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Featured research: UK-REACH

Description: Auto Generated Title The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) is being
Url: /ClinicalResearchinSouthampton/Public-and-patients/Featured-research-studies/Featured-research-UK-REACH.aspx

UHS launches COVID ZERO campaign to help protect patients and staff

Description: A campaign has been launched to wipe out the transmission of COVID-19 in Southampton's hospitals – and the community is being
Url: /AboutTheTrust/Newsandpublications/Latestnews/2020/July/UHS-launches-COVID-ZERO-campaign-to-help-protect-patients-and-staff.aspx

Finance and Performance Reports 2021-22 month 4 July 2021

Description: Report to the Trust Board of Directors Title: Agenda item: Sponsor: Author: Date: Purpose Issue to be addressed: Finance Report 2021-22 Month 4 11.3 Ian Howard – Interim Chief Financial Officer Philip Bunting – Interim Deputy Director of Finance 26 August 2021 Assurance Approval or reassurance Ratification Information X The finance report provides a monthly summary of the key financial information for the Trust. Response to the issue: The Trust continues to report an on plan financial position of breakeven. In month £1.3m of non-recurrent benefits have however helped support breakeven achievement with ERF income significantly lower than expected. Elective Recovery Framework (ERF): • Elective Recovery Framework achievement of £0.35m is estimated in month, based on activity of circa 97% of pre-Covid levels of activity for Elective and Outpatients. This compares to a baseline expectation of 95%. (M3 achievement of 94% vs. 80% baseline target). Although this has marginally improved from June this is significantly lower than the anticipated forecast of £3m achievement (108%). The drivers behind this are as follows: o Increased levels of annual leave and staff isolating. Rates of self-isolation increased from 0.5% of workforce in April to June to 2.5% of workforce in July. This has had a significant impact on the availability of staffing and therefore activity. o Continued non-elective pressure (spells increasing 3% from M3 and reaching 99% of production plan levels) and ED activity (also 3% increase from M3). Operational bed pressures are particularly acute within critical care. o Increasing numbers of Covid-19 patients on wards which ended July with 48 Covid positive inpatients reported. This number remains above 40 in mid-August having started July at below 10 patients. • ERF achievement is below the 110% target for elective and outpatient activity by July as per the accelerator programme ambitions. M4 Forecast Review: • We undertake a quarterly review of the Trust forecast position. • Operational pressures in July and August have significantly dampened the trusts ERF forecast for H1 which has been revised down by £6.6m from £23.8m to £17.2m as a result. This poses a significant risk to financial performance over the remainder of H1 however the trust remains in a strong position to Page 1 of 17 manage this risk making an underlying margin on ERF in Q1. • Overall, given the stability of the year-to-date position and balance sheet, the Trust are in a strong position to manage the risks of quarter 2 and achieve a break-even plan position for H1. • The forecast for H2 will be reviewed as part of the H2 planning process. Capital: • CDEL reported spend is £1.5m behind plan YTD with spend in month £1.3m below plan. The trust remains confident however that the annual CDEL allocation of £49.8m will be spent in full. ICS finance position: • All organisations at month 3 were reporting a break-even position. A verbal update will be provided to the Committee on the underlying position within the ICS. An ICS finance report will be made available to the Committee but is not ready for UHS paper deadlines. Other financial issues: • The finance team continue to undertake investigations with Pharmacy regarding use of drugs that are included within block contracts. The value has reduced from previous months but is still £2m ahead of plan YTD. • Specialist commissioning have started informal consultation around the transfer of a proportion of activity to ICS level which will be funded on a population needs basis. The exact quantum of activity, funding envelope and scope of services is currently undecided. This is likely to be in shadow format in 22/23 and then permanently embedded in 23/24. UHS intends to work closely with NHS England and the provider network throughout the consultation period. Implications: (Clinical, Organisational, Governance, Legal?) • 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 mainly linked to the uncertainty of H2 21/22 funding arrangements and ability to support long term decision making. • Cash risk linked to volatility above • Inability to maximise CDEL (which cannot be carried forward) if mitigations are not put into place Summary: Conclusion Trust Board is asked to note this report. and/or recommendation Page 2 of 17 2021/22 Finance Report - Month 4 Report to: Board of Directors and Finance & Investment Committee July 2021 Title: Finance Report for Period ending 31/07/2021 Author: Philip Bunting, Interim Deputy Director of Finance Sponsoring Ian Howard, Interim Chief Director: Financial Officer Purpose: Standing Item The Board is asked to note the report Executive Summary: In Month and Year to date Highlights: 1. In July 2021, the Trust reported a breakeven position as planned. 2. Elective Recovery Framework (ERF) income is estimated at £0.35m for July; however this has not yet been confirmed and is dependent on wider system achievement and NHSI validation. This was down from £3.1m the previous month and reflects the revised activity achievement target of 95% now in place for Q2. Significant operational pressures have also dampened ERF achievement and forecast. 3. In month, £3.6m (£2.5m pay and £1.1m non pay) was incurred on additional expenditure relating to Covid-19. This was £0.6m lower than in June mainly due to lower Covid vaccination costs (down £0.5m). Within the trusts block funding is a non-recurrent fixed element for Covid costs which will continue throughout H1. Covid inpatient volumes increased in month to 48 diverting resources away from elective. 4. The main underlying themes seen in M4 were : – Elective activity in July represents 94% of planned income levels, up slightly from 93% in June. – Non Elective activity levels in July was at 99% of planned levels, down from 103% in June. A&E attendances continue to be high, back to pre-Covid levels. – Outpatient activity in July was at 107% of planned levels, down slightly from 108% in June. – Drugs and devices expenditure was high in month with £4.6m over performance reported on pass through items, higher than the £2.2m over performance in M3. This is mirrored by additional income. – Trust underlying performance deteriorated slightly although remains at close to breakeven levels after adjusting for one off items. 1 Page 3 of 17 2021/22 Finance Report - Month 4 Finance: I&E Summary The financial position for M4 was breakeven as per plan. This position does however include £1.3m in non recurrent income. The Saliva testing finances are significantly distorting variances within income and expenditure categories as testing activity is not yet fully mobilised. Pay costs are £1.7m below plan in month and now £9.5m behind plan YTD. In addition to Saliva testing this is further driven by elective recovery costs that have not increased pay to the originally anticipated level. This is however offset by reduced ERF income. Agency costs spiked in month due partly to increased staff sickness due to covid self isolation notifications dramatically increasing. Block drugs costs were £0.2m above plan in M4 and remain under investigation as this remains an in year pressure having previously been pass through costs. Energy cost increases and overseas recruitment expenditure are the key areas of overspend within ‘other non pay’. NHS Income: Clinical Pass-through Drugs & Devices Other income Other Income excl. PSF Top Up Income Total income Costs Pay-Substantive Pay-Bank Pay-Agency Drugs Pass-through Drugs & Devices Clinical supplies Other non pay Total expenditure EBITDA EBITDA % Depreciation / Non Operating Expenditure Surplus / (Deficit) Less Donated income Add Back Donated depreciation Net Surplus / (Deficit) 2 Page 4 of 17 Current Month Cumulative H1 Plan Plan Actual Variance Plan Actual Variance Plan Forecast Variance £m £m £m £m £m £m £m £m £m 69.1 65.4 3.8 275.1 266.4 8.6 412.8 406.4 6.4 8.5 13.1 (4.6) 33.9 44.0 (10.1) 50.9 61.6 (10.7) 15.2 13.2 2.0 60.6 52.1 8.6 90.9 77.8 13.1 0.8 1.1 (0.3) 3.1 4.6 (1.4) 4.7 6.9 (2.2) 93.6 92.7 0.8 372.8 367.1 5.7 561.4 552.7 6.7 46.9 45.4 (1.6) 187.7 180.9 (6.8) 281.5 273.0 (8.5) 4.0 3.5 (0.4) 15.8 14.0 (1.9) 23.7 21.8 (1.9) 1.2 1.6 0.3 5.0 4.2 (0.8) 7.5 5.2 (2.3) 4.3 4.5 0.2 17.4 19.4 2.0 26.0 30.4 4.4 8.5 13.1 4.6 33.9 44.0 10.1 50.9 61.6 10.7 11.2 6.4 (4.8) 43.2 31.9 (11.3) 65.1 51.9 (13.2) 14.2 15.2 0.9 56.9 60.6 3.7 85.4 90.9 5.5 90.4 89.7 (0.7) 360.0 354.9 (5.0) 542.2 534.9 (5.3) 3.2 3.0 0.2 12.8 12.1 0.7 19.2 17.8 1.4 3.4% 3.3% 0.1% 3.4% 3.3% 0.1% 3.4% 3.2% 0.2% 3.2 3.1 (0.1) 12.9 12.4 (0.4) 19.3 18.6 (0.6) (0.0) (0.1) 0.1 (0.0) (0.3) 0.2 (0.1) (0.8) 0.8 0.1 0.0 0.1 0.4 0.0 0.3 0.5 0.0 0.5 0.1 0.1 0.0 0.4 0.6 0.2 0.6 0.9 0.3 (0.0) 0.0 (0.0) (0.0) 0.3 (0.3) (0.0) 0.0 (0.0) 2021/22 Finance Report - Month 4 Monthly Underlying Position The graph shows the underlying position for the Trust from 2019/20 to present. This position is however heavily linked to the numbers of Covid positive patients the Trust is managing. We are now operating at a position where we would be earning marginally more under PbR than the current block. However, we are also earning ERF, which would not be payable under PbR for activity below 100% of contract. After adjusting the income position to be reflective of what would prevail under PbR it is clear that the underlying position is close to breakeven and has been throughout Q1. This has slightly deteriorated in July as staffing pressures together with non elective and covid pressures have suppressed elective activity and PbR equivalent income. 