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Your care within the high dependency unit (HDU) - patient information

Description: This factsheet explains what the high dependency unit (HDU) is, why you are being cared for in the HDU and what
Url: /Media/UHS-website-2019/Patientinformation/Pregnancyandbirth/Your-care-within-the-high-dependency-unit-HDU-1838-PIL.pdf

Clean intermittent self-catheterisation - patient information

Description: This factsheet contains information about clean intermittent self-catheterisation (CISC) to improve bladder function.
Url: /Media/UHS-website-2019/Patientinformation/Womenshealth/Clean-intermittent-self-catheterisation-1336-PIL.pdf

Managing your child's earwax at home - patient information

Description: This factsheet contains information about earwax and ways that you can manage your child's earwax safely at home.
Url: /Media/UHS-website-2019/Patientinformation/Audiology/Managing-your-childs-earwax-at-home-3622-PIL.pdf

Your child has been referred for a hearing aid assessment - patient information

Description: This factsheet explains what to expect at your child's appointment and provides more information on hearing aids.
Url: /Media/UHS-website-2019/Patientinformation/Audiology/Your-child-has-been-referred-for-a-hearing-aid-assessment-2571-PIL.pdf

Differences in sex development (DSD) clinic - patient information

Description: This factsheet explains what the differences in sex development (DSD) clinic is, why your child has been referred to the clinic
Url: /Media/UHS-website-2019/Patientinformation/Childhealth/Differences-in-sex-development-DSD-clinic-3504-PIL.pdf

Welcome to the primary ciliary dyskinesia (PCD) service - patient information

Description: This self-management plan has been designed to help you record details of yourprimary ciliary dyskinesia (PCD) treatment, action plan and key information about your health and wellbeing throughout the coming year
Url: /Media/UHS-website-2019/Patientinformation/Respiratory/PCD-patient-self-management-plan-3330-PIL.pdf

DART study - summary for patients

Description: Your role in improving the diagnosis of lung disease Information sheet What is DART? NHS England have launched the Lung Health Check programme to help detect lung diseases early and improve care for people affected by lung diseases. The aim of the DART study is to see if we can further improve some parts of the Lung Health Check programme. The project is led by the University of Oxford working with the Lung Health Check centres, NHS hospitals, companies and charities. To perform the DART research project, we need data from as many people attending Lung Health Check centres as possible. If you do not want your data included, now or at any time, please tell us using the contact details below. Your role You do not need to do anything – the DART team will use computers to conduct additional analysis of your scans and look at the data from your lung health check. It does not require any extra time, scanning or visits for you, and does not interfere in any way with the health care you are already or about to receive. If you do not object to DART collecting your data, you will be helping the researchers to improve the diagnosis of lung and other smoking related diseases. Your personal information is kept confidential, so no-one can look at it, but the NHS research laboratory in Oxford will be able to link your data (NHS records, scans, biopsies and resections) to enable the research to happen. The DART research team in Oxford remove any link to you before it is used by any of the researchers so there is no link back to you and you will never be identified. This is known as anonymisation. What the research hopes to achieve Use computers (artificial intelligence) to: • identify nodules that are not cancers and are harmless • speed up the time to diagnose early lung stage lung cancer • remove the need for other investigations such as lung biopsies in some patients • make investigating patients for suspected lung cancer safer • allow the NHS to reach many more people for Lung Health Checks and ultimately save lives • Make other diagnoses from the data, such as heart or other lung problems Why this is important • If found at an early stage, lung cancer is treatable • DART aims to develop an Artificial Intelligence software programme that is fast and accurate and will assist doctors to interpret CT scans and detect cancer • This would speed up the time to diagnosis and reduce the numbers of additional scans and biopsies that might be needed in future. • As smoking can cause other lung and heart problems, we aim to use Artificial Intelligence software programmes to see if we can identify these as well. Further information If you want more information about the project visit www.dartlunghealth.co.uk. If you do not want your data included in the project, please email ouh-tr.dart@nhs.net. This study has been reviewed and approved by the West Midlands Black Country Research Ethics Committee, reference 21/WM/0278. We have special permission to conduct the DART study without study-specific consent (i.e. link, transfer, process and analyse the data) from the Confidential Advisory Group under Section 251 of the National Health Service Act 2006 and its current regulations, the Health Service (Control of Patient Information Regulations 2002) (CAG reference number: 22/CAG/0010]). Chief Investigator: Prof Fergus Gleeson, Consultant radiologist, University of Oxford, dart@oncology.ox.ac.uk DART Study Summary for Patients
Url: /Media/UHS-website-2019/Docs/Services/Blood-heart-and-circulation/DART-study-summary-for-patients.pdf

