to, for example, length of stay, culture, medical productivity;

Measuring cultural changes and shifts is not easy but as part of this process the Trust developed a survey with similar questions to those in the national staff survey;

The questionnaire was sent to colleagues across the organisation and the Trust received over 1000 responses;

Ernst & Young on behalf of the Trust also ran focus groups and the information from this is currently being analysed and will be triangulated with the feedback from the King’s in Conversation initiative and the staff survey;

The Trust would hold a senior management event next week to present the findings across the two sites and give these senior people time to respond to feedback about their particular areas;

The cultural changes are a key consideration for the Board and non-executive directors;

There are four areas of concern at the PRUH including, the emergency department (ED) pathway, getting the nursing establishment right, cultural change (medical leadership, incident reporting, whistleblowing etc.) and capacity;

Cross site working has not been without its challenge but staff can see the light at the end of the tunnel. Both sites are part of the same hospital and it will take time for people to fully get embed the changes; and

Issues with emergency pathway relates to not having sufficiently consistent medical leadership at the PRUH. At the Denmark Hill site, there are 15 ED consultants whilst there are only 3 at the PRUH.

In addition, there has been a change in the provider of the discharge process which has caused further challenges.

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Item Subject Action

Performance Reports

At the Denmark Hill site good performance is being made on cancer pathways but there are challenges with:

o Agreeing the winter pressure funding with commissioners;

o Meeting referral to treatment targets where it is hoped the Centenary Wing will alleviate some of the pressure on capacity;

o Healthcare acquired infection in particular c. difficile;

o Finances as a result of the inability to conduct income generating

activity because of the challenges with capacity taken up by emergency admissions.

The picture is much the same at the PRUH.

13/73 Francis Report Roland Sinker (RS) and Angela Huxham (AH) presented the latest report from the Francis Working Group (FWG). The following was raised and noted:

The working group has focused on 5/6 areas of work in an effort to address the key areas in the Francis Report;

The workstreams are making good progress, and these will revert to ‘business as usual’ from April 2014

The FWG considered some of the feedback from King’s in Conversation (KiC) and agreed that information should be fed back to staff via the Chief Executives Brief. KiC will be rolled out at the PRUH site. Finally that the combined organisation is very complex and would benefit from a structured transformation integration programme led by the Executive;

The roundtable KiC events were very good and some governors were disappointed they have not yet seen the results;

The work is not yet concluded, and information would be fed back at the appropriate time

The initiative was well executed and it is important to keep the momentum going and let staff know what are the next steps, what was said and the broader agenda; and

A statement will be sent to staff from the Chair and CEO.

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Item

Subject Action

13/74 Membership & Community Engagement (MCE) Committee Brady Pohle provided an update on the activities of the Membership and Community Engagement Committee and the recent meeting. He reported the following:

Following the acquisition the Trust is on track with achieving its membership targets;

The governor awareness session, suggested and endorsed by governors, was very successful; and

Andrew McCall has kindly agreed to take over as the Chair of MCE. The Council noted the verbal update from Brady Pohle and the supporting key discussion points and actions arising from the MCE meeting on held on 16 October 2013.

13/75 Strategy Committee

Chris North provided an update on the activities of the Strategy Committee and the recent meeting. He reported the following:

The Committee received a very useful presentation from Lambeth Clinical Commissioning Group around the integration of care; and

It was also useful to get a detailed presentation from the strategy team and the progress within KHP and the proposed merger discussions.

The Council noted the verbal update from Chris North and the supporting key discussion points and actions arising from the Strategy Committee meeting held on 24 October 2013.

13/76 Patient Experience and Safety Committee (PESC) Tom Duffy provided an update on the activities of the Patient Experience and

Safety Committee (PESC) and the recent meeting. It was noted that the

Committee heard there had been improvement in the phlebotomy service but

there is still more to be done. The physical transformation has improved

things for patients but there is still an issue in relation to EPR. TS agreed to follow-up on correspondence relating to the Phlebotomy Focus Group in which some governors were involved.

The Council noted the verbal update from Tom Duffy and the supporting key discussion points and actions arising from the PESC meeting on held on 22 October 2013.

TS

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Item

Subject Action

13/77 Board Report to the Council of Governors, including KHP Update The Council received and noted the report from the Board of Directors presented by Tim Smart. The following key points were noted:

The Board is very grateful for the contribution of Governors in the acquisition and for the part they played in the current multi-site structure of the Trust;

The next steps for the Trust is to develop a robust transformation programme which takes full account of what the organisation looks like now – King’s 3.0;

The transformation programme will embrace the complexities of the new organisation and address the new challenges;

The healthcare system does not seem to fully understand the complexities of transforming a hospital in the current healthcare landscape;

It is intended that the KHP documents which were being produced in relation to ongoing discussions about potential merger would be shared with governors.

The KHP Partners’ Board also recognise that the governance structure of KHP needs to be refreshed and work in this area is underway. The development of the Academic Integrated Care Organisation is enabling KHP to give better effect to the integrated care agenda and real engagement with the community. This is a real issue for South London and Maudsley because 60% of its services are delivered through an integrated care pathway.

13/78 Trust Finance Report The Council received the Trust’s finance report for month 4 and noted the verbal update from Simon Taylor. The following was noted:

There are four areas of concern: o Income impacted by constraints on capacity and not being able

conduct elective work which is income generating. o Expending more monies to deal with winter pressures; o Temporary staff expenditure; and o Issue with drug spend as a result of increased activity.

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Item

Subject Action

The Trust has introduced additional capacity in the form of the Centenary Wing and two clinical decision units to help alleviate the pressures;

The Trust had submitted bids to the commissioners for additional income to address the winter pressure challenges;

Demand and the acuity of patients presenting at the Trust is driving the need for additional staff. The recruitment process for full time staff is progressing but with 4000 applications for jobs between October-November this will take time;

The Trust has plans in place to address these issues but the Board will consider alternate contingency plans next month;

The adverse financial movement relates to the Denmark Hill site predominately. The Trust budgets income based on seasonal variances but the demand on services has remained consistently high throughout the year;

As a precautionary measure, the Trust regularly takes deposits from fee paying private patients before they commence their treatment; and

There are currently three streams of recruitment to fill vacancies, in the new sites, resulting from internal transfers and ongoing divisional recruitment. Now that the Trust has circa 11,000 staff members it is time to centralise the recruitment process to ensure recruitment is done in the most effective and efficient way. The recruitment process since the engagement of Capita on 1 October has been more streamlined and it is promising that they are meeting KPIs. The Trust went through a thorough tender and review process for the outsourcing of the recruitment process to Capita. This was done in conjunction with 6 other Trusts.

13/79 Council of Governors Reports

13/79.1 Council Activity Report The Council noted update on council of governors’ activities since the last meeting on 18 September 2013.

13/79.2 Council Forward Plan The Council noted and approved the forward plan for 2014 subject to any comments sent to Nicky Hayes outside the meeting.

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Item

Subject Action

13/80 Patient Complaints Jane Walters presented the patients complaints report to the Council of Governors. The following key points were raised and noted:

In 2012/13 there were circa (c.) 162,000 complaints about NHS services a year – 3000 per week;

The Trust receives c. 700 at its Denmark Hill site and c. 500 at its PRUH site per annum. This is in addition to 3500 contacts through the Trust’s PALs service and circa 25,000 sources of feedback from the patient surveys per annum;

The number of complaints at the PRUH has been historically high, but have fallen since the acquisition. The Trust has now established a PALs team on site and more issues are now being addressed through this service. The Trust should continue to publicise its PALs service to prevent issues being escalated to formal complaints unnecessarily.

There is a centralised complaints team and all serious complaints are escalated to executive directors;

The monthly patient experience report which details complaints is widely circulated;

The Trust is keen to learn from complaints so has invited patients to listening events, enshrined complaints management in staff training, screening patient video stories at Board meetings and regularly conduct trend analysis;

A Serious Incident Committee with membership from executive and non-executive board members has been established;

The Chief Operating Officer reads and signs off all patients complaints;

If appropriate/relevant Consultants also review patient complaints;

Reports on complaints are presented to the Patient Experience Committee and the Chair of the Governors’ PESC sits on the Committee;

The Trust will be publishing what it is learning from patient complaints on the website; and

The Trust is working on improving its response times and the Trust is also trying to address a large backlog of complaints from the PRUH.

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Item

Subject Action

13/81 Council of Governors Annual Review The Council of Governors Annual Review was noted.

13/82 Register of Governors Attendance The Council of Governors Register of Attendance was noted.

13/83 Quarter 2 – Monitor Submission The Council noted the submission made to Monitor for quarter 2.

13/84 Member-Governor Contact via Trust Website The Council noted the report on Member-Governor Contact which was presented and agreed by the Membership & Community Engagement Committee.

13/85 New Governors Induction Programme The Council noted the report on New Governors Induction Programme which was presented and agreed by the Membership & Community Engagement Committee.

13/86 Sub-Committees Confirmed Minutes The Council noted the following sub-committee minutes:

Membership & Community Engagement Committee – 26 June 2013

Strategy Committee – 25 July 2013

Patient Experience and Safety Committee – 04 July 2013

13/87 Any other business There were no matters of any other business raised from discussion.

13/88 Date of Next Meeting Wednesday, 05 March 2014 in the Boardroom at 15:00.

Council of Governors Action Tracker Enc 1.5

Council of Governors Meeting – 05 March 2014 1 of 1

Meeting Date Item Action Who Due Date Notes

Completed

11/12/2013 13/76 Patient Experience and Safety Committee Update – TS agreed to follow-up on correspondence relating to the Phlebotomy Focus Group in which some governors were involved.

TS TS contacted the relevant King’s staff and responded to the relevant governor(s).

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Purpose of the Report:

Report to: Council of Governors Date of meeting: 05 March 2014 Presented By: Nicky Hayes, Lead Governor Subject: Governor Involvement and Engagement Report

Governors have a general duty to “to represent the interests of the members of the corporation as a whole and the interests of the public”. Monitor’s guidance for governors suggests the following key principles as the means for governors to represent the interest of members and the public:

Governors should seek the views of members and the public on material issues or changes being discussed by the trust.

Governors should feedback to members and the public information about the trust, its vision, performance and material strategic proposals made by the trust board.

Governors should try to make sure when they are communicating with directors of the trust that they represent the interests of members and the public rather than just their own personal views.

This report includes examples from some governors on the initiatives they have undertaken to engage with members and the public at external meetings and events. The report also provides the list of ongoing engagement activities provided by the Trust with which governors are encouraged to get involved. The Governor Membership and Community Engagement Committee is also taking the lead on governor-led initiatives to engage with members and the local community. Action required: Governors are asked to: 1. Note the report from fellow governors on their engagement activities; and

2. Consider and submit their interest in the opportunities for engagement and

involvement.

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Andrew McCall Public Governor, Southwark North

Engagement activity, location and date

Healthwatch Southwark – Induction for volunteers

13 December 2013 from 09.30-12.30

1 Addington Square, Camberwell, SE5 0HF

Summary of the event attended

This was an induction/training session for a small group of Healthwatch volunteer representatives. They did not have an existing association with King’s.

Jessica Bush, Head of PPI, attended with me. Together we delivered a short presentation about King’s followed by a question and answer session.

Outcome and feedback from the engagement activity

The mix of a staff member and a governor went down well with the audience and the presentation had been pitched at the right level for the occasion.

I have similar engagement activity planned at Southwark Cathedral and Friends of Burgess Park.

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Fiona Clark Public Governor, Lambeth North

Engagement activity, location and date

Local Groups concerned with healthcare:

Healthwatch Lambeth, regular open meetings

Lambeth Clinical Commissioning Group, bi-monthly meetings in public

The Citizens’ Forum for Southwark and Lambeth Integrated Care, four meetings a year

The Friends of Monkton Street Rehabilitation Centre, the Committee meets 4/5 times a year with an AGM and Open Meeting for the Friends.

Local Community Groups in Kennington area:

The Kennington Association, various meetings

The Kennington, Oval and Vauxhall Forum, four meetings a year

The Friends of Kennington Library, monthly meetings

Summary of the event(s) attended

I have lived in Kennington for over 35 years and go to several local groups to find out what is happening.

I find that attendance at any of the community and health organisations leads to contacts and conversations in smaller groups or in the street and on buses.

There is always an opportunity to ask questions at the meetings I go to.

Outcome and feedback from the engagement activity

It is not possible to attend every meeting concerned with health matters but when I can go it is helpful because I meet and talk with lots of people: the GPs, the local councillors, social service personnel and ordinary citizens with a story to tell.

I can then use this feedback to inform myself of the views and experiences people have of local health, disability and social services and, sometimes, of King’s College Hospital.

I tell people that I am a governor at King’s and talk about what that involves. I take membership forms with me and if they are not a member will suggest they become one.

Attendance at the community events frequently leads to more involvement, for example, helping at the bazaars for the Kennington Association, doing the food for the library meetings or the members meetings at Monkton Street etc.

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Jan Thomas Patient Governor

Initiative or involvement opportunity

Summary of governor involvement

Dignity Visit and Dignity Awards

Undertake one or more short visits to a clinical area within the hospital to meet with staff who will present their achievements and proposals for dignified care, and an understanding of the issues from a patient’s point of view.

Provide brief feedback and to make a recommendation to the judging panel as to whether the area should be considered for a Dignity Award to be presented at a ceremony on 17 March.

King’s in Conversation

Act a facilitator at staff and patient listening events to encourage participants to share their thoughts and opinions around three key topics:

Are patients always our first priority?

Would you recommend King’s as a place to work or receive care?

What do you think could be better?

Community Event

Participate in round table discussions around a number of current issues facing the Trust.

Talk to members, get views direct from patients and the public

Ask questions and input into development of the Trust’s forward strategy.

Video Patient Stories

Undertake training to collect patient feedback, known as ‘patient stories’, on film with the aim of helping clinicians to understand the patient perspective and what patients need from healthcare professionals.

Attend the user group to provide ongoing guidance and support and to share good practice.

Champion the initiative so that patient voices can be heard in service redesign or improvement projects.

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Tom Duffy Patient Governor

Initiative or involvement opportunity

Summary of governor involvement

Francis Steering Group

Provide an external viewpoint and governor representation to Trust management and staff on issues which are important to patients and the public at meetings of the Trust-wide steering group established to lead the Trust’s response to the Francis Report and its recommendations.

Patient Experience Committee

Provide an external viewpoint and governor representation on the Trust committee to support the planning and development of services and improvement programmes which enhance the experience of patients.

Recognise and promote examples of good practice and monitor trends in the Trust’s mechanisms for feedback and complaints.

Staff Commendation Panel

Review the nominations for individuals or teams to receive a King’s Commendation award for their outstanding contributions to patient care or hospital services.

Serious Complaints Committee

As Chair of the Patient Experience and Safety Committee, attend meetings of a committee dedicated to looking at individual serious complaints, complaints trends, performance, and how organisational learning can be embedded.

Ward 20/20

I was part of the Ward 20/20 patient experience project in 2012 and have continued to meet the ward manager of the ward I was attached to and carried out discussions with patients about their experiences and views.

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Governor Involvement February 2014

For further details or if you would like to get involved in a particular activity, please contact

Jessica Bush, Head of Engagement and Patient Experience, [email protected] or 020 3299 4618

Apart from the standard committees and workstreams, a range of opportunities come up on a regular basis and these are circulated to

Governors. Recent examples include assisting with a survey in the Emergency Department, conducting clinic observations

in outpatient clinics. If you would like to hear about new opportunities for gathering patient feedback, please let Jessica Bush know.

Involvement Activity

Governor Trust Lead Description Status Date

Public Health Committee

Michelle Pearce Chair - Mike Marrinan Contributing lay/Governor perspective to Public Health issues

Ongoing Meets quarterly

Staff Commendation Panel

Tom Duffy, Jan Thomas Chair - John Karani, Contact - Angela Huxham

Contribute to decisions on staff awards Ongoing Ongoing

Improving King's Patient Food ServiceFood Service and Nutrition Group

Jan Thomas Rick Wilson Contributing lay/Governor perspective Ongoing Ongoing

Patient Food Audits (DH)

Pam Cohen Rick Wilson Governor / Lay input into daily ward audits of the patient food service

Ongoing Bi-weekly

Organ Donation Committee

Jan Thomas Contributing lay/Governor perspective Ongoing

Community Events (DH and PRUH)

All Governors Jane Walters / Sally Lingard Series of annual events for members Annual Feb 25 DH adn 5 March Bromley

Patient Experience Committee

Jan Thomas, Tom Duffy Jane Walters / Jessica Bush Lay representation on trust committee which reports to the Board's Quality and Governance Committee.

Ongoing Monthly

End of Life Care Steering Group

Jan Thomas Wendy Prentice Lay involvement Ongoing

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National Governors' Forum (FTN Network)

Tom Duffy and Jan Thomas n/a External networking Current

Serious Incident Committee

Tom Duffy Richard Hinckley Contributing lay/Governor perspective

Serious Complaints Committee

Tom Duffy Chair: Faith Boardman, Trust Lead: Jane Walters

Contributing lay/Governor perspective February 21 2014

Bi-monthly

Maternity Services Liaison Committee (Maternity Matters)

Patti Kachidza Maxine Spencer, Director of Midwifery, Lay Chair - Joanna Brien

Lay representation of trust wide maternity group which seeks to improve all aspects of maternity care. MDT group with lay membership of women who have had babies at King's. Meet bi-monthly.

On-going Bi-monthly

End of Life Care Steering Group

Jan Thomas Jessica Bush and Wendy Pentice

Governor involvement in End of Life Care Steering Group looking at all aspects of end of life care

On-going

Older Person's Group

Fiona Clarke Graeme Groome Governor representation on Older Person's Group

Ongoing

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Patient Video Stories (Trust-wide)

Stuart Owen, Tom Duffy, Jan Thomas and Michelle Pearce. Other Governors welcome across all sites.

Jessica Bush / Rachel Sugarman

To take part in filming patient video stories. We are also looking at the possibility of Governors linking with Divisions to support the project and work with areas on service, improvement. Current areas of focus include Haematology, patient stories linked to nursing priorities of falls, pressure ulcers etc, working with nursing executive.

Jan-14 On-going

PLACE - Patient Led Assesements of the Care Environment (Trust-wide)

Stuart Owen, Carolyn Campbell-Cole. More assessors needed for all sites and other Governor involvement sought

Jorge Sousa / Cristina Romao PLACE 2014 will cover DH, PRUH and Orpington

Annual DH - 12 and 13 March, PRUH: 6 March, Orpington: 5 March

Francis Steering Group

Tom Duffy Jane Walters Trust-wide Steering Group to lead on KCH's response to the Fances Report

May-13

King's In Conversation (PRUH and other SE sites)

Tom Duffy, Fiona Clark, Jan Thomas

Jessica Bush To be facilitators at King's In Conversation Events.

Oct-13 Completes March 2014

Phlebotomy (DH)

Stuart Owen, Michelle Pearce

TBC To provide lay and service user perspective on transformation to improve King's phlebotomy service

Apr-13 TBC

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Friends and Family (DH and PRUH)

Fiona Clarke, Pam Cohen. Further Governor involvement welcome.

Jessica Bush Assisting with gathering of Friends and Family survey feedback. Including in DH and PRUH Emergency Departments and on PRUH inpatient wards.

Ongoing

Improving Ophthalmology Services (DH)

Michelle Pearce Alex Forster, Outpatient Service Manager

To provide lay and service user perspective on transformation to improve DH Ophthalmology service

Decmber 2013 TBC

Pharmacy Service DH Site

Stuart Owen, Michelle Pearce, Carolyn Campbell-Cole

Chris Barrass To provide Governor input into improving pharmacy service

Current TBC

Quality Account Stakholder Meetings (Trust-wide)

All Governors Jessica Bush Stakeholder involvement in developing annual quality priorities

Autumn 2014

1

Membership & Community Engagement Committee Key discussion points & actions arising from the meeting on

23 January 2014

Issue Discussion Point/Action Lead

Committee Work Plan and Targets for 2014

Andrew McCall (AM) introduced himself as Committee Chair having taken over the position from Staff Governor Brady Pohle who left the Trust earlier this month. The Committee discussed the draft committee work plan and suggested targets. It was agreed that each meeting should have a focus on: Membership engagement, engagement with public, governors in the community and learning from other organisations. All elements are important and reflect changes to the governor role brought about by the Health & Social Care Act 2012 and the remit of this committee It was noted that the Trust will continue to provide opportunities, for example, through listening events and member focus groups as part of governor workshops, but governors should feel encouraged to create further ‘touch points’ by using their own networks and links with community organisations. The Committee agreed that in future, where opportunities for membership recruitment and/or raising awareness of the Trust have been identified and acted on, information about the outcome would be captured and presented to the Council in order to provide an example and encouragement (see Enc. 2.2 in this set of papers). The confirmed committee work plan for 2014 would be circulated to all governors with a note from AM encouraging more governors – particularly form the new constituencies - to join the committee.

AM

Membership Recruitment

Rachel Sugarman presented a summary of membership numbers, changes and recruitment activity for the period 01 October 2013 to 01 January 2014. The Committee noted that overall the number of members has increased from 8,608 to 10,789 and the majority of new members were recruited via a direct mail sent to circa. 30,000 PRUH patients. Now that the Trust has met its targets for members in the new constituencies, the focus will be on consolidating the membership by offering more activities for members to get involved with, increasing work with schools and colleges e.g. Bromley College, and collecting and promoting the use of email addresses.

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Election Update & New Governors’ Induction Programme

Tamara Cowan updated the Committee on the concluding stages of the current elections, plans for the summer elections and the induction programme for new governors. Voter turnout currently stands at 29% and 20.5% in Bromley and Lewisham respectively. There were 45 candidates for the four Bromley seats and 4 for the Lewisham seat.

Constructive feedback was received from the governor awareness session held on 28 November 2013. Participants particularly appreciated the honest depiction of the time commitment involved in being a governor.

The Trust intends to maintain contact with those candidates who are unsuccessful this time. They may be good candidates for 'Member Ambassadors' or similar.

A note inviting governors to be part of the buddying scheme will be circulated to all governors.

TC/LM

Report on Community Engagement Activity

AM introduced this item as a new, regular feature of the committee agenda so that committee members can report back on any engagement activity they have undertaken since the last meeting. AM reported that he had attended a meeting at Southwark Healthwatch on 13 December 2013 to deliver a presentation to an audience of volunteer representatives who did not have an existing association with the Trust followed by a question and answer session (see Enc. 2.2 in this set of papers).

AM and Fiona Clark reflected on their experience of becoming involved in community engagement, noting that it’s easy and that some governors are already doing it but perhaps don’t realise it e.g. attending the Integrated Care Citizens Board or talking informally with people they know in the community.

It was also noted that support and presentation materials are available on request – governors just need to contact a member of the team for help – and that community engagement is an essential part of fulfilling the governor duty to ‘represent the interests of members and the interests of the public’, as outlined under the 2012 Health & Social Care Act.

Community Events Planning

Sally Lingard (SL) presented an outline for two community events to be held on 25 February and 05 March 2014. Governors will be asked to attend to participate in the round-table discussions.

LM

@King’s: Governor Contribution and Feedback

SL presented an update on @King’s distribution and an outline of content for the spring 2014 edition. Copies of the autumn 2013 edition were distributed to all King’s sites. It was particularly popular at the PRUH and

Enc 2.3.1

3


more stock has been ordered.

Governors would be asked via the CoG bulletin to suggest items for the summer edition.

LM

AOB – Members Survey

RS and SL updated the committee on the progress to produce and roll out a survey of foundation trust members.

Question areas have been identified. Governors will be asked via the governor bulletin to send further suggestions to RS and then the draft survey will then be sent to all governors for comment.