5.00 - -5.00 -10.00 -15.00 -20.00 -25.00 -30.00 With future funding arrangements unclear due to non recurrent ERF and additional Covid-19 funding, we exercise caution over the Trust’s underlying position going forwards. Monthly Underlying Position 2020/21 & 2021/22 Budget 2019/20 Underlying Actuals 2020/21 & 2021/22 Underlying Actuals 3 Page 5 of 17 2021/22 Finance Report - Month 4 Clinical Income Clinical income for the month of July was £0.9m favourable to plan and including Non NHS income was £0.7m favourable to plan. Most of the Trust's income remains fixed with confirmed block contract funding in place for at least the first half of the financial year. July has seen a small increase in activity from June. Plans for 21/22 have been phased to account for the variation in calendar and working days in relevant POD Groups. Elective income increased to 94% of planned levels although this follows a dip in June having been over 100% in May. Overall non elective activity increased but against the working day adjusted plan reduced to 99% of planned level. A&E attendances continue to be high, back to pre-Covid levels having shown a downward trend for much of the previous financial year. Outpatient income remains strong at over 100% of planned levels although not as high against plan as in May. The graphs overleaf show trends over the last 16 months and the impact of Covid-19 as well as the recovery to pre Covid levels of activity in many areas. (Fav Variance) / Adv Variance POD GROUP NHS Clinical Income Elective Inpatients Non-Elective Inpatients Outpatients Other Activity Blocks & Financial Adjustments Other Exclusions Pass-through Exclusions Subtotal NHS Clinical Income Additional funding Covid block adjustments Total NHS Clinical Income Non NHS Clinical Income Private Patients CRU Overseas Chargeable Patients Total Non NHS Clinical Income In Month In Month Plan £000s Estimate £000s In Month Variance £000s 2021/22 YTD Plan £000s YTD Estimate £000s YTD Variance £000s £13,159 £19,474 £7,718 £11,864 £5,590 £8,003 £8,485 £74,292 £5,848 (£2,535) £77,605 £12,413 £20,140 £8,249 £11,571 £1,872 £5,648 £13,100 £72,993 £5,848 (£368) £78,473 £745 (£666) (£531) £294 £3,718 £2,355 (£4,616) £1,299 £0 (£2,167) (£868) £49,645 £76,638 £29,119 £46,239 £20,449 £31,543 £33,938 £287,571 £23,392 (£1,952) £309,011 £47,675 £78,250 £32,081 £45,770 £8,530 £31,105 £44,025 £287,438 £23,392 (£368) £310,462 £1,969 (£1,612) (£2,962) £469 £11,919 £438 (£10,087) £133 £0 (£1,584) (£1,450) £368 £235 £134 £208 £186 £23 £66 £64 £2 £643 £484 £158 £1,504 £833 £264 £2,601 £2,023 £683 £158 £2,864 (£519) £150 £106 (£263) 2019/20 YTD Actuals £000s £47,966 £71,796 £28,339 £42,701 £1,475 £1,260 £38,725 £232,262 £232,262 £1,394 £840 £651 £2,885 Grand Total £78,248 £78,958 (£710) £311,612 £313,325 (£1,713) £235,147 Income (£m) NHS Clinical Income £100 £80 £60 £40 £20 £0 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 2020/21 2021/22 Plan - Income Actual - Income 4 Page 6 of 17 2021/22 Finance Report - Month 4 Clinical Income Activity ('000) Income (£m) Elective spells £16 8 £14 7 £12 2% 6 £10 5 £8 4 £6 3 £4 2 £2 1 £0 0 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 2020/21 2021/22 Plan - Activity Actual - Activity Plan - Income Actual - Income Activity ('000) Income (£m) Non elective spells £25 7 £20 3% 6 5 £15 4 £10 3 2 £5 1 £0 0 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 2020/21 2021/22 Plan - Activity Actual - Activity Plan - Income Actual - Income Outpatients £10 70 £8 -1% 60 50 £6 40 £4 30 20 £2 10 £0 0 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 2020/21 2021/22 Plan - Activity Actual - Activity Plan - Income Actual - Income Activity ('000) Income (£m) A&E £3 14 £2 3% 12 10 £2 8 £1 6 4 £1 2 £0 0 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 2020/21 2021/22 Plan - Activity Actual - Activity Plan - Income Actual - Income 5 Page 7 of 17 Activity ('000) Income (£m) 2021/22 Finance Report - Month 4 Clinical Income Activity ('000) Income (£m) Adult critical care £6 4 £5 3 £4 2% £3 2 £2 1 £1 £0 0 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 2020/21 2021/22 Plan - Activity Actual - Activity Plan - Income Actual - Income Activity ('000) Income (£m) Neonatal & paediatric critical care £3 3 £3 5% £2 2 £2 £1 1 £1 £0 0 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 2020/21 2021/22 Plan - Activity Actual - Activity Plan - Income Actual - Income Tariff excluded drugs £14 1 £12 -8% £10 £8 £6 £4 £2 £0 0 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 2020/21 2021/22 Plan - Activity Actual - Activity Plan - Income Actual - Income Activity ('000) Income (£m) Tariff excluded devices £3 2 £3 -14% £2 £2 1 £1 £1 £0 0 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 2020/21 2021/22 Plan - Activity Actual - Activity Plan - Income Actual - Income 6 Page 8 of 17 Activity ('000) Income (£m) 2021/22 Finance Report - Month 4 Income and Activity The tables shown illustrate by division and care group the % of the activity and income plan being achieved across the first month of 2021/22 for Elective, Non Elective and Outpatient Activity. The plan for 2021/22 has been phased to reflect working day differences for Elective and Outpatient and calendar days for Non Elective. Elective activity in July represents 94% of planned income levels, up slightly from 93% in June. Recovery planning is targeting improvement in all areas but will be governed by clinical priority. Non Elective activity levels in July was at 99% of planned levels, down from 103% in June. It should be noted that non elective spells actually increased 3% month on month but due to July being a day longer the % of production plan delivered actually reduced slightly. Page 79 of 17 2021/22 Finance Report - Month 4 Income and Activity Outpatient activity in July was at 107% of planned levels, down slightly from 108% in June. Page 180 of 17 2021/22 Finance Report - Month 4 Elective Recovery Fund 21/22 The Elective Recovery Fund has been launched as part of the 21/22 planning guidance as a mechanism for distributing £1bn of national recovery funds for Elective and Outpatient activity. Providers are targeted with achieving threshold equivalent PbR income levels set at a % of pre-Covid income levels (Price x Activity). The graph shows both the trends through 20/21 and estimated performance for July. This indicates performance of 97% of baseline activity which is 2% over the revised target threshold of 95% in July. This would yield an estimate of £0.35m additional income if paid at tariff. It should be noted that this is an early estimate of this data and has dependencies on the performance of others from within the ICS. The 20% premium has already been agreed with ICS partners will be centrally pooled rather than allocated directly to providers. Elective Recovery Framework Performance 20-21-22 % 120% 100% Actual Activity 80% (OP & EL) 70% Threshold 60% (April-21) 85% Threshold 40% 20% 0% Month Apr-21 May-21 Jun-21 Jul-21 YTD Total ERF Achievement - Elective/Daycase/Outpatients (£'000) Baseline Actuals Variance % £ 18,770 £ 18,575 -£ 195 99% £ 18,276 £ 19,673 £ 1,398 108% £ 21,464 £ 20,274 -£ 1,189 94% £ 20,780 £ 20,091 -£ 688 97% £ 37,046 £ 38,249 £ 1,203 103% ERF Top-up 100% Top Up 20% Top Up Total £ 5,436 £ 524 £ 5,960 £ 5,967 £ 828 £ 6,794 £ 3,104 £ 406 £ 3,510 £ 351 £ -£ 351 £ 14,506 £ 1,758 £ 16,264 9 Page 11 of 17 2021/22 Finance Report - Month 4 ICS Elective Recovery Fund 21/22 ICS current estimated performance and forecast is shown for the four main Providers for the Elective Recovery Framework (ERF). April – July numbers are all currently based on local assessment and awaiting national finalisation. It should be noted that the Q2 forecast reflects the recent increase to the baseline for Q2 moving from 85% to 95% hence the trajectory indicating below plan performance for these months. At M4 the ICS has collectively reported £38.9m in ERF income vs an original (unadjusted) plan of £35.1m. The H1 forecast is now £46.3m dropping from £55.3m last month, this is against an original (unadjusted) plan of £50.4m. This includes circa £3.4m estimated impact of accelerator programmes on ERF income. 16000 14000 12000 10000 8000 6000 4000 2000 ICS ERF - All Organisations Plan vs Estimates(M1-4) vs Forecast (M5-6) 0 Apr May Jun Jul Aug Sep Plan Estimates/Forecast 10 Page 12 of 17 2021/22 Finance Report - Month 4 Substantive Pay Costs Total pay expenditure in July was £50.5m. This was higher than in June (up by £0.9m). The main increase was nursing agency staff (£0.7m) due mainly to staff sickness backfill and increased staffing requirements due to non elective pressures and covid. There was also a small increase in substantive medical staff costs. Pay costs remain in excess of that seen last year prior to the second covid wave as the organisation continues to drive recovery. Substantive recruitment has been challenging however with workforce numbers remaining broadly flat since April 21. These will be monitored closely going forward as costs are expected to increase as new theatre capacity comes on board this summer, in addition to investment in recovery plans and accelerator programme initiatives which are fully funded. £m £m £m 53.0 51.0 49.0 47.0 45.0 43.0 41.0 39.0 37.0 35.0 Total Pay Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr-21 May-21 Jun-21 Jul-21 18.0 Substantive Pay 16.0 14.0 12.0 10.0 Covid Agency Bank Substantive Plan Total Medical Nursing Other 48.0 Substantive Pay 46.0 44.0 42.0 40.0 Start Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Substantive Plan 21/22 Substantive Actual 21/22 Substantive Actual 20/21 11 Page 13 of 17 2021/22 Finance Report - Month 4 Temporary Staff Costs Agency spend has increased sharply month on month by £0.7m. All staff groups increased spend but the majority was in nursing (£0.5m) which was driven by increased short notice sickness (covid self isolation) plus bed pressures due to non elective and covid forcing ward costs higher. Expenditure on bank staff has fallen slightly month on month (£0.2m) with the largest fall in nursing. The plan adjustment within the bank graph relates to staffing requirements to deliver elective recovery that were forecast to increase the need for bank staffing. 1,700,000 1,600,000 1,500,000 1,400,000 1,300,000 1,200,000 1,100,000 1,000,000 900,000 800,000 700,000 600,000 500,000 400,000 300,000 200,000 100,000 0 5,000,000 4,500,000 4,000,000 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 0 2021/22 Agency Total Spend 2021/22 Bank Total Spend Page1142of 17 Total Agency Nursing Medics Scient & Tech Admin & Estates NHSI Plan Nursing Medics Scient & Tech Admin & Estates Total Bank 2021/22 Finance Report - Month 4 Cash The cash balance decreased slightly in July to £117.3m. This continues the marginal downward trend as cash reserves are used to deliver capital expansions. There are no foreseen material movements forecast now the cash regime has adjusted back to pre-covid levels with block income paid in the month for which it is due. We may however see some in-month volatility as we move to a more “normal” period and the working capital position stabilises. A gradual reduction is expected over the next two years as capital expenditure plans exceed depreciation. 180.0 160.0 140.0 120.0 100.0 80.0 60.0 40.0 20.0 - Cash Position Actual Minimum Cash Holding 13 Page 15 of 17 2021/22 Finance Report - Month 4 Capital Expenditure Expenditure on internally funded capital schemes YTD is £14.6m against budget of £16,2m. Total expenditure including externally funded schemes is £16m against budget of £17,4m, £1.4m behind plan. Significant expenditure in M4 included the vertical extension theatres scheme, which is nearing completion, the ED expansion scheme, where phase 1b of the works has commenced and the Ophthalmology Outpatients scheme where significant expenditure was incurred this month. The Trust continues to forecast to spend all of the Capital Departmental Expenditure Limit (CDEL) funding. The forecast shows expenditure of £2.46m over plan based on the expectation of receiving £2m of external funding for community diagnostic hubs and an allowable overspend of £0.46m on medical equipment as part of the accelerator funding scheme . Forecast variances on individual schemes include the vertical extension theatres scheme (-£1m), the ED expansion scheme where unforeseen generator and VAT costs were incurred (+£0.7m), IISS leases (£2.5m slippage) and equipment leases, where additional leases have been authorised. (Fav Variance) / Adv Variance Month Year to Date Full Year (Forecast) Plan Actual Var Plan Actual Var Plan Actual Var Scheme £000's £000's £000's £000's £000's £000's £000's £000's £000's Fit out of E level. Vertical Extension - Theatres 2,460 1,056 1,404 9,463 7,174 2,289 11,941 10,950 991 Strategic Maintenance 258 242 16 1,032 1,087 (55) 6,183 6,183 0 ED Expansion and Refurbishment 827 428 399 2,908 1,642 1,266 5,791 6,489 (698) Wards 0 17 (17) 0 17 (17) 4,000 4,000 0 Ophthalmology OPD 737 718 19 787 937 (150) 