Papers Trust Board 27 May 2021

Description: Date Time Location Chair Agenda Trust Board – Open Session 27/05/2021 9:00 - 13:00 Microsoft Teams Peter Hollins 1 Chair’s Welcome, Apologies and Declarations of Interest 9:00 To note apologies for absence, and to hear any declarations of interest relating to any item on the Agenda. 2 Staff Story The patient or staff story provides an opportunity for the Board to reflect on the experiences of patients and staff within the Trust and understand what the Trust could do better. 3 Minutes of Previous Meeting held on 30 March 2021 9:15 4 Matters Arising and Summary of Agreed Actions To discuss any matters arising from the minutes, and to agree on the status of any actions assigned at the previous meeting. 5 QUALITY, PERFORMANCE and FINANCE Quality includes: clinical effectiveness, patient safety, and patient experience 5.1 Briefing from the Chair of the Charitable Funds Committee (Oral) 9:25 Dave Bennett, Chair 5.2 Briefing from the Chair of the Finance and Investment Committee (Oral) 9:30 Dave Bennett, Chair 5.3 Briefing from the Chair of the Quality Committee (Oral) 9:35 Tim Peachey, Chair 5.4 Chief Executive Officer's Update (Oral) 9:40 Sponsor: David French, Chief Executive Officer 5.5 Integrated Performance Report for Month 1 10:00 To review the Trust's performance as reported in the Integrated Performance Report Sponsor: David French, Chief Executive Officer 5.6 Equality and Diversity Update (WRES and WDES) 10:45 Sponsor: Steve Harris, Chief People Officer Attendee: Gemma Genco, Head of Equality, Diversity & Inclusivity 5.7 Gender Pay Gap Reporting 2020 11:05 Sponsor: Steve Harris, Chief People Officer Attendee: Kirsty Durrant, Strategic HR Projects Manager 5.8 Freedom to Speak Up Report 11:25 Sponsor: Gail Byrne, Chief Nursing Officer Attendee: Christine Mbabazi, Equality & Inclusion Adviser/Freedom to Speak Up Guardian 5.9 Finance Report for Month 1 11:45 Sponsor: Ian Howard, Interim Chief Financial Officer 6 STRATEGY and BUSINESS PLANNING 6.1 CRN: Wessex 2020/21 Annual Report and 2021/22 Annual Plan 11:55 Sponsor: Paul Grundy, Chief Medical Officer Attendees: Rebecca McKay, Chief Operating Officer, CRN: Wessex/Clare Rook, Deputy COO, CRN: Wessex 7 CORPORATE GOVERNANCE, RISK and INTERNAL CONTROL 7.1 Register of Seals and Chair's Actions 12:15 In compliance with the Trust Standing Orders, Standing Financial Instructions, and the Scheme of Reservation and Delegation. Sponsor: Peter Hollins, Trust Chair 7.2 Emergency Planning and Business Continuity Annual Report 2020/21 12:20 Sponsor: Joe Teape, Chief Operating Officer 7.3 Charitable Funds Committee Terms of Reference 12:30 Sponsor: Peter Hollins, Trust Chair Attendee: Karen Flaherty, Associate Director of Corporate Affairs and Company Secretary 7.4 Trust Executive Committee Terms of Reference 12:35 Sponsor: David French, Chief Executive Officer Attendee: Karen Flaherty, Associate Director of Corporate Affairs and Company Secretary 8 Any Other Business 12:40 To raise any relevant or urgent matters that are not on the agenda 9 To note the date of the next meeting: 29 July 2021 Page 2 10 Resolution regarding the Press, Public and Others Sponsor: Peter Hollins, Chair To agree, as permitted by the National Health Service Act 2006 (as amended), the Trust's Constitution and the Standing Orders of the Board of Directors, that representatives of the press, members of the public and others not invited to attend to the next part of the meeting be excluded due to the confidential nature of the business to be transacted. 11 Follow-up discussion with governors 12:45 Page 3 3 Minutes of Previous Meeting held on 30 March 2021 1 Minutes TB 30 March 2021 OS Minutes Trust Board – Open Session Date Time Location Chair Present 30/03/2021 9:00 - 12:05 Microsoft Teams Peter Hollins (PH) Dave Bennett (DB), Non-Executive Director (NED) Gail Byrne (GB), Chief Nursing Officer Cyrus Cooper (CC), NED Keith Evans (KE), NED David French (DAF), Interim Chief Executive Officer Paul Grundy (PG), Interim Chief Medical Officer Steve Harris (SH), Chief People Officer Jane Harwood (JH), NED (until item 5.10) Ian Howard (IH), Interim Chief Financial Officer Tim Peachey (TP), NED and Senior Independent Director/Deputy Chair Joe Teape (JT), Chief Operating Officer In attendance Brenda Carter (BC), Assistant Director of People (for item 5.8) Ellen Copson (EC), Associate Professor of Medical Oncology, University of Southampton and Honorary Medical Oncology Consultant (for item 2) Kirsty Durrant (KD), Strategic HR Projects Manager (for item 5.8) Karen Flaherty (KF), Associate Director or Corporate Affairs and Company Secretary Sarah Herbert (SHe), Divisional Head of Nursing and Professions, Division B (for item 5.9) Sandra Hodgkyns (SHo), Head of Emergency Planning Response and Resilience/Security (for item 5.9) Stephanie Ramsey (SR), Director of Quality and Integration (Chief Quality Officer and Chief Nurse), NHS Southampton City CCG (for item 5.6) 3 governors (observing) 3 members of the public (observing) 5 members of staff (observing) 1 member of the public (for item 2) 1 Chair’s Welcome, Apologies and Declarations of Interest The Chairman welcomed all those attending to the meeting. The following declaration of interests for GB were reported to the Board: • Chair of the Directors of Nursing Group, University Hospital Association; • Chair of the Wessex Patient Safety Collaborative; and • Member of the Policy Board, NHS Employers. The Board also noted that DB was no longer a director of Davox Consulting Limited. 2 Patient Story The patient story was told by the husband of a patient who sadly died in early 2020 following treatment for cancer at the Trust. As a result of the treatment she had received at the Trust following a diagnosis in April 2017, her life had been extended by over three years. In terms of areas for improvement, better communication of his wife’s initial diagnosis would have helped her and her family to come to terms with the diagnosis more quickly. Following their arrival at hospital, they were being asked lots of questions and his wife was being sent for tests and scans without being given information about what concerns the clinicians had or potential diagnoses. The diagnosis was also delivered on the ward just prior to a visit from a relative and with better planning this could have been done more sensitively by providing a better environment in which to have the conversation and more time for his wife to absorb the information. Once his wife met the specialist team, including the specialist nurse, she felt more reassured and was given hope by the availability of different treatment options. The Trust’s appointment of a dedicated specialist nurse for his wife’s particular cancer shortly after her diagnosis made a huge difference. The specialist nurse was always present when his wife met the consultants and would check if there was anything he or his wife needed and provided practical advice and support, which meant that he and his wife were able to spend more time together. GB reiterated the importance of specialist nurses across different patient pathways and the Trust continued to invest in more specialist nurses. While acknowledging that there was a shortage of private spaces to speak with patients and their families, through its End of Life Care Steering Group the Trust had identified a number of rooms across the hospitals to enable clinicians to go somewhere private in situations like these. The cancer service also continued to adapt to changes in cancer care and the needs of patients, with patients now living longer. Maggie’s Southampton had recently opened at the Southampton General Hospital site to provide help and support for those living with cancer, although the services it offered were currently reduced as a result of the Covid-19 pandemic. The Board expressed its gratitude for sharing the story with such strength and dignity. 3 Minutes of Previous Meeting held on 28 January 2021 The minutes of the meeting held on 28 January 2021 were approved as an accurate record of that meeting. 4 Matters Arising and Summary of Agreed Actions The updates on the actions were noted. The action relating to cancelled appointments in ophthalmology (reference 354) had been followed up and could be closed, as could the actions relating to patients medically optimised for discharge (reference 351 and 393) and the Ockenden report (reference 395), which were included as items on the agenda later in the meeting. The action relating to patient nutrition (reference 394) would be reviewed at the next meeting of the Quality Committee, which would then report to the Board. The Board agreed that the actions relating to specialty outcomes (reference 350 and reference 326) should be combined, with the paper due to be presented to the Board at its meeting in April 2021. Page 2 5 QUALITY, PERFORMANCE and FINANCE 5.1 Briefing from the Chair of the Audit and Risk Committee KE updated the Board on the meeting of the Audit and Risk Committee held on 15 March 2021: • the external audit work had commenced and there were no issues to report at this early stage; • the internal auditors had reviewed referral to treatment (RTT) data quality and while data inaccuracies had been identified in the sample testing, these had not impacted on patients clinical treatment or on Trust’s the overall performance against the RTT target, and in most instances had resulted in the Trust overreporting on pathways; and • updates had been provided on progress against the recommendations in the board governance review and the ongoing review of the data security and protection toolkit. 5.2 Briefing from the Chair of the Finance and Investment Committee DB provided an overview of the Finance and Investment Committee meeting the previous day, highlighting: • that funding for the loss of other income and additional accruals of annual leave that staff had been unable to take due to the Covid-19 pandemic had been received; • the update on the planning process for 2021/22 following the publication of new national guidance that sought to achieve a balance between restoring services and reducing backlogs while supporting staff recovery; • the review of the most recent operational productivity dashboard, from which it had been difficult to draw any meaningful conclusions given the impact of the Trust’s response to the most recent wave of the Covid-19 pandemic in the previous months; and • the business case for the expansion of the outpatients area in ophthalmology, which would be considered by the Board later in the meeting. 5.3 Briefing from the Chair of the Quality Committee TP provided an update on the meeting of the Quality Committee held on 15 March 2021 focusing on the following areas: • the increase in waiting times for diagnostics and plans to recover performance, with a review of patient harm to be completed once patients who had waited longer than six weeks had been seen; • the review of a ‘never event’ relating to a retained swab including the recommendations for a number of sensible actions that had already been implemented; • the latest update on experience of care including the Trust’s accreditation as a Veteran Aware NHS trust; • the recommendations for reporting on maternity safety following the Ockenden review of maternity services at Shrewsbury and Telford Hospital NHS Trust, which would be considered by the Board later in the meeting; • the urgent investigation of aspergillus infections in the intensive care unit to establish whether there was a link to an earlier leak in a pipe above the ceiling in that area; • the latest report on clinical outcomes, with the Board to receive a full Page 3 report at its meeting in April 2021; and • the review of the committee’s effectiveness. 5.4 Chief Executive Officer’s Update The Trust had taken part in the national day of reflection and one minute’s silence on 23 March 2021 to commemorate the anniversary of the first national lockdown due to the Covid-19 pandemic. This had given staff an opportunity to pause and reflect on the loss of life over the previous year, including patients and staff. There were currently 20 patients in the hospital who had tested positive for Covid-19, three of which were in intensive care. An average of three or four patients with Covid-19 were being admitted daily, which highlighted the importance of continuing to follow the rules as lockdown measures were eased. Staff were being encouraged to take annual leave and wellbeing conversations were taking place with every member of staff. Second doses of the Covid-19 vaccine were being administered to Trust staff and staff at health and social care partners. 92% of frontline staff and 90% of all staff had received at least one dose of the vaccine, including 88% of BAME (Black and Minority Ethnic) staff. Staff who had not yet received the vaccination were being contacted individually to understand the reasons for this and provide additional information where appropriate. As well as planning for the recovery of services in the short term, the Trust was carrying out long-term modelling of future demand and capacity supported by external consultants and architects, which would form the basis of the Trust’s estates masterplan for the main hospital site. In advance of this work, the corporate objectives for 2021/22 would be presented to the Board at its meeting in April 2021. The Trust had performed exceptionally well in its recent external accreditation of endoscopy by the Joint Advisory Group on GI Endoscopy (JAG), providing one of the best submissions reviewed by JAG. Each of the executive directors provided an update in turn, covering the following areas: • reopening of theatres in Southampton General and Princess Anne Hospitals, replacing the current additional capacity in the independent sector from 1 April 2021; • four ‘Always Improving’ quality improvement projects relating to the emergency department (ED), discharge of patients medically optimised for discharge (MOFD), theatres and outpatients; • the launch of the ‘Always Improving’ strategy with staff in June 2021; • the review of patients who had been waiting for surgery, in particular those in priority level 2 (surgery that can be deferred for up to four weeks); • modelling of the potential impact on the waiting list of GP referrals returning to more normal levels and patients potentially presenting with more advanced disease than if they had seen their GP earlier; • the business intelligence programme to improve prospective as well as retrospective reporting; • allowing time for teams to readjust to working together as part of the recovery process with additional support from the Trust for those teams experiencing challenges; • plans to safely reopen the hospitals to visitors, particularly while the Page 4 Trust continued to admit patients with Covid-19; • re-energising the COVID ZERO campaign to ensure that the infection control measures continued to be followed rigorously even as the number of cases reduced, with a nosocomial infection the previous week acting as a timely reminder of the risk; • the successful renegotiation of the limit on expenditure (CDEL) for 2020/21 through which the Trust had been able to access additional capital and the negotiation of the allocation of CDEL across the integrated care system (ICS) for 2021/22; and • the current projects in development including theatres, the private patient unit, ophthalmology and the pathology laboratory information system. The Board noted that that the Trust would need to establish how it would balance the needs of those patients who had been waiting longest for treatment with the clinical prioritisation process already in place as it planned for the recovery of activity. 