LM/RS

Enc 2.3.1

Transport Feeder Group Key discussion points & actions arising from the meeting on 04 February 2014


Denmark Hill Station Update

JB1 reported that he had received a response from Mark Ellerby about the points raised at the last TFG meeting in relation to the outstanding improvement works at the Denmark Hill station. The following points were noted:

The cafe is due to be completed and opened in early March 2014;

The redevelopment plan for taxi office and taxi waiting area did not progress and instead the cafe has been reconfigured to allow it to serve customers on both the public and station sides of the station;

Currently, there are no plans or funds identified for provision of additional public toilets at the station and an additional station entrance on Windsor walk. However, getting additional ticket machines at the front of the new station building is being investigated; and

The issue in relation to the problems that Freedom Pass users have when trying to access the station through the barriers before 09:30am should be raised to southeastern customer care services.

The Group noted the response and suggested that a user group survey and review of the Denmark Hill station should be carried out.

JB1

Transport Links Between Sites

JG updated the Group on the transport links between sites. The following key points were noted:

The shuttle bus service runs between 08:15 and 17:30 with an hour gap during lunch times;

The lunch break gap is not satisfactory as it is a peak travel use by staff. The Head of Logistics has been informed and they will look into revising the timetables; and

The Facilities team will carry out a 6 monthly review of the shuttle service, which will include negotiating with alternative providers and reviewing the shuttle service timetables. The review will take place in consultation with the staff.

Wider Transport Issues and Impact on the Trust

Bakerloo Line Update The Group discussed the possibility of the Bakerloo line extension to Camberwell. It was noted that the feasibility study on Bakerloo Line extension is still not available. The Group agreed to focus and carry out alternative campaigns on transports coming into Camberwell and keep a watch in brief on Bakerloo Line. The alternative campaign data may also help with specific future transport links into Camber well. South-eastern December 2014 Timetable Consultation The Group discussed the Southeastern 2014 Timetable Consultation, in particular section 5 of the proposal which affects Denmark Hill services. The Consultation proposes to:

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1


Operate additional services between Dartford and Victoria via Peckham Rye and Denmark Hill at 30 minute intervals later into the evening; and

Stop the hourly off-peak Victoria – Gillingham – Dover stopping services at Denmark Hill to enhance connections into the London Overground and Thameslink Routes.

The Group agreed for JG to write a feedback by 07 February 2014 to welcome and fully support the proposals pertinent to Denmark Hill, as it would provide benefit to staff, patients and families travelling to the hospital, enhancing accessibility as well as offering more choice and ease of journey. Loughborough Junction Services AB reported that Network Rail had proposed that from 2018 all services in the Sutton loop line running through Loughborough Junction station, would terminate at Blackfriars instead of continuing north to St Albans and Luton. However, the central government has over-ruled this proposal and now the trains will continue further north. There is also a proposal to increase the number of Thames Link trains going through Elephant Castle from 8 services per hour to 16 services per hour. The 7 Bridges project to regenerate the area is being planned. This is an arts led regeneration project focusing on improving the appearance of the Loughborough Junction’s many railway bridges through art installations, colour, light and community engagement. AB will enquire from Network Rails about their plans to install a lift at Loughborough Junction. Currently, the disabled, people with buggies, travellers with suitcases are often limited to use the station without a lift.

JG/TA

AB

Any Other Business

Active Travel Plan JB1 reported that the funding that was received as part of the London 2012 Olympic legacy would be used to launch the Active Travel Project. The aim of this project is to change travel behaviours and promote cycling and walking. Part of the funding will be used to help active travel champions with training and mentoring events. The champions would be provided with resources to promote active travel within their local communities and organisations. Active Champions could also be contacted to help carry out travel surveys and reviews of the local travel sites. Preventative Care Initiative JB1 informed the Group that full support from Public Health England and NHS England have been received to support the initiative of preventative care and review people’s lifestyles for healthier living. JB1 will involve partner organisations to promote preventative care initiatives within their organisations and communities.

Enc 2.3.1 Appendix

2

Enc. 2.3.2

Governors’ Strategy Committee Key discussion points & actions arising from the meeting on

11 February 2014


Trust-wide Strategic Matrix Q3

David Dawson presented the Trust’s Strategic Matrix for quarter 3 which outlined Trust-wide and divisional strategic priorities. The Committee noted that the Trust had held consultation events regarding selection of quality priorities for the year 2014/15. It was also noted that significant progress has been made with developing and implementing an evidence-based care bundle for the care of patients with Chronic Obstructive Pulmonary Disease. The Trust is acting as host for the Collaboration for Leadership in Applied and Health service Research and Care (CLAHRC). This project mixes social and clinical research and aims to translate research into practical care models. Professor Irene Higginson, Assistant Director of Research, will be driving the CLAHRC and working to ensure that the Trust has a robust R&D strategy. George Alberti summarised the on-going discussions between the Trust and Guy’s and St Thomas’s regarding the configuration of vascular services.

Strategic Issues Joe Farrington-Douglas outlined current key issues for the Trust’s strategy. The Committee noted that for the Trust will submit a five-year strategy to Monitor. Major strategic issues will be considered in consultation with KHP partners and colleagues in the local health economy as part of the preparation for developing the five-year strategy. Projecting the Trust’s financial and operational needs over the next five years highlights the importance of making strategic decisions based around sustainability, which may include alternative models of funding.

Strategic Planning for Change

Pedro Castro outlined the Trust’s process for strategic planning in 2014. The Committee noted that the Trust will conduct an internal assessment of its emergency and specialist services and commissioning contracts in order to develop a revised strategic vision, that takes into account system pressures, institutional changes and a ‘do nothing’ scenario. Co-ordination with partner organisations and consultation with internal and external stakeholders will be part of the process and one of the deliverables will be a transformational plan and process for achieving the vision. It was noted that there is scope for governor involvement through community events, this committee and the Council of Governors.

1

Enc. 2.3.2


Committee Work Plan 2014

The Committee Chair presented the outline committee work plan for 2014 and asked for feedback and suggestions. The Committee agreed that the five-year strategy should be a standing item at each meeting. Other related items would flow from it, including integrated care and issues of public health and the role of local councils.

It was agreed that October would be an appropriate juncture to reflect on the progress of the integration programme (one year on from acquisition) plus any developments with KHP/proposed service reconfiguration.

2

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Patient Experience & Safety Committee Key discussion points & actions arising from the meeting on 11 February 2014


Matters Arising/ action Tracker

The following key points were noted:

Phlebotomy

The “demand analysis” report should be presented at a future PESC meeting;

It was agreed that JB would facilitate a meeting between SO, TD and Zebina Ratansi, Divisional Manager in Critical Care, Theatres & Diagnostics to further discuss the Phlebotomy issues in relation to waiting times and the methodology used for data analysis.

Pharmacy

JB to facilitate a meeting between MP, CC and Chris Barrass, Director of Pharmacy to further discuss Pharmacy issues in relation to seating space, ‘user review survey results’ and the staff queue.

SH/TA

JB

JB

Quality Report & Priority Development

JB presented the draft quality report which included a review of performance for the 2013/14 quality priorities and outlined the quality priorities for 2014/15.

It was noted that:

All the priorities for 2013/14 were achieved and on target apart from ‘surgical safety checklist’ and ‘improving patient experience of discharge’. These will be carried as priorities for 2014/15;

The Trust held 2 Stakeholder Events in Bromley and Lambeth/Southwark to invite comments and suggestions from the stakeholders on the 2014/15 priorities;

The following priorities have been proposed for 2014/15:

Improving the identification and management of patients at risk of falling in hospital;

Improving surgical safety checklist;

Improving experience and coordination of discharge;

Improving the experience of cancer patients;

Maximising King’s contribution towards reducing mortality due to use of alcohol; and

Improve the experience of patients with hip fracture/ hip and knee replacement.

The draft report will be considered again by the Stakeholders and it will be presented at the next Council of Governors on 05 March 2014. The final report will be presented to the Board for approval in May 2014 as part of the Annual Report and Accounts before its submission to Monitor in June 2014.

The Committee noted the report and commented that ensuring different ways to measure improvements are essential.

Improving patient experience on the Acute Medical Units (AMU)

Vanessa Sweeney, Head of Nursing for Acute Medicine updated the Committee on the Trust’s approach to improve patient experience in the Acute Medical Units (AMUs).

Key points included:

Following the review of patient experience in January 2013 and the analysis of various data, a number of initiatives and interventions were put in place to improve patient experience in acute wards;

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These included a number of changes in the acute medicine pathway such as:

Introduction of patient experience CQUIN;

Using Volunteers to help capture real-time patient experience;

Supporting staff to deliver compassion in practice; and

Revising nursing levels in line with the increasing acuity and dependency of patients.

Key outcomes included reducing the number of steps in patient pathway, daily nursing rounds to maintain and deliver care with compassion, minimal ward moves for patients, better quality of ward rounds with ward based consultants and senior admin support for junior doctors.

The committee commended all the improvement initiatives and highlighted that the outcomes from this review would be fundamental in improving patient experience. The Committee suggested that learnings from this review should be considered and rolled out in other areas around the Trust.

Cultural Integration (incorporating King’s in Conversation)

Angela Huxham, Mary Currie and Kristen Nelson provided a detailed summary of the findings from the King’s in Conversation (KiC) and the Cultural Integration Programme across sites. Key points included:

Under the “all together better” banner there are 3 key projects, the King’s in Conversation (KiC), Cultural Integration Programme and the Staff Survey;

The KiC listening events included a number of round table discussions and pop-up sessions with staff and patients to have their say and raise issues;

Overall, staff are very proud to work in Denmark Hill and eager to do well for both patients and staff. Patients praised staff for kindness, taking time to listen, empathy, etc.;

The Cultural Integration Project involved undertaking a base line assessment of culture across all sites. 1500 responses have been received and the feedback has been shared with senior managers;

Additionally, a survey based on the national staff survey is also being launched at the PRUH site;

A number of opportunities for improvement were identified and categorised into 12 key themes, which are then split into granular level to plan and implement actions. Making patient care the number one target was one of the main areas to improve on across all sites; and

The 3 key areas of focus that has been identified by the Trust’s Board Integration Committee (BIC) and given priority are doctors and managers working effectively together, promoting positive behaviour and performance and empowering staff to take confidence in decisions.

The Committee noted the reports and suggested that a mechanism or an appropriate forum should be identified for Governors to continue their involvement in these initiatives.

Governor Involvement Updates

JB outlined continuing opportunities for Governor involvement and thanked those already taking part in various initiatives.

Governors are invited to be a patient assessor for this year’s Patient Led Assessments of the Care Environment (PLACE). This is an excellent opportunity for Governors to improve hospital environment. Interested Governors should inform JB in the first instance.

Enc 2.3.3

Enc. 3.1

Board Report to CoG 05 March 2014 1

Report to: Council of Governors Date of meeting: 05 March 2014 Presented By: Tim Smart, Chief Executive Subject: Board of Directors’ Report to the Council of Governors Purpose of the Report: To provide the Council of Governors with an overview of the key strategic, operational and performance issues facing the Trust. Action required: The Council of Governors is asked to receive the report and is invited to ask questions or to discuss the issues raised in the report.

Enc. 3.1


Board of Directors’ Report to the Council of Governors

05 March 2014 | Introduction

Today we are holding our first Council of Governors meeting in Bromley and I am delighted to welcome in particular our newly elected staff and public governors. A significant amount has been achieved since 01 October. King’s College Hospital is a different organisation, an expanded organisation, but with the same core values and approach to patient care as before. One of our key values is ‘Understanding You’ and another is ‘Inspiring Confidence in our Care’. Both of these require us to value diversity. Our new membership and their representatives have added to the richness of King’s in this regard. The past year has been enormously testing, financially and operationally, and we know that next year will be no different. We also know that other foundation trusts are facing similar challenges because of system pressures nationally. Thinking carefully about our strategic priorities and putting energy into maintaining relationships with key stakeholders are essential part of navigating our way to long-term sustainability. As ‘critical friends’, governors play an important role in guiding the organisation and acting as conduits between foundation trust members and the Board to ensure that the decisions we make place the highest value on patient care and interests. The Board looks forward to lively discussion at the Board to Council meeting on 19 March and to working with you all throughout 2014/15. | Key Strategic Issues

1. Strategic Forward Plan

A key piece of work currently underway is the development of our forward strategic plan. This year our regulator, Monitor, requires all foundation trusts to submit a five-year strategy. We are now one hospital across multiple sites with a staff of approximately 11,000 and in recent meetings the Board have been giving serious thought to long-term sustainability as part of our forward plan.

Internal assessment of our services and research endeavours will be one of our starting points. Learning from the internal incident at the Denmark Hill site and the planned ‘Safer, Faster Hospital Week’ at the Princess Royal University hospital (PRUH) will also inform our thinking. There is undoubtedly a rising demand for our services and we cannot keep doing everything. Working closely with our commissioner colleagues and partner organisations will help us to make the best choices in order to remain sustainable, and to deliver safe, high quality care.

Board members were pleased to see a good turnout at the community meeting held on 25 February and to have the opportunity to hear at first hand the views of members. This is a valuable part of the process and on behalf of the Board I would like to thank those governors and members who participated.

2. King’s Health Partners

As governors who have been with us for a while will understand, King’s Health partners and our relationship with our partner organisations have an important bearing on our academic, strategic and operational future.

Enc. 3.1


Clinical Academic Groups continue to develop and work together across their respective organisations. The KHP Partners Board met last month to reach agreement on a governance structure to take forward discussions about producing a full business case for closer integration. We are aware of the uncertainties around the competition and regulatory issues for integrations or mergers of this kind and so it will be necessary to put forward the strongest possible patient benefits case. Site configuration will be a key part of the preparations and there is a need for KHP to become ever more relevant to staff and patients.

3. Integration and Culture Change

Integration of our multiple sites continues under the direction of the programme management office. We are working through issues which were identified as part of the due diligence process prior to the acquisition, plus additional issues which have arisen in the past five months. The challenge of extremely tough cost improvement plans looms large alongside the maintained focus on driving productivity and recruiting safe levels of skilled and qualified staff to all of our sites and new developments. We are working hard to integrate, re-configure and develop all of our sites and this important integration work will continue alongside long-term planning and projections. Feedback has been collected from the anonymous staff survey which was rolled out across all sites towards the end of 2013 and the programme of listening events has continued in early 2014. From this information, the Board is developing an understanding of what steps need to be taken to strengthen the organisation from this point on. A culture change programme has been initiated focussing on three core areas: doctors and managers working effectively together; promoting positive behaviours and performance; and empowering staff to take confident decisions.

4. Progress with Capital Projects

The Trust now has three estates to maintain and with demand for additional capacity rising there are a number of projects in progress to build new facilities and improve existing ones in order to enhance the environment for patients and staff and to improve efficiency. PRUH infrastructure - There have been some problems recently with heating and back-up power at the PRUH. Works are being undertaken to address legacy issues of resilience and reliability in the mechanical and electrical services.

Clinical Decision Unit, PRUH – A new clinical decision unit is to be delivered in early March to help address operational and capacity problems. Enabling works are underway and there will be an accelerated build programme to deliver the building for occupational use as soon as possible. Training & Development Centre, PRUH – Plans are underway for the procurement of a five-storey modular build which connects to the Education Centre and replaces the existing two-storey portakabin. Orpington Hospital – Phase 2 of the development programme is underway. Two additional external modular theatres are planned plus expansion of Ontario ward to provide additional beds and seminar facilities on-site. Analysis of capacity and

Enc. 3.1


demand will be undertaken for a potential phase 3 of works, which would include reconfiguration of reception plus a kitchen and canteen. Infill Block 5, Denmark Hill - A feasibility study is being undertaken to ascertain the most appropriate location for this major new development which will be designed to provide a range of facilities, wards and departments. One possible solution is units 7 and 8 in the business park. New Critical Care Unit, Denmark Hill – Enabling works have commenced and some demolition works are taking place to enable excavation for the new build foundations. The tower crane has been delayed due to ground obstructions but is expected to be installed in March.

| Current Operational Challenges

5. Operational Performance

Both the Denmark Hill and PRUH sites were extremely busy over the winter and remain so. Much of this is driven by the increase in people attending our two emergency departments (ED) and requiring admission. Last winter saw an increase in emergency admissions of 15%. This year they increased by a further 11%. The emergency care 4-hour waiting time target was not achieved at either the Denmark Hill or PRUH site in quarter 3 (October-December) or in the first month of quarter 4 (January). Non-achievement of this target is consistent with the Trust’s annual plan submission to Monitor; however, management of performance in this area is one of the Trust’s top priorities and from 20-31 January an internal incident was declared at the Denmark Hill site. This enabled a strong focus to be placed on key areas of Trust performance and for care to be delivered more quickly in the most appropriate setting. Outcomes included improved emergency care performance and a reduction in inappropriate admissions and cancelled elective procedures. The performance of the PRUH ED has been on a downward trajectory for some time, with the exception of a spike in June/July 2013. Emergency activity continues at very high levels and performance is challenging. From 07-14 March we will be launching ‘Safer, Faster Hospital Week’ at the PRUH, which is a planned week of heightened activity for the purpose of learning, like January’s internal incident at Denmark Hill. Learning from both incidents will help us to identify the respective strengths and weaknesses of each hospital and will be used to sustain best practice and further improve the way we work to ensure that patients flow quickly and safely through the hospital alleviating pressure on beds wherever possible. Two further cases of MRSA and two of C-difficile were attributed to the Denmark Hill site in January taking year to date totals to seven and 42 respectively. Full root cause analyses will be conducted. Concerns remain around the increase in cases of CRE and other multi-resistant organisms. Whilst no further cases of MRSA have been attributed to the PRUH, a further 10 cases of C-difficile have been reported in January and February. Infection Prevention and Control governance structures are being re-instated. Providing encouragement is the improved section scores and response targets for the ‘How are we doing?’ patient experience survey at both the Denmark Hill and PRUH sites. The increase in workload from 01 October has impacted the backlog of complaints and response times. At both sites the number of complaints received has

Enc. 3.1


increased between December and January; however, since the Trust took responsibility of the PRUH in October 2013 the rate of complaints has almost halved.

6. Financial Performance

In summary, at the end of month 10 (January) the consolidated financial position of the Trust across all sites and services had an operational deficit position of £5.773m, against a planned year to date surplus of £3.135m. This is an adverse variance from plan of £8.908m. Monitor’s continuity of service risk (CSR) rating is intended to flag the risk of insolvency over the next 12-18 months on a scale of one to four, with the lowest rating signifying the highest level of concern. At month 10 the Trust has been rated 3, which is in line with the CSR forecast in the annual plan. There are several reasons behind the adverse financial position and these are closely linked to clinical and operational strategies. One key driver is the inability of the Trust to complete elective procedures due to a lack of capacity. The drop in cancelled elective activity during the internal incident at Denmark Hill had a positive effect on the financial position. A total of £8.6m in non-recurring winter pressure income has been secured. This will help with 2013/14 costs, but the projected CIP target for 2014/15 will be very challenging. The finance team are working closely with divisions to develop savings plans for the new financial year and a two-year financial plan will be submitted to Monitor on 04 April.

7. Care Quality Commission Inspection of the PRUH

The Care Quality Commission (CQC) has now published its quality report on the PRUH. It can be found on the CQC website and I would encourage you all to read it: Princess Royal University Hospital | Care Quality Commission It makes difficult reading on the one hand, but it is encouraging in that it endorses the plans that we developed as part of the acquisition plan. In particular the report praises the work of the nursing teams. On 30 January we participated in a Quality Summit to discuss the outcome of the inspection and the draft report. On 06 February the final report was published highlighting areas of good practice and areas requiring improvement. There is a series of compliance actions to address the essential standards of quality and safety that were not being met when the inspection took place. We are required to submit to the CQC a report outlining the actions we are going to take to meet these essential standards. I was invited to provide some feedback on the pilot phase of the CQC’s new inspection regime. I felt it was valuable to share our thoughts and experience of the pilot with the Chief Inspector of Hospitals and to hear from representatives from other trusts.

| Review of the Last Quarter

Throughout the year members of the Board are pleased to attend the various events held here to engage members, staff and the local community with our work. We also spread the word through the wider media. These are a few of the highlights from the past three months:

http://www.cqc.org.uk/directory/rjz68#latest-checks

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On Monday 23 December the BBC news and the Daily Mirror covered a trial being led by King’s College Hospital, which is the first of its kind outside of the US, to treat an aggressive form of brain cancer. Professor Linda Cardozo, Consultant Gynaecologist, was listed in the Daily Telegraph’s article on the New Year’s Honours list on 03 January. She was awarded an OBE in for services to urogynecology and women’s health. We welcomed the Prince of Wales and the Duchess of Cornwall to our Denmark Hill site on 23 January. The visit attracted widespread media coverage in print, on TV and online. On Friday, 31 January the South London Press reported on delays in our Emergency Departments, citing 38 people waiting more than 12 hours to be found a bed on a ward. In our response, we made clear that all of these extended waits occurred at the PRUH, a service which we took over in October and were working hard to improve. Between 03 and 14 February governors and directors took part in dignity visits as part of Dignity Month 2014. During visits to various parts of the hospital, staff presented their achievements and proposals for dignified care from the patient perspective. An article in the Bromley News Shopper on Wednesday, 5 February highlighted how our new orthopaedic centre in Orpington has been praised for its standard of care by the first patients to have been treated at the newly refurbished facility. On Tuesday 25 February the first of two community meetings took place to give members an opportunity to hear about the Trust’s strategic vision and to input into the five-year strategy.

Finance Report

Month 10 (January) 2013/14

Council of Governors

05 March 2014

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Report to: Council of Governors

Date of meeting: 05 March 2014

Subject: Finance Report – Month 10 (January 2014)

Author(s): Simon Dixon, Nicola Hoeksema, Iris Lewis

Presented by: Simon Taylor, Chief Financial Officer

Sponsor: Simon Taylor, Chief Financial Officer

Status: For Report

1. Purpose The Finance Reports includes information on the Trust’s financial performance and position which

support the in-year submissions to Monitor on a quarterly basis.

2. Action required The Council is asked to note the Finance Report for Month 10.

Enc 3.2

Legal: Reporting to Monitor and Commercial Bank

Financial: Trust reports financial performance and position against published plan and notifies the

committee of financial risks, cost pressures and action plans to mitigate any material variance

from financial targets.

Assurance: The summary and appendices provide assurance that the Trust is meeting Financial targets

(internal and those set by Monitor) and is compliant with its terms of authorisation.

Clinical: There is no direct impact on clinical issues

Equality & Diversity: There is no direct impact on E&D

Performance: Financial Performance against annual plan, budgets, CIPs and Monitor Risk Ratings and

Limits.

Strategy: Performance against the Trust’s Annual Plan including Risk Ratings

Workforce: There are implications for workforce recruitment in respect to service developments and

vacancies.

Estates: There are implication on the Trust’s estates strategy.

Reputation: Finance Committee Report is provided to Monitor and Commercial Bankers as additional

information to support the quarterly Monitor Return.

Other:(please specify) None.

3. Key implications

Page 3

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Contents

Page(s)

Executive Financial Summary 5 - 7

Continuity of Service Risk Ratings 8

I&E Summaries 9 - 17

Patient Spells and Medical Outliers 18 - 20

Winter Pressure Schemes 21 - 22

Divisional Variance Analysis 23 - 24

Temporary Pay Analysis 25 - 26

Drug Expenditure 27 - 31

CIP Update 32

Financial Plan 2014-2015 33 - 34

Reference Costs 2012/2013 35 - 36

Capital, Working Capital & Cash Summary 37 - 46

Statement of Financial Position 47 - 48

Glossary 49

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Month 10 Executive Financial Summary

Financial Key issues:

The Trust is reporting an operating deficit of £5.773m year to date excluding the asset impairment accrual of £6.3m. The Continuity of

Service Risk Rating is 3. The rating has dropped from a 4 to 3 due to the increased debt coverage required in quarter 3 as a result of

including the PRUH PFI liability.