3,303 3,098 205 Maternity Induction Suite 0 0 0 0 (0) 0 2,000 2,000 0 NICU Pendants 0 0 (0) 0 0 (0) 896 355 541 Oncology Ward 0 2 (2) 861 430 431 861 751 110 Decorative / Environment Improvements 21 0 21 84 0 84 500 500 0 Side Rooms 0 5 (5) 490 517 (27) 490 537 (47) Information Technology Programme 250 137 113 1,000 810 190 5,000 5,000 0 Other Projects 175 374 (199) 1,208 1,073 135 3,060 2,803 257 Pathology Digitisation 59 5 54 236 22 214 1,171 1,171 0 Medical Equipment 42 64 (22) 168 476 (308) 1,000 2,016 (1,016) Accelerator Funded Equipment 0 0 0 0 0 0 0 460 (460) Slippage (516) 0 (516) (2,464) 0 (2,464) (5,035) (3,143) (1,892) Total Trust Funded Capital excl Finance Leases 4,313 3,049 1,264 15,773 14,185 1,588 41,161 43,170 (2,009) Finance Leases - IISS 0 0 0 0 32 (32) 5,230 2,765 2,465 Finance Leases - MEP 92 0 92 368 179 189 2,200 1,183 1,017 Finance Leases - Other Equipment 75 104 (29) 300 159 141 1,500 3,083 (1,583) Finance Leases - Opthalmology OPD 0 0 0 0 0 0 1,166 1,166 0 Finance Leases - Divisonal Equipment 25 (25) 50 75 82 (7) 475 500 (25) Donated Income (88) (32) (56) (352) (49) (303) (1,921) (1,596) (325) Total Trust Funded Capital Expenditure 4,417 3,096 1,321 16,164 14,588 1,576 49,811 50,271 (460) Fit out of E level. Vertical Extension - Theatres 140 140 0 538 538 0 700 700 0 Maternity Care System (Wave 3 STP) 96 243 (147) 384 753 (369) 1,917 1,776 141 Digital Outpatients (Wave 3 STP) 41 47 (6) 164 72 92 814 955 (141) LIMS Digital Enhancement 38 (0) 38 152 (0) 152 455 455 0 Community Diagnostic Hub 0 0 0 0 0 0 0 2,000 (2,000) Total CDEL Expenditure 4,732 3,526 1,206 17,402 15,950 1,452 53,697 56,157 (2,460) Page 16 of1147 2021/22 Finance Report - Month 4 Statement of Financial Position The July statement of financial position illustrates net assets of £443.6m which has decreased £7.6m compared to June 2021. This is however within the bounds of normal month on month volatility. The downward movement on inventories is driven by a reduction in Pharmacy stock (£2m). The Payables reduction of £5.3m was primarily due to the clearing of aged trade payables and also a reduction in capital creditors. Payables is becoming a greater focus area for the NHS and an improvement plan is being developed to help tackle this down to Better Payment Practice Code (BPPC) compliant levels. The Receivables increase of £4.6m was due to Chilworth invoicing. 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 Other Reserves Total Taxpayers' Equity 15 Page 17 of 17 2020/21 YE Actuals £m 415.4 14.7 71.3 129.0 (171.5) (2.8) (9.0) 447.1 (18.3) (8.5) (36.3) 384.0 246.0 114.0 24.0 0.0 384.0 (Fav Variance) / Adv Variance M3 Act £m 425.6 15.9 77.9 123.6 (180.2) (2.7) (8.8) 451.3 (17.5) (7.8) (34.7) 391.3 246.0 121.3 24.0 0.0 391.3 2021/22 M4 Act £m 426.9 13.8 82.5 117.3 (185.5) (2.7) (8.6) 443.6 (18.1) (7.5) (34.3) 383.7 246.0 113.7 24.0 0.0 383.7 MoM Movement £m 1.3 (2.0) 4.6 (6.4) (5.3) 0.0 0.2 (7.6) (0.6) 0.3 0.4 (7.6) 0.0 (7.6) 0.0 0.0 (7.6) Report to the Trust Board of Directors Title: Agenda item: Sponsor: Date: Purpose Integrated Performance Report 2021/22 Month 4 11.2 Chief Executive 26 August 2021 Assurance Approval or 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 Integrated Performance Report reflects the current operating environment and is aligned with our strategy. 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 out the change / or not: Summary: Conclusion and/or recommendation This report is provided for the purpose of assurance. This report is provided for the purpose of assurance. Page 1 of 29 Integrated KPI Board Report covering up to July 2021 Sponsor - Andrew Asquith, Director of Planning, Performance and Productivity, andrew.asquith@uhs.nhs.uk Page 2 of 29 Chart Type Cumulative Column Example Cumulative Column Year on Year Line Benchmarked Line & bar Benchmarked Control Chart 100% 0% 49.0% 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). 72.09% The line shows our performance and the bar underneath represents the range of 0.72 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 Page 3 of 29 Report to Trust Board in August 2021 Introduction The Integrated Performance Report is presented to the Trust Board each month. 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 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 • An ‘Appendix’, with indicators presented monthly, aligned with the five themes within our strategy This month, several of the new indicators have commenced reporting and further development is also taking place. Our indicators and this report structure will continue to be regularly reviewed, and feedback would be welcome. 3 Page 4 of 29 Report to Trust Board in August 2021 Summary This month the ‘Spotlight’ section features: 1. Clostridium Difficile Infection (C. diff) There have been 25 infections compared to a ‘target’ limit of 20 year to date, whilst in 2020/21 there were 63 infections compared to a limit of 64. UHS performance remains good compared to peer hospitals. The spotlight discusses variability in infection rates, the link to antibiotic prescribing, and actions being taken to further reduce the number of C. diff infections. 2. Diagnostic waiting time target Diagnostic waiting times have experienced major impacts during the pandemic, and 17% of patients are currently waiting longer than the national 6-week target. Trends at UHS are similar to those at peer hospitals. The spotlight discusses current performance and forecast recovery timescales for different test types, alongside strategic issues, and opportunities for diagnostics. Highlights to note in the appendix containing indicators by strategic theme include: • A further decline in Emergency Department performance to 78.4% and an increase in attendances to a new maximum • An increase to 129 inpatients who had been medically optimised for discharge but were waiting for care at home / in the community • Staff sick absence remains close to target (although COVID-19 absence including isolation of COVID-19 ‘contacts’ reached a peak of 2.5% during July) • Excellent research performance across a range of measures. 4 Page 5 of 29 Report to Trust Board in August 2021 Spotlight Spotlight Subject - Clostridium Difficile Infection (C. diff) C. diff infections are caused by an imbalance of gut microbiota. The person must have been exposed to C. diff spores either from food or from acquisition from the healthcare environment. The toxigenic C. diff spores reside in the large intestine for months to years. In the case of exposure to a broad-spectrum antibiotic, or cancer chemotherapy, the toxigenic spores start to produce toxins causing clinical disease manifesting with diarrhoea. In 2020/21 UHS reported 63 infections compared to a limit of 64. In 2021/22 to date, the monthly limits have been exceeded. The graph below shows the most recent 12 month period in blue, and prior 12 months in yellow. UHS ranks 3rd out of 16 self-selected peer acute trusts, with a rate of 16.2 cases/ 100,000 bed days. Reporting criteria are standardised across trusts. 5 Page 6 of 29 Report to Trust Board in August 2021 In 2021/22 there were 19 Community Onset – Hospital Attributable (COHA), 44 Hospital Onset – Hospital Attributable (HOHA) cases. The total number of infections has varied significantly in the past 18 months. The reasons for peaks are unclear but a possible reason might relate to the pandemic, C. diff infections appear to have peaked three months after both the first and second waves. Spotlight It is likely that C. diff rates relate to rates of antibiotic use, possibly in the community as well as hospital; hospital antibiotic usage has been at higher levels during COVID-19 peaks. Underlying trends are of stable / reducing antibiotic use, and the use of ‘broad-spectrum’ antibiotics is particularly closely managed. The average length of an antibiotic course at UHS has also reduced from 7.5 days in 2018/19 to 6.7 in 2020/21. 6 Page 7 of 29 Report to Trust Board in August 2021 Spotlight A wide range of other potential influences upon C. diff infection have been examined including: Infection control – most cases are not part of a cluster or outbreak Infection control – infections in chemotherapy patients appear to relate to their treatment, not an association between the patients themselves or the care environment Cleaning – Audited and generally found to be of a high standard; some opportunities for improvement identified with those items that are to be cleaned by clinical staff Hand hygiene – Improved during the pandemic, and is audited, though a minority of areas still require improvements Physical environment – UHS has relatively few individual rooms, which risks delay in isolation in patients with symptoms which might indicate an infection i.e. loose stools A range of measures are in place, and further actions have been taken, which are expected to impact upon C. diff infection rates and maintain them within acceptable levels: All inpatient cases are reviewed by the infection prevention team to ensure all elements of the care bundle were followed. All hospital acquired cases are reviewed by a Consultant microbiologist/Infection control doctor. The Antimicrobial Review Group reviews cases for appropriate antibiotic use and duration. An updated C. diff policy was approved in July, including changes to the required prevention, treatment and infection control measures. The care plan documentation was expanded. Additional individual rooms have been built in 2020 and 2021, within adult and paediatric wards, and the new Cancer Care ward (C2). This need will remain an important focus for the Trust. Improvements in the turnaround time for stool samples has helped to achieve appropriate isolation of infected patients / closure of bays, whilst making effective use of available bed capacity. Further innovation in point of care testing and rapid laboratory testing are expected to deliver additional improvement in 2021/22. Investment in equipment, and 24/7 operation of the microbiology laboratory, have significantly improved the turnaround time for blood cultures for patients with bacteraemia, and enabled earlier implementation of more specific antibiotics which are less likely to promote C. diff infection. The ongoing review of anti-microbial guidelines and high-risk broad-spectrum antibiotics had been disrupted by the pandemic, and by the resource requirements of the COVID-19 vaccination programme. This is expected to be addressed during the remainder of 2021/22. 7 Page 8 of 29 Report to Trust Board in August 2021 Spotlight Spotlight Subject - Diagnostic waiting time target The national target is that at least 99% of the patients waiting for an elective diagnostic test will have waited less than 6 weeks / no more than 1% will have waited more than 6 weeks. 15 different tests are reported at the end of each month, although Trust performance is normally assessed for the group of tests as a total. UHS is not currently achieving the target, largely due to the impact of COVID-19. During the pandemic, diagnostic services have experienced postponement of nonurgent patients, staff shortages, and reduced productivity due to enhanced infection control measures. Performance is gradually improving, although 17% patients currently waiting have still waited more than 6 weeks. UHS performance is typical of the NHS, UHS is currently 7th best amongst a peer group of large teaching hospitals. As referral volumes recovered following a steep drop when the pandemic started (referrals come from both primary and secondary care clinicians, dependent upon the test), the total number of patients on the waiting list increased beyond pre-pandemic levels (Feb 2020 = 7907), but this is currently relatively stable. 