5.5 Integrated Performance Report for Month 11 The integrated performance report (IPR) for month 11 was noted. During February 2021 the direct impact of Covid-19 infections upon the Trust continued to be significant. There were 263 patients in the hospital with Covid19 at the start of February and 129 at the end of the month. The number of patients in intensive care reduced from 67 at the beginning of the month to 39 by the end of February. This compared to the first wave of Covid-19 pandemic, when the number of patients with Covid-19 in the hospital peaked at 173 and 38 in intensive care. This also had an impact on elective activity within the Trust, which was 42% of the level in February 2020. The Board discussed the following areas: Responsive • while the Trust’s ED was performing well comparatively, it was not meeting the performance target on the length of time patients spent in ED, despite attendances at 71% of the normal level; • this was principally due to patients presenting with mental health conditions and surges of high acuity patients, however, new junior doctors had also joined ED in February who were not used to the level of attendances; • leadership in ED was central to managing the department in these situations particularly the effective operation of the consultant of the day model to ensure that decisions regarding patients were made in a timely manner; • performance in ED had improved overall as 87% of patients were currently seen within four hours with an average daily attendance of 345 patients compared to 78% of patients two years ago when the average daily attendance was 350 patients; • to continue to improve performance and the flow of patients through ED the Trust was ensuring that specialties adhered to the one hour standard for referrals; • infection control measures remained in place, including respiratory assessment and rapid testing in ED and the acute medical unit, although it was difficult to establish whether this had a material impact on performance as ED had performed consistently well during the Page 5 period of the pandemic; • activity in ED had increased in March 2021 as lockdown restrictions had eased; • while the number of non-face-to-face outpatient appointments had increased following the first wave of the pandemic, some of these had not been full appointments but rather an opportunity to check in with patients; • the use of non-face-to face outpatient appointments varied by condition and specialty and was more appropriate for some of these than others, however, the Trust was seeking to learn from those clinicians who had used these types of appointment successfully as part of its quality improvement work in outpatients; • feedback from patients non-face-to face appointments had been positive on the basis that their care was continuing, however, limited work had been done to assess effectiveness in terms of the experience and outcome of these appointments; and • although cancer performance measures remained stable, both the Trust and the Wessex Cancer Alliance had performed well comparatively and ranked as second highest performing in their respective peer groups. Safe • • the unusually high number of medication incidents reported with moderate or severe harm in February and the actions taken in response to these; and ensuring that staff continued to report incidents, particularly as they returned to their normal areas of work following the pandemic. Caring • the number of overnight ward moves for non-clinical reasons given that most patient moves during this period would be related to patients admitted with Covid-19; • the percentage of patients with a disability or additional needs reporting that those needs were met had reduced and there were resource challenges in this area currently with a vacancy in one of the two adult learning disabilities nursing roles, although the recruitment process was underway; and • increasing the number of vulnerable women on a continuity of carer pathway given the benefit to all these women in terms of the quality of oversight in maternity. ACTIONS: (1) GB would review the non-clinical reasons for overnight ward moves and provide an overview to the Quality Committee. (2) The Quality Committee would review the resourcing required to increase the percentage of vulnerable women on a continuity of carer pathway and update the Board. Well-led • the impact of research activity on outcomes, more detail of which would be provided in the report on clinical outcomes at the meeting of the Board in April 2021. The Board’s review of the IPR, led by TP, would report to the Board in May 2021 with a candidate IPR. Page 6 5.6 Inpatient Flow - Medically Optimised for Discharge Update SR joined the meeting for this item. The Board noted the current performance against the process improvement trajectories and key performance indicators agreed by the system, system plans in the light of current performance and the Trust’s internal work programme for MOFD. The Board was interested to learn what the Trust could be doing differently or better in order to help improve performance as a system. The work to date had made a significant impact as the system responded to discharge an increased number of patients with more complex needs such as stroke patients, patients with challenging behaviours, patients requiring more intensive therapy and homeless patients. There was a specific issue with discharging to care homes at weekends and providing the necessary clinical support to these care homes to enable discharge. The main areas of focus for the Trust were to speed up processes and ensure patients MOFD were ready to be discharged earlier in the day as this would make it easier for services in the community to respond. While there was a target to get to 40-60 patients MOFD in hospital, no specific timescales had been set. ACTION: JT agreed to include a trajectory for MOFD patients in the regular reports to the Finance and Investment Committee. Funding was also likely to be an issue in the future as additional national funding provided during the Covid-19 pandemic to support the discharge of patients would be withdrawn at the end of June 2021. The Board recognised that system partners were aligned in their aim to address the delays in discharging patients MOFD and prevent potential patient harm as a result. However, the Board suggested a more holistic view of the issue would be beneficial when reviewing future resourcing, taking into account the revenue and capital implications and the consequences in terms of hospital capacity and addressing the current backlog of patients waiting for treatment. This analysis may identify where investment was needed to support discharge, including additional capacity, albeit that the ambition remained ‘home first’ when discharging patients in order to assess ongoing needs more accurately and reduce dependency. The meeting was adjourned briefly to allow for a break. 5.7 Ockenden Review of Maternity Services The Board noted the update on progress on the emerging findings and recommendations of the independent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust released on 10 December 2020. The Trust had rated its progress against two of the recommendations as red, with no actions currently in place, and nine of the recommendations as amber, where actions were still in progress. Completion of these recommendations was dependent the Trust’s submission to NHS Resolution’s maternity incentive scheme which would be made by mid-July 2021 and therefore other trusts would be in a similar position. The Trust had received feedback on the information submitted to NHS England and NHS Improvement, which had been positive overall. A template had been designed to report to the Board and the local maternity Page 7 service (LMS) on maternity safety, which would incorporate a summary of serious incidents (SIs) and moderate harm incidents. This report would be submitted to the Board maternity safety champions and LMS on a monthly basis. The Board maternity safety champions would also meet with complainants before the referral of a complaint to the Parliamentary and Health Service Ombudsman. It was proposed that reporting to the Board on maternity safety issues including SIs and moderate harm incidents, the perinatal mortality report tool, early notification scheme, red flag incidents, staff concerns and evidence of listening to families including complaints would take place quarterly following review of the information by the Quality Committee. The frequency of reporting to the Board was in line with the recommendations in the Ockenden review although not with the guidance issued subsequently. The Board was keen to ensure it maintained a good understanding of the culture and patient experience in the maternity service given the impact of each on the quality of the service. Proposals to regularly survey staff would be considered later in the meeting. In addition the Board requested that the regular patient story should include maternity at least once annually. ACTION: KF to arrange a patient story from a patient using the maternity service at least once annually. DECISION: The Board agreed: • to receive a quarterly report on maternity safety issues; and • that all SIs and moderate harm incidents would be provided to the Board maternity safety champions and LMS. 5.8 UHS Staff Survey Results 2020 Report BC and KD joined the meeting for this item. The results of the NHS staff survey 2020 were noted by the Board. The survey had been completed by staff between September and November 2020. Overall the Trust’s results were at or above the acute trust average in nine out of ten themes. 77% of staff would recommend the Trust as a place to work and 87% of staff agreed that care of patients was the top priority for the Trust. Performance on health and wellbeing had significantly increased compared to 2019. However, the survey had also identified some areas for improvement. The areas with statistically significant decreases in performance compared to the 2019 staff survey results were: • Equality, diversity and inclusion; • Immediate managers; • Violence; and • Team working. In response to a question from a NED, it was clarified that only a small number of incidents of violence against staff from managers and colleagues reflected in the staff survey results were reported leading to an investigation. The reporting through the Trust’s Freedom to Speak Up processes had identified incidents involving microaggressions rather than acts of violence. Work was also ongoing to improve leadership skills within the organisation, which would set out expectations regarding values and behaviours. Over 1,000 free text comments had been submitted from staff as part of the survey and a national analysis of themes was being prepared, which would Page 8 provide further insight into how staff were feeling following the first wave of the pandemic. The Board supported more regular surveying of staff, particularly around the areas of improvement identified, recognising that things had changed since the survey was carried out six months ago and would continue to change. 5.9 Plan to Address Violence and Aggression against Staff SHe and SHo joined the meeting for this item. The Board noted the update on the progress made since the previous update in September 2020. This included closer working with Hampshire Constabulary, proposed changes to security arrangements, staff training and staff support. These plans aimed to reduce incidents of violence and aggression against staff and provide support to staff in the management of violence and aggression and following any incidents. The Board recognised that violence and aggression against staff would never be eliminated entirely as the Trust provided care to individuals with mental health issues, brain injuries, dementia and who lacked capacity who may find it difficult to control their behaviour. It was important, however, that violent and aggressive behaviour was challenged consistently when appropriate. The Board supported the approach to exclude violent and aggressive individuals from the Trust when they repeatedly displayed unacceptable behaviour that it was not possible to manage through de-escalation, anticipatory care planning and the challenging behaviour protocol. While not formally approving the funding for the plans set out in the paper, the Board noted the importance of investment in this area in order to support staff. A further update on progress would be provided in December 2021. 5.10 Finance Report for Month 11 The finance report for month 11 was noted. The following areas were highlighted: • the Trust has received the payments for the loss of other income, additional accruals of annual leave that staff had been unable to take due to the Covid-19 pandemic and the elective incentive scheme; • the Trust remained on track to achieve a breakeven position for 2020/21 as did the other trusts in the Hampshire and Isle of Wight ICS; and • the Trust’s balance sheet position remained strong, which placed the Trust in a good position to address likely pressures in 2021/22. 6 CORPORATE GOVERNANCE, RISK and INTERNAL CONTROL 6.1 Register of Seals and Chair's Actions for ratification DECISION: The Board ratified the application of the Trust seal and the Chair’s actions set out in the report. ACTION: IH would follow up on the Wessex Clinical Research Network and the assisted conception service items in the paper as these were not single tender actions required to be reported in accordance with the Trust’s Standing Financial Instructions. 6.2 Amendment to Constitution for CCG Merger With effect from 1 April 2021, the individual Clinical Commissioning Groups Page 9 (CCGs) within Hampshire and the Isle of Wight were to merge to create a new NHS Hampshire, Southampton and Isle of Wight CCG. The Council of Governors (CoG) included an appointed governor from each of NHS Southampton City CCG and NHS West Hampshire CCG and as a result of the merger these two organisations would cease to exist. It was proposed that the Trust should reflect the merger in the composition of the CoG, by amending the composition of the CoG in Annex 3 of the Trust’s constitution to remove the Appointed Governor from each of NHS Southampton City CCG and NHS West Hampshire CCG and include an Appointed Governor from NHS Hampshire, Southampton and Isle of Wight CCG in their place. A separate review of the composition of the CoG would be undertaken as part of the annual review of the Trust’s constitution to ensure that the overall composition of the CoG remains representative and reflected the changes to NHS governance structures. DECISION: The Board approved the amendment to the Trust’s constitution with effect from 1 April 2021, subject to the approval of the CoG at its meeting on 31 March 2021. 7 Any Other Business There was no other business. 8 To note the date of the next meeting: 27 May 2021 9 Resolution regarding the Press, Public and Others DECISION: The Board resolved that, as permitted by the National Health Service Act 2006 (as amended), the Trust's Constitution and the Standing Orders for the Practice and Procedure of the Board of Directors, representatives of the press, members of the public and others not invited to attend to the next part of the meeting be excluded due to the confidential nature of the business to be transacted. The meeting was adjourned. Page 10 4 Matters Arising and Summary of Agreed Actions 1 List of Action Items List of action items Agenda item Assigned to Deadline Status Trust Board – Open Session 30/03/2021 5.5 Integrated Performance Report for Month 11 426. Caring - overnight ward moves Byrne, Gail Peachey, Tim 27/05/2021 Pending Explanation action item GB would review the non-clinical reasons for overnight ward moves and provide an overview to the Quality Committee. 