The annual surplus target for the year is £2m excluding the non-operating asset impairment cost of £8m for the year. The phased operating

surplus for the plan for month 10 is £3.135m and therefore the Trust is £8.908m adverse from plan. The adverse movement in month is

£325k.

There were unplanned material adverse movements in Surgery (£1m) and Neurosciences (£1.2m) in month 10. The adverse variance

movements are due to the financial trading loss at Orpington (£2m to date since October);off-site working (£0.5m in month) and increasing

agency use for nursing staff (£0.33k in month). The reduced activity levels on Murray Falconer (Neuro) have also contributed to a reduction

in income. Liver Division (£1m) is due to income falling below the projected forecast level. Critical Care (£1m) (Income £0.6m and agency

nursing £0.423m) also moved adversely against forecast. See pages 23 - 24. PFI and Facilities budget was overspent in month by

£0.75m (page 24) due to contract variations.

These unplanned movements were covered by contingency reserves in month 10 and additional income through the Project Diamond work

stream.

The year-projection will deteriorate further than expected unless the Orpington site is utilised to its full potential, off-site working is stopped

across the Trust and the agency/medical locum spend is curtailed through recruitment and strict usage controls.

The winter pressure income of £8.6m has been secured and will cover the 13/14 costs committed on a non-recurring basis.

Annual Budget YTD Budget YTD Actual

Month 10 YTD

Variance

Month 9 YTD

Variance

Movement in

Month

£'000 £'000 £'000 £'000 £'000 £'000

Income (excluding off Tariff Drugs) 794,939 638,818 658,557 19,739 18,392 1,348

Off Tariff drugs Income 45,122 37,355 44,143 6,788 6,685 102

Pay (471,636) (379,880) (398,810) (18,930) (15,396) (3,534)

Non-Pay (excluding off tariff drugs) (278,730) (221,620) (232,800) (11,180) (12,500) 1,319

Off Tariff Drugs Expenditure (45,122) (37,355) (44,143) (6,788) (6,685) (102)

Capital Charges, Interest and Dividends (50,991) (40,785) (38,990) 1,795 1,131 664

SLR / Internal Recharges 418 275 (57) (332) (209) (122)

Total (6,000) (3,192) (12,100) (8,908) (8,582) (325)

Impairment Expense 8,000 6,327 6,327 0 0 0

Consolidated Annual Surplus/(Deficit) 2,000 3,135 (5,773) (8,908) (8,582) (325)

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The Trust has now received the draft accounts from the TDA ‘SLHT’ Legacy Office for the first six months of the year to 30 September 2013

and is currently reviewing these figures. Any adverse impact on the financial position should be recovered through the capped indemnity

agreed with the TDA.

Potential cost pressures include differences in stock valuations on transfer (£0.5m), PRUH asset site valuations and accounting treatments

of the PFI. The Trust has received draft valuations of all Trust sites as at 31 March 2014. These indicated an overall increase in the value of

the properties and as such, the estimated annual impairment cost is expected to be lower than forecast at year end. The higher asset

valuations will, however, result in a cost pressure to the Trust in relation to PDC Dividends (£1m).

Contract income over-performance

As at month 10, the LSL contract over-performance position is £13m and the NHSE over-performance position is £16.2m. The BBG CCG

contract income level is capped for the PRUH and a financial control total regarding income over-performance has been agreed with LSL

CCG. The Trust has received confirmation of the Project Diamond funding (£2.6m) and the R&D MFF income (£0.7m). This is transitional

funding and will eventually be wrapped up in PbR prices for 15/16.

The number of elective patient spells are still above last years phased outturn; which are partly driving the income over-performance (see

page 18). However the medical outliers are still adversely impacting on the potential income of the Trust (see page 19 and 20). The Trust is

potentially under performing against income by £1.8m per year due to General Medicine patients outlying in other wards.

Operating Expenses

Medical and Nursing staff costs are still over-spending due to locums and agency staff to cover vacancies and to meet the increasing

patient activity levels, patient acuity and vacancies.

Critical Care, TEAM, Liver and Neurosciences are the key areas of concern (see page 25 and 26). There is still an upward trend despite

the recruitment plans.

Year-to-date Trust-wide expenditure for off-site working is £5.85m.

The drugs expenditure is £11m over-spent to date and there has been a steep increase in usage since July (see pages 27-31). This is due

to additional off-tariff drug expenditure of £6.7m and a greater usage in general drug expenditure across all divisions.

The Trust Reference Costs (see page 35) indicate that the Trust’s cost base is in line with peer London teaching hospitals.

Cost improvement Programme

The overall achievement to date is 70% against plan. The CIP value achieved to date is £10.567m and income generation is £14.686 (see

page 32). A key concern is the current level of RED RAG rated CIP schemes for both KCH and the PRUH. A contingency reserve was

established to mitigate the KCH schemes and the remaining gap should be covered by additional activity capacity coming on line. There

are a number of PRUH schemes that have now been deemed unachievable by the Division’s and this is a concern going into next year.

This will put pressure on the Trust to achieve synergy CIPs earlier than planned.

Enc 3.2

Page 7


Capital and Cash

The capital plan is over-committed by £10.6m primarily due to 4 schemes; the delivery of the Orpington Hospital development in quick

time to meet the capacity pressures (building works £1.5m and equipment & IT £2.5m), a further £2m re-phasing on the Energy

Performance Scheme, upgrading of Christine Brown ward (£1.5m) and general Medical Equipment purchases and replacements

(£2.3m). A capital development strategy is under review to meet future requirements and within the available resources.

The 2 major capital development schemes impacting on the future capital plan are the new Helideck (£5m) and Infill Block 5 (£50m). A

business case will be submitted to the TDA in the next 2-3 weeks and will require commissioner support.

Outstanding debts from NHS England currently total £18.644m (including Integration support £5.8m, Over-performance £7m and

Project Diamond funding £2.6m). Outstanding CCG SLA and SLA over-performance debts total £19.241m. This will not impact on the

risk rating but will generate a delay in payments to creditors.

The Trust has received the PRUH PDC transactional funding (£23m) and part payment of the revenue integration funding from NHSE

(£17.07m).

Operational Planning 2014/15

The strategic and operational planning timetable is condensed into a much tighter timescale for 14/15; requiring a two year financial

plan by 4th April as opposed to the end of May as in previous years. This will overlap with the year-end close down timetable and

generate additional pressure on divisional management structures and corporate departments; particularly with the PRUH transaction.

The projected cost improvement target for 14/15 is £71.9m. This is a challenging target due to the projected deficit carried forward,

FYE of nursing investments and the FYE of funding the winter pressure schemes through the operational plan. The winter pressure

income is non-recurring and this will be a key funding issue outside of the PBR tariff rules with the Commissioners. The QIPP

challenge has yet to be disclosed by the CCG’s and NHSE.

The Lambeth and Southwark CCGs are proposing a block contract for 14/15 which includes funding for winter pressure schemes on a

recurring basis (£4.5m); but includes a QIPP of £6m. RTT activity backlog will be built into the contract as well as growth for the

additional Critical Care capacity. Other CCG and NHSE contracts will be based on last year’s outturn and the usual cost and volume

rules will apply. Discussions continue with NHSE and Bromley CCG regarding winter pressure funding on a recurring basis (£6m FYE).

The financial plan will be dependant on national winter pressure funding as per 13/14 (£3.9m).

Enc 3.2

King’s Winter Pressure Schemes 2013/14

Page 8

Denmark Hill Site 2013/14

Projected

Total Spend

£'000

Neuro Nursing needed to cope with the increased acuity of patients 804

CDU portacabin hire/ housekeeping & hostess service 453

LAS performance nursing/ admin 295

1 band 6 ED Paeds nurse shift 24/7 272

ED Twilight SpR shift 7/7 270

RDL additional beds (12 beds until 30/9/13 then increasing to 28 beds) 963

Acute Medicine wards nursing shift review 1,000

Acute Medicine Consultant rota review to support weekend cover for 7/7 working 210

Increased CDU capacity & new RAT/ majors assessment area 329

Paediatric Short Stay Unit 500

2 Story CDU/Paediatric short stay modular unit 500

Acute Medicine 7 day working 398

Other Schemes 792

Kings Total 6,786

Funding Agreed

DOH/NHSE Cenral funding via LSL CCGs 2,000

NHSE Emergency Admissions Tariff at 100% 1,000

LSL CCG Emergency Admissions Tariff at 100% 2,800

LSL CCG Emergency 13/14 Baseline increase at full tariff 986

Total Funding 6,786

Enc 3.2

King’s Winter Pressure Schemes 2013/14

Page 9

PRUH Site 2013/14

Projected

Total Spend

£'000

CDU facility & staffing 717

Winter pressure ward (M1) 331

2 additional nursing shifts in ED 24/7 (to include all new majors capacity and

paeds) 208

Therapists - 7/7 working (ED/ CDU & EAU) 83

15 Paediatric Beds 187Other Schemes 374

Total 1,900

Funding Agreed

DOH/NHSE Central Funding via Southwark CCG 1,900

Total Funding 1,900

Enc 3.2

Page 10

Month 10 Capital Summary

Capital Plan

• The annual budget for 2013/14 has been reduced from £52.586m to £27,164m due to the re-phasing of the Critical

Care Unit (£25.422m) between 13/14 and 14/15. In 13/14, £9.560m for the Critical Care Unit is to be funded by the

loan received from the Foundation Trust Financing Facility.

• £1.024m of the Capital Plan will be funded by charitable donations, £3m is funded by an Energy Grant from the

Department of Health Energy Fund, with the remaining being funded by internal Trust resources such as

Depreciation. The £3m budget for Orpington major works is funded by SLHT.

Forecast Capital Expenditure

• Forecast capital expenditure for 13/14 has increased by £10.685m against the Trust’s Annual Plan budget. Below is

the breakdown of the changes to date.

Budget per Annual Revised Forecast Net Variance

Scheme Plan - 2013/14 Spend - 2013/14 2013/14 Comment

£'000 £'000 £'000

Maternity & Paediatrics 1,280 2,000 720

Additional costs for Fees and VAT, and project now incorporates the

refurbishment of Suites 4 & 7 in the Golden Jubilee Wing

Emergency Centre 1,279 550 (729)

Lease of a 2 storey Portakabin with CDU and Paediatric beds has reduced the

need for capital spend on this project.

Catering Courtyard Scheme (MRI) - 250 250 New project to install 2 MRI

Christine Brown Ward upgrade works - 1,500 1,500 Upgrade of Christen Brown to level 2 use

Trundle Ward 750 150 (600) Scheme aborted

Energy Performance Contract 4,000 6,080 2,080 VAT excluded from initial estimate and payment to supplier has been re-phased

Ultrasound reconfiguration 700 50 (650)

Scope of project reduced due to design viability issue, remaining project to be

carried forward

CT Scanner Enabling Works - 84 84 Additional enabling works to install CT Scanner on ground floor of GJW

Helideck 43 143 100 Additional preparatory works

Diabetic Foot Clinic 300 13 (287) Project to be carried forward

Mortuary Expansion 300 - (300) Project delayed due to works been carried out on Infill Blk 5

Decked Car Park 500 4 (496) Project to be carried forward

Other major works - 250 250 Projects overspent at month 9

Minor Works - Capital Maintenance 1,000 1,150 150 Budget required to complete Corridor Refurbishment project.

Medical Equipment 1,165 2,692 1,527 Additional funding required for Infill Block 4 Equipments and ED CDU unit

Medical Equipment - CCU 349 1,173 824 Additional funding required for CCU equipment on Christen Brown ward

Orpington Major Works 3,000 4,512 1,512

Overspend due to change in planned use of Orpington hospital resulting in

additional works been carried out.

Orpington Equipment & IT - 2,558 2,558 IT Infrastructure, theatre and therapies equipments for Orpington Hospital

Total - KCH 14,666 23,159 8,493

PRUH - Estate projects 2,192 2,192 Additional works due to integration of PRUH

Integration Project 11,000 11,000 -

Total - PRUH 11,000 13,192 2,192

Total capital budget/ forecast /

variance (+ over, - under spend) 25,666 36,351 10,685

Enc 3.2

Capital Expenditure Summary - KCH

Month 10

Page 11

Capital Expenditure - KCH

• Capital expenditure to month 10 was £26.391m against a re-phased year-to-date budget of £22.845m. This is

mainly due overspend of £4m in Orpington Hospital.

• Overall, the Trust is forecasting to spend £38.657m at the end of the year against a budget of £30.164m, resulting

in an overspend of £8.493m (excluding PRUH integration).

Capital Programme - KCH

Total per capital category

Major works 21,475 16,106 15,896 7,501 23,397 1,922

Capital Maintenance (Minor Works) 1,000 750 748 402 1,150 150

Medical Equipment 1,165 874 2,154 538 2,692 1,527

IT and infrastructure 2,369 1,777 981 1,395 2,376 7

Intangibles (IT) 131 120 120 4 124 (7)

Donated - Major Projects 649 95 95 1,378 1,473 824

Donated - Medical Equipments 375 123 123 252 375 -

Orpington - Estate major works 3,000 3,000 4,512 - 4,512 1,512

Orpington - Equipments & IT - - 1,762 796 2,558 2,558

Total Capital Position :

Overspend (+) / Underspend (-) 30,164 22,845 26,391 12,266 38,657 8,493

Budget Period Budget Actual to date

Anticipated

Changes Y/E Forecast

Gross capital expenditure b/f 30,164 22,845 26,391 12,266 38,657

(Intangible Assets Included Above)

Non Cash Purchase of OMS

Gross Cost 30,164 22,845 26,391 12,266 38,657

Less:

Capital Donations held on Trust, NOF monies 1,024 218 218 806 1,024

Total 1,024 218 218 806 1,024

Capital Charge against Capital Resource Limit 29,140 22,627 26,173 11,460 37,633

Depreciation (Including Orpington) 15,876 11,907 11,840 4,036 15,876

PDC Receivable 2,980 2,980 2,980 0 2,980

SLHT Funding - Orpington 3000 3000 3000 0 3000

External Borrowings 9,560 19,900 19,900 0 19,900

Internal Cash Resources (2,276) (15,160) (11,547) (1,069) (12,616)

FT Capital Plan 29,140 22,627 26,173 2,967 29,140

Variance : + over / (-) under 0 0 0 8,493 8,493

Budget

Forecast

Variance

Expenditure

Annual Plan

13/14 Period Budget Actual YTD Cost to Complete Total Cost 13/14

Enc 3.2

Capital Expenditure Summary - KCH

Month 10 – Major Works

Page 12

Major capital works breakdown

There is a significant increase in the forecast for energy performance contract as the initial budget did not

include VAT that will not be reclaimable and Christine Brown ward upgrade. Other projects are been re-phased

to next financial year resulting in a net over-spend of £1.922m.

MAJOR WORKS PROJECTS

SchemeAnnual Plan

2013/14

£'000

Actual Spend

to Month 4

£'000

Cost to

Complete

£'000

Forecast

Cost

£'000

Variance

to Plan

£'000

Maternity (MLU/MAU Expansion) 1,280 1,611 389 2,000 720

Emergency Centre (Majors & External Works) 1,279 264 286 550 (729)

Catering Courtyard Scheme - MRI - 250 250 250

Christine Brown Ward upgrade works - 10 1,490 1,500 1,500

Sitewide Infrastructure - - - -

Infill Block 5 (Annie Zunz) - - - -

Energy Performance Contract 4,000 4,771 1,309 6,080 2,080

Day Surgery Unit 377 239 138 377 -

Liver Lab Research Facility 252 169 83 252 -

Critical Care Unit 9,560 6,696 2,864 9,560 -

Pharmacy Dispensing Expansion 84 68 16 84 -

Helideck 43 24 119 143 100

Pet CT Scanner Enabling Works 1,000 820 180 1,000 -

Diabetic Foot Clinic 300 13 - 13 (287)

Office Moves & Reconfigurations (eg E-learning to Unit 4) 100 42 58 100 -

Trundle Ward 750 76 74 150 (600)

Ultrasound Reconfiguration 700 11 39 50 (650)

Mortuary Expansion 300 - - - (300)

Endoscopy - Perfusionists Move 200 232 - 232 32

Endoscopy - Changing Rooms 50 1 49 50 -

Endoscopy - Fire Damage Works 500 218 76 294 (206)

Endoscopy - Building Works - 174 - 174 174

Decked Car Park 500 4 - 4 (496)

Clinical Research Facility (Building) 200 182 18 200 -

CT Scanner Enabling Works - 84 - 84 84

Other Major Works - 187 63 250 250

TOTAL 21,475 15,896 7,501 23,397 1,922

Enc 3.2

Capital Expenditure Summary - Integration

Month 10

Page 13

Capital Expenditure – PRUH Integration

• There is a forecast overspend in integration works as we are currently forecasting to spend £13.192m of which

£11m is funded by capital integration funding.

• The overspend of £2.192 will impact on the Trust total overspend as this will have to be funded internally from

depreciation

Total per capital category

PRUH

PRUH - Estate Projects - - 976 1,216 2,192 2,192

Integration Projects 11,000 5,500 1,015 9,985 11,000 -

Total Capital Position :

Overspend (+) / Underspend (-) 11,000 5,500 1,991 11,201 13,192 2,192

Budget Period Budget Actual to date

Anticipated

Changes Y/E Forecast

Gross capital expenditure 11,000 5,500 1,991 11,201 13,192

Gross Cost 11,000 5,500 1,991 11,201 13,192

Depreciation - PRUH 1,944 1,458 0 1,944 1,944

PDC - Capital Integration Funding 11,000 11,000 11,000 0 11,000

Internal Cash Resources (1,944) (6,958) (9,009) 7,065 (1,944)

FT Capital Plan 11,000 5,500 1,991 9,009 11,000

Variance : + over / (-) under 0 0 0 2,192 2,192

Forecast

Variance

Capital Programme - Integration of PRUHBudget Expenditure

Annual Plan

13/14 Period Budget Actual YTD

Cost to

Complete

Total Cost

13/14

Enc 3.2

Working Capital - Debtors

Page 14

Provision for Bad Debts is based on debts outstanding over 6 months.

The NHS Provision has been adjusted for debts which are not contested and are considered recoverable.

Total Outstanding 0 - 30 days 31 - 60 days 61 -90 days Over 90 days

£ £ £ £ £

NHS BodiesCCGs & Primary Care Trusts 45,598,369 17,251,197 9,239,537 6,955,454 12,152,181

Department of Health / SHA 478,633 713,326 1,029 (15,423) (220,300)

Provider Trusts 9,912,238 2,111,891 990,465 1,215,482 5,594,399

NHS Trade Debtors 55,989,240 20,076,415 10,231,031 8,155,513 17,526,281

Provision for Bad Debts (1,687,458) - - - (1,687,458)

NHS Bodies Total 54,301,782 20,076,415 10,231,031 8,155,513 15,838,823

Non NHS BodiesScottish, Welsh & Irish Health Bodies 917,682 74,767 235,790 (13,541) 620,667

King's College London University 2,278,750 264,771 421,197 142,667 1,450,115

King's Charitable Trust 147,300 30,599 14,949 1,448 100,304

Other Non NHS Bodies 3,493,843 1,285,712 527,393 213,728 1,467,011

Non NHS Trade Debtors 6,837,575 1,655,848 1,199,329 344,301 3,638,097

Provision for Bad Debts (336,294) - - - (336,294)

Non NHS Bodies Total 6,501,281 1,655,848 1,199,329 344,301 3,301,803

Total Accounts Receivable 62,826,815 21,732,262 11,430,360 8,499,814 21,164,378

% of Total Outstanding - Month 10 100% 35% 18% 14% 34%

Month 9 100% 41% 11% 11% 36%

Private Patients Accounts Receivable 6,811,887 1,761,254 464,204 153,993 4,432,436

Provision for Bad Debts (742,850) - - - (742,850)

Private Patients Accounts Receivable Total 6,069,037 1,761,254 464,204 153,993 3,689,586

Overseas Visitors Accounts Receivable 4,366,111 655,785 423,892 621,246 2,665,188

Provision for Bad Debts (4,114,698) (404,372) (423,892) (621,246) (2,665,188)

Overseas Visitors Accounts Receivable Total 251,413 251,413 0 0 (0)

Total PP & Overseas Visitors Accounts Receivable 11,177,998 2,417,039 888,096 775,239 7,097,623

Enc 3.2

Working Capital - Creditors

Page 15

Overall Total 0 - 30 days 31 - 60 days 61 -90 days Over 90 days

£ £ £ £ £

NHS Bodies 2,019,912 170,970 1,041,477 2,543 804,922

Non NHS Bodies 9,461,569 176,254 6,216,151 694,201 2,374,964

Total 11,481,481 347,224 7,257,628 696,744 3,179,886

% of Total Outstanding - Month 10 100% 3% 63% 6% 28%

- Month 9 100% 10% 53% 11% 26%

Enc 3.2

Statement of Financial Position (Balance Sheet)

Page 16

Trade and Other Receivables includes NHS and Non-NHS debtors on page 43

Trade and Other Payables includes NHS and Non-NHS creditors on page 44

STATEMENT OF FINANCIAL POSITION AS AT 31 March 2013

Qtr 1

30 June

Qtr 2

30 September

Qtr 3

31 December

Month 10

31 January

Consolidated

Annual Plan

Forecast

2013 2013 2013 2014 31 March 2014

£'000 £'000 £'000 £'000 £'000 £'000

NON-CURRENT ASSETS

Intangible Assets 1,399 1,246 1,151 1,297 1,247 1,370

Property, Plant & Equipment 270,311 272,045 275,140 297,345 300,416 326,627

Investments in associates 816 816 816 816 816 1,749

On-Balance Sheet PFI 76,496 73,111 72,646 202,017 202,694 187,200

Trade and Other Receivables, Non- Current 3,834 3,834 3,834 4,865 4,865 4,865

Total Non-Current Assets 352,856 351,052 353,587 506,340 510,038 521,811

CURRENT ASSETS

Inventories 11,333 11,250 13,299 14,960 12,194 13,520

Trade Receivables 38,684 17,871 32,398 62,514 56,900 41,015

Other Receivables 1,968 19,257 26,679 26,886 27,081 5,968

Impairment of Receivables (4,666) (4,821) (6,067) (7,024) (7,704) (4,667)

Other Financial Assets 5,866 51,228 40,823 42,772 23,232 9,613

Prepayments 3,258 5,188 6,429 4,582 5,609 3,258

Cash & Cash Equivalents 40,502 16,028 11,200 41,317 49,500 67,397

Total Current Assets 96,945 116,001 124,761 186,007 166,812 136,104

CURRENT LIABILITIES

Interest-Bearing Borrowings (1,135) (629) (567) (62) (62) (1,091)

Deferred Income (5,552) (6,199) (7,635) (5,473) (6,702) (4,442)

Provisions (3,316) (3,181) (1,327) (1,694) (904) (1,087)

Current Taxes Payable (4,095) (8,173) (8,147) (10,938) (10,970) (4,400)

Trade Payables (32,908) (33,358) (27,222) (30,728) (27,940) (31,948)

Other Payables (14,958) (18,724) (19,640) (8,092) (8,238) (17,054)

Other Financial Liabilities (31,664) (36,691) (49,287) (99,509) (80,068) (32,336)

Total Current Liabilities (93,628) (106,955) (113,825) (156,496) (134,884) (92,358)

Total Assets less Current Liabilities 356,173 360,098 364,523 535,851 541,966 565,557

NON-CURRENT LIABILITIES

Interest-Bearing Borrowings (15,349) (21,249) (27,449) (25,755) (35,249) (49,590)

Provision (6,893) (6,893) (6,893) (8,504) (7,243) (6,734)

Other Financial Liabilities (75,583) (75,584) (75,584) (146,696) (159,156) (150,901)

Total Non-Current Liablilities (97,825) (103,726) (109,926) (180,955) (201,648) (207,225)

Total Assets Employed 258,348 256,372 254,597 354,896 340,318 358,332

Financed By (taxpayers' equity):

Public Dividend Capital 135,678 135,678 135,678 161,904 161,904 162,929

Revaluation Reserve 87,538 87,757 87,302 87,566 87,323 88,913

Income & Expenditure Reserve 35,132 32,937 31,617 105,426 91,091 106,490

Total Taxpayers' Equity 258,348 256,372 254,597 354,896 340,318 358,332

Enc 3.2

Glossary

Page 17

CIP – Cost Improvement Plan

SLA – Service Level Agreement

PDC – Public Dividend Capital

PSPP – Public Sector Payment Policy

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 3.2

1


2013-14 Month 10

Performance @ Denmark Hill

Roland Sinker

Chief Operating Officer

Enc 3.3


Date of meeting: 05 March2014

Subject: Performance Report, Month 10 2013/2014

Author(s): Steve Coakley, Acting Associate Director of Performance and Contracts

Presented by: Roland Sinker

Sponsor: Roland Sinker

Status: For Information

2

1. Background/Purpose This report provides the details of performance achieved against the governance indicators defined in the

Monitor Risk Assessment framework for the interim Quarter 4 position. It also contains an update on the Trust’s

contractual position with the CCG’s and NHS England at Month 10 including the latest position on CQUIN

agreements.