8 Page 9 of 29 Report to Trust Board in August 2021 Spotlight Diagnostic activity levels, as a whole, have recovered and are now above pre-pandemic levels. 20000 15000 10000 5000 0 Diagnostic activity per month The following table show the position at end July, ordered by the number of patients waiting over 6 weeks. There are significant differences between the size and duration of the waiting lists for each of the tests. Tests also require different professions and equipment to perform them (although there are some resources in common e.g. Radiographers and Radiologists shared between MRI and CT, Endoscopy rooms shared between Colonoscopy, Gastroscopy and Flexible Sigmoidoscopy). Diagnostic Area NEUROPHYSIOLOGY - PERIPHERAL NEUROPHYSIOLOGY MAGNETIC RESONANCE IMAGING NON-OBSTETRIC ULTRASOUND GASTROSCOPY CARDIOLOGY - ECHOCARDIOGRAPHY CYSTOSCOPY COLONOSCOPY RESPIRATORY PHYSIOLOGY - SLEEP STUDIES FLEXI SIGMOIDOSCOPY COMPUTED TOMOGRAPHY URODYNAMICS - PRESSURES & FLOWS DEXA SCAN CARDIOLOGY - ELECTROPHYSIOLOGY AUDIOLOGY - AUDIOLOGY ASSESSMENTS BARIUM ENEMA Breach 6 Week Target Within 6 Week Target Grand Total % achieved within 6 weeks 499 629 1128 55.76 425 1583 2008 78.83 175 2779 2954 94.08 150 233 383 60.84 84 370 454 81.5 69 145 214 67.76 44 292 336 86.9 40 89 129 68.99 22 90 112 80.36 18 937 955 98.12 13 27 40 67.5 9 311 320 97.19 9 4 13 30.77 1 110 111 99.1 1 65 66 98.48 9 Page 10 of 29 Report to Trust Board in August 2021 Spotlight All services are forecasting recovery of their pre-pandemic performance by the end of October 2021, with the exception of Neurophysiology and Magnetic Resonance Imaging (MRI). Neurophysiology waiting times were substantially impacted by a two month cessation of most investigations at the start of the pandemic in order to reduce the risk of COVID-19 transmission, and also by subsequent staff shortages - due to vacancies and role changes to protect staff at high risk from COVID-19, and reductions in productivity in outpatients as a result of additional infection control measures. The service is now fully staffed, but capacity to increase activity is constrained by physical space, ability to recruit further, and limited capacity amongst staff to undertake further overtime / additional sessions. Further opportunities to improve productivity, and test new working practices, continue to be investigated. MRI waiting times are at risk because our scanners are already operated for extended hours each day, both Radiographers and Radiologists are difficult to recruit in sufficient numbers, and capacity is currently being supported by scanner time contracted from Independent Sector suppliers which is not secure in the long term. A business case is being prepared which will propose an option to replace existing older scanners without the loss of capacity that would normally be experienced during decommissioning / commissioning, and to upgrade an existing scanner to extend its life and increase the number of UHS operated scanners by one. Strategic issues and opportunities related to diagnostic services include: Community Diagnostic Hub (CDH) - The NHS Long Term Plan recognised a need for radical investment and reform, and an Independent Review of Diagnostic Services* in Oct 2020 recommended ‘Community Diagnostic Hubs’ be established away from Acute Hospital Sites. UHS is currently part of a collaborative bid which, if successful, would provide an additional NHS CT scanner and Ultrasound room in Southampton. Further NHS CDH investment is likely, and UHS will consider this as part of the Estate Strategy. Growth in Demand – Significant (national) growth rates include CT (6.8%), MRI (5.6%), Colonoscopy (5.3%) and Flexible Sigmoidoscopy (8.4%). Diagnostic activity rates are also often significantly below international comparators. Further growth in demand should be anticipated and planned for, for example recommendations* that CT scanning capacity should be increased by 100% within 5 years, and that at least 200 new endoscopy rooms are required in NHS trusts. Capacity Expansion and Innovation – is supporting the current recovery. For example, national funding supported construction of an additional UHS endoscopy room which opened in April, and the purchase of equipment which enables ‘sleep studies’ to be performed in greater volumes and in a patient’s home rather than in the hospital. * https://www.england.nhs.uk/wp-content/uploads/2020/11/diagnostics-recovery-and-renewal-independent-review-of-diagnostic-services-for-nhs-england2.pdf 10 Page 11 of 29 Report to Trust Board in August 2021 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 o Start your consultant-led treatment within a maximum of 18 weeks from referral for non-urgent conditions o 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 o All patients should receive high-quality care without any unnecessary delay o 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 11 Page 12 of 29 Report to Trust Board in August 2021 NHS Constitution Standards for Access to services within waiting times Monthly May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul target YTD % Patients on an open 18 week 100% 72.1% UT28-N pathway teaching (within 18 weeks ) with hospital min-max range and 49.0% ≥92% rank (of 20) 14 7 6 7 7 10 10 10 9 9 8 7 8 8 30% 100% 96.3% % Patients following a GP referral for - suspected cancer seen by a specialist within 2 weeks 83.8% ≥93% 80% Cancer waiting times 62 day standard - Urgent referral to first definitive 100% 87.8% UT34-N treatment (Latest data held by UHS) ≥85% - with teaching hospital min-max range 73.5% 4 3 1 1 1 9 10 9 3 4 2 1 4 6 and rank (of 20) 30% Patients spending less than 4hrs in ED - 93% 94.1% SGH Main ED (Type 1 and UCH) UT25-N Major Trauma Centres (Type 1) 85% 77% 78.4% ≥95% - Rank of 8-> 5 3 3 4 2 2 1 1 1 2 3 3 3 3 703.28% % of Patients waiting over 6 weeks for 80% 35.4% UT33-N diagnostics with teaching hospital min- 16.9% ≤1% - max range and rank (of 20) 7 7 9 13 14 14 11 12 9 10 10 10 9 7 0% 12 Page 13 of 29 Report to Trust Board in August 2021 Outstanding Patient Outcomes, Safety and Experience Outcomes UT1-N HSMR - UHS HSMR - SGH UT2 HSMR - Crude Mortality Rate May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul 83 77 3.1% 78.3 77.9 2.9% 2.6% 800 597 UT3 Emergency readmissions within 30 days of discharge from hospital 627 200 Monthly target ≤100 - - UT4-L Cumulative Specialities with Outcome Measures Developed 54 56 56 57 61 +1 260 285 305 332 396 100% UT5 Developed Outcomes RAG ratings 81% 75% 79% 77% 76% 80% - 50% Appendix YTD YTD target 13 Page 14 of 29 Report to Trust Board in August 2021 Outstanding Patient Outcomes, Safety and Experience Safety May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Cumulative Clostridium difficile UT6-N This year vs. last year 2732 3039 3543 4250 4852 5455 6057 7063 57 1116 1521 1825 35 Healthcare-acquired COVID infection: UT7 COVID-positive sample taken > 14days 39 after admission (validated) 0 12 1 0 0 0 8 0 10 2 5 0 0 0 3 Probable hospital-associated COVID 80 UT8 infection: COVID-positive sample taken > 7 days and 70.28% 533422111233333 05:00 UT26 Average (Mean) time in Dept - nonadmitted patients 02:14 03:06 - 01:00 05:00 03:17 UT27 Average (Mean) time in Dept - admitted patients 04:13 - 01:00 100% % Patients on an open 18 week pathway 72.1% UT28-N (within 18 weeks ) with teaching 49.0% ≥92% hospital min-max range and rank (of 20) 14 7 6 7 7 10 10 10 9 9 8 7 8 8 30% 42,500 Total number of patients on a waiting 42149 UT29 list (18 week referral to treatment 33401 - pathway) 30,000 21,000 Patients on an open 18 week pathway UT30 (waiting 52 weeks+ ) with teaching 951 2309 - hospital min-max range and rank (of 20) 0 13 11 11 11 10 9 6 6 6 5 4 4 4 6 Appendix YTD YTD target - - - - - - - - - - 17 Page 18 of 29 Report to Trust Board in August 2021 Outstanding Patient Outcomes, Safety and Experience May Jun 1000 UT31 Patients on an open 18 week pathway (waiting 78 weeks+ ) 0 11,000 UT32 Patients waiting for diagnostics Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul 799 7 7875 9223 Monthly target - - 4,000 80% % of Patients waiting over 6 weeks for UT33-N diagnostics with teaching hospital min- max range and rank (of 20) 7 0% Cancer waiting times 62 day standard - Urgent referral to first definitive 100% UT34-N treatment (Latest data held by UHS) with teaching hospital min-max range 4 and rank (of 20) 30% 100% 31 day cancer wait performance - UT35-N decision to treat to first definitive treatment (Latest data held by UHS) 80% 100% 31 day cancer wait performance - UT36-N Subsequent Treatments of Cancer (Latest data held by UHS) 80% 35.4% 7 9 13 14 14 11 12 9 87.8% 3 1 1 1 9 10 9 3 97.6% 98.6% 10 10 10 9 16.9% 7 73.5% 4 2 1 4 6 96.0% 96.2% ≤1% ≥85% ≥96% ≥95.2% Appendix YTD YTD target - - - - - - - - - - 18 Page 19 of 29 Report to Trust Board in August 2021 Pioneering Research and Innovation PN1-L Comparative CRN Recruitment Performance - non-weighted May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul 2 5 9 10 10 9 Monthly target Top 10 PN2-L Comparative CRN Recruitment Performance - weighted 2 2 5 3 7 8 Top 5 PN3-L Comparative CRN Recruitment contract commercial 7 13 17 PN4-L Achievement compared to R+D Income 160% Baseline Monthly income increase % YTD income increase % -50% 2 12 11 Top 10 46.0% 152.0% 55.0% -22.0% 45.0% ≥5% Appendix YTD YTD target 19 Page 20 of 29 Report to Trust Board in August 2021 World Class People Appendix Workforce Capacity May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Monthly target 14% Substantive Staff - Turnover WR1-L -R12M turnover % -Leavers in month (FTE) 10% 12.6% 80 200 12.7% R12M 100 =92.0% 84.5% > =76% 20 Page 21 of 29 Report to Trust Board in August 2021 World Class People Staff survey engagement score WR8-L National NHS Staff Survey May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul 8 7.3 0 WR8-L - Maximum score = 10, Average of “Acute and Acute&Community”, group is 7 Compassion and Inclusion 11% WR9-L % of Band 7+ staff who are Black and Minority Ethnic 9.21% 7% WR10 14% % of Band 7+ Staff who have declared a disability or long term health condition 13.7% WR11 12% Pulse survey % of staff recommend UHS as a place to work- White British staff compared with all other ethnic groups combined Data available from August 2021 - new monthly staff survey 10.19% 13.5% WR12 Pulse survey % of staff recommend UHS as a place to work- Disabled compared with non disabled / prefer not to answer Data available from August 2021 - new monthly staff survey WR13 Pulse survey % of staff recommend UHS as a place to work- Sexuality = Heterosexual compared with all other groups combined Data available from August 2021 - new monthly staff survey Appendix Monthly target YTD YTD target 15% by 2023 - 21 Page 22 of 29 Report to Trust Board in August 2021 Integrated Networks and Collaboration Local Integration Number of inpatients that were NT1 medically optimised for discharge (monthly average) May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Monthly target 150 129 92 ≤80 50 Emergency Department NT2 activity - type 1 This year vs. last year Percentage of virtual appointments as a NT3 proportion of outpatient consultations This year vs. last year 15,000 9,482 9,077 5,000 70.00% 44.40% 15.6% 0.00% 11,722 - 8,456 51.5% - 28.1% Appendix YTD YTD target - - - - - - 22 Page 23 of
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2021-Trust-document/Finance-and-performance-reports/Finance-and-Performance-Reports-2021-22-Month-4-July-2021.pdf