427. Caring - vulnerable women Byrne, Gail Peachey, Tim 27/05/2021 Pending Explanation action item The Quality Committee would review the resourcing required to increase the percentage of vulnerable women on a continuity of carer pathway and update the Board. Trust Board – Open Session 30/03/2021 5.6 Inpatient Flow - Medically Optimised for Discharge Update 428. Trajectory for MOFD patients Teape, Joe 27/05/2021 Pending Explanation action item JT agreed to include a trajectory for MOFD patients in the regular reports to the Finance and Investment Committee. Trust Board – Open Session 30/03/2021 5.7 Ockenden Review of Maternity Services 429. Patient story Flaherty, Karen 31/03/2022 Pending Explanation action item KF to arrange a patient story from a patient using the maternity service at least once annually. Page 1 of 2 Agenda item Assigned to Deadline Status Trust Board – Open Session 30/03/2021 6.1 Register of Seals and Chair's Actions for ratification 430. Follow up Howard, Ian 27/05/2021 Pending Explanation action item IH would follow up on the Wessex Clinical Research Network and the assisted conception service items in the paper as these were not single tender actions required to be reported in accordance with the Trust’s Standing Financial Instructions. Page 2 of 2 Report to the Trust Board of Directors Title: Agenda item: Sponsor: Date: Purpose Issue to be addressed: Integrated Performance Report 2021/22 Month 1 5.5 David French, Chief Executive Officer 27 May 2021 Assurance Approval or reassurance Y Ratification Information This report is intended to support the Trust Board in assuring that: • the care we provide is safe, caring, effective, responsive and well led in the context of the COVID-19 pandemic • at the same time we continue our journey toward our vision of World Class Care for Everyone. Response to the issue: The Integrated Performance Report reflects the current operating environment and is aligned with the Care Quality Commission Key Lines of Enquiry. Implications: This report covers a broad range of trust services and activities. It is (Clinical, Organisational, intended to assist the Board in assuring that the Trust meets regulatory Governance, Legal?) requirements and corporate objectives. Risks: (Top 3) of carrying This report is provided for the purpose of assurance. out the change / or not: Summary: Conclusion This report is provided for the purpose of assurance. and/or recommendation Page 1 of 1 Integrated KPI Board Report covering up to April 2021 Sponsor - Andrew Asquith, Director of Planning, Performance and Productivity, andrew.asquith@uhs.nhs.uk Chart Type Cumulative Column Example Cumulative Column Year on Year Line Benchmarked Line & bar Benchmarked Control Chart 100% 0% 66.8% Variance from Target Report Guide Explanation A cumulative column chart is used to represent a total count of the variable and shows how the total count increases over time. This example shows quarterly updates. A cumulative year on year column chart is used to represent a total count of the variable throughout the year. The variable value is reset to zero at the start of the year because the target for the metric is yearly. The line benchmarked chart shows our performance compared to the average performance of a peer group. The number at the bottom of the chart shows where we are ranked in the group (1 would mean ranked 1st that month). 66.49% The line shows our performance and the bar underneath represents the range of performance of benchmarked trusts (bottom = lowest performance, top = highest performance) A control chart shows movement of a variable in relation to its control limits (the 3 lines = Upper control limit, Mean and Lower control limit). When the value shows special variation (not expected) then it is highlighted green (leading to a good outcome) or red (leading to a bad outcome). Values are considered to show special variation if they -Go outside control limits -Have 6 points in a row above or below the mean, -Trend for 6 points, -Have 2 out of 3 points past 2/3 of the control limit, -Show a significant movement (greater than the average moving range). Variance from target charts are used to show how far away a variable is from its target each month. Green bars represent the value the metric is achieving better than target and the red bars represent the distance a metric is away from achieving its target. 2 Report to Trust Board in May 2021 Introduction The Integrated Performance Report is presented to the Trust Board each month. The report aims to: • Provide assurance that the care we provide is safe, caring, effective, responsive and well led in the context of the COVID-19 pandemic • Ensure that at the same time we continue our journey toward our vision of World Class Care for Everyone. We adjust / add to these indicators – informing the Board and keeping a comparative narrative – as the situation changes as we work through these unusual circumstances. The structure of the report is currently being reviewed in order that it can better reflect the ambitions within ‘Our Strategy 2025’, and to support the strategic discussions of the Board. April 2021 Summary During April the direct impact of COVID-19 infections upon the Trust reduced further. Patients with a confirmed COVID-19 diagnosis during their admission: • Started the month at 48 (11 of which were in intensive care / high care) • Finished the month at 24 (5 of which were in intensive care / high care) The phased resumption of the elective admissions continued within NHS facilities, and the additional access to independent sector theatres and beds that had been secured by NHS England during the pandemic terminated at the end March. 3 Report to Trust Board in May 2021 Key aspects of performance for consideration this month include: • The total number of patients on the RTT waiting list increased by over 1,000 patients to 37,613 in April. There are over 3,000 patients waiting over 52 weeks for treatment and over 500 patients waiting over 78 weeks. Our benchmarking confirms that we are continuing to perform well in comparison to our peer group. • The crude mortality rate and Hospital Standardised Mortality Ratio (HSMR) both increased significantly in January (though HSMR remained significantly better than would be expected on average in the NHS). Patient details have been requested in order that the recorded diagnosis can be checked as a first step in investigation. It may be relevant that January saw a peak in COVID-19 occupancy. • UHS 62 day performance (RE 23) improved to 86.5% (better than our local target and the national target applying to the majority of 62 day pathways). UHS was the best performing trust amongst our 10 ‘peer’ teaching hospitals in March. 4 Report to Trust Board in May 2021 RESPONSIVE • Emergency Department timeliness deteriorated slightly to 87% (RE 9) whilst remaining 3rd best amongst 8 benchmark trusts. Attendance numbers increased further to the highest levels since the COVID-19 pandemic started (RE 8). • Elective spell volumes (excluding daycases, at SGH/PAH only) (RE 13) recovered further, yet remained below those in Autumn 2020. Two SGH theatres are currently closed due to building works and are due to reopen in June. • The total number of patients on the RTT waiting list increased by over 1,000 patients this month. The cohort of patients who have waited over 52 weeks (RE 16) reduced by over 300 patients, whilst those waiting over 78 weeks (RE 17) increased by over 100 patients. We remain concerned by this situation and are focussed on improving the situation as soon as possible for our patients. Our benchmarking (in a group of 20 Teaching hospitals) confirms that we are continuing to perform well in comparison to our peer group. • Cancer performance measures for March indicate continued improvement in performance: o UHS 62 day performance (RE 23) improved to 86.5% (better than our local target and the national target applying to the majority of 62 day pathways). UHS was the best performing trust amongst our 10 ‘peer’ teaching hospitals again this month. o 31 day performance (RE 24) was maintained above the target at 97.6%. 5 Report to Trust Board in May 2021 RESPONSIVE RE1 Non-elective Spells (discharged, including CDU) Non Elective LOS RE2-L Rolling 12 months (Solid) Monthly (Dashed) Number of inpatients that were RE3 medically optimised for discharge (monthly average) Monthly Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr target 6,800 6,292 4,000 7.5 6.0 4,128 6.49 - 5.45 - 4.5 250 76 0 122 - Longer LOS Census average RE4-N (Patients with LOS > =21days) 203.38 160.86 118.33 73 145 - RE5-l RE6 RE7 Adult midday bed occupancy Last minute cancelled operations not readmitted within 28 days Last minute cancelled operations 100% 98.2% 84.6% 71.1% 82.6% 40% 55 40 0 150 5 0 79.0% 90-95% - 6 35 - 6 Report to Trust Board in May 2021 RESPONSIVE Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr QTD 12,000 10663 RE8 Total ED Attendances - 5735 5,000 RE9-N Patients spending less than 4hrs in ED SGH Main ED (Type 1 and UCH) 92% 84% Major Trauma Centres (Type 1) 76% 90.2% 87.2% 81.30% 87.2% Rank of 8-> RE10-N Patients spending less than 4hrs in ED UHS Total (includes SGH all types) - 532533422111233 92.22% 85.5% 78.82% 91.1% 91.1% 88.0% 88.0% Q target - 95% 95% RE11-N Total time Total spent in ED - Percentiles UHS RE12 27,000 Accepted Referrals (excluding -initiated by consultant responsible) 0 RE13 2,000 Elective spells (excluding daycase, onsite SGH/PAH only) 0 90th, 4:00 Mean, 2:45 8,013 446 90th, 4:59 - - Mean, 3:04 19,100 - - 1,438 - - 7 Report to Trust Board in May 2021 RESPONSIVE Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan 100% % Patients on an open 18 week pathway 66.8% RE14-N (within 18 weeks ) with teaching hospital min-max range and rank (of 20) 18 12 14 14 7 6 7 7 10 10 10 9 30% 38,000 Total number of patients on a waiting RE15-N list (18 week referral to treatment 33106 pathway) 30,000 Patients on an open 18 week pathway 9,000 RE16-N (waiting 52 weeks+ ) with teaching hospital min-max range and rank (of 20) 0 15 154 13 13 13 11 11 11 10 9 6 6 6 1000 RE17 Patients on an open 18 week pathway (waiting 78 weeks+ ) 500 0 0 65,000 RE18 Face to face outpatient attendances 40,105 Feb Mar Apr 66.5% 9 8 37613 3108 5 4 553 34,415 Target > =92% - 0 65,000 RE19 Non-face to face outpatient attendances 15,703 0 RE19 - Latest month is awaiting approx ~3k outpatient attendances to be reported 18,748 - RE20-N Average weeks waited for first outpatient appointment 12.00 10.47 8.89 10.3 7.00 7.30 8.5 - 8 Report to Trust Board in May 2021 7.00 7.30 RESPONSIVE Target Patients to Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar /Apr recover target QTD 11,000 9563 RE21-N Patients waiting for diagnostics - 4317 4,000 80% % of Patients waiting over 6 weeks for RE22-N diagnostics with teaching hospital min- 45.2% 27.2% 90% N = 7 L= L=> 0 of 197 80% 85% 69.1% UHS Total ………………….Rank(of 10)-> 6 5 3 1 1 1 1 1 5 7 4 2 1 1 0.5 31 day cancer wait performance RE24-N (Latest data held by UHS, Combined measure – First and Subsequent Treatments of Cancer) 97.1% 93.2% 89.4% 92.2% 97.6% N=> 96% N=0 of 948 97.41% RE25-N Snapshot of waits > 104 days (from referral on a 62 day pathway) 36 27 29 25 11 17 9 11 25 24 17 13 16 22 - - - RE26-N 28 Day Faster Diagnosis 100% 70% 82.7% 87.5% => 75 % - 84.16% 9 Report to Trust Board in May 2021 RESPONSIVE RE27 My Medical Record - UHS patient logins Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr Monthly target 20,000 18,182 10,000 5,566 - 0 2,500 RE28 Number of Estates Help desk requests 900 and percentage completed on time 100% 85% 997 89.6% 1,592 - 84.7% > 85% 50% Elective inpatient activity - % of same month pre COVID-19 100% RE29 UHS Corporate peer average ------------------------------Rank--> 20% Non-elective inpatient activity - % of same month pre COVID-19 100% RE30 UHS Corporate peer average ------------------------------Rank--> 50% 1st outpatient attendances - % of same month pre COVID-19 100% RE31 UHS Corporate peer average ------------------------------Rank--> 30% Follow up outpatient attendances - 110% % of same month pre COVID-19 RE32 UHS Corporate peer average ------------------------------Rank--> 50% RE29-32 corporate peers group size = 7 90.4% 85.1% 35.23% 3 2 2 2 2 2 1 1 4 4 2 95.0% 66.6% 95.42% 534422232254 96.2% 51.7% 93.77% 47.20%2 2 2 2 2 2 2 2 2 2 2 3 70.3% 108.9% 102.8% - 63.6% 6 3 2 2 1 1 2 2 1 1 4 5 QTD - 86.2% - 10 Report to Trust Board in May 2021 SAFE • Only a single case of probable hospital associated COVID-19 acquisition > 7 days occurred in April (SA 6). • Our measure related to pressure ulcers was amended this month to distinguish between category 2 and 3 ulcers, regardless of level of ‘harm’ (SA 7/8). Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr Target YTD SA1-N Cumulative Clostridium difficile 2 SA2 MRSA bacteraemia 0 100 SA3 Clinical cleaning scores for very high risk areas 95 100 SA4 Serco cleaning scores for very high risk areas 95 Healthcare-acquired COVID 35 SA5 infection: COVID-positive sample taken > 14days after admission (validated) 0 Probable hospital-associated 80 SA6 COVID infection: COVID-positive sample taken > 7 days and 95% - 93.4% YTD target 95% 12 Report to Trust Board in May 2021 CARING • Inpatient feedback (CA 1) continues to be good and significantly better than target. • Maternity patient negative feedback (CA 2) continues to be worse than target; 6.6% compared to the target of =70% 41.5% 65.6% 14 Report to Trust Board in May 2021 0% CARING Monthly Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr target Total vulnerable women (living 100% CA8 within 10% most deprived decile) booked onto a continuity of carer 40.0% pathway 0% 100% % Patients reporting being CA9 involved in decisions about care and treatment 50% 86.0% 85.0% > =90% CA10 100% % Patients reporting finding somebody to talk to about worries and fears 50% 97.0% % Patients with a disability/ 100% additional needs reporting those 81.0% CA11 needs/adjustments were met (total number questioned included at chart base) 30 165 39 50% 57 153 215 133 164 174 178 240 77 CA11 - Performance is a scored metric with a "Yes" response scoring 1, "Yes, to some extent" receiving 0.5 score and other responses scoring 0. Overnight ward moves with a 100 CA12 reason marked as non-clinical (excludes moves from admitting 75.58 44.08 10 wards with LOS =90% 89.0% > =90% 63 110 289 29 - 10.8 - 15 Report to Trust Board in May 2021 EFFECTIVE • The crude mortality rate (EF 4) and Hospital Standardised Mortality Ratio (HSMR) (EF 3), both increased significantly in January (though HSMR remained significantly better than would be expected on average in the NHS). More deaths than ‘expected’ are reported in General Medicine, Respiratory Medicine and Medicine for Older People, with a primary diagnosis of ‘viral infection’. Information for 97 patients has been requested in order that the recorded diagnosis can be checked as a first step in investigation. • Measures relating to patients screened for smoking and harmful alcohol consumption (EF 5), with those found to smoke and given brief advice or a medication offer (EF 7), stalled in their recovery following the COVID-19 peak in January and are currently slightly below target. EF1-L Cumulative Specialities with Outcome Measures Developed EF2 Developed Outcomes RAG ratings EF3-N HSMR - UHS HSMR - SGH EF4 HSMR - Crude Mortality Rate Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr 53 54 56 56 57 255 260 285 305 332 100% 75% 80% 81% 79% 77% 76% 50% 85 82.2 81.5 75 3.5% 3.0% 2.5% Monthly target +1 - 80% EF6-N % patients screened & found to 100% have either moderate or high alcohol dependence given advice or referral 80% 96.7% 95.7% > 90% 100% % patients screened & found to EF7-N smoke given brief advice or a medication offer 60% 83.6% 88.9% > 90% 17 Report to Trust Board in May 2021 WELL LED • Non-medical appraisal rates (WL 2) have continued their modest rate of recovery to 81%, but still remain significantly below the target of 92%. • Overall sickness absence (WL 6) reduced to 3%, which is within target, whilst COVID-19 related absence (WL 7) reduced to 1% of employed time during the month of April. WL1-L Substantive Staff - Turnover Monthly Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr Target 13.63% 12.92% 12.22% 13.4% 12.3% 92% 95.0% 3.4% 12.4% =76% WL9-N Response rate of - staff recommend UHS 60% as a place to work: UHS Quarterly staff FFT National NHS Staff Survey 20% 50.0% 30% 11% WL10-L % of Band 7+ staff who are Black and Minority Ethnic 9.2% 10.0% 15% by 2023 7% WL11 14% % of Band 7+ Staff who have declared a disability or long term health condition 13.3% 13.6% - 12% WL12- QI training programme, and reporting, is currently temporarily suspended as team members support urgent change programmes as part of our Covid 19 response and recovery WL12-L Statutory & Mandatory Training Achieving Target 7 7 7 6 6 6 6 6 6 6 6 6 6 6 6 - 5 5 5 6 6 6 6 6 6 6 6 6 6 6 6 100 WL13-L Number of Apprenticeship Starts 44 49 59 23 - 0 19 Report to Trust Board in May 2021 0 WELL LED Monthly Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr target WL14-L Comparative CRN Recruitment Performance by clinical specialty 56% 52% 28% 36% 40% > =70.0% WL15-L Comparative CRN Recruitment Performance - weighted WL16-L Comparative CRN Recruitment - contract commercial WL17-L Proportion of studies closing in FY on time and to recruitment target non-commercial WL18 NIHR CRF & BRC cumulative quarterly publications 2 5 13 88% 13 50% 600 137 120 0 2 17 43% 246 261 7 7 45% 424 329 Top 5 8 2 Top 10 42% 452 562 > =80% 20 Report to Trust Board in May 2021 Changes and Corrections Section Responsive Safe Safe Caring Caring KPI KPI Name Type RE29-32 Activity metrics - % of same month pre COVID-19, UHS and corporate peer average change SA7 Pressure ulcers category 2 per 1000 bed days change SA8 Pressure ulcers category 3 and above per 1000 bed days change CA11 % Patients with a disability/ additional needs reporting those needs/adjustments were met correction (total number questioned included at
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Finance and Performance Reports 2023-24 Month 2 May 2023