2. Action required The Council is asked to note the M10 performance report.

Enc 3.3

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 the performance targets

as defined within the Monitor Risk Assessment framework for the interim Q4 position

with the exception of the RTT 18 Week Admitted target, the 4-hour Emergency

Performance target and the C-difficile target. Subject to further feedback from Monitor,

the Trust’s current risk rating is Green.

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 the performance

indicators for the interim Q4 position as defined in the Monitor Risk Assessment

framework, with the exception of the RTT 18 Week Admitted target as planned, the 4-

hour Emergency Performance target and the C-difficile 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)

3. Key implications

Enc 3.3

4

Contents

•Executive Summary

•Trust Performance Summary

•Divisional Performance Summary

•Regulatory/Contractual Performance

• Monitor 2013-14 interim Q4 position

• Contractual 2013-14 position update

•Specific Performance Reports

• Key Areas of Concern

• Infection Control Plan

• ED Action Plan Update

• RTT Action Plan Update

Enc 3.3

5

Executive Summary (1/5)

1. Denmark Hill 2013-14 Key Areas of Performance for Month 10:

1.1 Good Performance

Access Targets – Cancer waiting time targets have been achieved for January despite the challenging

pressures on inpatient beds during the month, and the Referral to Treatment (RTT) non-admitted

completed pathways and RTT Incomplete pathway targets have also been achieved for January.

Patient Experience – HRWD Patient survey section scores improved for January, and response targets

have been achieved in all 3 sections for Care Perceptions, Patient Engagement and Environment.

Length of Stay (LOS) – The Elective LOS target of 4.7 days was achieved for the first time since setting

the stretch target 2 years ago with an average elective LOS at 4.6 days in January, with a notable

reduction in LOS in Surgery to 2.6 days.

1.2 Performance challenges – 5 Areas

RTT Admitted – The RTT Admitted pathway target of 90% was not achieved in January with 87.8% of

patients admitted within 18 weeks, consistent with the Trust plans submitted to Monitor. Whilst the

incomplete pathway target was narrowly achieved for January, the Trust is behind the revised backlog

trajectory position of 1,223 by 525 patients to reduce the number of patients waiting over 18 weeks.

Emergency Care Performance – The Emergency Care 4-hour performance target of 95% was not

achieved in January at 93.1% for all emergency type attendances. This is one of the performance

indicators that the Trust did highlight to Monitor as ‘at risk’ of not achieving for Q4 in its annual plan.

Comparing ED activity figures over the last 6 weeks to the same position last year, key themes emerging

are a significant increase in majors attendances, an increase in out of area red phone attendances and an

increase in major trauma referrals. Mental Health (MH) attendances remain high and LAS has advised the

Trust that typically 50% of these MH attendances are patients in crisis who are known to SLAM. This has

a dis-proportionate impact on breach performance in ED as 2-4 cubicles in majors can typically be

occupied for periods of up to 12 hours managing MH patients. Front-line clinics have been reduced from

within the mental health sector and this is being picked up with commissioners. There are further MH

patients who require admission for medical conditions, and it is difficult to find a SLAM bed for patients

Enc 3.3

6


when they are medically fit for discharge.

Health Care Acquired Infection (HCAI) – There were 2 further MRSA cases attributed to the Trust in

January so 7 cases have been reported to date this year. There have been only 2 c-difficile cases

reported in January but the Trust is above its trajectory position of 41 cases to January with 42 cases

reported. Concerns remain around the increase in CRE cases and other multi-resistant organisms. The

Trust self-certified likely non-compliance for c-difficile, given the tight trajectory and rise in activity.

Finance – The financial net variance for the M10 position is -£10.949m from plan.

Complaints – The number of complaints received increased from 54 cases in December to 73 cases in

January whereas the number of complaints rated high or severe remained static at 13 cases. The number

of responses that were either still open or not responded to within the 25 day internal target increased

from 32 cases in December to 69 cases in January. The increase in the complaints backlog has been

impacted by an increase in workload following the acquisition of the PRUH sites and additional operational

pressures that have been sustained throughout the current winter period.

1.3 Actions – 5 areas

RTT admitted - The Trust's first waiting list priority is the reduction of the number of 52+ week wait

patients, but the number waiting at the end of January is static with 75 patients waiting. Lack of critical

care capacity has been a contributing factor and plans are on-track for the 12 critical care beds to be

available in the Christine Brown ward area from 26 February. Treatment plans are being confirmed for all

current 52+ week wait patients and the Trust is planning to have 50 patients waiting over 52 weeks by the

end of March. The second waiting list priority is the reduction in the number of over 18 week patients

which the Trust had planned to reduce to 550 patients by the end of March. However, at the end of

January there are just under 1,750 patients waiting over 18 weeks which is 525 patients above the revised

trajectory position. Based on the latest delivery plans that have been worked-up within the divisions, the

Trust expects the backlog position to reach 1,250 patients by the end of March. In addition, the Executive

is undertaking a detailed review of demand and capacity with a view to identifying any more

Enc 3.3

7


material strategic changes.

Emergency Care Performance – Weekly Emergency Care Board meetings are being held to review

performance and progress against the ED Action plan which is included later in this report. Daily

Emergency Department (ED) breach meetings are being held to review the 4-hour breaches. The Trust is

implementing its plans for 7-day working in medicine but a number of areas have not been able to make

progress due to challenges finding appropriate temporary staffing solutions. The fill rate for posts is

improving and substantive recruitment has commenced for the clinical administrator and bed manager

posts. Increased weekend therapies presence is supporting the discharge process, and weekend

discharges has improved to 31 patients during the first 2 weeks in February compared to 20 weekend

discharges on average during January. Additional support from Social Services will contribute towards

improving weekend discharges further.

Health Care Acquired Infection (HCAI) – A full root cause and analysis will be conducted into the MRSA

and c-difficile cases that have been attributed to the Trust in January. The latest HCAI Action plan is

included later in this report.

Finance - Review meetings were held with each division from the week commencing 27 January.

Complaints – The first meeting of the Serious Complaints committee will be held on the 21 February 2014,

chaired by one of the non-executive directors and including executive directors and senior clinicians.

2. Other areas of concern:

2.1 Diagnostic Waiting Times – There were 57 breaches of the 6-week diagnostic waiting time target

reported at the end of January, an decrease of 11 patients compared to the December position. This

represents 1.25% of the diagnostic waiting list, and is above the national target of 1% but is improving in-

month during February where the key area of concern are backlog patients waiting in Paediatric

Gastroscopy.

2.2 Tertiary transfers - Repatriation bedday delays have increased significantly from 454 beddays in

December to 1,076 beddays in January, effectively representing at least 35 beds per day on average for

January. Nearly 50% of the transfer delays are Neurosciences patients which also includes patients on our

Enc 3.3

8


Stroke Unit. Repatriation delays are escalated daily to the Director of Operations at relevant Trusts and now

to NHS England, given the higher volume of repatriation delays for stroke and neurosciences patients. The

CEO of Southwark CCG is writing to CEO’s in out of area CCG’s in relation to the tertiary transfer pressures

that we are facing on the Denmark Hill site.

2.3 Red Shifts – The number of ward-based red shifts decreased from 102 in December to 64 in January,

still higher than the number of red shifts reported at this time last year: with 31 red shifts reported in TEAM

wards, 10 in Child Health wards and 9 in Surgical wards.

2.4 Red Adverse Incidents (AIs) – 20 incidents were reported in January compared to 14 in December, of

which 8 cases were community-acquired pressure ulcer cases that we are required to report.

2.5 Vacancy Rate - Staff vacancy rate continues to increase, from the 8.9% rate reported in December to

14% in January, considerably above the target range of 5 - 8.0%.

2.6 Mandatory and Statutory Training - The overall index score for reporting staff who have attended

mandatory & statutory training courses reduced by 1 point to 72, below the expected index of 100. Further

focus on training is required in order to achieve the internal target of 95%.

3. Regulatory and Contractual Performance

3.1 Monitor

Monitor Q4 position - The Trust has achieved all the performance indicator targets in the Monitor Risk

Assessment Framework for January with the exception of the RTT 18 Week Admitted target, C-difficile target

and the 4-hour A&E performance target. A&E attendances and sustained emergency access pressures

continued into January and All Types performance of 93.1% was achieved.

3.2 Contractual

CCG - The Contract has been signed with the CCG Commissioners for 2013-14.

NHS England – The revised offer from NHSE has been accepted and the Contract has now been signed.

Enc 3.3

9


CQUIN 2013/14 – CCG Q3 update – The Trust has submitted its Q3 CQUIN evidence and we are

anticipating achieving 99% compliance. The Trust is predicting a loss of £63k in Q3 CQUIN income due to

the Acute Surgical Unit not achieving the target for the Inpatient Patient Experience CQUIN.

CQUIN 2013/14 – NHS England – The Trust has submitted its Q3 CQUIN evidence and is waiting for

feedback.

Specific Performance Reports and other updates

This month’s report includes updates for :

4.1 Key Areas of Concern

Summary page to highlight key areas of concern on the Denmark Hill site under the categories of: Quality,

Efficiency, Finance and Strategy.

4.2 Infection Control Action Plan Update

Further details on the enhanced actions for 2013-14 can be found in the HCAI Action Plan, provided later in

this report.

4.3 Emergency Department (ED) Action Plan Update

Further details on the additional action plans to manage the 4-hour emergency care performance target can

be found in the ED Action Plan update, provided later in this report.

4.4 RTT Performance Update

Further details on the revised trajectories and additional action plans to reduce the over 18 week backlog

can be found in the RTT Performance update, provided later in this report.

Enc 3.3

1


2013-14 Month 10

Performance @ PRUH

Roland Sinker

Chief Operating Officer

Enc 3.3



Subject: Performance Report, Month 10 2013/2014

Author(s): Steve Coakley, Acting Assistant Director of Performance and Contracts

Presented by: Roland Sinker

Sponsor: Roland Sinker

Status: For Report

2

1. Background/Purpose This report provides the details of performance achieved against the governance indicators defined in the

Monitor Risk Assessment framework for the interim Quarter 4 position. It also contains an update on the Trust’s

contractual position with the CCG’s and NHS England at Month 10 including the latest position on CQUIN

agreements for PRUH hospital only.

2. Action required The Council is asked to note the M10 performance report.

Enc 3.3

3

Legal: Statutory reporting to Monitor and the DH.

Financial: Trust reports financial performance against published plan.

Assurance: In the absence of having cancer waiting time information for January, none of the other

indicators in the Monitor Risk Assessment framework for the interim Q4 position have

been achieved, with the exception of the RTT Non-Admitted Completed pathway target.

Clinical: There is no direct impact on clinical issues.

Equality & Diversity: There is no impact on equality & diversity issues.

Performance: In the absence of having cancer waiting time information for January, the summary

report demonstrates that PRUH has achieved the RTT Non-Admitted completed

pathway target for January but the year-end trajectory for c-difficile cases has also

already been reached. The 4-hour emergency performance target has also not been

achieved for January.

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)

3. Key implications

Enc 3.3

4


1. PRUH 2013-14 Key Areas of Performance for Month 10:

1.1 Good Performance

Patient Experience – All HRWD patient survey scores improved again in January, with the section score

targets for Care Perceptions and Environment being achieved. The recent CQC inspection report also

highlighted the real commitment from front-line and other staff in providing compassionate care to patients.

1.2 Performance challenges – 5 Areas

Referral to Treatment (RTT) – The RTT Non-admitted completed pathway target of 95% was achieved

for January with 95.0% of patients seen within 18-weeks in outpatient settings for the PRUH and Queen

Mary Sidcup hospitals. However, the RTT Admitted completed pathway target of 90% was not achieved

with 81.3% of patients admitted within 18 weeks, and the RTT Incomplete pathway target of 92% for

patients still waiting on an open pathway was also not achieved at 90.6%. This is consistent with our

plans set out with Monitor and reflects the multiple service moves that have been implemented since

October across the old SLHT hospital sites, and high medical demand leading to elective cancellations

during January.

Emergency Care Performance – The Emergency Care performance target was not achieved in January

for either the Type 1 A&E attendances at 67.1% or for all type attendances which includes the Urgent Care

centre (UCC) at the PRUH at 79.6%. Again, this is consistent with our plans set out to Monitor. Fragile

discharge processes and patient outflow issues continue to affect performance from the ED compounded

by staff capacity issues in relation to consultant cover and nursing staff shortages on the wards.

Health Care Acquired Infection (HCAI) – No MRSA cases have been attributed to the Trust since

October 2013 and this quality indicator is no longer assessed by Monitor in the Risk Assessment

Framework for Q3 onwards. There were 5 c-difficile cases attributed to the PRUH in January so 8 cases

have been reported for the cumulative position from October 2013 to January 2014 which would put the

PRUH above trajectory for the January position. However, 2 further cases have been reported to-date in

February so 10 cases have been reported in total which means the year-end trajectory has now been

reached. Any further cases will mean that this target will be breached in Q4.

Enc 3.3

5


Cancer Waiting Times - Cancer waiting time data is not yet available for January, but the Q3 position

reported that the 2-week wait time and 62-day time to first treatment cancer standards were not achieved

for Q3. This is consistent with our self-certification on cancer waiting achievement with Monitor.

Finance – Further details on the financial position will be picked up separately in the Finance paper.

1.2 Actions – 5 areas

RTT admitted – RTT Board meetings continue to take place on the PRUH site specific to services

provided from the PRUH and Queen Mary Sidcup hospitals, to which all divisions are required to send a

representative.

Emergency Care Performance – Daily operational site performance meetings are held at 10:30 to

highlight and review key areas of operational concern. The ED Action plan to improve 4-hour performance

is reviewed at weekly Emergency Care Board meetings at PRUH, and commissioners are also invited to

attend. Further work is underway to refresh the ED recovery plan following recommendations from the

NHSE visit, CQC report feedback as well as feedback from the DH Intensive Support Team.

A “Safer Faster Hospital” planned internal incident is scheduled to start from 8am on Friday 7 March to

1pm Friday 14 March at PRUH. The objective is to improve safety and flow through the PRUH site and

community colleagues have been briefed and are supporting the initiative. Community organisations

involved include the CCG, Bromley Health Services, Bromley Social Services, Continuing Health Care, St

Christopher’s, LAS, Oxleas Trust and Bexley Social Services.

The Trust has also invited the Emergency Care Intensive Support Team (ECIST) to work with our Director

of Therapies and Community partners to undertake an audit of patients in hospital for 7 days or more at

the PRUH earlier in February. ECIST are due to provide a report with feedback and recommended

actions.

Health Care Acquired Infection (HCAI) – Infection Prevention and Control (IPC) governance structures

are being re-instated at the PRUH and due to commence in February including an Environmental Action

Group and an Infection Prevention and Control Committee which is due to meet in March. Work is also

Enc 3.3

6


being undertaken with divisions to establish an IPC consultant lead role at the PRUH with a focus on

identifying candidates for this role. A baseline review of practice relating to IV lines has been completed

and an action plan is being implemented to standardise documentation and consumables, and to introduce

ANTT training.

Cancer Waiting Times – A Cancer Action Plan has been developed in response to the DH Intensive

Support Team visit earlier in the financial year.

Finance – Review meetings were held with each division from the week commencing 27 January.

2. Other areas of concern:

2.1 Diagnostic Waiting Times – The number of 6+ week diagnostic waiting time breaches at the PRUH

reduced slightly from 458 in December to 414 patients as at the end of January, and the national 1% target

for patients waiting over 6 weeks is not being achieved. Over half of the breaches are non-Obstetric

ultrasound tests which have increased due to clinician vacancies causing short-term capacity issues.

2.2 Red Adverse Incidents – the number of red adverse incidents increased from 26 cases in December

to 22 cases in January - 5 of these cases are internal with the other cases relating to community-acquired

pressure ulcers. All cases are the subject to a root cause analysis and will be presented to the Serious

Incidents committee.

2.3 VTE Assessments – The percentage of patients admitted who had a VTE assessment performed

decreased from 87% in December to 82% in January, and the position is still below the national target of

95%. Changes have been implemented with respect to the recording and reporting of VTE assessment

data at PRUH.

2.4 Complaints – The number of complaints received increased from 21 cases in December to 38 cases in

January, and the number of complaints rated high or severe increased from 4 to 6 cases. The number of

complaints that are still open or not responded to within the internal target of 25 days has improved from 21

cases in December to 12 cases in January.

Enc 3.3

7


2.5 Inpatient Cancellations – The number of inpatient operations cancelled on the day due to non-medical

reasons increased from 60 cases in December to 133 cases in January, with bed pressures being one of the

key reasons for cancellation.

2.6 Vacancy Rate – Figures are not yet available for January but the staff vacancy rate at PRUH was 16.1%

in December, above the target rate range of 5-8%.

3. Regulatory and Contractual Performance

3.1 Monitor

Monitor interim Q4 position – Only the RTT non-admitted pathway target was achieved at PRUH, as

neither the RTT Incomplete and Admitted targets were achieved for January, consistent with our plans to

Monitor.

A&E attendances and sustained emergency access pressures continued during January and PRUH did not

achieve the 95% 4-hour A&E performance target at 79.6% for All Type attendances in January.

5 C-Difficile case was reported in January with the Trust having 8 attributable cases since October 2013 to

January 2014. 2 further cases have been reported in February which means that that year-end trajectory of

10 cases has now been reached.

Cancer waiting time data for Q4 was not available at the time that this report was published.

The Trust is therefore reporting non-achievement of four targets for the interim Q4 2013/14 assessment due

to the RTT 18 Week Admitted completed and Incomplete targets as well as the A&E 4-hour target and c-

difficile trajectory not being achieved for January.

3.2 Contractual Update

CCG - Contracts have been novated to receivers, however, there is a contract variation required to move

Direct Access Pathology (£4m FYE) into the King’s Contract, and Queen Mary’s Sidcup Neurology

outpatients (£274k FYE) out of the King’s Contract. Receiver splits have been agreed and the Trust is

awaiting the final contract documentation from the Commissioning Support Unit to agree and sign.

Enc 3.3

8


NHS England – Contracts have been novated successfully with no issues outstanding to resolve.

CQUIN 2013/14: CCG Q3 update – The Trust has submitted its Q3 CQUIN return evidence and is waiting

feedback from CCG’s. A number of data recording and reporting issues have been found which we are now

improving which are having an adverse effect on compliance with targets based on previous SLHT-baseline

data.

CQUIN 2013/14: NHS England – The Trust has submitted its Q3 CQUIN return evidence and is waiting

feedback.

Specific Performance Reports and other updates

This month’s report includes updates for :

4.1 Key Areas of Concern

Summary page to highlight key areas of concern on the PRUH site under the categories of: Quality,

Efficiency, Finance and Strategy.

4.2 HCAI Action Plan Update

Further details on the enhanced actions for 2013-14 can be found in the HCAI Action Plan, provided later in

this report.

4.3 Cancer Action Plan Update

Further details on the action plan that has been developed to manage cancer pathways, incorporating

recommendations from the IST review earlier in 2013 can be found in the Cancer Action Plan, provided later

in this report.

4.4 RTT Performance Update

Further details on the action plans to manage 18-week pathways are provided later in this report.

Enc 3.3

9


4.5 Emergency Department (ED) Action Plan Update

Further details on the additional action plans to manage the 4-hour emergency care performance target can

be found in the ED Action Plan update, provided later in this report.

4.6 Learning Disability Action Plan Update

Further details on managing adult safeguarding issues and compliance can be found in the Learning

Disability Action Plan update, provided later in this report.

Enc 3.3

STRATEGIC

PLANNING FOR

CHANGE


5.03.14

Enc 3.4

1

The 5-year Strategic Plan 2014-19

Set of choices on where to allocate resources (money, time,

effort) that will determine the long term success of the new

King’s as both an and a multi-site hospital in a challenged

health economy

1. Refreshed Vision for “the new King’s” that is well

communicated and understood through the

organisation

2. Strategic Priorities that cascade from KHP strategy

and drive all other Trust strategies (clinical, research,

other)

3. A King’s 3.0 transformational plan that has the buy-in

of the board and all the divisions

4. A new Planning Process that meets tighter regulatory

requirements and is embedded for future years

What is the 5yr

strategic plan?

What will we

deliver?

Enc 3.4

2

What is the context for planning in 2014?

Quality aims and expectations

• Post-Francis focus on nursing quality and safe staffing

• Drive for 7/7 consultant-led services

• Scrutiny of waiting times

• Challenging specialised service specifications.

• Transparency of quality performance e.g. mortality, safety, staffing.

Changing needs/ demand

• Rising acute unplanned demand

• Complex co- morbidity and chronic conditions

• Population growth

• Commissioner focus on high

premature mortality and high

burden health issues in SEL

Deepening financial pressures

• £30bn NHS funding shortfall by 2021/22

• Better Care Fund: £3bn diverted from NHS for integrated care from 15/16.

• QIPP requirements in SEL up from £60m 13/14to £107m 14/15.

• Tariff 4% efficiency requirement.

• Projected operating deficit for

13/14 is £3.38m.

• >£60m projected CIP target for

14/15.

Syste

m p

ressure

s

Institu

tional c

hanges

Team King’s and KHP

• King’s’ first multi-site plan.

• Implementation of PRUH integration plan is key

• Consolidation of services across King’s sites

• Strategically aligned capacity plans required, reconciled across health economy

• KHP integration plan for key clinical-academic specialties

• Development of SLIC into AICO to manage chronic disease across economy.

New commissioning environment

• CCGs developing own 2-year and 5-year plans, shaping local provision

• Local CCGs and NHS England ‘call to action’ agenda signals major change

• NHSE specialised services agenda – reducing to 5-20 providers

• Shift to competitive tendering and opportunities to expand market share

New regulatory requirements

• Overhaul of FT planning requirements by Monitor

• 2 year operational and finance plan 4 April (was end-May)

• 5 year strategy + financial plan 30 June (new requirement)

• New templates and guidance

• Commissioner and provider plans must align across economy

• Regulatory action against FTs with weak or unaligned plans.

Enc 3.4

3

What does Monitor require in 2014?