Spinal cord stimulator implantation aftercare advice - patient information

Description: This factsheet explains what to expect after having surgery to implant a spinal cord stimulator and how to recover well at home.
Url: /Media/UHS-website-2019/Patientinformation/Brain-and-spine/Spinal-cord-stimulator-implantation-aftercare-advice-4075-PIL.pdf

SWL (shockwave lithotripsy) for kidney stones - patient information

Description: This factsheet explains what shockwave lithotripsy (SWL) involves so that you know what to expect at your appointment.
Url: /Media/UHS-website-2019/Patientinformation/Digestionandurinaryhealth/SWL-shockwave-lithotripsy-for-kidney-stones-658-PIL.pdf

Fetal MRI - patient information leaflet

Description: A fetal MRI scan is a special type of MRI scan which takes detailed images of a baby's brain while they are in the womb. It is a safe and painlessprocedure for both you and your baby.
Url: /Media/UHS-website-2019/Patientinformation/Pregnancyandbirth/Fetal-magnetic-resonance-imaging-MRI-3887-PIL.pdf

Thalamotomy - patient information

Description: This factsheet explains what a thalamotomy is, what the procedure involves, and what the possible benefits and risks are.
Url: /Media/UHS-website-2019/Patientinformation/Brain-and-spine/Thalamotomy-3292-PIL.pdf