Description: Report to the Trust Board of Directors Title: Agenda item: Sponsor: Author: Date: Purpose Finance Report 2023-24 Month 2 9.2 Ian Howard – Chief Financial Officer Philip Bunting – Director of Operational Finance David O’Sullivan – Assistant Director of Finance – Financial Performance 29 June 2023 Assurance or reassurance Approval Ratification Information Issue to be addressed: Response to the issue: X The finance report provides a monthly summary of the key financial information for the Trust. M2 Financial Position UHS is reporting a deficit of £3.9m in May compared with a deficit plan of £3.7m. This is therefore £0.2m adverse to plan. This is an improvement of £1.5m from the previous month (£5.4m deficit reported in April) although April contained £1.1m of additional cost or lost income relating to the junior doctor strike hence was not anticipated to reoccur. May also included £0.8m of backdated income that had not been previously reported. YTD the deficit is £9.3m compared to a plan of £7.7m so £1.6m adverse to plan. The forecast remains as per the trust plan of £26m deficit. Financial improvement beyond plan will therefore be needed in future months to offset the YTD shortfall. Underlying Position The underlying position for May remained very consistent with the previous two months illustrating a stabilisation of the position. This was £4.7m deficit in month so £0.8m worse than the reported position of £3.9m due to several one-off benefits showing in month that are removed from the underlying position. Drivers The key underlying drivers for the deficit remain consistent with 22/23 including non-pay inflation, energy, drugs spend and the volume of patients not meeting the criteria to reside leading to surge bed costs. These have been partly offset with efficiencies in 22/23 but have left a legacy underlying deficit that remains. Additionally mental health patients are growing in number and causing significant cost pressures, particularly within agency, as patients often require one to one care and additional support from mental health qualified staff. Efforts are being made to capture these costs more accurately on a monthly basis to aid financial reporting. Drugs costs (non-pass through) have also increased in month from £2.6m in April to £4.5m in May, an increase of £1.9m. These costs are currently being reviewed with the pharmacy department in order to understand which areas this growth relates to and whether some costs may actually be pass through and should be reclassified in June with offsetting income then reported. Clinical supplies also increased however there were offsetting downward movements in other non-pay categories. Page 1 of 15 The expenditure increases above were however offset by clinical income increases mainly relating to ERF (discussed below) meaning the underlying position remained stable. The financial plan for 2023/24 targets eradication of the underlying financial deficit by the end of the year ensuring that cash reserves don’t fall below minimum levels. This is predicated on the achievement of £69m of CIP. Elective Recovery Funding Position The activity position in M2 improved significantly from M1 with achievement of 120% of 19/20 levels (this is currently an estimate based on ‘early run’ data). The previous month had seen activity of 112% of 19/20 achieved despite the junior doctor strike. Two theatre refurbishments were completed in month offering additional operating capacity from mid-May. Theatre utilisation also improved. This level of overperformance means UHS is anticipating an additional £1.4m YTD within the clinical income position. The plan also incorporates additional capacity coming online later in the year specifically relating to new wards expected to open in September and December. There should therefore be an opportunity to further increase activity levels during the year via this step change in capacity. Cost Improvement Plans The Trust has been working hard to identify plans for 2023/24 in contribution towards a target of £69m. This equates to delivery of 6% of income. Identification increased dramatically from £29.7m in April to £56.5m in May (82% of the total). It is also planned that efforts will be made to ‘over identify’ due to the risk of delivery for some schemes. Achievement at M2 was £6.3m YTD against a plan of £8.1m (£1.8m shortfall). It should be noted that this was c£5m ahead of that reported in 2022/23 and traditionally CIP delivery tends to occur to a greater degree in later months. A large number of schemes are in development including several that cut across multiple providers with the HIOW system. Further to this UHS is taking measures to increase financial grip and control especially around recruitment and temporary staffing to ensure staff growth is as per plan. Workforce / Pay Growth Substantive workforce growth provides both an opportunity and risk for the organisation. A material part of the 2023/24 workforce plan is to recruit to shortage areas and release temporary staffing spend that is often in the form of high-cost agency, premium bank or WLI spend. If delivered this should release significant workforce savings. There is however a significant challenge in ‘transacting’ these benefits as fill rates may just improve in areas where previously shifts were unfilled leading to cost not being released. As at May 2023 UHS was 212 wte (1.6%) ahead of its workforce plan with substantive staff 90 wte ahead of plan and bank staff 108 wte ahead of plan. Continuation of this trend presents a significant risk for UHS in the delivery of its financial and workforce plan. Capital Capital expenditure totals £3.7m YTD which is £3.4m behind plan. This is predominantly driven by wards, theatres, strategic maintenance and decarbonisation projects that are all currently behind plan. Spend is forecast to increase in future months to catch up for this shortfall. The plan for 2023/24 totals £49.4m including £5m of externally funded capital. A further award of £3.5m has also been granted in year relating to endoscopy expansion. Currently plans are 15% higher than our CDEL allocation with a level of slippage assumed. Spend will be monitored closely through 2023/24 to ensure risks and mitigations are fully understood and managed. Page 2 of 15 We are also awaiting final confirmation of £3.3m of additional national funding (CDEL only) to support the Neonatal business case with Specialised Commissioning. Cash The cash position has reduced by £20m from April to £85m in May 2023. This is consistent with the cash plan as a high volume of payables relating to capital have now been paid to suppliers. An underlying downward trend is still forecast to prevail due to the underlying financial deficit. We are continuing to have a current-account deficit, which is being funded by our capital investment savings account. NHS Pay Award Update The pay award for Agenda for Change staff has now been agreed following majority support by staffing unions. This will be paid in June with additional funding being paid in month to cover both the 22/23 non-consolidated payment and 23/24 pay award YTD. The finance team are in the process of confirming the level of financial exposure the trust has with regards to funding not covering the full cost of the award. There still remains some uncertainty regarding local differences to the national calculation and we await further clarification over whether funding will be adjusted. For example, the UHS contract with Serco is dynamically linked to agenda for change and therefore we may be contractually obliged to match the pay award although this has not been picked up within the funding calculation. This principle also applies to other Trusts e.g., PFI contracts. HIOW ICB Position A verbal update will be provided on the position at month 2. Implications: • Financial implications of availability of funding to cover growth, cost pressures and new activity. • Organisational implications of remaining within statutory duties. Risks: (Top 3) of carrying out the change / or not: • Financial risk relating to the underlying run rate and projected potential deficit if the run rate continues. • Investment risk related to the above • Cash risk linked to volatility above • Inability to maximise CDEL (which cannot be carried forward) and the risk of a reducing internal CDEL allocation for 2024/25 due to the forecast deficit for 2023/24. Summary: Conclusion and/or recommendation Members of Trust Board are asked to: • Note the update to the financial position. Page 3 of 15 Finance Report Month 2 Report to: Board of Directors and Finance & Investment Committee June 2023 Title: Author: Finance Report for Period ending 31/05/2023 Philip Bunting, Director of Operational Finance David O’Sullivan, Assistant Director of Finance Sponsoring Director: Ian Howard, Chief Financial Officer Purpose: Standing Item The Board is asked to note the report Executive Summary: In Month and Year to date Highlights: 1. In Month 2, UHS reported a deficit position of £3.9m which was £0.2m adverse to plan. YTD the deficit is now £9.3m which is £1.6m adverse to plan. The total plan for the year is £26m deficit which is currently forecast for delivery. The current shortfall to plan will need to be recovered in future periods in order to deliver to the full year plan. 2. The underlying position in May is a £4.7m deficit which has remained stable from M1. 3. CIP delivery was reported behind plan with £6.3m achieved compared to a plan of £8.1m. £56.5m of savings have been identified in plans, 82% of the trust target of £69m. There is continued focus on savings identification and delivery to support financial recovery. 4. The themes seen in M2 were: 1. UHS is over its elective recovery target in M2 by £1.4m (120% achieved v 113% target). 2. Associated clinical supplies costs increased by £1.0m from April in line with increased activity although this was offset by other non pay reductions. Drugs costs increased by £1.9m and are under investigation with pharmacy. 3. Underlying drivers for the monthly financial deficit remain as per 22/23 including inflation, energy, drugs and increased volumes of patients not meeting the criteria to reside. 4. Upward workforce trends remain a risk with particular pressure in month around additional nursing spend related to providing safe care for mental health patients. 5. Surge capacity also remains open at times to support flow at times of peak bed pressure. Page 14 of 15 Finance Report Month 2 Finance: I&E Summary UHS has submitted an annual plan position of £26m deficit for the 2023/24 financial year. In May a deficit position of £3.9m was reported, £0.2m adverse to plan. The YTD position of £9.3m deficit is £1.6m adverse to the planned deficit target of £7.7m. In month, clinical income exceeded the plan by £2.1m, positively impacting the position. This was mainly driven be ERF. Clinical supplies spend has however increased by £1.0m from Month 1 in line with activity increases however other non pay has reduced by £1.0m offsetting this. Drugs costs are under investigation with Pharmacy following an increase of £1.9m from April. Pay expenditure exceeded plan in month, primarily due to substantive staffing costs. Total pay costs were £1.0m over the plan. Current Month Plan Actual Variance £m £m £m NHS Income: Clinical 69.7 71.8 (2.1) Pass-through Drugs & Devices 15.8 16.0 (0.2) Other income Other Income 18.3 18.5 (0.2) Total income 103.8 106.3 (2.5) Costs Pay-Substantive 52.0 53.0 0.9 Pay-Bank 3.9 4.0 0.1 Pay-Agency 1.5 1.5 0.0 Drugs 2.7 4.5 1.8 Pass-through Drugs & Devices 15.8 16.0 0.2 Clinical supplies 5.7 5.6 (0.1) Other non pay 24.5 24.2 (0.3) Total expenditure 106.2 108.8 2.6 Remove Depreciation and Amortisation 3.2 3.1 0.1 Donated income (0.7) (0.7) (0.0) EBITDA 0.1 (0.1) 0.2 EBITDA % 0.1% -0.1% 0.2% Non operating expenditure/income (3.3) (3.4) 0.1 Surplus / (Deficit) (3.2) (3.4) 0.3 Less Donated income (0.7) (0.7) (0.0) Profit on disposals 0.0 0.0 0.0 Gain/ Loss on absorption 0.0 0.0 0.0 Add Back Donated depreciation 0.2 0.2 (0.0) Impairments 0.0 0.0 0.0 Net Surplus / (Deficit) (3.7) (3.9) 0.2 Cumulative Full Year Plan Actual Variance Plan Forecast Variance £m £m £m £m £m £m 139.7 140.0 (0.4) 836.2 836.2 0.0 31.4 30.5 0.9 204.1 204.1 0.0 36.9 37.2 (0.3) 196.1 196.1 0.0 208.0 207.7 0.2 1,236.4 1,236.4 0.0 104.0 105.6 1.6 630.4 630.4 0.0 7.8 8.4 0.5 43.6 43.6 0.0 2.9 2.7 (0.3) 15.1 15.1 0.0 5.7 7.1 1.4 32.4 32.4 0.0 31.4 30.5 (0.9) 204.1 204.1 0.0 11.4 10.1 (1.3) 70.3 70.3 0.0 48.8 49.4 0.6 240.7 240.7 0.0 212.0 213.7 1.7 1,236.6 1,236.6 0.0 6.4 6.3 0.1 38.0 38.0 0.0 (1.7) (1.4) (0.3) (18.4) (18.4) 0.0 0.6 (1.1) 1.7 19.4 19.4 0.0 0.3% -0.5% 0.8% 1.6% 1.6% 0.0% (7.0) (7.1) 0.2 (29.5) (29.5) 0.0 (6.4) (8.2) 1.9 (10.1) (10.1) 0.0 (1.7) (1.4) (0.3) (18.4) (18.4) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.4 0.4 (0.0) 2.5 2.