Document Operational plan

Coverage: 2014/15 – 2015/16

Deadline: 4 April 2014

Feedback: May 2014

Strategic plan

Coverage: 2014/15 to 2018/19

Deadline: 30 June 2014

Feedback: September 2014

Content • Sets out how FT will deliver services and meet

challenges e.g. better Care Fund.

• Monitor looking for: understanding of risks to short

term stability and adequate response.

• Sections required:

• Short term challenge

• Quality plans to meet short term

challenges

• Productivity, efficiency and CIPs

programme

• Financial plan

• Summary of FT’s strategy, analyses and

implementation plans.

• Demonstrates transformation of key services for

better quality at reduced cost. Shows investment /

divestment plans or transfer of unsustainable

services.

• Monitor looking for: understanding of the key risks to

longer term sustainability and the sufficiency of the

trust strategic response.

• Sections required:.

• Market analysis and context

• Risk to sustainability and key options

• Strategic plans

• Financial plans

Implications

for King’s

• Alignment with local health economy including

commissioning intentions and Better Care Fund.

• Thorough and credible demand and capacity plans.

• Clear programmes for both incremental and

transformational CIPs.

• More external analysis of health economy over

longer time period.

• Focus on sustainability risks for key service lines.

• Transformation as lever – no incremental plans post

2016.

Monitor planning assumptions

Affordability challenge shows the gap between budgets and projected pressures rising to unprecedented levels over next five years.

Plans must deliver greater gains in efficiency through redesign of individual services and a step change in efficiency of system

through completely redesigning care pathways to transform care quality outside of hospitals.

Enc 3.4

4

Feb Mar Apr May Jun

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 21 20

Data

collection 2nd draft 1st draft Final

Team

Setup

Agree

Strategic

Priorities

Trust Level

Internal and

External Analysis

Define

Vision/Aspirati

ons

Identify and Develop Strategic

Initiatives

Trust Activity

Modelling and

Projections

Transformational

Plan

2nd draft 1st draft Final

Planning Processes and Timelines

Team /

Steering

Group

Setup

Service level

Fact Base and

Model

Option

Identification,

Analysis and

Prioritisation

Scenario Modelling

and Evaluation

2-Year Operating Plan

5-Year Trust Strategic Plan

Clinical Academic Site Strategy

The Clinical Academic Site

Strategy will underpin the

Trust Strategic Plan

determining its clinical,

research and academic

priorities, considering

capacity, capital and financial

constraints and the strategic

aims of the Trust

Enc 3.4

5

Stakeholders we are engaging with during the

development of our strategy Internal

Stakeholder Role

Divisions x6 Service line analysis and options

Estates Capital and capacity

HR/workforce Analysis and plans for workforce

needs

Finance Financial analysis and budget setting

Contracts Engagement with commissioners

Capacity Demand and capacity planning

process, site strategy

Quality Quality accounts lead and internal

analysis

Commercial services Market analysis

Transformation Transformation and site integration

plans

Research & Development (Irene

Higginson)

Research and innovation analysis

and plans

Education Academic activities and plans

IT IT infrastructure and innovation

Trust office Governance process

Stakeholder Role

Local Commissioners High level intentions, health needs and

shared approach for SEL

NHS England Specialist services intentions

Local Authorities including:

Public Health Health needs assessment

Social Care Health/ social care interface

Health and Wellbeing Boards Integration and Better Care Fund plans

Health Overview and Scrutiny Accountability hearings, engagement

Local Primary Care Collaboration in pathway redesign

Local Community services Collaboration in pathway redesign

King’s Health Partners KHP strategic context

GSTT and SLAM Specialist services/ academic strategy

SLIC Development of Integrated Care

Local health economy planning group Sharing analysis and joint strategies

Health Innovation Network South London approach to innovation

Specialist networks e.g. trauma, stroke Shared plans for pathway changes

Monitor Oversees planning process

DH, CQC, NICE, HEE etc Requirements and guidance

Community, members, Healthwatch Involvement and consultation

Local politicians Engagement in major challenges

External

Enc 3.4

6

Information that will support our strategic thinking

– Activity and growth rates/trends

– Assets (infrastructure, capacity, workforce) by site

– Research and Academic activities

– Interdependencies between services/research/educational activities

– Quality performance

– Financial contributions and margin

– Productivity performance and improvement potential

– Research and Academic performance

– Competitive position

• Market share by geography

• Referral performance

• Commissioner intentions

• Competitor analysis

– Market opportunities for growth and threats

– Long term model that projects KCH’s activity, financials and capacity by site /

specialty and enables analysis of various scenarios

7

Service mapping

Service

performance

Market

assessment

Key components of the fact base to be collated and analysed:

Analytical

modelling

Enc 3.4

7

Quality Priorities and

Report 2014-15


Meeting: 05 March 2014

Author: Helen Day, Assistant Director of Nursing

Sponsor: Geraldine Walters, Executive Director of Nursing

& Midwifery

Status: For Report

Enc 3.5.1

1

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 3.5.1

2

2

Review and

comments by

external

stakeholders

Agree key priority

areas

Finalization

of full-year

results and

report

Mid-year

update

Dec Jan Feb Mar Apr May Jun

Report on

improvem’t

priorities

Adjusting actions

and monitoring

improvements

Stakeholder event 2 Stakeholder event 1

Embed:

sustain and

grow

improvem’ts

Full-year

evaluation

of results

Agree improvement

objectives and

develop framework

Lookin

g b

ack

20

13

2/1

43

Pla

nnin

g

forw

ard

20

14

/15

R

ep

ort

ing

The quality priorities process in practice

Int/Ext Audit

This is the timeline for our assessment of work on the current year’s priorities & the identification of

those for next year

Enc 3.5.1

3

3

Quality Priorities 2013/14

Priority Objective Target for first 6 months Results Status

Management of

the acutely

unwell patient

• To build on the work in 2012/13

to establish a consistent

performance framework for the

identification and escalation of

acutely ill patients.

-Better identification of the

deteriorating patient through the use

of the Wardware electronic

observations system and improved

knowledge of key pathways such as

sepsis.

- More effective escalation of patient

deterioration using formal

communication protocols (eg

SBAR).

- Swifter escalation to the right

person through clear local

escalation policies with clear

alternatives when initial escalation

isn’t successful.

- More effective support from

intensive care for the wards in

managing acutely unwell patients

- All areas will be able to

demonstrate how they are using the

data to identify improvement

opportunities and corrective actions

to improve patient safety

- Improved penetration and

alignment with relevant national

recommendations (NCEPOD, NICE)

- Establish accessible central store

of relevant information and data (on

Kwiki) for all staff to

-access

Achieved, exceeded &

ongoing

– iMobile

On target At risk Not on target

Enc 3.5.1

4


4


Surgical

Safety

checklist

To develop and

implement a strategy to

ensure the Surgical

Safety Checklist (SSC)

is integrated into the

working practices of all

theatre/interventional

teams.

• All surgical procedures on an inpatient or day case basis

which involve general or local

anaesthesia or sedation use an approved version of the SSC

• Audit of SSC use indicates improvement in compliance from

baseline

• Defined surgical outcome/s shows improvement from

baseline

- there are 16

specialty versions of

the SSC in use and

audit has shown it is

being completed,

however mystery

shopper audit

showed quality of

use was poor in a

number of areas

- 4 Never Events in

2013-14 against a

target of zero

Improve

Outpatient

Experience

To make focused

speciality specific

improvements, based

on and measured by,

direct patient feedback

on the Outpatient ‘How

Are We Doing?’ survey.

• Improve HRWD survey response rates to provide robust

feedback on patient experience.

• Improve scores on the local How Are We Doing outpatient

survey on five key questions in Suite 1 Orthopaedics.

• Achieve a reduction in patient complaints relating to the

Outpatient department.

-5% improvement in

first 6 months of the

year

-On track to achieve

further

improvements by

year end

--Redesign planned

Improve

patient

experience

of

discharge

To implement key

elements of the

Discharge Policy and

deliver improvements

to patient satisfaction in

relation to discharge

information.

•Implement the new Trust Wide Discharge Policy

• Roll-out the ‘Home for Lunch’ information sheet Trust wide to

improve the standard of discharge planning information given

to patients

• Improve trust-wide patient satisfaction in two key areas:

•providing information about medication after discharge

•providing patients with information on what to do and who

to contact if they have a concern after discharge.

Partially achieved


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 3.5.1

5


5


Dementia To improve the care of

patients with dementia

by focussing on the

detection of

undiagnosed patients,

admitted to acute care,

support for carers of

patients with dementia

and level of staff with

specialised training in

dementia

Progress will be monitored through the 2013/14 National Dementia

CQUIN framework. Monthly data will be collated and reported

directly to the Department of Health as follows:

• Report on the total number of patients aged 75 and over, who

were admitted as emergencies and stayed for more than 72 hours;

of these how man were screened for dementia using a

combination of the assessment below:

a) were asked if they have been more forgetful in the past 12

months to the extent that it has significantly affected their daily

life, or

b) had a clinical diagnosis of delirium on initial assessment, or

c) had a known diagnosis of dementia;

• Report on how many of these patients had appropriate

investigation & follow up.

- On target to

deliver

Chronic

Obstructive

Pulmonary

Disease

(COPD)

To improve the self-

management of

symptoms for patients

with the long term

condition COPD and

improve community

support in a way that

reduces acute CPD

related re-admissions

• Roll out the COPD bundle Trust wide to include all patients with a

confirmed diagnosis who are admitted with an acute exasperation

of COPD.

• Report figures for quarter 1 to our local commissioners and set

improvement targets for quarters 3 and 4.

• Achieve the quarter 3 and year end improvement targets for the

percentage of patients who have received the COPD bundle.

• Measure the impact if bundle through a comparison of 11/12,

12/13 and 13/14 attendance and readmissions data for this group

of patients.

-Bundle rolled

out and

improvements

being achieved


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 3.5.1

6

6

Review and

comments by

external

stakeholders

Agree key priority

areas

Finalisation

of full-year

results and

report

Mid-year

update


Report on

improvem’t

priorities

Adjusting actions

and monitoring

improvements

Stakeholder consultation 2 Stakeholder consultation 1

Embed:

sustain and

grow

improvem’ts

Full-year

evaluation

of results

Agree improvement

objectives and

develop framework

Lookin

g b

ack

20

13

/14

Pla

nnin

g

forw

ard

20

43

/15

R

ep

ort

ing


Int/Ext Audit


those for next year

Enc 3.5.1

7

Stakeholder Events – PRUH & Denmark

Hill

7

Explanation of the event & its purpose

Review of 2013/14 priorities & progress

Explanation of candidate priorities for 2014/15

Stakeholders invited to comment on candidate priorities & make suggestions

Enc 3.5.1

8

Patient Safety – Stakeholder proposals

8

BROMLEY STAKEHOLDERS

Improving the identification

and management of patients

at risk of falling in hospital

Bromley CCG

Pressure Ulcers Bromley Healthwatch

Staff Training Bromley Healthwatch

Improve communication

across pathways

Bromley

CCG

Cleanliness and Infection

Control

Bromley Healthwatch

KCH AND LAMBETH AND

SOUTHWARK STAKEHOLDERS

Improving the identification

and management of

patients at risk of falling in

hospital

KCH

NHS

Southwark

CCG

Bromley CCG

Improving surgical safety: KCH

NHS

Southwark CCG

Electronic Sharing of test

results

KCH /

CCG (CQUIN)

Enc 3.5.1

9

Patient Experience– Stakeholder proposals

9

Bromley Stakeholders

Improve access

to pathology and

diagnostics

Bromley CCG

Embed Francis

work areas

Bromley CCG

Improve

communication

between

departments.

Bromley Healthwatch

Staff attitude Bromley Healthwatch

KCH and Lambeth and Southwark Stakeholders

Improving the experience of

cancer patients

KCH

NHS Southwark CCG

S and L Healthwatch

Improving patient experience

linked to performance in the

Friends and Family Test

KCH

Co-ordination of discharge NHS Southwark CCG

S and L Healthwatch Bromley Healthwatch

Access to care: cancellations

and waiting times

NHS Southwark CCG

Communication and

Accountability

S and L Healthwatch

Patient Complaints NHS Southwark CCG

Hard to reach groups KCH / CCG (CQUIN)

Enc 3.5.1

10

Patient Outcomes– Stakeholder proposals

10

Bromley Stakeholders

Maximising King’s contribution towards

reducing mortality due to use of

alcohol

Bromley

Health

Maximising King’s contribution to

reducing hospital admissions due to

misuse of alcohol

Bromley

Health

Maximising King’s contribution towards

reducing mortality due to smoking

Bromley

Health

Benchmark against NICE standards

Bromley

CCG

Improve outcomes for patients with

knee replacement

Bromley

CCG

Improve Diabetes car

Bromley

Healthwatch

Services to older people e.g. dementia

Bromley

Healthwatch

KCH and Lambeth and Southwark

Stakeholders

Maximising King’s contribution

towards preventing disease e.g.

smoking and alcohol

KCH

S and L Healthwatch

Every Contact counts (Public

health and promoting well being)

including implementation of NICE

guidance on smoking cessation

in secondary care, alcohol and

weight reduction

NHS

Southwark CCG

Maternity S and L Healthwatch

Improve the experience of

patients with hip fracture

KCH

Provision of on call telephone

advice to GPs

KCH

Enc 3.5.1

11

SUMMARY OF PRIORITIES AND

INDICATORS OF SUCCESS….TBC!

• PATIENT SAFETY

– Improving the identification and management of patients at risk of falling in hospital

• Reduction in falls with injury per 1000 bed days,

• Reduction in falls by age band

• Associated reduction in pressure ulcers (?!)

• ENGAGE initiatives – hearts, minds, behaviour – ‘intent to harm’

• Appropriately assessed pre fall

– Improving surgical safety (2nd year)

• Zero never events

• Effective use of surgical checklist; completion & situational awareness

11

Enc 3.5.1

12

SUMMARY OF PRIORITIES AND INDICATORS

OF SUCCESS….TBC!

• PATIENT EXPERIENCE

– Improving experience and coordination of discharge

• Percentage improvement on Q2022 HRWD

• GP suggested measures

– Improving the experience of cancer patients

• TBC

• PATIENT OUTCOMES

– Maximising King’s contribution towards reducing mortality due to use of alcohol

• % pts assessed

• No. of ‘quitters’

• Patient feedback

• Staff trained

– Improve the experience of patients with hip fracture

• Reduced length of stay

• More patients discharged to their own home

• Reduction in time before surgery

• Increase of physio provision

• Reduced pain

• Increase in the % of patients who have a bone health and falls assessment

Enc 3.5.1

13

These are our priorities for quality improvement in recent years:

13

Pa

tie

nt

Sa

fety

Reduce hospital acquired

infection

Pa

tie

nt

Ex

peri

en

ce

Improve the consistency

of positive inpatient

experience

Improve cleanliness of

the hospital environment

2011/12

Pa

tien

t O

utc

om

es

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 2013/14

Management of the

acutely unwell patient

Surgical Safety checklist

Improve outpatient

experience

Improve patient

experience of discharge

Dementia

Chronic obstructive

pulmonary disease

2014/15

Reduction in falls

Surgical safety

Reducing mortality

associated with alcohol

& smoking

Improve outcomes of

patients with hip fracture

Improve experience of

cancer patients

Improve patient

experience and

coordination of

discharge

Enc 3.5.1

14

14

Review and

comments by

external

stakeholders

Agree key priority

areas

Finalisation

of full-year

results and

report

Mid-year

update


Report on

improvem’t

priorities

Adjusting actions

and monitoring

improvements

Stakeholder consultation 2 Stakeholder consultation 1

Embed:

sustain and

grow

improvem’ts

Full-year

evaluation

of results

Agree improvement

objectives and

develop framework

Lookin

g b

ack

20

12

/13

Pla

nnin

g

forw

ard

20

13

/14

R

ep

ort

ing


Int/Ext Audit


those for next year

Enc 3.5.1

15

Enc 3.5.2

1 | P a g e



Subject: Quarterly Patient Safety Report

Author(s): Mr Michael Marrinan (Medical Director) & Richard

Hinckley (Head of Patient Safety & Risk)

Presented by: Mr Michael Marrinan (Medical Director)

Sponsor: Mr Michael Marrinan (Medical Director)

Status: For Report

1. Background/Purpose

This report outlines the key patient safety issues that have been reported through the

governance framework as at January 2014.

2. Action required

The Council of Governors is asked to note the contents of this report and make any

recommendations as necessary.

3. Key implications Legal: There are no direct legal implications

Financial: Financial impact from failure to maintain discount on CNST

insurance premium (for 2013/14 contribution is c. £14.8 M)

Assurance: This summary highlights key patient safety issues and the actions

taken to mitigate risk where this has been possible

Clinical: Significant clinical issues affecting the safety of patients are

highlighted

Equality & Diversity: Equality and Diversity issues are highlighted, where appropriate

Performance: Summary performance against the Trust’s 2013-14 Safety Quality

Priorities is provided

Strategy: Risk identification as outlined in Risk Management Strategy

Estates: Where risks impact on the Trust’s Estate or future Estates plans

these will be highlighted

Reputation: Areas of significant risk could potentially damage reputation at King’s

through poor clinical outcome and patient experience

Other:(please

specify)

N/A

Enc 3.5.2

2 | P a g e

1. Executive Summary

Divisions have reviewed their governance structures for the enlarged organisation. Site specific risk/ governance meetings have been setup where appropriate in a number of specialities and feed through to overarching Divisional quality governance committees. We will be auditing the arrangements in March 2014 to ensure they are becoming embedded and are working effectively;

An announced CQC inspection occurred at the Princess Royal University Hospital between 2 and 4 December 2013. A draft report is currently being reviewed which will be published by the CQC in due course;

3 Never Events were reported at Denmark Hill in the Oct-Dec 2013 quarter (none were reported at other Trust sites):

o 2 cases related to retained foreign objects o 1 case related to a wrong tooth extraction

Each incident has been fully investigated and the actions to improve safety are being monitored by the Serious Incident Committee. Further detail about actions to improve surgical safety are detailed in section 2 below.

A King’s Health Partners (KHP) day event on patient safety is planned for May 2014 and will be hosted at Guy’s Hospital. The purpose of the event will be to showcase patient safety innovations and develop KHP-wide projects to improve safety

2. Safety Quality Priority: Improving Safety in Surgery through use of the Safer

Surgery Checklist (SSC)

Implementation of the SSC is monitored by the Surgical Safety Improvement Group (chaired by Mr Bhangoo, Consultant Neurosurgeon) which reports to the Patient Safety Committee chaired by the Medical Director. A summary of the actions being taken to improve surgical safety was noted in the last quarterly report. However the following additional actions have been implemented subsequent to the 3 surgical Never Events reported in the last quarter – these are listed below:

A memo co-signed by the Medical Director & Director of Nursing & Midwifery has been sent to all surgical staff about their responsibilities in relation to the SSC;

The SSC has been re-launched at Denmark Hill in January 2014. This has involved: o SSC presentations at all of the January 2014 theatre audit mornings;

o Implementation of a communications campaign to ensure effective use of SSC. This

has included: Posters for use in theatres, staff rooms and as screensavers Production of a video on the SSC for use in training and corporate induction

(featuring the Medical Director, Director of Nursing & Midwifery, and a consultant neurosurgeon, anaesthetist and theatre nurse involved in a Never Event)

Development of a website News articles on SSC for the CEO Brief & King’s web

Enc 3.5.2

3 | P a g e

o Launch of a new audit programme which will provide real-time feedback to surgical staff about the effectiveness of SSC use. From February audit results will feature in Divisional scorecards.

The SSC will be re-launched at PRUH, Orpington & QMS sites from February 2014, and in the interim a theatres survey is being undertaken in these areas to assess the safety culture;

The use of the SSC has been provisionally identified as a Trust Safety Quality Priority for 2014-15.

3. Safety Quality Priority: Improving the identification and escalation of acutely ill

patients Work to improve the management of acutely ill-patients is led by the Director of Nursing and Midwifery.). Although this remains an important patient safety issue, significant progress has been made in the last 12 months. The focus of current work includes:

Uptake of the I-mobile service at Denmark Hill (a 24/7 critical care outreach service staffed with medics and nurses) has been very positive since inception of the service in September 2013. A critical care outreach team is also in operation at the PRUH;

The electronic vital signs software (Wardware) is expected to be rolled out across all wards at Denmark Hill by the end of 2014;

A Safer Care Forum has been setup which will review deteriorating patient investigations to ensure that actions are being implemented to improve safety;

Plans are underway to increase critical care capacity in the short, medium and long term. Construction of a new 60 bedded critical care unit will begin at the end of 2013 with planned completion in 2015/16. This will enable the Trust to better respond to both planned and unplanned increases in critical care demand.

The Deteriorating Patient Group monitors these workstreams and reports into the Patient Safety Committee.

4. Patient Falls In Quarter 3 there was a slight decrease in the total number of patient falls reported at Denmark Hill (compared to Quarter 2). The vast majority of these did not result in any significant injury to the patient (less than 3%). At the PRUH the number of falls remained static between Quarter 2 and Quarter 3. Actions being implemented to reduce incidence of patient falls include:

An increase in establishment of the Falls Team across the enlarged organisation including falls prevention nurses at the PRUH;

The falls risk assessment documentation is being reviewed to ensure consistency in approach between sites;

A Safer Care Forum has been setup which will review falls root cause analysis investigations to ensure that actions are being implemented to reduce falls risk;

A business case is being developed to establish a pool of staff who will be available to provide immediate 1:1 care to patients who are deemed at high risk of falls.

Enc 3.5.2

4 | P a g e

Patient falls continue to be monitored by the Falls Strategy Group which reports to the Patient Safety Committee. The Falls workstream is led by the Deputy Director of Nursing. 5. Pressure Ulcers At Denmark Hill in the period Oct-Dec 2013 there were 28 hospital acquired pressure ulcers, compared to 36 in the previous quarter. However, despite the overall reduction there was an increase in the number of serious pressure ulcers (those graded 3 or 4). All grade 3 or 4 hospital acquired pressure ulcers are fully investigated and the report and actions monitored by the Serious Incident Committee. At the PRUH there were 87 hospital acquired pressure ulcers reported in the period Oct-Dec 2013. However, 84 of these were grade 2 pressure ulcers where the damage is minimal. Specialist tissue viability nurses have commenced at the PRUH and will be working to ensure that grade 2 pressure ulcers do not develop into grade 3 or 4 pressure ulcers. Pressure ulcers are closely monitored through the Tissue Viability Team and will be reviewed at the Safer Care Forum. This workstream is led by the Deputy Director of Nursing.

6. Infection Control Specific targets for MRSA bacteraemia and CDT are set by the Department of Health and performance against these targets at Denmark Hill is listed below:

The Trust reported 3 cases of MRSA bacteraemia in the Oct-Dec 2013 quarter, bringing the total year-to-date figure to 5 cases (the target is zero);

As at the end of December 2013 the Trust remains below target on reported CDT cases. The Trust has in place an infection control governance framework to ensure that hospital acquired infections are identified and investigated and appropriate action is taken to prevent recurrence (this includes a Director and Deputy Director of Infection Prevention and Control). This infection control governance framework has been extended to the PRUH. The Infection Prevention and Control Committee continues to monitor Trust infection control performance and reports to the Patient Safety Committee. 7. Recommendation The Council of Governors is asked to note the content of this report.

REGISTER OF GOVERNOR ATTENDANCE

(PUBLIC)

Enc. 4.1

CONSTITUENCY REASON FOR ABSENCE

1 2 3 4 5 6 7 8 9 10

Prof

SirGeorge Alberti Chair c c c

May 2012: Sent apologies for absence - Unwell

Marc Meryon deputised.