Papers-CoG 26.04.2023

Description: Agenda attachments 1 CoG Agenda - 26.04.2023.docx Date Time Location Chair Agenda Council of Governors 26/04/2023 14:00 - 16:05 Microsoft Teams Jenni Douglas-Todd 1 Chair’s Welcome and Opening Comments 14:00 2 Declarations of Interest 14:02 3 Minutes of Previous Meeting 14:03 Approve the minutes of the previous meeting held on 25 January 2023 4 Matters Arising/Summary of Agreed Actions 14:04 5 Strategy, Quality and Performance 5.1 Annual Report and Quality Accounts Timetable 14:05 Note the Annual Report and Quality Accounts Timetable Sponsor: David French, Chief Executive Officer Attendee: Craig Machell, Associate Director of Corporate Affairs and Company Secretary 5.2 Chief Executive Officer's Performance Report 14:10 Receive and note the report Sponsor: David French, Chief Executive Officer 5.3 Operational Plan 2023/24 14:30 Receive and note the update Sponsor: Ian Howard, Chief Financial Officer Attendees: Andrew Asquith, Director of Planning and Productivity and Philip Bunting, Director of Operational Finance 5.4 Non-NHS Activity 14:50 Receive and note the update Sponsor: Ian Howard, Chief Financial Officer Attendee: Pete Baker, Commercial and Enterprise Director 15:00 Break 6 Governance 6.1 Appointment of Deputy Lead Governor 15:10 Note the appointment of Sandra Gidley as Deputy Lead Governor Sponsor: Jenni Douglas-Todd, Trust Chair Attendee: Karen Russell, Council of Governors' Business Manager 6.2 Review Terms of Reference - Council of Governors and Working Groups 15:15 Approve the proposed changes to the terms of reference Sponsor: Jenni Douglas-Todd, Trust Chair Attendees: Craig Machell, Associate Director of Corporate Affairs and Company Secretary and Karen Russell, Council of Governors' Business Manager 6.3 Council of Governors' Elections 2023 15:20 Note the timetable for the Council of Governors' elections Sponsor: Jenni Douglas-Todd, Trust Chair Attendee: Karen Russell, Council of Governors' Business Manager 6.4 Appointed Governor for Hampshire County Council (Oral Update) 15:25 Receive an update regarding the appointed governor for Hampshire County Council Sponsor: Jenni Douglas-Todd, Trust Chair 6.5 Proposal for Filling the Vacancy in the Rest of England and Wales 15:30 Constituency Approve the proposal for filling the vacancy in the Rest of England and Wales constituency Sponsor: Jenni Douglas-Todd, Trust Chair Attendee: Karen Russell, Council of Governors' Business Manager 7 Membership Engagement and Governor Activity 7.1 Membership Engagement 15:35 Receive and note the report Sponsor: David French, Chief Executive Officer Attendee: Sam Dolton, Events and Membership Officer 7.2 Feedback from Strategy and Finance Working Group 15:45 Chair: Mandy Fader 7.3 Feedback from Patient and Staff Experience Working Group 15:50 Chair: Sandra Gidley 7.4 Feedback from Membership and Engagement Working Group 15:55 Chair: Kelly Lloyd 8 Review of Meeting 16:00 Review and feedback on the content of this meeting Sponsor: Jenni Douglas-Todd, Trust Chair 9 Any Other Business 16:02 Raise any relevant or urgent matters that are not on the agenda 10 Date of Next Meeting: 26 July 2023 16:04 Note the date of the next meeting Page 2 3 Minutes of Previous Meeting 1 3 COG Minutes Open Session Final - 25.01.2023.docx Minutes - Council of Governors (CoG) Open Session Date Time Location Chair Present 25 January 2023 14.00-16.00 Conference Room, Heartbeat Education Centre and Microsoft Teams Jenni Douglas-Todd, Trust Chair Jenni Douglas-Todd, Trust Chair Theresa Airiemiokhale, Elected, Southampton City Shirley Anderson, Elected, New Forest, Eastleigh and Test Valley Patricia Crates, Elected, New Forest, Eastleigh and Test Valley Dr Nigel Dickson, Elected, New Forest, Eastleigh and Test Valley Helen Eggleton, Appointed, Hampshire and Isle of Wight Integrated Care Board Lesley Gilder, Elected, Southampton City Sathish Harinarayanan, Elected, Medical practitioners and dental staff Linda Hebdige, Elected, Southampton City Sandra Gidley, Elected, New Forest, Eastleigh and Test Valley Jenny Lawrie, Elected, Southampton City Kelly Lloyd, Elected, Health Professional and Health Scientist Staff and Lead Governor Councillor Cathie McEwing, Appointed, Southampton City Council Catherine Rushworth, Elected, Isle of Wight Liz Taylor, Elected, Non-clinical and support staff Quintin van Wyk, Elected, Rest of England and Wales Professor Emma Wadsworth, Professor of Work Environment and Vice Provost Research and Innovation, Solent University JDT TA SA KB PC ND HE LG SH LH SG JL KL CMc CR LT QvW EW In attendance Tracey Burt, Minutes Sam Dolton, Events and Membership Officer Steve Harris, Chief People Officer (for Item 6.1 Craig Machell, Associate Director of Corporate Affairs and Company Secretary Karen Russell, Council of Governors’ Business Manager David French, Executive Officer (for Item 5.1) TB SD SHa CMa KR DAF Apologies Katherine Barbour, Elected, Southampton City KB Professor Mandy Fader, Appointed, University of Southampton MF Councillor Alexis McEvoy, Appointed, Hampshire County Council AM Esther O’Sullivan, Elected, New Forest, Eastleigh and Test Valley EO Ian Ward, Elected, Rest of England and Wales IW 1 Chair’s Welcome and Opening Comments JDT welcomed everyone to the meeting and in particular EW who was attending for the first time. 1 2 Declarations of Interest There were no new declarations of interest relating to matters on the agenda. 3 Minutes of Previous Meeting The minutes of the meeting held on 19 October 2022 were approved as an accurate record of the meeting. 4 Matters Arising/Summary of Agreed Actions The updates on the actions in the paper were noted. Young governor representatives (action no. 444) was on the agenda for discussion (item 6.3). 5 Strategy, Quality and Performance 5.1 Chief Executive Officer’s Performance Report DAF joined the meeting to present the performance report. He also provided updates on the last three months and the Trust’s financial position. He advised that the last peak of Covid-19 had been in October 2022, when there had been nearly 100 patients with Covid-19 in the hospital, although most had been admitted for other reasons. That had caused operational challenges as it had been necessary to cohort patients with Covid-19, which had not been the most efficient way to run the hospital and was also not ideal for the patients. Despite national and local efforts, the uptake of flu vaccinations had been less strong than in previous years. Going into December another wave of Covid-19 had just started and there had also been a high prevalence of flu and RSV. Children’s ED and 111 had been close to being overwhelmed and ED attendances had more than doubled at UHS, which had put massive pressure on the hospital. That picture had been mirrored nationally and many hospitals (excluding UHS) had gone into critical incident mode. It had been an exceptionally difficult time going into Christmas and pressure created by non-elective emergency patients had continued throughout the holiday period. A year ago, attendances during a typical day in ED at UHS (excluding Eye Casualty) had been around 300 but during December, that number had exceeded 500 on several days. Whilst the hospital had regained a more normal feel during the latter half of January, the RCN strikes had commenced. UHS had not been impacted by the first wave of industrial action but it had experienced two days of action last week and the Trust had aimed to achieve four things: 1. to respect people’s right to strike. 2. to keep as much work going as possible, even with the capacity problems the hospital faced. 3. to keep the hospital safe. 4. to ensure that there was not polarisation amongst the staff after the strikes. DAF said that he felt the Trust had done reasonably well at achieving its aims but around 700 of its nurses had taken industrial action on both days, which had been higher than expected. The Trust had, however, kept roughly half the elective surgery going and he thanked the planning team and senior nurses for their efforts. 2 In response to questions from governors, DAF advised that issues around contractual pay and conditions were a matter for the government to resolve but UHS had tried to focus on the smaller things it could do to support staff, e.g. discounted meals/food and reduced parking costs. The Staff Satisfaction Survey had, however, shown a deterioration in satisfaction levels but UHS remained one of the top ten hospitals in the country to work in. With regard to the Trust’s financial position, DAF advised that the hospital was currently spending around £4m more each month than it was earning and the reserves it had built up over the years for capital investment, were dwindling. The number of patients in the hospital’s beds was higher than planned due to the difficulties of discharging to social care and the cost of staffing those extra beds was significant. Trusts had been challenged to do 104% more activity than they had done in the year prior to Covid-19. UHS had achieved 106% and in some months around 110%, which was more than many Trusts and was worth around £25m. The Trust had not, however, received any money for that activity and it was lobbying for payment. SA queried whether the extra activity was impacting on quality. DAF advised that the Trust’s clinical outcomes remained strong but it was beginning to have an impact and he noted that organisations under pressure often did less well. Staff tended to suffer morale injury if they were so busy they felt unable to do the best for their patients and that was being seen across the country. DAF described the hospital as feeling like a hamster wheel and he advised that the Trust Board had recently discussed how it could be slowed down. If it was not possible to increase capacity, then it may be necessary to consider ways of reducing demand. HE highlighted the cancer metrics and the psychological impact on patients who had to wait longer for their treatment. DAF noted that cardiac patients faced similar delays, due to capacity issues, and acknowledged that whilst work was being done to improve these situations, more work was needed. 6 Governance 6.1 Chair and Non-Executive Director Appraisal Process SHa advised that each year the Non-Executive Directors (NEDs) and the Trust Chair were required to participate in an annual appraisal process. The results were shared with the Governors’ Nomination Committee (GNC) and the CoG. The appraisal process was based on a national framework from NHSE and guidance provided by them would be used. High quality, multi-source feedback would be obtained from Trust Board members and governors for both the NED and Chair appraisals. Feedback from the Integrated Care System (ICS) would also be sought as part of the Chair’s appraisal process. The Chair would conduct individual appraisal meetings with each NED, once feedback had been collated and would consider objectives for the following year. The appraisal process for the Chair would be undertaken by Jane Harwood, NED and Senior Independent Director (SID) and a summary would be provided to the NHSI Regional Director. 3 SHa advised that he would guide KL through the process of collecting feedback from the governors as this was her first term as Lead Governor. He also acknowledged that many governors were relatively new in their roles and he assured them that guidance would be provided in good time. Decision: The CoG approved the appraisal process as recommended by the GNC, following its meeting on 11 January 2023. 6.2 Annual Business Plan 2023/24 KR highlighted the Business Plan and advised that the CoG was required to review (and approve) it on an annual basis, prior to commencement of the new financial year. Decision: The CoG approved the Annual Business Plan for 2023/24. 6.3 Composition of the Council of Governors CM advised that as part of a review of the composition of the CoG, the Membership and Engagement Working Group had discussed proposals regarding the representation of young people on the CoG. In the past, two young people had been appointed to the CoG, one from a college and one from a university. The Trust already had a Youth Ambassador Group (made up of service users) and it had been suggested that the group was asked to provide two representatives (one each from the 16-18 and 18-25 age groups) to join the CoG as associate members. They would be non-voting roles and would not affect the formal composition of the CoG or require any change to the Trust’s constitution. Following discussion, the governors agreed that the young governor representatives should be invited to become associate members for up to two years. The possibility of reaching out to other minority groups, in a similar way, was also suggested and may be considered in the future. Decision: The CoG approved the proposal to invite two representatives from the Trust’s Youth Ambassador Group (one each from the 16-18 and 18-25 age groups) to become associate members of the CoG for up to two years. 6.4 Vacancy for the Nursing and Midwifery Staff Governor JDT advised that Wendy Marsh, who had been elected as the governor for the Nursing and Midwifery staff group, with effect from 1 October 2022, had stood down for personal reasons with effect from 6 December 2022. In accordance with the Trust’s constitution, the paper outlined the three options available to fill the vacancy but JDT advised that given the circumstances, the first was the only viable option. KR advised that once the election had been arranged, the vacancy would be publicised and Gail Byrne, Director of Nursing and Midwifery, would be asked to encourage interest from within the Trust’s nursing and midwifery community. Decision: The CoG approved Option 1 to fill the vacant seat for the Nursing and Midwifery staff group by calling an election to coincide with the scheduled governor elections in 2023. 4 6.5 Confirmation of Chair of the Patient and Staff Experience Working Group JDT advised that a vacancy had arisen for the chair role of the CoG Patient and Staff Experience Working Group as the previous incumbent had stood down when his first term of office had ended on 30 September 2022. SG had expressed an interest in the role and the working group had voted unanimously to support her appointment. Decision: The CoG confirmed the appointment of SG as chair of the CoG Patient and Staff Experience Working Group following her election by the working group. 6.6 Appointment of Deputy Lead Governor JDT advised that HE would complete her first term of office as Deputy Lead Governor on 11 March 2023. Any governor who wished to apply for the role would be required to submit a written statement to the Company Secretary by a specified date (tbc). The statements would then be circulated to all governors by email and an electronic vote would take place. HE advised that she would be happy to talk to any governor about the role. Decision: The CoG noted the process for the appointment of a new Deputy Lead Governor. 