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 - (7.7) (9.3) 1.6 (26.0) (26.0) 0.0 Page 25 of 15 Finance Report Month 2 Monthly Underlying Position The graph shows the underlying position for the Trust from April 2022 to present. This differs from the reported financial position as it has been adjusted for non recurrent items (one offs) to get a true picture of the run rate. The underlying position has remained static in May at £4.7m deficit (following revision to M1 figures). Throughout 2022/23 financial year, the run rate deteriorated from approximately £3m per month to reaching £5m per month by year-end. This decline was primarily driven by escalating energy costs and pressures related to activity, particularly during the winter period, including the need for surge beds. The plan for 2023/24 is to eradicate the underlying deficit by financial year end . A table outlining risks is also shown and will be monitored and added to in year. Risk Variable Unidentified CIP System CIP Initiatives Identified CIP Delivery Risk Inflationary Pressure (non pay and unfunded pay award) Total Risk Mitigations Additonal CIP Net Risk Page 36 of 15 £m 15.8 11.2 7.0 8.0 42.0 (18.0) 24.0 Finance Report Month 2 Clinical Income - Elective Page 47 of 15 Finance Report Month 2 Clinical Income – NEL and Other Page 58 of 15 Finance Report Month 2 Elective Recovery Fund 22/23 The graph shows the ERF performance for 23/24 as well as a trend against plan for 22/23. In 23/24 the Trust has a target to achieve 113% of 19/20 activity for elective inpatients, outpatient first attendances and outpatient procedures. Delivery above this targeted level will generate additional funding for the Trust. Month 2 saw an overperformance against the phased target baseline, valued at £1.5m. This was a significant increase on the restated April position which was £0.1m under target. Total YTD is £1.4m overperformance. In % terms compared to the original 2019-20 baseline this would be equivalent to 120% for May and 112% for April (including loss of 5% of activity due to industrial action). Advice & Guidance activity is not yet included with national data awaited. ERF Performance (Target = 113%) Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Total Elective and Daycase 114% 121% 118% Outpatients Firsts 100% 114% 107% Outpatients Procedures 119% 118% 119% Overall ERF Performance 112% 120% 116% Financial over / Under performance (£'000) (89) 1,481 1,392 Outpatient Follow Ups 107% 136% 122% Page 69 of 15 Finance Report Month 2 Staff Costs The total pay expenditure in May was £58.5m, an increase from April’s position of £58.0m. Additional costs of £0.4m were incurred during the month, specifically related to Bank holiday enhancement payments. Normalising for these costs were up by £0.1m as staffing numbers increased in month predominantly in substantive nursing due to an increased overseas nursing intake. Out of the £0.5m increase during the month, £0.2m was attributed to Medical staff, and £0.3m was attributed to Nursing staff. Workforce trends are being closely monitored, with a headcount reduction being part of the in-year efficiency plans. Page 170 of 15 Finance Report Month 2 Temporary Staff Costs Expenditure on bank staff decreased by £0.4m in month following a position of £4.4m in April. In month costs are in line with average levels experienced in 2022/23 but have not yet reduced following additional substantive recruitment across the organisation. Agency spend increased by £0.1m compared to the previous month. The in month position has remained below the 2022/23 run rate by £0.1m. Whilst an overall reduction in agency year to date has been experienced, this has not been in line with increases in substantive costs over the same period. Reducing agency spend remains a focus area for the Trust Savings Group (TSG). In month total temporary staffing costs by staff group were: Nursing £3.7m Medical £0.7m Other £0.9m Page 181 of 15 Finance Report Month 2 Cash The cash balance reduced by £20m to £85m in May. This reduction had been anticipated following significant capital spend in Q4 with cash payments due to suppliers in Q1. A cash forecast has been completed for the next 10 months projecting a material decline in cash driven by an underlying deficit and sizeable internally funded capital programme of £44m per annum. This is currently based on the 2023/24 plan submission. Better Payment Practice Code (BPPC) performance in month for May is over the 95% target for count but has dropped significantly below for value. This reduction largely relates to the payments made to other NHS bodies. Work has been focused on NHS suppliers following the ‘agreement of balances’ exercise completed as part of the year end process but this will now be refocused to commercial suppliers. Page 192 of 15 Finance Report Month 2 Capital Expenditure Expenditure in month 2 was £2.1m taking the year to date expenditure position to £3.7m. Significant areas of expenditure were on the wards project (£0.4m), ward refurbishments (£0.2m), Banksy charity funded schemes (£0.6m) and informatics (£0.6m). Also the purchase of land at Adanac Park (£0.5m) was completed this month. Year to date expenditure is relatively low due to materials delivered to site for the wards scheme being accounted for in 22-23, much of the spend being offset by donated income (£1.4m YTD) and some large schemes yet to commence. A funding award from NHSI of £3.5m for the endoscopy training centre, that was not in the original plan, has now been confirmed. It is anticipated that the trust will spend all of it’s CDEL allocation (£44.4m) plus £8.5m of external awards in year. A review of the forecast will take place before reporting in month 3. Scheme Internally Funded Schemes Strategic Maintenance Oncology Centre Ward Expansion Levels D&E F Level Theatres / Theatres 10 & 11 Neonatal Expansion Community Diagnostic Centre Phase 2 General Refurb Fund / GICU Refurb Donated Estates Schemes Decarbonisation Schemes Informatics (incl Digital Pathology) Medical Equipment panel (MEP) Other Equipment IMRI Targeted Lung Health Checks CT Scanner Other Slippage Donated Income Total Trust Funded Capital excl Finance Leases Leases Equipment leases IISS 4th C Level MRI Scanner / CT Scanner Total Trust Funded Capital Expenditure Externally Funded Schemes Asceptic Pharmacy / SSD Building Community Diagnostic Centre Phase 2 - PDC Frontline Digitisation LIMS/Pathology Digitisation Endoscopy Centre Total Externally Funded Schemes Total CDEL Expenditure Outside CDEL Limit In year IFR16 Leases Total Capital Expenditure Page 13 of1105 Plan £000's Month Actual £000's Var £000's (Fav Variance) / Adv Variance Year to Date Full Year Forecast Plan Actual Var Plan Actual Var £000's £000's £000's £000's £000's £000's 584 1,950 839 0 0 300 1,000 1,500 363 0 39 0 0 0 0 (2,500) 4,075 39 428 26 29 0 243 645 0 509 0 264 0 0 36 0 (651) 1,567 545 1,522 813 (29) 0 57 355 1,500 (146) 0 (225) 0 0 (36) 0 (1,849) 2,508 1,168 2,700 1,678 0 0 500 2,000 1,500 726 0 78 0 0 0 0 (3,500) 6,850 190 592 74 58 0 412 1,298 0 1,226 79 360 0 0 198 0 (1,394) 3,092 978 5,200 5,200 0 2,108 7,135 7,135 0 1,604 9,604 9,604 0 (58) 10,030 10,030 0 0 3,250 3,250 0 88 4,250 4,250 0 702 2,624 6,124 (3,500) 1,500 11,259 11,259 0 (500) 5,890 5,890 0 (79) 2,069 2,069 0 (282) 925 925 0 0 1,310 1,310 0 0 1,364 1,364 0 (198) 518 518 0 0 (7,181) (7,181) 0 (2,106) (18,383) (21,883) 3,500 3,758 39,864 39,864 0 31 0 31 62 0 62 500 500 0 0 0 (0) 0 0 (0) 1,870 1,870 0 0 0 0 0 0 0 2,210 2,210 0 4,106 1,567 2,539 6,912 3,093 3,819 44,444 44,444 0 0 542 (542) 0 575 (575) 3,000 3,000 0 0 0 0 0 0 0 775 775 0 49 0 49 98 0 98 785 785 0 28 0 28 56 17 39 450 450 0 0 0 0 0 0 0 0 3,500 (3,500) 77 542 (465) 154 592 (438) 5,010 8,510 (3,500) 4,183 2,110 2,073 7,066 3,685 3,381 49,454 52,954 (3,500) 0 0 0 0 0 0 0 0 0 4,183 2,110 2,073 7,066 3,685 3,381 49,454 52,954 (3,500) Finance Report Month 2 Statement of Fi nancial Position The May statement of financial position illustrates net assets of £580.9m which is £1.9m down on April. This is predominantly due to: A reduction in Payables of £18.7m driven by large payments made including £3.4m for Supply Chain and £4.9m relating to Adanac. There have also been reductions in capital creditors that was anticipated following Q4 and suppliers being due payments in Q1. Cash reduced to £85.9m in line with the reduction in Payables. The underlying deficit also continues to drive a reducing cash balance. Statement of Financial Position Fixed Assets Inventories Receivables Cash Payables Current Loan Current PFI and Leases Net Assets Non Current Liabilities Non Current Loan Non Current PFI and Leases Total Assets Employed Public Dividend Capital Retained Earnings Revaluation Reserve Total Taxpayers' Equity 2022/23 YE Actuals £m 620.4 15.8 88.5 105.0 (224.6) (1.5) (12.6) 591.0 (23.0) (5.3) (108.6) 454.1 286.2 102.2 65.7 454.1 M1 Act £m 617.2 18.1 92.9 105.5 (237.0) (1.5) (12.2) 582.9 (22.8) (5.3) (105.6) 449.2 286.2 97.3 65.7 449.2 (Fav Variance) / Adv Variance 2023/24 M2 Act £m 619.2 18.1 89.8 85.9 (218.4) (1.5) (12.2) 580.9 (22.8) (5.3) (107.1) 445.8 286.2 93.8 65.7 445.8 MoM Movement £m 2.0 (0.0) (3.0) (19.6) 18.7 0.0 0.0 (1.9) 0.0 0.0 (1.5) (3.4) 0.0 (3.4) 0.0 (3.4) Page 1114 of 15 Finance Report Month 2 Efficiency and Cost Improvement Programme UHS Total - £56.5m identified 82% of the total 23/24 requirement of £69m. Of the identified UHS total, £5.9m is Pay, £28.9m is Non-Pay, and £21.7m is Income. Divisions and Directorates £29.5m of CIP schemes identified. This represents 69% of the 23/24 target of £43.1m Central Schemes - £26.9m of CIP schemes identified. This represents 104% of the 23/24 target of £25.9m M2 Trust YTD delivery is £6.3m. This is below planned delivery of £8.1m but compares favourably to M2 FY22/23 which showed a £1m achievement. Of the £6.3m delivered: £1.8m has been transacted by Divisions and Directorates £4.6m has been transacted through Central Schemes. £4.3m is non-recurrent. This includes £2.9m of nonrecurrent Central Schemes. A risk assessment of schemes will be completed for M3. Page 1125 of 15 Report to the Trust Board of Directors Title: Agenda item: Sponsor: Author Date: Purpose Performance KPI Report 2023/24 Month 2 9.1 David French, Chief Executive Jason Teoh, Director of Data and Analytics 29 June 2023 Assurance or Approval reassurance Y Ratification Information Issue to be addressed: The report aims to provide assurance: • Regarding the successful implementation of our strategy • That the care we provide is safe, caring, effective, responsive, and well led Response to the issue: The Performance KPI Report reflects the current operating environment and is aligned with our strategy. Implications: This report covers a broad range of trust performance metrics. It is (Clinical, intended to assist the Board in assuring that the Trust meets Organisational, regulatory requirements and corporate objectives. Governance, Legal?) Risks: (Top 3) of carrying out the change / or not: This report is provided for the purpose of assurance. Summary: Conclusion and/or recommendation This report is provided for the purpose of assurance. Page 1 of 23 Report to Trust Board in June 2023 Performance KPI Board Report Covering up to May 2023 Sponsor – David French, Chief Executive Officer Author – Jason Teoh, Director of Data and Analytics Page 2 of 23 Report to Trust Board in June 2023 Report guide Chart type Cumulative Column Cumulative Column Year on Year Example Line Benchmarked Line & bar Benchmarked Control Chart Variance from Target Explanation A cumulative column chart is used to represent a total count of the variable and shows how the total count increases over time. This example shows quarterly updates. A cumulative year on year column chart is used to represent a total count of the variable throughout the year. The variable value is reset to zero at the start of the year because the target for the metric is yearly. The line benchmarked chart shows our performance compared to the average performance of a peer group. The number at the bottom of the chart shows where we are ranked in the group (1 would mean ranked 1st that month). The line shows