Sept 2012: Sent apologies for absence - unwell.

Graham Meek deputised.

Dec 2013: Sent apologies for absence - Overseas work

Marc Meryon deputised

Mr Andy Alatise Southwark Central c c c c N/A N/A N/AMay 2012: Sent apologies for absence - Unwell

Dec 2011: Sent apologies for absence - Out of the country.

Ms Phyllis Barnett Allied Health Professionals c c c c c cDec 2012 and May 2013: Reasons for absence personal and

notified to the Chair.

Ms Carol Bell Joint Staff Committee c c c N/A N/A N/ADec 2012: Sent apologies for absence

Feb 2013: Sent apologies for absence: union commitment

Dr Rachel Burman Medical and Dentistry

Ms Carolyn Campbell-Cole Nurses and Midwives c c c

Dec 2011: Sent apologies for absence - Unwell.

Dec 2012: Sent apologies for absense

05 Sept 2013: Sent apologies for absence - Reasons

Unknown

Ms Fiona Clark Lambeth North

Ms Pam Cohen Southwark Central N/A N/A N/A N/A N/A N/A c May 2013: Sent apologies for absence - Reasons Unknown

Mr Derek Cookson Patient c c c c

May 2012: Sent apologies for absence - Unwell.


Unknown

December 2013: Sent apologies for absence - Unwell

Cllr Jim Dickson Lambeth Council N/A N/A c c c c

Dec 2012: Sent apologies for absence - Urgent Council

Business


Unknown


Unknown

Dec 2013: Sent apologies for absence - reasons unknown

Mr Thomas Duffy Patient c c c

May 2012: Sent apologies for absence - On holiday

Sept 2012: Sent apologies for absence - On holiday

May 2013: Sent apologies for absence - Reasons Unknown

Mr Richard Gibbs Southwark Primary Care Trust c c May 2013: Sent apologies for absence - On holiday

Ms Nicky Hayes Nurses and Midwives

Ms Sue Gallagher Lambeth PCT N/A N/A N/A N/A c c Dec 2012: Sent apologies for absence - Work commitments

Ms Patti Kachidza Patient c c c c c

May 2012: Sent apologies for absence - Away

Sept 2012: Sent apologies for absence - work commitments

Dec 2012: Sent apologies for absence - work commitments


Unknown


Unknown

Ms Christine Klaassen Patient c c cFeb 2012: Sent apologies for absence - On holiday.

Feb 2013: Sent apologies for absence - On holiday.

Mrs Phidelma Lisowska Joint Staff Committee N/A N/A N/A N/A N/A N/A N/A

Ms Madeliene LongSouth London & Maudsley NHS Foundation

Trust c c c c c c

Feb 2013: Sent apologies for absence - conflicting meeting

May 2012: Reason unknown

Feb 2012: Sent apologies for absence - Conflicting meeting.


Unknown


Unknown

Dec 2013: Sent apologies for absence - reasons unknown

Mr Andrew McCall Southwark North

Cllr Catherine McDonald Southwark Council N/A N/A N/A c c c

May 2013: Sent apologies for absence - On holiday


Unknown


Unknown

Mr Chris Mottershead King's College London c c c

Feb 2012: Sent apologies for absence - Conflicting meeting

Dec 2011: Unknown

Dec 2012: Sent apologies for absence - Transportation

problems


Unknown

Mr Christopher North Lambeth North

Mr Joe Onabaworin Southwark North N/A N/A N/A N/A N/A N/A c Feb 2013: attended meeting as an observer prior to taking up

role as governor

Mr Stuart Owen Southwark South c Feb 2012: Sent apologies for absence - Unwell.

Ms Barbara Pattinson Southwark Central c Sept 2012: Reason unknown

Mrs Michelle Pearce Southwark South

Mr Brady Pohle Administration and Clerical c May 2012: Sent apologies for absence - Personal conflict

Mr Nandakumar Ratnavel Lambeth South

Mr Michael Robinson Lambeth Central c c

May 2012: Reason unknown


Unknown

NAME MEETINGS ATTENDED

Meeting Dates Key: (1) 01 December 2011; (2) 14 February 2012; (3) 09 May 2012; (4) 13 September 2012; (5) 05 December 2012; (6) 13 February 2013; (7) 15 May 2013 (8) 05 September 2013

(9) 18 September 2013 (10) 11 December 2013

REGISTER OF GOVERNOR ATTENDANCE

(PUBLIC)

Enc. 4.1

Mr David Sullivan Patient c c c c c c c

May 2012: Sent apologies for absence - Reasons Unknown

Sept 2012: Sent apologies for absence - Reasons Unknown

Dec 2012: Sent apologies for absence - Reasons Unknown

Dec 2013: Absent - reason unknown

Ms Diane SummersGuy's & St Thomas' Hospital NHS

Foundation Trust c c c

Dec 2012: Sent apologies for absence

Feb 2013: Sent apologies for absence: union commitment

18 Sept 2013: Sent apologies for absence - Clashes with

GSTT Annual Meeting

Dec 2013: Attended Private session, apologies for Public

Session - Reason Unknown

Ms Jan Thomas Patient c c c c c

Feb 2012:Sent apologies for absence - On holiday.

Feb 2013:Sent apologies for absence - On holiday.


Unknown

Dec 2013: Attended Private session - apologies for Public

session

Mr Ahmad Toumadj Support Staff c c c

Sept 2012: Reason unknown


Unknown

Dec 2013: Sent apologies for absence - reason unknown

Dr Warren Turner London South Bank University N/A N/A N/A N/A N/A c 05 Sept 2013: Sent apologies for absence - Reasons

Unknown

Mr Godwin Ubiaro Lambeth Central c c c

Dec 2012: Sent apologies for absence - Personal reasons

notified to the Chair. May

2013: Sent apologies for absence - Reasons Unknown

Mrs Alam Zabit Lambeth South c c c c N/A N/A N/A

Sept 2012 - Hospital Appointment.


Feb 2012: Sent apologies for absence - Unwell.


Resigned 01 August 2013.

Meeting Dates Key: (1) 01 December 2011; (2) 14 February 2012; (3) 09 May 2012; (4) 13 September 2012; (5) 05 December 2012; (6) 13 February 2013; (7) 15 May 2013 (8) 05 September 2013

(9) 18 September 2013 (10) 11 December 2013

Enc 4.2

1. Purpose NHS Foundation Trusts are required to make in-year submissions on a quarterly basis during 2013/14 which includes information on its financial performance, statements from the board certifying compliance with specific board statements including the underlying data that informs them where appropriate, any relevant exception reports and results of any governor elections. This report provides the details of the proposed submission to Monitor for the Trust based on results/data in Quarter 3, October-December 2013. 2. Action Required

The Council of Governors is as to note report on the Quarter 3 submission approved by the Board (28 January) and submitted to Monitor (30 January).



Subject: Monitor Submission Quarter 3, 2013/2014

Author: Tamara Cowan, Assistant Board Secretary

Presented by: Tim Smart, Chief Executive

Status: For Information

1

Enc. 4.2

1. Introduction

The Trust is required to summit quarterly reports to Monitor as part of its in-year reporting. The Trust is also required to submit monthly reports on performance to Monitor pertaining to the Princess Royal University Hospital. With effect from 01 October 2013, the Risk Assessment Framework (RAF) was implemented and replaces the Compliance Framework. Of note, are the following substantive changes:

Continuity of Service Risk Rating (CSRR) replaces the Financial Risk Rating

(FRR);

Monitor will collect, annually, details of the Trust’s Auditors;

Monitor will use executive team turnover as a potential indicator of quality

governance concerns. Accordingly as requested the Trust complete the new

Quality Governance sheet detailing the turnover of executive team members;

The scoring methodology of target and indicator performance has been changed

depicted below. MRSA and CQC compliance actions will no longer generate a

score (See Figure 1 below); and

The Governance Statements which the Board is required to self-certify

(Confirmed/Not Confirmed) have also been revised as follows:

1. For finance, that: The board anticipates that the trust will continue to

maintain a Continuity of Service risk rating of at least 3 over the next 12

months.

2. For governance, that: The board is satisfied that plans in place are sufficient

to ensure: ongoing compliance with all existing targets (after the application

of thresholds) as set out in Appendix A of the Risk Assessment Framework;

and a commitment to comply with all known targets going forwards.

3. Otherwise: The board confirms that there are no matters arising in the

quarter requiring an exception report to Monitor (per the Risk Assessment

Framework page 21, Diagram 6) which have not already been reported (See

Figure 2 below).

2

Enc. 4.2

Figure 1: New Scoring Methodology for Target & Indicator Performance

3

Enc. 4.2

Figure 2: Examples of exception reporting

2. Quarter 3 (Q3) – Board Certification

For finance The Board approved Confirmed to governance statement 1 because the Trust has attained a CSRR of 3 in Q3 and it is anticipated this trend will continue to for next 12 months although the Trust faces significant challenges. For governance The Board approved Not Confirmed to governance statement 2 as the Trust failed to achieve the following targets and indicators as certified in its Annual Plan 2013-14:

18 week admitted referral to treatment targets (RTT)

MRSA

C-Difficile

Emergency Department (ED)

The Trust continues to work hard to achieve these targets and indicators but ED and RTT was much challenged in Q3 and going into Q4 this trend has not changed. In addition, the Trust has had one C-Difficile case to add to the 40 cases seen in Q3 which puts the Trust at risk of breaching the quota of 49 by year-end.

4

Enc. 4.2

Otherwise

The Board approved Confirmed to governance statement 2 because there have been no exceptional matters or incidence arising in the Q3 which the Trust has not previously advised Monitor or self-certified. 3. Quarter 3 (Q3) – Key Returns

As part of the submission the Board is noted the following key returns which will be submitted to Monitor for Q3.

Appendix 1: Continuity of Service Risk Rating and Financial Summary

Appendix 2: Declarations of risks against healthcare Targets and Indicators

Appendix 3: Governance Statement – Board Certification

Appendix 4: Quality Governance return which details executive director turnover in

Q3. As mentioned above this metric has been introduced with the implementation of

the RAF. Monitor wants to use this metrics as an indicator for quality governance

concerns, however the RAF provides for the use either patient metrics (satisfaction

surveys), staff metrics (sickness and absence rate, proportion of temporary staff,

staff turnover and high executive team turnover) and aggressive cost reduction

plans.

4. Recommendation

The Council of Governors is asked to note the above decisions of the Board in relation to

the Q3 submission to Monitor.

5

Classified as Restricted per Monitor's Information Security Policy

Continuity of Service Shadow Risk Ratings (pilot indicators for 2013/14)

Historic Year to

31-Mar-13

Reported Quarter to30-Jun-13

Reported YTD to

30-Jun-13

Reported Quarter to30-Sep-13

Reported YTD to

30-Sep-13

Reported Quarter to31-Dec-13

Reported YTD to

31-Dec-13

Reported Quarter to31-Mar-14

Reported YTD to

31-Mar-14

Capital Service Cover

IS04400 PDC dividend expense from SoCI (7.764) (1.950) (1.950) (2.050) (4.000) (2.663) (6.663) - (6.663)IS04100 Interest Expense on Overdrafts and Working Capital Facilities from SoCI - (0.035) (0.035) (0.035) (0.070) (0.035) (0.105) - (0.105)IS04110 Interest Expense on Bridging loans from SoCI - - - - - - - - -IS04120 Interest Expense on Non-commercial borrowings from SoCI (0.578) (0.215) (0.215) (0.215) (0.430) (0.216) (0.646) - (0.646)IS04130 Interest Expense on Commercial borrowings from SoCI - - - - - - - - -IS04140 Interest Expense on Finance leases (non-PFI) from SoCI - - - - - - - - -IS04150 Interest Expense on PFI leases & liabilities from SoCI (7.513) (1.860) (1.860) (1.860) (3.720) (3.871) (7.591) - (7.591)IS04200 Other Finance Costs from SoCI (0.175) (0.042) (0.042) (0.040) (0.082) (0.037) (0.119) - (0.119)IS04610 Non-Operating PFI costs (eg contingent rent) from SoCI (2.143) (0.622) (0.622) (0.622) (1.244) (1.609) (2.853) - (2.853)CF07150 Public Dividend Capital repaid from SoCF - - - - - - - - -CF07610 Repayment of bridging loans from SoCF - - - - - - - - -CF07710 Repayment of non-commercial loans from SoCF (1.012) (0.506) (0.506) - (0.506) (0.506) (1.012) - (1.012)CF07810 Repayment of commercial loans from SoCF (0.123) - - (0.062) (0.062) - (0.062) - (0.062)CF07360 Capital element of finance lease rental payments - On-balance sheet PFI from SoCF (0.733) (0.201) (0.201) (0.201) (0.402) (0.599) (1.001) - (1.001)CF07350 Capital element of finance lease rental payments - other from SoCF - - - - - - - - -

key to scoringMEM0180 Revenue available for Debt Service 35.451 7.739 7.739 8.304 16.043 10.758 26.801 0.000 26.801 Capital Service Cover 50%

Amended Capital Service -20.041 -5.431 -5.431 -5.085 -10.516 -9.536 -20.052 0.000 -20.052 Amended Capital Service Cover metric 1.77x 1.42x 1.42x 1.63x 1.53x 1.13x 1.34x 0.00x 1.34x 4 3 2 1

Amended Capital Service Cover rating 3 2 2 2 2 1 2 1 2 2.5 1.75 1.25 <1.25

Liquiditykey to scoring

Cash for CoS liquidity purposes from SoFP -8.016 -2.206 -2.206 -2.361 -2.361 15.664 15.664 0.000 0.000 Liquidity 50%IS02000 Operating Expenses within EBITDA, Total from SoCI -643.584 -166.490 -166.490 -181.262 -347.752 -244.752 -592.504 0.000 -592.504

Liquidity metric -4.5 -1.2 -1.2 -1.2 -1.2 5.8 7.1 0.0 0.0 4 3 2 1

Liquidity rating 3 3 3 3 3 4 4 4 4 0 -7 -14 <-14

Continuity of Service Risk Rating 3 3 3 3 3 3 3 3 3

Enc 4.2 - Appendix 1 - CSSR & Financial Summary

6

High level summary of financial plan of KINGS

Previous YE FYActual Plan Actual Variance Plan Actual Variance Plan

Operating Revenue for EBITDA 678.1 246.1 255.5 9.4 609.8 619.2 9.4 853.0 Employee Expenses (374.1) (129.3) (141.6) (12.2) (337.3) (349.5) (12.2) (466.6)Drugs (67.9) (20.3) (26.5) (6.2) (57.6) (63.8) (6.2) (80.6)PFI operating expenses (26.4) (11.8) (13.3) (1.5) (25.6) (27.1) (1.5) (37.4)Other costs (175.2) (75.0) (63.4) 11.6 (162.6) (152.2) 10.5 (222.4)

Clinical supplies (64.9) (20.5) (26.3) (5.8) (52.3) (58.1) (5.8) (74.2)Decrease (increase) in inventories of finished goods & WIP 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Vehicle Fuel costs (ambulance trusts) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Non-clinical supplies (35.2) (9.9) (15.3) (5.4) (27.9) (33.3) (5.4) (38.4)Cost of Secondary Commissioning of mandatory services 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Research & Development expense 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Education and training expense 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Misc. other Operating expenses (73.4) (38.9) (20.8) 18.1 (76.6) (58.4) 18.1 (109.8)

EBITDA 34.6 9.6 10.7 1.1 26.8 26.7 (0.1) 46.0 Donations of PPE & intangible assets 1.1 0.1 (0.1) (0.2) 0.2 (0.0) (0.2) 0.5 Depreciation and amortisation (14.7) (5.8) (5.4) 0.4 (12.3) (11.8) 0.4 (18.1)Impairment Losses (Reversals) net (on non-PFI assets) (9.1) (2.0) (1.8) 0.3 (6.0) (5.8) 0.3 (8.0)Impairment Losses (Reversals) net on PFI assets 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Restructuring Costs 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Operating Surplus 11.9 9.0 3.5 (5.5) 14.6 9.1 (5.5) 20.4 Net interest (7.9) (4.3) (4.1) 0.2 (8.5) (8.3) 0.2 (12.8)

Interest Income 0.2 0.0 0.0 0.0 0.1 0.1 0.0 0.1 Interest Expense on Overdrafts and Working Capital Facilities 0.0 (0.0) (0.0) 0.0 (0.1) (0.1) 0.0 (0.1)Interest Expense on Bridging loans 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest Expense on Non-commercial borrowings (0.6) (0.2) (0.2) (0.0) (0.6) (0.6) (0.0) (0.9)Interest Expense on Commercial borrowings 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest Expense on Finance leases (non-PFI) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest Expense on PFI leases & liabilities (7.5) (4.1) (3.9) 0.2 (7.8) (7.6) 0.2 (11.8)

Other Non-Operating items (9.8) (4.1) 74.8 78.9 (9.5) 69.4 78.9 (13.6)Gain (Loss) on Financial Instruments Designated as Cash Flow Hedges 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Gain (Loss) on Derecognition of Available-for-Sale Financial Assets 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Gain (Loss) on Derecognition of Non-Current Assets Not Held for Sale, Total 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Gain (Loss) from investments 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Dividend Income 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Share of profit (loss) from equity accounted Associates, Joint Ventures, Total 0.7 0.3 0.0 (0.3) 0.3 0.0 (0.3) 0.6 Other Non-Operating income, Total (0.5) (0.0) 79.1 79.2 (0.1) 79.0 79.2 (0.1)Other Finance Costs (0.2) (0.1) (0.0) 0.0 (0.1) (0.1) 0.0 (0.2)PDC dividend expense (7.8) (2.7) (2.7) 0.0 (6.7) (6.7) 0.0 (9.4)PFI Contingent Rent (2.1) (1.6) (1.6) 0.0 (2.9) (2.9) 0.0 (4.5)Other Non-Operating expenses (incl. Misc) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Income Tax (expense)/ income 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Net Surplus / (Deficit) (5.9) 0.6 74.2 73.6 (3.4) 70.3 73.6 (6.0)

EBITDA % Income 5.1% 3.9% 4.2% 0.3% 4.4% 4.3% -0.1% 5.4%CIP% of Op.Exp. less PFI Exp. 1.5% 2.2% 0.0% -2.2% 1.7% 0.8% -0.9% 1.8%Pay CIPs as % Pay Costs -1.1% -1.4% 0.0% 1.4% -0.9% -0.3% 0.6% -1.0%

Net Surplus / (Deficit) (5.9) 0.6 74.2 73.6 (3.4) 70.3 73.6 (6.0)Change in working capital 13.1 17.0 7.6 (9.4) (19.5) (28.9) (9.4) (15.4)

(Increase)/decrease in inventories (0.4) (0.2) (1.7) (1.5) (2.1) (3.6) (1.5) (2.2)(Increase)/decrease in tax receivable 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 (Increase)/decrease in NHS Trade Receivables (1.6) 10.8 (27.2) (38.0) (9.1) (47.1) (38.0) (6.1)(Increase)/decrease in Non NHS Trade Receivables (4.8) 0.6 6.3 5.7 2.0 7.7 5.7 1.0 (Increase)/decrease in other related party receivables (1.0) 0.0 0.0 0.0 0.0 0.0 0.0 (0.3)(Increase)/decrease in other receivables (1.0) (2.0) (6.3) (4.4) (2.0) (6.4) (4.4) (1.0)(Increase)/decrease in accrued income 2.5 20.1 10.4 (9.7) (11.0) (20.7) (9.7) (4.0)(Increase)/decrease in other financial assets 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 (Increase)/decrease in prepayments 0.6 5.3 5.9 0.7 (2.0) (1.3) 0.7 0.0 (Increase)/decrease in Other assets 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Increase/(decrease) in Deferred Income (excl. Donated Assets) (0.6) (1.7) (2.2) (0.4) 0.4 (0.1) (0.4) (1.1)Increase/(decrease) in Deferred Income (Donated Assets) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Increase/(decrease) in Current provisions 2.3 (0.8) (0.1) 0.7 (2.8) (2.1) 0.7 (2.2)Increase/(decrease) in post-employment benefit obligations 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Increase/(decrease) in tax payable 0.2 0.2 1.5 1.2 0.2 1.4 1.2 0.3 Increase/(decrease) in Trade Creditors 14.7 (5.1) (9.0) (4.0) 3.9 (0.1) (4.0) 1.1 Increase/(decrease) in Other Creditors (3.8) 4.7 3.3 (1.4) (0.0) (1.4) (1.4) 0.0 Increase/(decrease) in accruals 5.9 (15.4) 26.7 42.1 3.0 45.1 42.1 (1.0)Increase/(decrease) in other Financial liabilities 0.2 0.4 0.0 (0.4) 0.0 (0.4) (0.4) 0.0 Increase/(decrease) in Other liabilities 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Increase/(decrease) in Non Current provisions 0.7 0.5 0.4 (0.1) 0.5 0.4 (0.1) (0.2)

Non cash I&E items 41.4 15.9 (64.3) (80.2) 36.1 (44.1) (80.2) 51.7 Tax expense/(refund) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Finance (income)/charges 7.9 4.3 4.1 (0.2) 8.5 8.3 (0.2) 12.8 Share of (profit)/loss from equity accounted investments net of cash distributions received 0.7 (0.2) 0.0 0.2 (0.2) 0.0 0.2 (0.5)Donations & Grants received of PPE & intangible assets (non cash) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Other operating non-cash (revenues)/expenses 0.2 1.5 (79.0) (80.5) 1.5 (79.0) (80.5) 3.0 Depreciation and amortisation, total 14.7 5.8 5.4 (0.4) 12.3 11.8 (0.4) 18.1 Impairment losses/(reversals) 9.1 2.0 1.8 (0.3) 6.0 5.8 (0.3) 8.0 Unrealised (gains)/losses on foreign currency exchange 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 (Gain)/loss on disposal of property plant and equipment 0.5 0.0 (0.1) (0.1) 0.1 (0.0) (0.1) 0.1 (Gain)/loss on disposal of intangible assets 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Share of (profit)/loss loss from investments 0.0 (0.3) 0.0 0.3 (0.3) 0.0 0.3 (0.6)PDC dividend expense 7.8 2.7 2.7 (0.0) 6.7 6.7 (0.0) 9.4 Other increases/(decreases) to reconcile to profit/(loss) from operations 0.5 0.1 1.0 0.9 1.6 2.5 0.9 1.3

Cashflow from operations 49.3 34.0 17.9 (16.0) 13.7 (2.3) (16.0) 30.1 Cashflow from investing activities (23.1) (12.2) (11.3) 0.9 (24.8) (23.9) 0.9 (41.5)

Property, plant and equipment - maintenance expenditure (1.1) (0.2) 0.0 0.2 (0.8) (0.5) 0.2 (1.1)Property, plant and equipment - non-maintenance expenditure (18.3) (12.0) (11.2) 0.8 (20.7) (19.9) 0.8 (35.9)Plant and equipment - Information Technology (1.1) (0.6) 0.0 0.6 (1.0) (0.5) 0.6 (1.7)Plant and equipment - Other (1.6) (0.4) 0.0 0.4 (2.1) (1.8) 0.4 (2.6)Property, plant and equipment - other expenditure 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Proceeds on disposal of property, plant and equipment 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Purchase of investment property 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Proceeds on disposal of investment property 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Purchase of intangible assets (0.6) (0.2) 0.0 0.2 (0.2) (0.0) 0.2 (0.3)Proceeds on disposal of intangible assets 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Expenditure on capitalised development 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Increase/(decrease) in Capital Creditors (0.3) 1.1 (0.2) (1.3) 0.0 (1.3) (1.3) 0.0 Payments for other capitalised costs 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Purchase of subsidiaries net of cash acquired 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Net bank balance acquired with subsidiaries 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Proceeds from disposal of subsidiaries net of cash disposed 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Net bank balance disposed with subsidiaries 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Purchase of associates net of cash acquired 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Net bank balance acquired with associates 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Proceeds from disposal of associates net of cash disposed 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Net bank balance disposed with associates 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Purchase of joint ventures net of cash acquired 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Net bank balance acquired with associates 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Proceeds from disposal of joint ventures net of cash disposed 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Net bank balance disposed with joint venture 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Government grants received 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Deposits and investments made 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Deposits and investments liquidated 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Other cash flows from investing activities 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Cashflow before financing 26.2 21.7 6.6 (15.1) (11.1) (26.3) (15.1) (11.4)Cashflow from financing activities (13.3) 33.1 23.5 (9.6) 36.7 27.1 (9.6) 41.3