6.7 Audit and Risk Committee Terms of Reference The Terms of Reference for all Board committees should be reviewed regularly, and at least once annually, to ensure that they reflected the purpose and activities of each committee. The NHS Foundation Trust Code of Governance required consultation with the Council of Governors on the Audit and Risk Committee Terms of Reference. The Terms of Reference were then to be approved by the Board of Directors (the Board). The Terms of Reference ensured that the purpose and activities of the Audit and Risk Committee were clear and supported transparency and accountability in the performance of its role and complied with the NHS Foundation Trust Code of Governance. The Code of Governance for NHS Provider Trusts, applicable from April 2023, included provisions which stated that the Deputy Chair should not be Chair of the Audit Committee. However, the key concern was that the Audit Committee Chair should be independent, and where the Deputy Chair was expected to act as Chair of the Board, there was potential for the director’s independence to become compromised over time. It was proposed to include the proviso in the Audit and Risk Committee Terms of Reference, that should the Deputy Chair have to act as Chair of the Board for an extended period of time, they would resign as committee Chair in order to preserve the independence of the committee Chair. Given the current committee Chair’s experience and qualifications, it was considered appropriate that he should remain as committee Chair and that the non-compliance could be justified under the ‘comply or explain’ principle and that the underlying concern in respect of independence was to be mitigated through that proviso. This explanation was to be documented in the Trust’s Annual Report. This had been discussed with the Audit and Risk Committee and the CoG Governors’ Nomination Committee (GNC) had also been consulted. 5 An additional consideration was that, as part of succession-planning and Board composition discussions, the Board was to consider the need for an additional suitably (financially) qualified individual to be a member of the committee, who could replace the committee Chair should he have to resign due to his Deputy Chair commitments. The CoG was asked for its views on the proposals: • in response to questions from SG and CMc about the possibility of replacing either the Audit and Risk Chair or Deputy Chair, CMa advised that this would be difficult due to the relevant experience and qualifications of the individual. CMa also explained that the Code of Governance for NHS Provider Trusts was not in alignment with corporate business and agreed that feedback on the change should be provided in the annual review. • KL felt that the proposals had been well considered and were justified but agreed that feedback on the change should be provided. Decision: The CoG agreed with the proposals subject to feedback being provided regarding the changes introduced to the Code of Governance and that its views would be considered when the proposals were reviewed by the Board. 7 Break 8 Membership Engagement and Governor Activity 8.1 Membership Engagement SD introduced the Membership Engagement report and noted that over the last three months most of the Trust’s membership engagement had been through virtual and digital platforms but there had been some activity in the community. He highlighted the following: • a Connect membership newsletter had been sent out in October and December 2022; • approximately 275 postal members of the Trust had now provided their email address which would make it easier to keep in touch with them on a more cost effective basis; • in October public members who specified a stated interest in cardiac, orthopaedics or rheumatology had been invited to take part in real examinations from final year University of Southampton medical students on placement at the Trust. This had resulted in a good interest rate among members; • the Annual Members’ Meeting had taken place in November and had included highlights from the report and accounts as well as a look at progress made in implementing the Trust’s five-year strategic plan. An update on the membership strategy had kindly been provided by HE; • as part of the global men’s health awareness month in November, the Trust had held a men’s health matters event for both public and staff members. IT had focussed on raising awareness on prostate and testicular cancer and also mental health; • members had been invited to a virtual event to mark 20 years of the Trust’s Wessex Blood and Marrow Transplant Programme in November, with staff and former patients reflecting on the service; • the Trust had marked Disability History Month in November with a virtual event looking at how Workforce Disability Equality Standards data was put into action to improve the experience of its disabled staff, with guest speaker Pete Loughborough, a senior analyst at NHS England; • to mark Black History Month in October, Lou Taylor, director of Black History Month South, had been invited to speak about his organisation’s new 6 partnership with the Trust. Staff of black heritage had been encouraged to take part in a project; • a virtual event had been held in January inviting members to contribute to the Trust’s plans to become a tobacco smoke-free hospital site, with examples of interventions to help patients to quit smoking; • the Trust, including some of the governors, had taken part in community sessions in public libraries across Southampton. These provided an opportunity for the public to learn more about how they could get involved in developing UHS services, participate in specific projects and give their views on care received; and • there had been good engagement with stories on social media. For example, a team of UHS medics had received the Best Team award at The Sun’s Who Cares Wins awards after transporting 21 young Ukrainian cancer patients back to England so they could continue their life-saving treatment. Priorities included: • the continuation of virtual health education events exclusively for members; • production of an edition of Connect in February 2023; and • engagement with the University of Southampton Students Union and other stakeholders on attracting younger members. As most of the recent community activities had taken place in the Southampton area, SD encouraged public governors from other constituencies to contact him if they would like any support in engaging with their constituents. 8.2 Feedback from Governors’ Nomination Committee (GNC) A meeting of the GNC had been held on 11 January 2023 to consider the Chair and Non-Executive Director appraisal process for 2022/23. This had been presented to the CoG for approval earlier in the meeting. There was still a vacancy on the GNC and KR had emailed governors on 18 January 2023 to invite expressions of interest. JDT encouraged governors to consider if they would like to volunteer for this additional role. 8.3 Feedback from Strategy and Finance Working Group A meeting of the Strategy and Finance Working Group had been scheduled for 24 January. Unfortunately, this had been cancelled as the Chair had become unwell. This would be re-arranged once she had recovered. 8.4 Feedback from Patient and Staff Experience Working Group A meeting of the Patient and Staff Experience Working Group had been held on 17 January. SG, who had been appointed by the Working Group members as its new Chair, had been unable to attend. KR advised that following a request from the Southampton City governors, there had been a discussion on tackling health inequalities which included a presentation on a prevention project related to diabetes which was underway at the Trust. The presentations had been well received by governors. 8.5 Feedback from Membership and Engagement Working Group A meeting of the Membership and Engagement Working Group had been held on 19 January. SD had attended to provide an update on membership engagement which had also been covered at Item 8.1, and there had been a discussion regarding proposals for young governor representatives which had been presented to the CoG at Item 6.3. 7 KL also advised that where virtual membership events had been recorded and the videos were available for viewing at a later date, via social media, these could incorporate a link to join as a member of the Trust. Consideration was also to be given to inviting network leads to attend future Membership and Engagement Working Group meetings. Proposals for financial support for international staff had been put to SHa which included a possible loan. 9 Any Other Business A question was raised as to whether governors could use the Park and Ride facility when attending CoG meetings as car parks on site could be extremely busy. KL reminded governors that Hampshire and Isle of Wight ICB were to hold a virtual strategy update event for governors on 14 February from 5.30pm-7pm. KR had circulated the calendar invitation. Action: KR to establish whether governors could use the Park and Ride facility when attending CoG meetings. 10 Review of Meeting There were no comments following the meeting. 11 Date of Next Meeting - 26 April 2023 The next meeting would be held on 26 April 2023. 8 4 Matters Arising/Summary of Agreed Actions 1 4 Action items as at 19 April 2023.docx List of action items Agenda item Assigned to 19 April 2023 17:56 Deadline Status Council of Governors 31/03/2021 5.5 Amendment to the Trust's Constitution - CCG Merger 444. Review the Council of Governors' Composition Craig Machell Karen Russell 26/04/2023 Explanation action item A review of the Council of Governors' composition is to be carried out to check that it still remains appropriate. Closed Following discussions by the Membership and Engagement Working Group, proposals for a change to the composition of the CoG, it was agreed to reduce the number of governors representing the Rest of England by one governor; and to increase the number of governors representing New Forest, Eastleigh and Test Valley by one governor. Suggestions regarding young governor representatives were considered further at a sub-group on 24 August 2022 and these will be discussed at the Membership and Engagement Working Group at its meeting on 17 October 2022. Proposals have now been prepared and will be presented at the Membership and Engagement Working Group Meeting on 19 January 2023. Explanation Russell, Karen At its meeting on 25 January 2023, the CoG approved the proposal to invite two representatives from the Trust’s Youth Ambassador Group (one each from the 16-18 and 18-25 age groups) to become associate members of the CoG for up to two years. We have now been advised that the two associate members have been selected and details of their appointment was confirmed to governors on 19 April 2023. 19 April 2023 17:56 Council of Governors 19/10/2022 8.2 Governors' Nomination Committee Feedback 868. Public and Staff Governor Vacancies on the Governors' Nomination Committee (GNC) Russell, Karen 26/04/2023 Closed Explanation action item There were two vacancies on the GNC. Governors who were interested in joining the GNC were invited to submit an expression of interest to the Chair. KR also circulated an email to governors inviting expressions of interest on 24 October 2022. KR circulated an email to governors inviting expressions of interest on 24 October 2022. Shirley Anderson submitted an application and the CoG approved her membership of the GNC by written resolution in November 2022. A further email to invite expressions of interest for the remaining vacancy was sent to governors on 18 January 2023. Patricia Crates submitted an application and the CoG approved her membership of the GNC by written resolution in March 2023. Council of Governors 25/01/2023 10 Any Other Business 890. Use of the Park and Ride facility by governors Russell, Karen 26/04/2023 Closed Explanation action item Two governors asked about the possibility of using the Park and Ride facility when attending CoG meetings as car parks on site could be extremely busy. Explanation Russell, Karen It has been agreed that governors are able to use the Park and Ride facility. Information regarding its use was circulated to governors on 7 February 2023. Page 2 5.1 Annual Report and Quality Accounts Timetable 1 5.1a Annual Report and Quality Accounts timetable cover sheet.doc Report to the Council of Governors Title: Agenda item: Sponsor: Author: Date: Purpose Issue to be addressed: Annual Report and Quality Accounts Timetable 5.1 David French, Chief Executive Officer Craig Machell, Associate Director of Corporate Affairs and Company Secretary 26 April 2023 Assurance Approval or reassurance Ratification Information Y NHS England has published the timetable for the 2022/23 annual report and accounts and associated guidance. The Trust is required to produce an annual report and accounts as well as a Quality Account. The Trust has decided to align the timetables of both the Quality Account and the annual report and accounts, and to incorporate these into the same document. Response to the issue: Implications: Risks: Summary: Conclusion and/or recommendation The Quality Account is required to be published by 30 June 2023, whereas the annual report and accounts cannot be published until after they have been laid before Parliament. Parliament’s summer recess commences on 20 July 2023. The Trust has taken the decision to produce the annual report and accounts and the quality accounts on the same timetable as a single document. However, due the additional work required to complete the value for money external audit, the quality accounts will be published as a separate document by 30 June 2023. The attached timetable sets out the process in greater detail. The Trust meets the requirements of the National Health Service Act 2006, The National Health Service (Quality Accounts) Regulations 2010 and the NHS foundation trust annual reporting manual 2022/23. 1. Non-compliance with the National Health Service Act 2006, The National Health Service (Quality Accounts) Regulations 2010 and the NHS foundation trust annual reporting manual 2022/23. 2. Ensuring openness, transparency and accountability regarding the performance and activities of the Trust. 3. Pressure on staff to provide information for inclusion in the annual report and accounts and the quality accounts as the Trust deals with significant emergency pressures and delivers the elective recovery programme. The Council of Governors is asked to note the timetable. 