our performance, and the bar underneath represents the range of performance of benchmarked trusts (bottom = lowest performance, top = highest performance) A control chart shows movement of a variable in relation to its control limits (the 3 lines = Upper control limit, Mean and Lower control limit). When the value shows special variation (not expected) then it is highlighted green (leading to a good outcome) or red (leading to a bad outcome). Values are considered to show special variation if they -Go outside control limits -Have 6 points in a row above or below the mean, -Trend for 6 points, -Have 2 out of 3 points past 2/3 of the control limit, -Show a significant movement (greater than the average moving range). Variance from target charts are used to show how far away a variable is from its target each month. Green bars represent the value the metric is achieving better than target and the red bars represent the distance a metric is away from achieving its target. Page 3 of 23 Report to Trust Board in June 2023 Introduction The Performance KPI Report is presented to the Trust Board each month. The report aims to provide assurance: • regarding the successful implementation of our strategy; and • that the care we provide is safe, caring, effective, responsive, and well led. The content of the report includes the following: • The ‘Spotlight’ section, to enable more detailed consideration of any topics that are of particular interest or concern. The selection of topics is informed by a rolling schedule, performance concerns, and requests from the Board; • An ‘NHS Constitution Standards’ section, summarising the standards and performance in relation to service waiting times; and • An ‘Appendix,’ with indicators presented monthly, aligned with the five themes within our strategy. This month, the following changes have been made to the report. • Updated data availability: There are several data sets which have been updated with two months of data, having not been available for the previous report. • Data correction: Following review, the Clostridium Difficile data (metric 6) for April 2023 was revised from 9 to 4 cases. • Revision of data source: Following the completion of a pilot, there are two sites which are unable to support the Continuity of Care model within maternity. Therefore, these sites have been removed from the data sets, and the data backdated to January 2023 without these sites (to allow for trending). This is reflected within the Total UHS women booked onto a continuity of carer pathway (metric 23) and Total BAME women booked onto a continuity of carer pathway (metric 24) measures. The maternity team are reviewing the composition of this metric for future reports. • New metric: We have temporarily added a new metric 35a: Patients on an open 18 week pathway (waiting 104 weeks+)given the impact of corneal transplants on our long waiter performance. Page 4 of 23 Report to Trust Board in June 2023 Summary This month the ‘Spotlight’ section contains an update on Referral to Treatment (RTT) performance. The RTT spotlight highlights that: • UHS has been removed from the Tier 2 performance management process. • Although progress has been made on clearing the longest waiters, the impact of the NHS England request to include corneal transplants as part of the waiting list has meant that we have seen an increase in 78+ and 104+ week waiters for the first time in over a year. • Despite high levels of activity, we continue to see growth in the waiting list, and in May 2023 it stood at 57,878 patients, a 2% increase (1,310 patients) compared to April 2023, and a 17.4% increase compared to May 2022 (circa 8,500). Areas of note in the appendix of performance metrics include: 1. We continue to see volatility within our cancer performance statistics. a. 2WW performance has dropped to 57.7% in April 2023. This is the lowest monthly performance for several years, driven by capacity challenges in our highest volume tumour sites of Breast, Head and Neck, and Skin. b. There has also been a reduction in 31D performance to 86.8%, with the Skin service most greatly impacted performance wise. c. However, our focus on the breaches has started to reflect within our overall 62D performance. This improved to 64% in April 2023, putting us back into the top quartile of relative performance versus other teaching hospitals. 2. Inpatient noting has now gone live in the Medicine Care Group, and this has resulted in a significant increase in unique users and data recorded via Inpatient Noting. 3. Following the completion of a pilot, there are two sites which are unable to support the Continuity of Care model within maternity. Therefore, these sites have been removed from the data sets (UHS and BAME women – continuity of care), and the data backdated to January 2023 without these sites (to allow for trending). This makes it look like there has been a significant reduction in performance, and the team are reviewing the composition of this measure. 4. Pressure ulcers remain high and above target. This continues to be linked to junior skill mix and need for further education, and there are follow ups with nursing teams to remind them of the importance of regularly turning patients. 5. There were six reported severe/moderate medication errors, the highest reported number for several months. These reports are subject to internal review, and a further update will be provided next month. Page 5 of 23 Report to Trust Board in June 2023 Ambulance response time performance The latest unvalidated weekly data provided by the South Coast Ambulance Service (SCAS) shows that UHS does not significantly contribute to ambulance handover delays. In the week commencing 12 June 2023 our average handover time was 16 minutes 24 seconds across 790 emergency handovers, and 21 minutes 17 seconds across 33 urgent handovers. There were 51handovers over 30 minutes, and 4 handovers taking over 60 minutes (of which we believe at least two are data errors) within the unvalidated data. Page 6 of 23 Report to Trust Board in June 2023 Spotlight Spotlight: Referral to Treatment Waiting Lists The following information is based on the validated May 2023 submission, with some operational insight based on the latest position for our long waiters. Update on Tier 2 position In the last RTT spotlight to Board (April 2023) we reported that UHS had been put into Tier 2 monitoring by the ICB and Region. Feedback from the Region and the ICB is that this is partly due to timing – the decision to put UHS into Tiering was at a point where they felt there was a risk of us having a significant volume of 78+ week breaches. At the time, we provided feedback to the ICB that we did not feel that this was proportionate to our recent progress on 78+ week long waiters, and in late April 2023 we were notified that we had progressed out of the Tier 2 monitoring process. UHS continues to make progress on reducing long waiters (further information below), although the headline position has been impacted by the NHS England request to report Corneal transplants as part of the RTT Waiting List (see next section) Corneal grafts In last month’s Performance KPI Report to Board we provided a short update on Corneal transplants. Historically, we have not counted transplants as part of the RTT waiting list as transplant material is assigned by NHS Blood & Transplant (NHSBT), and the provision of this material is not within UHS’s control. However, NHS England have requested that we add all patients awaiting Corneal transplants onto the RTT waiting list, in line with guidance provided within an FAQ document from 20151. It appeared that this guidance was missed by UHS – and many other trusts around the country. Corneal transplants are specifically referred to as an exception within the FAQ document (but not the NHS RTT Policy2, which in fact explicitly states that if a patient has been added to a transplant list, then they should be removed from the RTT waiting list) to most other transplants as they are deemed as “unmatched transplants”. However, many trusts – including UHS – have taken the approach to not count any transplants as the material is centrally provided by NHSBT, and therefore the time which the patient waits are not fully within an individual trust’s control. NHS England have asked us to now add all corneal transplant patients onto our waiting list. At the time of writing, we have added approximately 120 patients onto the waiting list, with presently 25 having waited over 78 weeks. Table 1 outlines our current forecast of expected volume s and wait times based on the remaining patients awaiting a corneal graft. 1 https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2017/10/Accompanying-FAQs-v7.32-ASI-FAQ-update.pdf 2 https://www.gov.uk/government/publications/right-to-start-consultant-led-treatment-within-18-weeks/referral-to-treatment-consultant-led-waiting-times-rules-suiteoctober-2022 Page 7 of 23 Report to Trust Board in June 2023 Spotlight Table 1: Forward forecast of Corneal graft volumes 0-78 weeks 78-104 weeks 104+ weeks End of May 88 12 1 End of June 68 22 6 End of July 64 25 7 End of August 56 31 9 Total PTL 101 96 96 96 This forecast position will change as it does not currently account for new corneal referrals to the waiting list, and further validation of the waiting list is underway. In addition, the availability of material is changing, and therefore patients should be treated and be removed from the waiting list. Until early June 2023, tissue was only being issued to patients who have waited over two years. More recently, NHS England has asked us to request transplant material for patients who had waited more than 65+ weeks. Therefore, it is possible that this forecast position will improve . Waiting list We have continued to see a growth in the waiting list, and in May 2023 it stood at 57,878 patients, an increase of 1,310 patients compared to April 2023 (graph 2) and over 8,500 patients more than May 2022 (a 17.4% growth rate). Despite UHS’s continued over performance on elective recovery, the waiting list continues to grow, and we are undertaking more detailed analysis to understand why we are continuing to see this level of growth. It is not immediately clear at this time why certain specialities have seen a significantly higher growth rate than others (see table 3 for the specialties with the highest growth rates). Graph 2: PTL by wait band Table 3: Percentage growth in waiting list at specialty level Specialty May-23 May-22 % growth 331 - CONGENITAL HEART DISEASE 84 28 200% 316 - CLINICAL IMMUNOLOGY 102 40 155% 320 - CARDIOLOGY 3055 1595 92% 173 - THORACIC SURGERY 323 177 82% 215 - PAEDIATRIC EAR NOSE AND THROAT 1395 779 79% 221 - PAED CARDIAC SURGERY 96 55 75% 430 - GERIATRIC MEDICINE 200 118 69% 307 - DIABETIC MEDICINE 102 63 62% 314 - REHABILITATION 96 60 60% 216 - PAEDIATRIC OPHTHALMOLOGY 660 427 55% 311 - CLINICAL GENETICS 2386 1555 53% 259 - PAED NEPHROLOGY 78 52 50% Page 8 of 23 Report to Trust Board in June 2023 Spotlight Given the overall waiting list challenge, the 18 week wait constitutional standard remains unmet, and in May 2023 only 65% of patients are currently waiting 18 weeks or less. Although there has been some improvement in this standard, this is linked to the increase in recent referrals, rather than a wholesale improvement in the waiting list. While this is below the national target of 92%, we remain in the top tertile of other comparator teaching hospitals (6 of 20 benchmark hospitals in graph 4 in April 2023), reflecting that this continues to be a national challenge throughout the NHS. Graph 4: RTT 18 week performance comparison for Teaching Hospitals Looking specifically at the patients waiting for admission (“current waiters”) in graph 5, in May 2023 this stood at 11.9k patients (20.7% of the waiting list). This remains proportionally similar to pre-pandemic levels (where it was between 20-22%) although the absolute number of patients waiting is higher. We continue to review how we can further optimise our operating services to generate additional capacity from the existing estate, alongside utilising outsource capacity where it is financially prudent to do so. Page 9 of 23 Report to Trust Board in June 2023 Graph 5: Waiting list for Current Waiters and Still on Pathway Spotlight Graph 6: 78+ week waits Long waiter performance UHS has made significant progress in clearing our longest waiters, and we were in a position with no reported two year waits since November 2022, and