Public Dividend Capital received 0.0 27.3 26.2 (1.0) 27.3 26.2 (1.0) 27.3 Public Dividend Capital repaid 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 PDC Dividends paid (7.8) 0.0 0.0 0.0 (3.6) (3.6) 0.0 (9.4)Interest (paid) on bridging loans 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest (paid) on commercial loans 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest (paid) on non-commercial loans (0.6) (0.3) (0.4) (0.2) (0.6) (0.7) (0.2) (0.8)Interest (paid) on overdraft and working capital facility 0.0 (0.0) 0.0 0.0 (0.0) 0.0 0.0 (0.1)Interest element of finance lease rental payments - other 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest element of finance lease rental payments - On-balance sheet PFI (7.5) (4.1) (3.9) 0.2 (7.8) (7.6) 0.2 (11.8)Capital element of finance lease rental payments - other 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Capital element of finance lease rental payments - On-balance sheet PFI (0.7) (0.6) (0.6) 0.0 (1.0) (1.0) 0.0 (1.6)Interest received on cash and cash equivalents 0.2 0.0 0.0 0.0 0.1 0.1 0.0 0.1 Movement in Other grants/Capital received 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Donations received in cash 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Drawdown of bridging loans 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Repayment of bridging loans 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Drawdown of non-commercial loans 4.4 9.5 0.0 (9.5) 21.6 12.1 (9.5) 35.3 Repayment of non-commercial loans (1.0) (0.5) (0.5) 0.0 (1.0) (1.0) 0.0 (1.0)Drawdown of commercial loans 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Repayment of commercial loans (0.1) 0.0 0.0 0.0 (0.1) (0.1) 0.0 (0.1)(Increase)/decrease in non-current receivables (0.3) (1.0) (1.0) 0.0 (1.0) (1.0) 0.0 (1.0)Increase/(decrease) in non-current payables 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Other cash flows from financing activities 0.0 2.8 3.7 0.9 2.8 3.7 0.9 4.6

Net increase/(decrease) in cash 12.9 54.8 30.1 (24.7) 25.5 0.8 (24.7) 29.9

Cash at period end 40.5 64.5 41.3 (23.2) 64.5 41.3 (23.2) 67.4 Cash and Cash equivalents at period end 40.5 64.5 41.3 (23.2) 64.5 41.3 (23.2) 67.4

Financial Summary£m

Current Quarter YTD


7

High level summary of financial plan of KINGS

Financial Summary Current Quarter YTDPrevious YE FYActual Plan Actual Variance Plan Actual Variance Plan

Community Co Cost & volume contract revenue 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Co Block contract revenue 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Ambulance Am Cost & volume contract revenue 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Am Block contract revenue 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Am Other clinical MS revenue 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Mental Health Mh Cost & volume contract revenue 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Mh Block contract revenue 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Mh Clinical partnership (s31) revenue 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Mh Secondary commissioning revenue 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Mh Other clinical MS revenue 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Acute Ac Elective revenue 108.3 41.3 36.8 (4.5) 95.5 91.0 (4.5) 137.4 Ac Non-Elective revenue 126.9 49.4 43.9 (5.5) 105.6 100.1 (5.5) 156.2 Ac Outpatient revenue 88.4 31.7 36.2 4.5 79.3 83.8 4.5 111.1 Ac A&E revenue 16.0 6.0 6.8 0.8 14.8 15.6 0.8 20.6 Ac other revenue 232.2 65.9 81.2 15.3 210.2 225.5 15.3 276.6

Private patient revenue 13.2 4.0 4.0 0.0 10.4 10.4 0.0 18.0 Grants and donations in cash 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Other operating revenues 93.3 47.9 46.6 (1.3) 94.1 92.8 (1.3) 133.0

Total operating revenue for EBITDA 678.1 246.1 255.5 9.4 609.8 619.2 9.4 853.0 Grants and donations of PPE and intangible assets 1.1 0.1 (0.1) (0.2) 0.2 (0.0) (0.2) 0.5

Total operating revenue 679.3 246.2 255.4 9.3 610.0 619.2 9.3 853.5

Employee Expenses (374.1) (129.3) (141.6) (12.2) (337.3) (349.5) (12.2) (466.6) Drugs expense (67.9) (20.3) (26.5) (6.2) (57.6) (63.8) (6.2) (80.6) Supplies (clinical & non-clinical) (100.1) (30.4) (41.6) (11.2) (80.1) (91.3) (11.2) (112.6)

Clinical supplies (64.9) (20.5) (26.3) (5.8) (52.3) (58.1) (5.8) (74.2) Non-clinical supplies (35.2) (9.9) (15.3) (5.4) (27.9) (33.3) (5.4) (38.4)

PFI expenses (26.4) (11.8) (13.3) (1.5) (25.6) (27.1) (1.5) (37.4) Other expenses (75.1) (37.5) (21.8) 15.8 (76.6) (60.8) 15.8 (109.8)

Decrease (increase) in inventories of finished goods & WIP 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Vehicle Fuel costs (ambulance trusts) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Cost of Secondary Commissioning of mandatory services 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Research & Development expense 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Education and training expense 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Misc. other Operating expenses (73.4) (38.9) (20.8) 18.1 (76.6) (58.4) 18.1 (109.8)

Total operating expenses within EBITDA (643.6) (229.3) (244.8) (15.4) (577.1) (592.5) (15.4) (806.9)

EBITDA 34.6 9.6 10.7 1.1 26.8 26.7 (0.1) 46.0 Depreciation and amortisation (14.7) (5.8) (5.4) 0.4 (12.3) (11.8) 0.4 (18.1)

Depreciation and Amortisation - owned assets (12.3) (5.3) (4.9) 0.4 (10.7) (10.2) 0.4 (16.0) Depreciation and Amortisation - assets held under finance leases (0.1) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Depreciation and Amortisation - PFI assets (2.3) (0.5) (0.5) 0.0 (1.6) (1.6) 0.0 (2.1)

Impairments & Restructuring (9.1) (2.0) (1.8) 0.3 (6.0) (5.8) 0.3 (8.0) Total operating expenses (667.4) (237.2) (251.9) (14.7) (595.3) (610.1) (14.7) (833.1)

Operating Surplus (Deficit) 11.9 9.0 3.5 (5.5) 14.6 9.1 (5.5) 20.4 Profit (loss) on asset disposal (0.5) (0.0) 0.1 0.1 (0.1) 0.0 0.1 (0.1) Net interest (7.9) (4.3) (4.1) 0.2 (8.5) (8.3) 0.2 (12.8) Taxation 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 PDC dividend (7.8) (2.7) (2.7) 0.0 (6.7) (6.7) 0.0 (9.4) Other non-operating items (0.5) 5.8 77.3 71.5 3.4 76.1 72.7 (3.6)

Net Surplus / (Deficit) (5.9) 0.6 74.2 73.6 (3.4) 70.3 73.6 (6.0)

EBITDA % of Op. revenue 5.1% 3.9% 4.2% 0.3% 4.4% 4.3% -0.1% 5.4%

EBITDA 34.6 9.6 10.7 1.1 26.8 26.7 (0.1) 46.0 Change in Current Receivables (8.5) 9.3 (27.3) (36.6) (9.1) (45.7) (36.6) (6.3)

(Increase)/decrease in tax receivable 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 (Increase)/decrease in NHS Trade Receivables (1.6) 10.8 (27.2) (38.0) (9.1) (47.1) (38.0) (6.1) (Increase)/decrease in Non NHS Trade Receivables (4.8) 0.6 6.3 5.7 2.0 7.7 5.7 1.0 (Increase)/decrease in other related party receivables (1.0) 0.0 0.0 0.0 0.0 0.0 0.0 (0.3) (Increase)/decrease in other receivables (1.0) (2.0) (6.3) (4.4) (2.0) (6.4) (4.4) (1.0)

Change in Current Payables 11.0 (0.1) (4.3) (4.2) 4.1 (0.1) (4.2) 1.4 Increase/(decrease) in tax payable 0.2 0.2 1.5 1.2 0.2 1.4 1.2 0.3 Increase/(decrease) in Trade Creditors 14.7 (5.1) (9.0) (4.0) 3.9 (0.1) (4.0) 1.1 Increase/(decrease) in Other Creditors (3.8) 4.7 3.3 (1.4) (0.0) (1.4) (1.4) 0.0

Other changes in WC 10.5 7.7 39.2 31.5 (14.5) 16.9 31.5 (10.5) Change in Non Current Provisions 0.7 0.5 0.4 (0.1) 0.5 0.4 (0.1) (0.2)Other non-cash items 0.9 6.9 (0.8) (7.6) 5.9 (0.5) (6.5) (0.4)

Cashflow from operating activities 49.3 34.0 17.9 (16.0) 13.7 (2.3) (16.0) 30.1 Capital expenditure (accurals basis) 0.0 (13.3) (11.2) 2.2 (24.8) (22.7) 2.2 (41.5) Asset sale proceeds 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 other Investing cash flows (23.1) 1.1 (0.2) (1.3) 0.0 (1.3) (1.3) 0.0

Cashflow before financing 26.2 21.7 6.6 (15.1) (11.1) (26.3) (15.1) (11.4) Net interest (8.1) (4.4) (4.3) 0.1 (8.4) (8.3) 0.1 (12.7)

Interest (paid) on bridging loans 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest (paid) on commercial loans 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest (paid) on non-commercial loans (0.6) (0.3) (0.4) (0.2) (0.6) (0.7) (0.2) (0.8) Interest (paid) on bank overdrafts 0.0 (0.0) 0.0 0.0 (0.0) 0.0 0.0 (0.1) Interest element of finance lease rental payments - other 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Interest element of finance lease rental payments - On-balance sheet PFI (7.5) (4.1) (3.9) 0.2 (7.8) (7.6) 0.2 (11.8)

PDC dividends (paid) (7.8) 0.0 0.0 0.0 (3.6) (3.6) 0.0 (9.4) Movement in loans 3.3 9.0 (0.5) (9.5) 20.6 11.0 (9.5) 34.2 PDC received/(repaid) 0.0 27.3 26.2 (1.0) 27.3 26.2 (1.0) 27.3 Donations received in cash 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 other financing cashflows (0.9) 1.2 2.1 0.9 0.8 1.7 0.9 2.0

Net cash inflow (outflow) 12.9 54.8 30.1 (24.7) 25.5 0.8 (24.7) 29.9

Cash at period end 40.5 64.5 41.3 (23.2) 64.5 41.3 (23.2) 67.4 Cash and Cash equivalents at period end 40.5 64.5 41.3 (23.2) 64.5 41.3 (23.2) 67.4

Long form Acute Financial SummaryNon Safe Harbour Investments at period end 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Detailed Financial Summary£m

Current Quarter YTD


8


Worksheet "Targets and Indicators"

Declaration of risks against healthcare targets and indicators for 2013-14 by King’s College Hospital

These targets and indicators are set out in the Risk Assessment Framework Key: must complete

Definitions can be found in Appendix A of the Risk Assessment Framework may need to complete

NOTE: If a particular indicator does not apply to your FT then please enter "Not relevant" for those lines. Quarter 1 Quarter 2 Quarter 3

Actual Actual Actual

Target or Indicator (per Risk Assessment Framework)

Threshold or

target YTD

Scoring

under

Compliance

Framework

Scoring

under

Risk Assessment

Framework

Risk declared at

Annual Plan

Scoring

under

Compliance

Framework Performance Achieved/Not Met

Scoring

under

Compliance

Framework Performance Achieved/Not Met

Scoring

under

Compliance

Framework Performance Achieved/Not Met Any comments or explanations

Scoring

under

Risk Assessment

Framework

Referral to treatment time, 18 weeks in aggregate, admitted patients 90% 1.0 1.0 Yes 88.90% Not met 88.00% Not met 87.8% Not met Oct 87.8, Nov 88.7, Dec 88.5

Referral to treatment time, 18 weeks in aggregate, non-admitted patients 95% 1.0 1.0 No 97.10% Achieved 96.90% Achieved 97.3% Achieved Oct 97.3, Nov 97.0, Dec 97.3

Referral to treatment time, 18 weeks in aggregate, incomplete pathways 92% 1.0 1.0 No 1 92.20% Achieved 1 92.10% Achieved 1 92.1% Achieved Oct 92.1 Nov 92.1, Dec 92.2 1

A&E Clinical Quality- Total Time in A&E under 4 hours 95% 1.0 1.0 Yes 1 96.30% Achieved 0 95.10% Achieved 0 94.2% Not met 1

Cancer 62 Day Waits for first treatment (from urgent GP referral) 85% 1.0 1.0 No 85.50% Achieved 90.20% Achieved 88.5% Achieved

Cancer 62 Day Waits for first treatment (from NHS Cancer Screening Service referral) 90% 1.0 1.0 No 0 96.60% Achieved 0 92.10% Achieved 0 93.5% Achieved 0

Cancer 31 day wait for second or subsequent treatment - surgery 94% 1.0 1.0 No 98.10% Achieved 97.80% Achieved 96.2% Achieved

Cancer 31 day wait for second or subsequent treatment - drug treatments 98% 1.0 1.0 No 98.30% Achieved 100.00% Achieved 100.0% Achieved

Cancer 31 day wait for second or subsequent treatment - radiotherapy 94% 1.0 1.0 No0

99.20% Achieved 0

100.00% Achieved 0

98.6% Achieved 0

Cancer 31 day wait from diagnosis to first treatment 96% 0.5 1.0 No 0 99.00% Achieved 0 98.20% Achieved 0 98.0% Achieved 0

Cancer 2 week (all cancers) 93% 0.5 1.0 No 97.20% Achieved 96.80% Achieved 97.8% Achieved

Cancer 2 week (breast symptoms) 93% 0.5 1.0 No0

98.90% Achieved 0

97.00% Achieved 0

100.0% Achieved 0

Care Programme Approach (CPA) follow up within 7 days of discharge 95% 1.0 1.0 No 0.00% Not relevant 0.00% Not relevant 0.0% Not relevant

Care Programme Approach (CPA) formal review within 12 months 95% 1.0 1.0 No 0 0.00% Not relevant 0 0.00% Not relevant 0 0.0% Not relevant 0

Admissions had access to crisis resolution / home treatment teams 95% 1.0 1.0 No 0 0.00% Not relevant 0 0.00% Not relevant 0 0.0% Not relevant 0

Meeting commitment to serve new psychosis cases by early intervention teams 95% 0.5 1.0 No 0 0.00% Not relevant 0 0.00% Not relevant 0 0.0% Not relevant 0

Ambulance Category A 8 Minute Response Time - Red 1 Calls 75% 0.5 1.0 No 0.00% Not relevant 0.00% Not relevant 0.0% Not relevant 0

Ambulance Category A 8 Minute Response Time - Red 2 Calls 75% 0.5 1.0 No 0 0.00% Not relevant 0 0.00% Not relevant 0 0.0% Not relevant 0

Ambulance Category A 19 Minute Transportation Time 95% 1.0 1.0 No 0 0.00% Not relevant 0 0.00% Not relevant 0 0.0% Not relevant 0

Clostridium Difficile -meeting the C.Diff objective 37 1.0 1.0 Yes 1 8 Achieved 0 21 Achieved 0 40 Not met Actual 40 against a trajectory of 37 1

MRSA - meeting the MRSA objective 3 1.0 N/A Yes 1 2 Achieved 0 2 Achieved 0 N/A Not relevant No longer applicable under RAF

Minimising MH delayed transfers of care <=7.5% 1.0 1.0 No 0 0.00% Not relevant 0 0.00% Not relevant 0 0.0% Not relevant 0

Data completeness, MH: identifiers 97% 0.5 1.0 No 0 0.00% Not relevant 0 0.00% Not relevant 0 0.0% Not relevant 0

Data completeness, MH: outcomes 50% 0.5 1.0 No 0 0.00% Not relevant 0 0.00% Not relevant 0 0.0% Not relevant 0

Compliance with requirements regarding access to healthcare for people with a learning disability N/A 0.5 1.0 No 0 0.00% Achieved 0 0.00% Achieved 0 N/A Achieved 0

Community care - referral to treatment information completeness 50% 1.0 1.0 No 0.00% Not relevant 0.00% Not relevant 0.0% Not relevant

Community care - referral information completeness 50% 1.0 1.0 No 0.00% Not relevant 0.00% Not relevant 0.0% Not relevant

Community care - activity information completeness 50% 1.0 1.0 No0

0.00% Not relevant 0

0.00% Not relevant 0

0.0% Not relevant 0

Risk of, or actual, failure to deliver Commissioner Requested Services N/A 4.0 Report by Exception No 0 No 0 No 0 No

CQC compliance action outstanding (as at 31 Dec 2013) N/A special Report by Exception No No No No

CQC enforcement action within last 12 months (as at 31 Dec 2013) N/A special Report by Exception No No No No

CQC enforcement action (including notices) currently in effect (as at 31 Dec 2013) N/A 4.0 Report by Exception No No No No

Moderate CQC concerns or impacts regarding the safety of healthcare provision (as at 31 Dec 2013) N/A special Report by Exception No No No No

Major CQC concerns or impacts regarding the safety of healthcare provision (as at 31 Dec 2013) N/A 2.0 Report by Exception No 0 No 0 No 0 No

Trust unable to declare ongoing compliance with minimum standards of CQC registration N/A special Report by Exception No No No No

Results left to complete 0 0 0 0

Total Score 4 1 1 3

Overide

Rating

(if any)

Enter the reason for any non-scoring

related rating override here

Compliance Framework Indicative Governance Risk Rating RED AMBER-GREEN AMBER-GREEN AMBER-RED

Enc 4-2 - Appendix 2 - Targets & Indicators

9


In Year Governance Statement from the Board of King’s College Hospital

The board are required to respond "Confirmed" or "Not confiirmed" to the following statements (see notes below)

For finance, that: Board Response

4

For governance, that:

11

Otherwise

Signed on behalf of the board of directors

Signature Signature

Name Name

Capacity [job title here] Capacity [job title here]

Date Date

3

Notes:

A

B

C

The board confirms that there are no matters arising in the quarter requiring an exception report to Monitor (per the Risk Assessment

Framework page 21, Diagram 6) which have not already been reported.

The board anticipates that the trust will continue to maintain a Continuity of Service risk rating of at least 3 over the next 12 months.

The board is satisfied that plans in place are sufficient to ensure: ongoing compliance with all existing targets (after the application of

thresholds) as set out in Appendix A of the Risk Assessment Framework; and a commitment to comply with all known targets going

forwards.

The board is unable to make one of more of the confirmations in the section above on this page and accordingly responds:

Monitor may adjust the relevant risk rating if there are significant issues arising and this may increase the frequency and intensity of monitoring for the

NHS foundation trust.

Monitor will accept either 1) electronic signatures pasted into this worksheet or 2) hand written signatures on a paper printout of this declaration posted

to Monitor to arrive by the submission deadline.

In the event than an NHS foundation trust is unable to confirm these statements it should NOT select 'Confirmed’ in the relevant box. It must provide a

response (using the section below) explaining the reasons for the absence of a full certification and the action it proposes to take to address it.

This may include include any significant prospective risks and concerns the foundation trust has in respect of delivering quality services and effective

quality governance.

KINGS 1314 Q3 in year reporting template (to issue)_V115012013 - Governance Statement

1 of 1 22/01/2014 09:16

Enc 4.2 - Appendix 3 - Governance Statements

10

Enc. 4.2

Appendix 4

In Year Quality Governance Metrics of King’s College Hospital The Risk Assessment Framework (diagram 13) sets out that Monitor will use executive team turnover as one of the potential indicators of quality governance concerns. Please provide the information requested below and ensure that any changes are explained in your commentary:

Units Quarter ending 31-Dec-13

Executive Directors

Total number of Executive posts on the Board (voting)

Posts 6

Number of posts currently vacant Posts 0

Number of posts currently filled by interim appointments

Posts 1

Covering substantive non-voting director currently on secondment

Number of resignations in quarter Resignations 0

Number of appointments in quarter Appointments

1 Interim to cover substantive non-

voting director currently on secondment

11

1

Governors’ Membership & Community Engagement Committee Minutes of the meeting held at 09.30 on 16 October 2013 in the Dulwich Committee Room, King’s College Hospital

Members: Brady Pohle (BP) Committee Chair/ Staff Governor Jan Thomas (JT) Patient Governor Fiona Clark (FC) Public Governor Christine Klaassen (CK) Patient Governor Barbara Pattinson (BP1) Public Governor In attendance: Christopher Stooke (CS) Non-Executive Director Tamara Cowan (TC) Board Secretary Sally Lingard (SL) Director of Communications Angela Grainger (AG) Chair of Disability Inclusivity Network (item 2.3.2) Tooba Ahmadi (TA) Corporate Governance Officer (minutes) Rachel Sugarman (RS) PPI and Membership Manager Apologies: Prof Sir George Alberti (GA) Trust Chair Jessica Bush (JB) Head of Public & Patient Involvement Faith Boardman (FB) Non-Executive Director Jane Walters (JW) Director of Corporate Affairs Patti Kachidza (PK) Patient Governor Stuart Owen (SO) Public Governor Andrew McCall (AM) Public Governor

Item

Subject

Action

013/39 Welcome and apologies Apologies for absence were noted.

013/40 Minutes of the Previous Meeting The minutes of the meeting held on 26 June 2013 were accepted as a correct record.

013/41 Action Tracking Progress made on the action tracker was noted. Action 013/18 – Healthcare Staff Benefit (HSB) - deferred to 23 January 2014 The Committee agreed for the information about members’ eligibility to apply for NHS Discount Scheme to be publicised to all Trust members at the next edition of @King’s. Action 013/29 – Geographic location of patient members – Complete. The report is included as part of the membership report, under agenda item 2.1.1.

RS/SL/LC

Enc 4.3.1

2

Item

Subject

Action

013/42 Matters Arising Brady Pohle – Chair of the Committee PH informed the Committee that he will be leaving the Trust to join Royal Free Hospital as Head of Legal. He will be resigning as a Staff Governor post from 03 January 2014. The MEC members have been emailed to put forward their interest to Tamara Cowan to chair the Committee.

013/43 Membership Recruitment

013/44 Membership Report as at October 2013 and Update on Recruitment in New Constituencies Rachel Sugarman presented a summary of membership numbers, changes and recruitment activity as at September 2013. Key points included:

74 new members in the Public Constituency and 189 in the Patient Consistency have joined in the second quarter of 2013/14;

Recruitment mailing was sent to PRUH patients and landed on doorsteps from 04th October 2013;

Recruitment activity has focused on the Bromley area. CK and FC have actively participated in initiatives to recruit new members at the PRUH;

Membership campaigns at the Beckenham Beacon site included face to face and leaflet publicity; and

The Trust is on track to reach the 2000 membership target (500 members per constituency) before the Governor Elections takes place in November 2013.

RS also presented the membership breakdown by area in response to the Committee’s request to have a better understanding of the Trust’s patient spread and what geographic areas are being represented by the Patient Governors. The Committee noted the membership breakdown by area with 66.3% members being in the inner London boroughs, 19.9% members in the outer London boroughs and the remaining from other parts of the country.