less than 14 patients having waited longer than 78+ weeks since March 2023. However, the inclusion of the corneal patients has increased the May 2023 78+ week waiters by 12 patients, and June’s impact will be greater after validation. Excluding the impact of the corneal patients, at the time of writing, currently only have nine patients who are breaching 78+ weeks. These patients were all patients who breached due to complexity across a number of specialties (table 7). Table 7: Reasons for patients breaching 78+ weeks at time of writing Page 10 of 23 Report to Trust Board in June 2023 Spotlight Looking at current NHS England target to have zero 65+ week waiters by the end of March 2024, we remain broadly in line with the glide which we set before the start of the financial year (graph 8). This target will continue to be challenging as our performance against the glide was partly dependent on the availability of mutual aid from other NHS providers, and because of the recent inclusion of the corneal transplant patients. At present, we are maintaining this glide – although the recent strikes have had an impact on overall activity and throughput. Graph 8: 2023/24 forecast glide for 65+ week waits For awareness, the following tables provide breakdowns of the current waiting list, for the top ten specialties in descending size order, split between patients in outpatient care and those waiting for admission. There have been no significant changes to the top specialties over the last few months. All Waiters Page 11 of 23 Report to Trust Board in June 2023 NHS Constitution NHS Constitution - Standards for Access to services within waiting times The NHS Constitution* and the Handbook to the NHS Constitution** together set out a range of rights to which people are entitled, and pledges that the NHS is committed to achieve, including: The right to access certain services commissioned by NHS bodies within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of suitable alternative providers if this is not possible • Start your consultant-led treatment within a maximum of 18 weeks from referral for non-urgent conditions • Be seen by a cancer specialist within a maximum of 2 weeks from GP referral for urgent referrals where cancer is suspected The NHS pledges to provide convenient, easy access to services within the waiting times set out in the Handbook to the NHS Constitution • All patients should receive high-quality care without any unnecessary delay • Patients can expect to be treated at the right time and according to their clinical priority. Patients with urgent conditions, such as cancer, will be able to be seen and receive treatment more quickly The handbook lists 11 of the government pledges on waiting times that are relevant to UHS services, such pledges are monitored within the organisation and by NHS commissioners and regulators. Performance against the NHS rights, and a range of the pledges, is summarised below. Further information is available within the Appendix to this report. * https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england ** https://www.gov.uk/government/publications/supplements-to-the-nhs-constitution-for-england/the-handbook-to-the-nhs-constitution-for-england Page 12 of 23 Report to Trust Board in June 2023 NHS Constitution Monthly Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May target YTD 75% % Patients on an open 18 week pathway 68.1% (within 18 weeks ) 31 UHSFT Teaching hospital average (& rank of 20) South East average (& rank of 17) 5 5 3 4 4 5 6 5 5 5 5 5 65.2% 4 4 ≥92% 7 7 7 6 6 6 6 5 5 5 5 5 6 6 50% 100% % Patients following a GP referral for suspected cancer seen by a specialist within 13 13 15 14 8 13 15 17 9 13 17 10 14 17 2 weeks (Most recently externally reported 88.3% 38 data, unless stated otherwise below) UHSFT 6 4 3 9 4 4 11 18 16 11 13 10 19 Teaching hospital average (& rank of 20) 8 57.7% South East average (& rank of 17) 55% ≥93% 64.0% 57.7% Cancer waiting times 62 day standard - 100% Urgent referral to first definitive treatment (Most recently externally reported data, 39 unless stated otherwise below) UHSFT 12 7 9 75.2% 13 11 11 17 14 14 17 14 14 18 694.0% ≥85% Teaching hospital average (& rank of 19) 2 South East average (& rank of 17) 40% 3 3 6 4 4 10 11 7 12 11 7 14 5 100% Patients spending less than 4hrs in ED - (Type 1) 28 UHSFT 64.7% 61.7% 8 7 5 4 9 12 6 4 7 7 4 5 7 6 6 ≥95% Teaching hospital average (& rank of 16) South East average (& rank of 16) 4 25% 4 4 3 4 3 4 4 4 4 3 3 3 5 7 40% 23.3% % of Patients waiting over 6 weeks for diagnostics 9 8 9 9 9 9 11 11 8 10 7 8 8 7 21.4% 37 UHSFT Teaching Hospital average (& rank of 20) 13 13 11 8 8 7 9 8 11 12 12 12 12 11 ≤1% South East Average (& rank of 18) 0% 64.0% 62.8% 22.0% Page 13 of 23 Report to Trust Board in June 2023 Outstanding Patient Outcomes,Safety and Experience Appendix Outcomes 1 HSMR - UHS HSMR - SGH 2 HSMR - Crude Mortality Rate Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May 95 85.9 86.5 Monthly target ≤100 60 3.1% 2.8% 2.8% <3% YTD 86.5 2.8% YTD target ≤100 <3% 2.5% 1 & 2: At time of IPR publication, the latest information available in HED was from Mar 2023. Metrics are 12 month rolling. YTD is for financial year for UHS up to Mar 2023. Previously, data was sourced from Dr Foster. 15% 13.2% 3 Percentage non-elective readmissions within 28 days of discharge from hospital 12.0% - 13.2% 10% 3 May data not available at the time of publication Cumulative Specialties with 4 Outcome Measures Developed (Quarterly) Q4 2122 85 63 Q1 22-23 64 Q2 22-23 64 Q3 22-23 68 Q4 22-23 71 393 419 403 430 452 25 100% Developed Outcomes RAG ratings (Quarterly) 5 Red Amber Green 75% 76% 74% 74% 74% 74% 50% Quarterly target +1 Specialty per quarter Red : below the national standard or 10% lower than the local target Amber : below the national standard or 5% lower than the local target Green : within the national standard or local target Page 14 of 23 Report to Trust Board in June 2023 Outstanding Patient Outcomes,Safety and Experience Appendix Safety Monthly Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May target YTD Cumulative Clostridium difficile 6 Most recent 12 Months vs. Previous 12 Months 90 1611 2118 2524 3328 3935 4447 4955 5665 6473 7177 7484 94 1112 ≤5 12 0 2 7 MRSA bacteraemia 0 0 11 111 0 00000 00000 80 YTD target ≤10 0 8 Gram negative bacteraemia 29 ≤16 43 0 21 17 22 19 27 17 22 14 24 16 17 14 32 14 Monthly Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May target YTD 1 9 Pressure ulcers category 2 per 1000 bed days 0.48 0.51 <0.3 0.52 0 1 10 Pressure ulcers category 3 and above per 1000 bed days 0 10 11 Medication Errors (severe/moderate) 0.67 4 0.60 0.43 <0.3 0.64 6 ≤3 6 ≤32 YTD target <0.3 <0.3 ≤6 0 3,500 Watch & Reserve antibiotics, usage per 2,924,5545 12 1,000 adms Most recent months vs. 2018*95.5% 2,863 2,945 2,945 33,794 33,134 1,500 12 - For 2022/23, a new requirement is applied: Reduction of 4.5% from calendar year 2018 usage in combined WHO/NHSE AWaRE subgroups for “watch” and “reserve” agents. The performance data relate to successive FINANCIAL years, however the comparator denominator remains CALENDAR year 2018 (we are not using 2020 or 2021 due to the disruptive effect of COVID on both usage and admissions). Data is reported 3 months in arrears. Page 15 of 23 Report to Trust Board in June 2023 Outstanding Patient Outcomes,Safety and Experience Appendix Safety Monthly Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May target YTD YTD target Serious Incidents Requiring Investigation 40 13 (SIRI) (based upon month reported as 5 SIRI, excluding Maternity) 0 - 3 8 - 5 14 Serious Incidents Requiring Investigation - Maternity 0 0 1 - 2 - 0.5 15 Number of falls investigated per 1000 bed days 0.13 0.05 - 0.08 - 0.0 100% % patients with a nutrition plan in place 16 (total checks conducted included at 98.0% 97.0% ≥90% 96% ≥90% chart base) 53 742 572 750 719 676 669 711 1624 780 1600 844 871 80% 16 - monthly audit was paused due to pressure on all ward areas between Dec 2021 to May 2022. The audit was partially restarted in some ward areas in May 2022, and fully restarted in June 2022. 100 17 Red Flag staffing incidents 23 19 - 32 - Maternity 0 Monthly Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May target YTD 600 YTD target Birth rate and Bookings 18 Birth Rate - total number of women birthed Bookings - Total number of women booked - - - 477 402 449 416 513 387 432 383 453 436 363 440 498 412 416 463 438 460 417 426 405 430 425 458 485 405 444 398 534 437 300 10 8 19 Staffing: Birth rate plus reporting / opel status - number of days (or shifts) at Opel 4. 6 5 2 1 3 2 0 3 1 1 0 2 1 1 - - - 0 100% 32.6% 51.7% 40.6% 46.4% 36.7% 48.2% 36.0% 53.6% 37.2% 49.3% 37.5% 48.2% 35.7% 48.5% 36.9% 47.1% 38.7% 48.9% 36.4% 51.2% 37.7% 49.1% 38.2% 48.0% 36.0% 48.1% 37.7% 47.5% 36.2% 51.5% Mode of delivery 20 % number of normal birthed (women) 50% % number of caesarean sections (women) % other - - - 0% Page 16 of 23 Report to Trust Board in June 2023 Outstanding Patient Outcomes,Safety and Experience Patient Experience Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May 3% 21 FFT Negative Score - Inpatients 0.7% 0.2% 0% 10% 22 FFT Negative Score - Maternity (postnatal ward) 3.5% 2.4% 0% 50% 23 Total UHS women booked onto a continuity of carer pathway 41.8% 13.5% 0% 85% 24 Total BAME women booked onto a continuity of carer pathway 83.3% 42.5% 10% 100% 25 % Patients reporting being involved in decisions about care and treatment 91.0% 89.0% 80% % Patients with a disability/ additional 100% needs reporting those 92.0% 93.0% 26 needs/adjustments were met (total number questioned included at chart 117 121 120 139 178 173 145 191 214 148 base) 70% 958 635 26 - Performance is a scored metric with a "Yes" response scoring 1, "Yes, to some extent" receiving 0.5 score and other responses scoring 0. 100 76 Overnight ward moves with a reason 39 27 marked as non-clinical (excludes moves 50 from admitting wards with LOS<12hrs) 0 Monthly target ≤5% ≤5% ≥35% ≥51% ≥90% ≥90% - YTD 0.6% 1.8% 12.6% 35.2% 89.0% 93.0% 138 Appendix YTD target ≤5% ≤5% ≥35% ≥51% ≥90% ≥90% - Page 17 of 23 Report to Trust Board in June 2023 Outstanding Patient Outcomes,Safety and Experience Access Standards Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May 100% Patients spending less than 4hrs in ED - 61.7% (Type 1) 64.7% 7 5 4 9 12 28 UHSFT 6 4 8 7 7 4 5 7 6 6 Teaching hospital average (& rank of 16) South East average (& rank of 16) 4 25% 4 4 3 4 3 4 4 4 4 3 3 3 5 7 04:00 03:15 03:46 29 Average (Mean) time in Dept - nonadmitted patients 01:00 08:00 05:22 30 Average (Mean) time in Dept - admitted patients 05:57 01:00 75% % Patients on an open 18 week pathway (within 18 weeks ) 31 UHSFT 5 68.1% 5 3 4 4 5 6 5 5 5 5 5 4 65.2% 4 Teaching hospital average (& rank of 20) South East average (& rank of 17) 7 7 7 6 6 6 6 5 5 5 5 5 6 6 50% 60,000 Total number of patients on a waiting list (18 32 week referral to treatment pathway) 49,283 57,878 Monthly target ≥95% ≤04:00 ≤04:00 ≥92% - 40,000 Patients on an open 18 week pathway 8,000 7 7 7 5 5 5 5 5 5 5 5 5 4 4 (waiting 52 weeks+ ) 33 UHSFT Teaching hospital average (& rank of 20) 2,152 2,191 2,011 South East average (& rank of 17) 0 14 14 12 12 13 13 13 12 12 12 12 12 11 11 Appendix YTD YTD target 62.8% ≥95% 03:27 ≤04:00 05:44 ≤04:00 64.0% ≥92% 57,878 - 2,191 2,011 Page 18 of 23 Report to Trust Board in June 2023 Outstanding Patient Outcomes,Safety and Experience Monthly Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May target 4,000 7 7 6 6 6 6 6 6 6 6 6 Patients on an open 18 week pathway 5 (waiting 65 weeks+ ) 5 4 34 UHSFT Teaching hospital average (& rank of 20) 985 1022 898 917 967 1043 1087 1043 943 950 827 702 506 510 480 - South East average (& rank of 17) 0 15 15 13 13 13 14 14 13 13 12 13 12 12 11 2,000 Patients on an open 18 week pathway (waiting 78 weeks+ ) 7 7 7 7 7 7 7 7 7 7 7 35 UHSFT 6 0 Teaching hospital average (& rank of 20) 327 South East average (& rank of 17) 4 4 21 0 15 15 13 13 14 15 15 15 15 15 15 15 12 10 400 6 Patient
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2023-Trust-documents/Finance-and-Performance-Reports-2023-24-Month-2-May-2023.pdf

Fit for surgery school - patient information

Description: This factsheet explains what the education session 'fit for surgery school' is about and provides instructions on how to join online.
Url: /Media/UHS-website-2019/Patientinformation/Surgery/Fit-for-surgery-school-3490-PIL.pdf

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