013/45 Election Update & New Governors’ Induction Programme TC updated the Committee on the forthcoming governor election process and the proposal for an induction programme for new governors. The Committee noted the election timetable, which is predicated on the Trust’s ability to register sufficient number of members (at least 500) in each constituency. It was highlighted that a number of methods such as letters, flyers, information in staff bulletin, face to face engagement and pop-up events by current governors are being used to reach out to different groups to become members and subsequently stand for elections. The Committee also noted that a “Governor Awareness Session” is being

Enc 4.3.1

3

Item

Subject

Action

introduced for prospective Governors to ensure they are aware of the breadth of the role. The Session will be held on 25 November 2013 and it will largely be delivered by current Governors. The Committee noted the election and induction update and agreed for the report to be presented at the next Council of Governors meeting on 11 December 2013.

TC

013/46.1 013/46.2

Effective Engagement Member-Governor Contact via Website TC presented a summary of the existing mechanism in place where members can contact a governor via the Trust’s website using the generic email address and how the process for incoming queries is being managed. It was highlighted that the process and wording on the web page has now been refined to highlight to members that emails will be reviewed by the Foundation Trust Office in the first instance. Members will also be asked to give formal consent for their information to be shared with the named governor, if their email contained sensitive or confidential information. The Committee noted the refined process and agreed for the report to be presented at the next Council of Governors on 11 December 2013 for information. Engaging with Diverse Community Angela Grainger, Assistant Director of Nursing reported on engaging with the diverse community and highlighted a number of inclusivity initiatives that are being undertaken by the Disability Inclusivity Group (DIG) with education and disability inclusivity being the key focus. AG highlighted the following points: Education Inclusivity:

There is an education budget that is distributed equally to all professional groups, including the Admin & Clerical group;

The existence and work of the DIG is also being communicated to the PRUH & Orpington based staff;

The Trust is working with various universities including King’s College London, London South Bank University and the Greenwich University to help those who do not have the set criteria for university entrance;

As part of the Personal Development Plan (PDP), staff are offered career surgeries; and

As part of the inclusivity initiative it is important to have a good spread of BME and the Trust ensures that the pre-registration courses reflect this spread.

Disability Inclusivity

TC

Enc 4.3.1

4

Item

Subject

Action

The Trust provides work opportunities to suitable people regardless of their disabilities. This is publicised widely through posters and promoted by executive team;

There is a confidential helpline for staff with any disability diagnosis;

Work experience is offered to disabled students on site during Saturdays; and

The DIG will be having meeting with ACORN to discuss work experience opportunities for disabled young people;

The Committee noted the update and highlighted that the Council of Governors have a duty to represent the general public. In order to fulfil this duty, Governors needs to ensure that they are engaging more effectively and supporting the work of DIG.

Governors are invited to be Governor Champions of the DIG and take part in some of the initiatives. AG will circulate the DIG meeting dates for 2014 to all Governors via the next Governor Bulletin.

AG

013/47 @King’s: Feedback on special edition and ideas for February 2014 edition SL reported that the September edition of @King’s was a special edition to mark the acquisition. It focused on the three main sites of the Trust; the Denmark Hill, the PRUH and the Orpington sites. The next edition will be published in February 2014 and Governors are invited to take an active part and suggest as well as write a Governor focus article about their involvements in various initiatives. A note will go out in the next Governor Bulletin to inform Governors to contribute an article for the next edition of @King’s. The Committee commended the layout and the content of the magazine and suggested a number of items that could feature in the February edition. These included:

Election update and welcome to new Governors;

The launch of the new Orthopaedic centre at the PRUH;

Commercial Services projects and activities;

NHS discount for members;

Capacity planning and sites;

Friends and Family; and

Themes from KiC.

LM/ All

013/48 Committee Work Plan The Committee made the following suggestions for the work plan:

Election and Governor induction update – January;

Community event planning – January;

Enc 4.3.1

5

Item

Subject

Action

Update on @King’s – January;

Forward plan for July Governor elections – April; and

Open day planning - April

013/49 Any Other Business LGBT Forum BP is a Governor representative at the LGBT Forum. Governors interested to replace BP in the LGBT Forum from January 2014 should inform Lindsay Batty-Smith (LBS). Friends of Carnegie Library Friends of Carnegie Library promotes the use and access to the Carnegie library in Herne Hill. They are having their winter fair on Saturday, 30 November 2013 and would like to raise their profile at King’s. BP1 highlighted that there are no Community Notice Boards around the Trust, where notices, posters and flyers could be displayed. SL to suggest options for community notices at the next meeting. Brady Pohle The Committee thanked BP for his support as a Governor member and chairing the MEC in the past 2 years. The Committee wished him well as he pursues his new role at the Royal Free Hospital.

SL

013/50 Date of next meeting:

Thursday 23 January 2014 14:00-16:00 in the Dulwich Committee Room

Enc 4.3.1

1

King’s College Hospital Governors’ Strategy Committee

Minutes of the meeting of the Governors’ Strategy Committee held at 09.30 on Thursday 24 October 2013 in the Dulwich Committee Room, King’s College Hospital. Members: Chris North (CN) Public Governor (Committee Chair) Tom Duffy (TD) Patient Governor Jan Thomas (JT) Patient Governor Michelle Pearce (MP) Public Governor Nanda Ratnavel (NR) Public Governor Joe Onabaworin (JO) Public Governor Phyllis Barnett (PB) Staff Governor Richard Gibbs (RG) Stakeholder Governor Phidelma Lisowska (PL) Stakeholder Governor In attendance: Prof. Sir George Alberti (GA) Trust Chair Jacob West (JW1) Director of Strategy Jane Walters (JW) Director of Corporate Affairs Jill Solly (JS) Head of Primary/Secondary Care Interface David Dawson (DD) Deputy Director of Strategy/Head of Change Leaders Team Joe Farrington-Douglas (JFD) Senior Strategic Advisor Tony Johnston (TJ) – item 013/41 only Head of Strategic Development Sarah James (SJ) – item 013/45 only Associate Director – Education & Development Leonie Mallows (LM) Corporate Governance Officer (Minutes) Andrew Eyres (AE) Chief Officer, Lambeth CCG Apologies: Andrew McCall (AM) Public Governor Christine Klaassen (CK) Patient Governor David Sullivan (DS) Patient Governor Derek Cookson (DC) Patient Governor Carolyn Campbell-Cole (CC) Staff Governor Brady Pohle (BP) Staff Governor Sue Slipman (SS) Non-Executive Director Graham Meek (GM) Non-Executive Director Item

Subject Action

013/36 Apologies Apologies for absence were noted.

013/37 Approval of Minutes of the Previous Meeting The minutes of the meeting on 25 July 2013 were approved as a correct record.

013/38 Action Tracking The action tracker was noted.

Enc 4.3.2

2

Item

Subject Action

013/39

Matters Arising ‘Paperless’ Hospital It was noted that the Trust has made significant progress and is a national leader in the move to become ‘paperless’. The project had been extended to include the PRUH and the Trust has submitted a funding bid for a scanning project to tackle the issue of historical paper notes. Patient Complaints It was noted that a paper addressing the Trust’s processes for following up and learning from complaints and suggestions for improvements would be presented at the next Council meeting. JW reported that complainants had recently been invited to participate in King’s in Conversation and a survey had been launched to assess people’s experience of making a complaint. The Committee requested an item on IT strategy to be included on the spring 2014 governor workshop agenda.

LM

013/40

Trust-Wide Strategic Matrix 2013/14 Review of Q2 DD presented the Trust’s Strategic Matrix for quarter 2 which outlined Trust-wide and divisional strategic priorities. The following key points were noted:

The Trust has implemented a policy for the screening (alcohol and smoking) of medical emergency patients which includes ‘brief intervention’ advice. Following assessment of the effectiveness of this policy, it is expected to be rolled out across the Trust;

It has proved extremely challenging to get the required response rate for the Friends and Family Test. Using volunteers to assist patients with completion of the survey has improved rates;

800 staff and patients have been interviewed as part of King’s in Conversation (KIC) and the Trust’s on-going commitment to improve responsiveness and facilitate patient feedback;

KIC will be rolled out to PRUH patients and staff from November;

Efforts to rapidly translate research into operational policy have been strengthened by the Trust’s involvement with establishment of an Academic Health Sciences Network (AHSN) and a successful bid to set up a Collaboration for Leadership in Applied Health Research and Care (CLAHRC); and

The long-running Outpatient transformation project in Suite 3 is beginning to have a positive effect on patient experience and continued dialogue with health professionals and teams is moving implementation of the project forward.

In discussion, the following points were raised and noted:

Enc 4.3.2

3

Item

Subject Action

There are a number of discussion fora relating to improving population health which the Trust attends or is involved with. Subscribing to multi-agency working is fundamental to the Trust’s approach to achieving this objective; and

Results of the KHP Organisational Health Index are currently being analysed and will feed into the Trust’s Organisational Development Strategy alongside the output from KIC and other work streams.

It was agreed that:

Details about how governors can be involved with the next phase of King’s in Conversation would be circulated when available;

Governors are invited to learn more about the Research & Development Department. Information about how to register interest will be circulated; and

Governors would like to see the report on the results of the KHP OHI in due course. LM to check.

LM

DD

LM

013/41 Integration/Transformation Plan TJ presented the governance framework for integrating and transforming the enlarged organisation and how this sits alongside day to day operations as business as usual. The following key points were noted:

A series of linked weekly, fortnightly and monthly meetings will monitor delivery of the various plans and major projects. These include individual divisions that will have responsibility for delivery of CIPs within their division;

The new Programme Management Office (PMO) will drive the integration work;

There are currently 7 major projects driving the integration programme. Each project will have an executive sponsor and internal project champion; and

A clear and structured ‘Gateway Review’ process will be employed to agree, develop and review projects and to secure the benefits of the business case.

In discussion, the following points were raised and noted:

The Trust is working with local Clinical Commissioning Groups (CCGs) and other agencies to reduce length of stay through pathway improvements;

Governors would also be interested in learning about any proposed ‘minor’ projects of the integration plan.

013/42 King’s Health Partners Update JW1 provided an update on discussions regarding the future of KHP.

Enc 4.3.2

4

Item

Subject Action

The following key points were noted:

The KHP Partners Board would meet on 30 October to consider two options and one major issue;

The two options relate to merger of the three foundation trusts and whether the option to merge should be pursued immediately or at a slower pace, bearing in mind recent developments such as the acquisition of the PRUH and the Competition Commission’s decision to prohibit the merger of Bournemouth and Poole hospitals;

The major issue is whether clinical and academic strategies and end goals can be commonly agreed between partners and, if so, how merger would help achieve them;

The five key areas under discussion are cancer, cardiac, paediatrics, regenerative medicine and integrated care; and

An alternative to merger would be to press ahead with agreed clinical priorities.

013/43 Academic Integrated Care Organisation (AICO) JS presented a summary of Southwark and Lambeth Integrated Care’s (SLIC) ambitions to create an Academic Integrated Care organisation (AICO). Key points included:

SLIC’s bid for ‘pioneer’ status was not successful but it is still exploring possibilities of working with KHP, commissioners, GPs and social care organisations to achieve radical system change;

There is a clear vision for how the new system will be different from the present system. One distinct difference being the creation of a ‘care co-ordinator’ role which has overall responsibility for an individual’s care;

It will also make a significant difference to care providers and the way in which they work, focusing on providing proactive, preventative, joined up and reliable care packages;

Organisations signed up to the AICO would need to transform their workforce to deliver the joint vision;

Community multi-disciplinary teams are already in existence, discussing individual cases and as primary care complete holistic health assessments we expect to find more older people in need of case management;

A provider business case will explore the possibilities of changing organisational form as an enabler of delivery, including the case for capitated health and social care budgets and the transfer of some services from incumbent organisations to the AICO;

It is anticipated that work to develop the business case will commence in

Enc 4.3.2

5

Item

Subject Action

January 2014;

Government is supportive of integrated care projects and funding has been allocated to local CCG budgets for transformation to models of integrated care.

013/44 Strategic Issues Q2 The Committee noted the review of strategic context for 2013/14 quarter 2. The following key points were noted:

The Competition Commission’s decision with regard to the merger of Bournemouth and Poole hospitals raises significant issues for KHP, not least the financial implications of pursuing a merger option which is subsequently rejected;

The future role of Monitor in assessing the benefit to patients of merger options and having stronger influence with the Competition Commission and Office of Fair Trading is under discussion. The Foundation Trust Network has written to the Secretary of State to urge him to look at the competition process;

Whole pathway tenders of musculo-skeletal and diabetes pathways in Bexley are an example of commissioners driving integrated care;

Publication of the Ombudsman report on sepsis has highlighted examples of poor care and raised the profile of this condition; and

‘Big Data’ has the potential to transform care models by tracking all patient interactions across the system leading to the prediction of conditions, although it also raises questions of patient confidentiality.

013/45 Organisational Development & Learning Strategy SJ presented a summary of the Trust’s Organisational Development & Learning Strategy, which was developed earlier this year in anticipation of the Trust becoming an enlarged organisation. The following key points were noted:

Developing an integrated, expanded organisation which aspires to the same vision and values as the Trust held prior to the acquisition is key to the strategy;

Development is taking place at three levels: organisational, directorate/divisional and individual and it is recognised that strong leadership is required to set the tone;

A series of activities will begin soon for medical and dental staff and non-medical staff, with some programmes run jointly with KHP. Benchmarking research is currently being undertaken to identify any gaps between the component organisations within the enlarged Trust;

Enc 4.3.2

6

Item

Subject Action

One aim is to get a strong continuing professional and personal development infrastructure in place; and

With the support of Ernst & Young, a survey will take place in November to measure the progress of cultural change.

The Committee noted the strategy and acknowledged its importance as crucial underpinning to the success of the acquisition and requested an update in approximately 6 months’ time.

SJ/LM

013/46 New NHS Commissioning Landscape Andrew Eyres, Chief Officer of Lambeth CCG, presented an outline of the new NHS commissioning landscape since changes came into force on 01 April 2013. The following key points were noted:

Commissioning responsibilities are now divided across local government, CCGs and NHS England;

CCGs are hybrid statutory and membership organisations;

The commissioning context is growing demand from a population that is living longer, but with increased incidence of long term conditions, resourced by flat NHS funding and a reduced social care budget;

Strategic planning by CCGs for a sustainable NHS is centred around clinical input and engagement with patients and local communities, funding allocations, integration planning and system-wide sustainability;

There is a shift in focus from access targets and waiting times to innovation, quality assurance and preventing ill health; and

A series of commissioning partnerships from the local level e.g. KHP and AHSNs, to sector-wide and national initiatives are central to this new approach to commissioning.

013/47 Any Other Business JW1 reported the following changes to the strategy team:

Joe Farrington-Douglas and Laura Gillam have been appointed as Senior Strategy Advisor and Strategy Analyst respectively;

David Dawson is now Deputy Director of Strategy; and

JW1 will be on secondment to the Mayor of London’s Health Commission from December until July 2014.

013/48 Date of next meeting: Tuesday 11 February 12:00-14:00 in the Dulwich Room

Enc 4.3.2

Confirmed Minutes - Patient Experience & Safety Committee 22 October 2013

Governors’ Patient Experience & Safety Committee Minutes of the meeting held at 9.30am on 22 October 2013 in the Dulwich Committee Room, King’s College Hospital Members:

Tom Duffy (TD) Patient Governor/ Committee Chair

Stuart Owen (SO) Public Governor

Joe Onabaworin (JO) Public Governor

Christine Klaassen (CK) Patient Governor

Jan Thomas (JT) Patient Governor

Nicky Hayes (NH) Staff Governor

In attendance:

Prof Sir George Alberti (GA) Trust Chair/ Non-Executive Director

Judith Seddon (JS) Associate Director of Governance

Jane Walters (JW) Director of Corporate Affairs

Chris Barrass (CB) Director of Pharmacy

Stephen Harding (SH) Pathology Development & Liaison Manager

Tooba Ahmadi (TA) Corporate Governance Officer (minutes)

Apologies:

Alam Zabit Public Governor

Chris North Public Governor

Patti Kachidza Patient Governor

Derek Cookson Patient Governor

Michelle Pearce Public Governor

Carol Bell Stakeholder Governor

Phyllis Barnett Staff Governor

Carolyn Campbell-Cole Staff Governor

Faith Boardman Non-Executive Director

Marc Meryon Non-Executive Director

Sue Slipman (SS) Non-Executive Director

Jessica Bush Head of Public & Patient Involvement

Item Subject Action

013/36 Welcome and apologies

Apologies for absence were noted.

013/37 Minutes of the meeting held on 04 July 2013

The minutes were accepted as a correct record of the last meeting.

013/38 Action Tracker

The Committee noted the progress on the action tracker and the following points in relation to specific actions: 013/27 Patient Video Stories Project JB reported that the Patient Video Stories Project decelerated due to the departure of the project manager as well as the funding scheme for the project.

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Item Subject Action

It is anticipated that the project will revive again in December 2013 when the recruitment of the project manager is established. Mock ‘CQC-style’ inspections within Ambulatory Division NH informed the Committee that this project is still on-going. NH will check with Ann Duffy about the timetable for mock CQCs. NH will also write to Heads of Nursing and Divisional Managers to inform them of the Governors interest and willingness to help in the unannounced mock CQC visits.

NH

013/39 Matters Arising

There were no additional matters arising raised for discussion.

013/40 Phlebotomy Transformation Project

Stephen Harding, Pathology Development & Liaison Manager reported that the Phlebotomy Transformation Project is in its final stages with 2 outstanding issues in relation to signage and training Phlebotomists on Electronic Patient Request (EPR).

It was noted that:

The Phlebotomy service is run by GSTS and there have been major improvements;

Patient waiting times have improved with an average waiting time of 7 minutes;

Customer care issues have been resolved with more phlebotomists during peak hours;

Issue with the automatic display downtime would be reported to GSTS; and

The phlebotomy service at the PRUH and Beckenham Beacon sites will be managed by the Trust and long waiting times will not be acceptable. A demand analysis will be carried out as at Denmark Hill to inform service improvement.

013/41 Changes to Pharmacy Services

Chris Barrass, Director of Pharmacy provided the Committee with an overview

of the Pharmacy services and answered a number of questions that were put

forward by SO in advance of the meeting.

Key discussion points included:

The Trust contracted out its Outpatient Pharmacy dispensing service to Sainsbury’s, which officially opened in July 2013;

The main reason for outsourcing the Outpatient Pharmacy service was to improve the quality of outpatient dispensing services by having longer opening hours, shorter waiting times and wider collection options. It also provides considerable VAT savings to the NHS and the Trust;

The nature of business between the Trust and Sainsbury’s is a standard NHS contract with normal contractual safeguards, that includes 38 Key Performance Indicators (KPIs);

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Item Subject Action

The Trust monitors the KPIs on monthly basis to check the quality of service and apply any financial penalties where quality and safety KPIs are not met;

The duration of the contract is 11 years with a review every 5 years. The Trust can terminate the contract if Sainsbury’s fail to meet contract

or if fail any KPIs for any 3 months out of 6 or if VAT rules change;

CB presented the average outpatient waiting times and the KPI charts to the Committee. The waiting times have decreased significantly since August 2013;

It was noted that the space provided to Sainsbury’s Pharmacy was agreed by the Trust and there are 13 seats in total in the pharmacy waiting areas. It was highlighted by Governors that adequate seating space in the pharmacy for patients and in particular for elderly patients is essential;

Patients should not be waiting long to hand in their prescription. Sainsbury’s will be conducting a patient satisfaction survey and it will be good to align the survey questions with those of HRWD;

The Pharmacy team has been focusing on discharge delays and 70% of drugs are now prescribed by Pharmacist and not junior doctors; and

It was highlighted that one of the key issue is advising patient on taking drugs properly and receiving all their required drugs from one prescriber. CB emphasised that this is not just a pharmacy issue but a wider Commissioner and prescriber responsibility to advise and provide clarification to patients about their drugs.

The Committee agreed that:

If possible, it might be helpful to discuss prescribing drugs from an integrated care perspective and across the wider health economy at a future Committee meeting; and

CB would provide a written update on points not covered at this meeting and he would attend a future PESC meeting to update on the progress of the Pharmacy Services.

CB

013/42 Update on Francis Working Group

Governors Response on Francis

TD reported on his involvement in the Francis Working Group and highlighted

the following key points:

The Group recently met on Monday, 21 October 2013 and considered the draft report from King’s in Conversation (KiC) project;

TD presented a summary of the key themes from the pop-up conversations and the table discussions that he had conducted to the Committee;

Overall staff and patients are happy with the Trust and there are some areas of concerns such as complaints procedure, nurse to patient ratio and culture of the hospital. The Trust should consider and take the opportunity to improve on these issues;

The KiC analysis will be discussed at the next Board and Council

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Item Subject Action

meetings. The themes and messages coming out of the KiC will be shared with staff in due course;

It was highlighted that the Trust has undertaken a number of initiatives in relation to the Francis Report and the involvement of Governors in some of these projects, in particular the KiC project has been valuable; and

In order to ensure Governors accountabilities to both members and the public, it was suggested that Governors should contribute to and feature in @king’s magazine as well as at the next Annual Members Meeting (AMM) in September 2014 by writing and presenting short articles about their involvements in various projects.

The Trust was complemented for the work around the Francis Report and for initiating the KiC project as an additional programme to the Francis work. It was agreed that the PESC and Governor Strategy Committee should continue to look at the issues and themes that are coming out of the KiC project.

All

013/43 Outpatients Update

CK reported on her involvement in the Outpatients Transformation Project and highlighted the following key points:

The outpatient appointment booking system is now centrally managed;

There have been significant improvements in the outpatient area with good IT system and an information board to advise patients on waiting times;

Suite 3 has improved in a number of ways with electronic check-in systems now in place. There are volunteers and reception staff on hand to assist and advise patients;

It was highlighted that there are reception staff to welcome patients but further customer care training for the reception staff should be considered; and

The Transformation Project work is on-going and it will now focus on improving Suite 1 and the Ophthalmogy department. CK will continue her involvement in this initiative.

013/44 Governor Involvement Updates

Jessica Bush outlined continuing opportunities for Governor involvement and key points included:

There is an opportunity for Governor involvement in quality improvement work in the Darwin Unit at the PRUH site. Governors interested to take part in this initiative to carry out patient interviews should inform JB.

NH will follow up with Ann Wood on possible Governor involvement in the mock CQC inspections;

NH also highlighted that dignity month and dignity ward visits will take place during February 2014. Dignity awards ceremony will be on 17 March 2014. A schedule of ward visits will be developed and circulated to Governors in due course. A message will go out to all Governors in the next Governor Bulletin; and

MP volunteered to get involved in the Ophthalmology Transformation project.

LM

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Item Subject Action

013/45 Committee Work-Plan 2014

The Committee noted the draft work plan for 2014 and suggested the following additions to the work plan:

Patient Experience from the PRUH dimension;

Legal claims; and

Maternity

FOR INFORMATION

013/46 Trust Patient Experience Report – August 2013

The Committee noted the Patient Experience Report as of August 2013.

013/47 Trust Performance Report – Month 5

The Committee noted the month 05 Performance Report and highlighted that number of complaints are on the rise with majority of complaints being in relation to clinical care.

013/48 AOB

There were no matters of any other business raised for discussion.

Date of next meeting: Tuesday 11 February 9:30-11:30 in the Dulwich Committee Room

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Documents

King’s College Hospital Council of Governors - 365.1 - cog agenda and papers ma… · CV Praveen Staff - Medical and Dentistry Carolyn Campbell-Cole Staff – Nurses and Midwives