1 5.1b Annual Report and Quality Accounts Timetable.doc Annual Report and Accounts (including the Quality Accounts) 2022-23 Timetable NHS England (NHSE) has published the timetable for the 2022/23 annual report and accounts and guidance on producing the annual report and accounts. The proposed timetable is set out below Action Draft quality account reviewed at Council of Governors’ meeting Deadline for draft accounts submission to NHSE Issue final draft quality accounts to ICB, Local Healthwatch, Overview and Scrutiny Committee and Council of Governors for one month consultation Early May Bank Holiday Coronation Bank Holiday Circulation of first draft annual report to external auditor, Board of Directors and Council of Governors Draft annual report and accounts reviewed at Audit and Risk Committee meeting Draft quality account reviewed at Quality Committee meeting Draft annual report and accounts reviewed at Board of Directors meeting Spring Bank Holiday Final draft annual report and accounts including quality accounts reviewed at Audit and Risk Committee meeting Final draft annual report and accounts including the quality accounts approved by Board of Directors Deadline for submission of signed annual report and accounts and supporting documentation to NHS England Add quality accounts to Trust website and forward the link to quality-accounts@nhs.net Final audit opinion and audit certificate (following completion of value for money external audit) Submit annual report to Parliament Publish annual report and accounts (including quality accounts) on Trust website Present update on annual report and accounts and external audit report to Council of Governors (in closed session) Present final annual report and accounts (including the quality accounts) to Council of Governors Annual Members’ Meeting Date Wednesday, 26 April 2023 Thursday, 27 April (noon) By Friday, 28 April 2023 Monday, 1 May 2023 Monday, 8 May 2023 w/c Monday, 8 May 2023 Monday, 22 May 2023 Monday, 22 May 2023 Thursday, 25 May 2023 Monday, 29 May 2023 Monday, 19 June 2023 Monday, 19 June 2023 By Friday, 30 June 2023 (noon) Friday, 30 June 2023 TBC TBC TBC TBC - Tuesday, 19 July 2022 TBC TBC Page 1 of 1 5.2 Chief Executive Officer's Performance Report 1 5.2a Council of Governors Cover Sheet.docx Report to the Council of Governors Title: Agenda item: Sponsor: Author: Date: Purpose Chief Executive Officer’s Performance Report 5.2 David French, Chief Executive Officer Jason Teoh, Director of Data and Analytics 26 April 2023 Assurance Approval or reassurance Ratification Information Y Issue to be addressed: Information about Trust performance supports the Council of Governors in their role. Response to the issue: This report is intended to inform the Council of Governors about aspects of the Trust’s performance. Implications: This report provides performance information relating to a broad range of Trust services and activities. There are no specific implications. Risks: This report is provided for the purpose of information. Summary: This report is provided for the purpose of information. 1 5.2b COG Chief Executive's Performance Report Apr 2023 FINAL.docx UHS Council of Governors 26th April 2023 Chief Executive’s Performance Report 1. Purpose and Context The purpose of this report is to summarise the Trust’s performance against a range of key indicators. Where available, this report covers data from the period December 2022 to February 2023, noting that some performance data in relation to some of the targets is reported further in arrears. This has again been a challenging operational period for the Trust. Notable features of the period included: • Ongoing high volume of attendances to the Emergency Department – particularly in December 2022 due to a high number of paediatric attendances due to Strep A. • A significant number of patients not meeting the criteria to reside, usually at between 180 – 210 patients, continuing to occupy hospital beds, restricting flexibility in our elective programmes, and impacting flow through the hospital (including patients awaiting admission from the Emergency Department onto wards). • Challenges with cancer services due to higher cancer referral volumes and the need to balance staffing capacity. • A number of days of industrial action impacting elective services during the period. • Ongoing growth in the RTT waiting list due to higher post-pandemic referral volumes causing the waiting list to rise to over 54,000 patients. However, good progress has been made in reducing the longest waiting patients at both 104+ and 78+ weeks. 2. Safety Infection Control Clostridium Difficile infection MRSA Bacterium infection Target 95.0% ≥ 90.0% Dec 2022 55.9% 66.2% Jan 2023 65.4% 72.9% Feb 2023 68.6% 73.3% Attendances to the Emergency Department (ED) have remained high through this period, averaging 371 per day (compared to 347 per day a year before – a 7% increase). This included a particularly challenging 12 day period in December 2022 where daily attendances were over 400 each day, including two days with over 500 attendances, due to the Strep A incidents before Christmas. The improvement in performance in January and February 2023 is linked to lower attendances compared to December 2022. Alongside the ongoing flow challenges due to the number of patients no longer meeting the Criteria to Reside, means that UHS four-hour performance remains below target. However, we continue to benchmark well against other trusts which demonstrates that this is a national challenge. In the period of December 2022 to February 2023, UHS ranked in the top quartile of the 17 teaching hospitals that we benchmark against (Type 1 attendances). In addition, UHS continues to ensure that we do not delay ambulance handovers. The average time to handover remains stable (approximately 16 minutes), and we have one of the lowest volumes of ambulance handover delays over 30+ and 60+ minutes in the South East and South West regions. Page 3 of 5 Referral to Treatment (RTT) % incomplete pathways within 18 weeks in month Total patients on a waiting list Target => 92% Dec 2022 63.3% 53,941 Jan 2023 63.7% 54,254 Feb 2023 63.1% 54,692 The number of patients on the RTT waiting list continues to increase as higher referrals continue above prepandemic levels. The proportion of patients that we have being treated within 18 weeks is in line with other teaching hospitals, with UHS within the top third of teaching hospitals. UHS continues to make good progress in reducing the longest waiting patients. We ended the year with no patients waiting over two years for treatment, and only 15 patients (all complex patients) who had waited over 78 weeks for treatment. Cancer Target Urgent GP referrals seen in 2 weeks => 93% Diagnosis within 28 days > =75% Treatment started within 62 days of urgent GP referral => 85% Dec 2022 79.6% 79.1% 55.3% Jan 2023 82.3% 68.7% 50.8% Feb 2023 Check after 31.03 Check after 31.03 Check after 31.03 As a specialist teaching hospital, we treat some of the more complex cancer cases from the region. However, all cancer services are under pressure from higher demand and this is a national trend. In January and February 2023, cancer referrals were 9.3% higher than the equivalent months in 2019. UHS has historically benchmarked in the upper quartile, relative to our teaching hospital peers. Our position slipped in the face of operational challenges in October and November 2022, into the second and third quartiles. To correct this each tumour site has developed clear recovery action plans, and we have seen signs of recovery and an upward performance trajectory in between December 2022 to February 2023. The Trust is focussed on progressing the action plans with support from the ICB and Wessex Cancer Alliance. 5. Finance The financial position for the trust is particularly challenging with a forecast deficit for 2022/23 of £11m. However, this position is supported by a number of non-recurrent measures including additional income, meaning our underlying deficit is well in excess of this position. The key drivers are: • COVID-19 related cost pressures – patient numbers remained significant in the early part of the year and staff sickness absence has also remained above pre-COVID levels. This has generated a cost pressure compared to plan assumptions. • Inflationary pressures especially related to energy costs – these are emerging to a greater extent as the year progresses with energy costs particularly high over the winter period despite the government price cap offering some protection. Energy costs are more than three times greater than they were in 2019/20. • An increase in the volume of patients not meeting the criteria to reside who are medically optimised for discharge – this is causing particularly acute operational challenges and means the trust has unfunded bed capacity open. This has also limited the Trust's ability to deliver additional elective activity supressing Elective Recovery Funding (ERF). • More recently industrial action is also creating one off costs due to backfill requirements needing to be put in place at short notice. This is likely to remain a challenge into 2023/24. Despite this the cost improvement programme for the Trust continues to deliver savings with the £45m savings plan forecast to be delivered in full. Page 4 of 5 Looking forward, there is a significant challenge for 2023/24 in improving both the Trust and HIOW Integrated Care System’s finances. For UHS we are currently projecting a £35m deficit, predicated on the achievement of a £60m (5%) cost improvement programme. Both internally, and with system partners, there is a focus on productivity improvement and exploring initiatives that can make a scalable difference. Similarly, financial controls and governance have been reviewed to ensure there isn’t any further deterioration. The Trust has made significant progress with its capital programme, including a new wards project and theatres refurbishments. The Trust remains on target to spend its full capital budget of £48m for 2022/23. Additional to this the Trust has been successfully awarded external capital of c£27m for spend in 2022/23 which will further support investment in capacity, infrastructure and digital. This will be spent in full in this financial year. 6. Human Resources Indicator Staff recommend UHS as a place to work Staff survey engagement score Target - Q3 22/23 6.91 7.1 Q4 22/23 6.92 7.02 The Pulse Survey results shows a small improvement in recommendation of UHS as a place to work (although down compared to last year), and a further decline in the engagement score. We believe this reflects the ongoing challenging environment that staff are working in. However, we remain slightly better than national averages. Indicator Turnover (internal target) Sickness absence 12 month rolling (internal target) Nursing Vacancies (Registered Nurse only in clinical wards) (internal target) Target 65 weeks by March 2024 • Deliver a balanced income and expenditure budget i.e. no financial deficit • Improve A&E waiting times to at least 76% within 4 hours • Improve maternity staffing ‘fill’ rates and safety 3 National Financial Framework 2023/24 • How will the trust be paid? – Fixed income in relation to most hospital activity, non-elective admissions in particular – Variable payments, at national tariffs, for elective, daycase, and outpatient activity (excluding follow ups) • Funding allocated for other specific service opening / increases requested of UHS, typically for specialised services • £28m (2.9%) increase for inflation (risk given headline CPI @ 10%) • £27m (2.8%) decrease relating to efficiency requirements (Covid reductions of £11m + Efficiency £16m) • Challenge therefore to 'consume your own smoke' 4 UHS Context 2022/23 • Exceptional growth in attendances to Emergency Department since 19/20 (15% approximately), deterioration in treatment times to 75% within 4 hours • Elective waiting list size increasing by 3% per annum, but waiting times > 104 weeks eliminated and waiting times > 74 weeks reduced to under 150 patients • UHS and HIOW ICS delivering relatively high levels of elective activity, but with relatively high costs / deficit compared to other ICSs / Regions • Increase in UHS staff by 2000 (18%) since 19/20, approximately ¼ for specific new services, ½ for activity/capacity increases, ¼ for a range of other reasons • UHS continues to be productive / cost effective in comparison with other hospital trusts, though our costs have grown faster than activity since 2019/20 5 UHS Context 2022/23 • Underlying UHS financial deficit (difference between expenditure and income) of £45m, largely as a result of factors outside local control e.g. inflation, energy costs, COVID funding reduction, increase in delayed discharges, sickness absence rates, unfunded cost of new NHS approved drugs • Increased Cost Improvement target of £45m delivered in full during 22/23, though only half of these savings were made through recurrent schemes, and savings were mainly achieved through non-pay costs • £88m Capital invested (using a combination of local funds and external bids mainly to NHSE programmes), including ward construction, theatre refurbishment, MRI scanner replacement, ‘park and ride’ for staff • Reducing levels of cash held, as a result of both the revenue deficit, and funding capital investments i.e. Buildings, Medical Equipment, IT Systems 6 Our Plan 2023/24 (Submitted 30th March with UHS Board Approval) • Increase elective activity levels to 113%, or ideally higher • Planned reduction in the number of follow-up appointments of 10%, compared to 2022/23 • Reduce the rate of growth in the elective waiting list size, and hold this level from Q4 onwards • Eliminate waiting times for treatment greater than 65 weeks • Reduce waiting times for cancer treatment and diagnostic tests, return to the national target of 85% of cancer treatment starting within 62 days • NHSE funded service expansions including Mechanical Thrombectomy, CAR- T, Paediatric ICU retrieval, and two inpatient wards to support elective activity 7 Our Plan 2023/24 (Submitted 30th March with UHS Board Approval) • Plan to keep numbers of staff posts level – increases of approx. 300 related to funded expansions, offset by reductions through efficiency / cost improvement • Plan to increase the number of employed staff (WTE) by 340, reducing the use of bank/agency workers by a similar amount • Cost Improvement requirement of £60m (6%), plan to achieve through pay / non-pay savings, financial contributions on additional NHS activity/income etc. • Financial Deficit of £35m (since improved to £30m), with the intention of fully recovering financial balance in 2024/25 • Avoid cash deterioration beyond £30m • Capital investment of £70m, including £21m externally funded 8 Our Plan 2023/24 (Submitted 30th March with UHS Board Approval) 9 Our Plan 2023/24 (Submitted 30th March with UHS Board Approval) Supporting notes: • The UHS Plan is submitted to NHSE as part of a combined HIOW ICS Plan which includes the ICB, 4 Acute Trusts, Solent, Southern, South Central Ambulance Trusts • Current NHS arrangements are ‘System by default’ i.e. NHSE expects to hold ICS to account collectively for their performance, and also seeks to distribute the majority of NHS funds via ICBs on a population based ’fair-shares’ basis • Our plan is the product of intensive focus on both planning and implementation, governance including consideration by UHS Executive Committee and Board monthly since January, and significant dialog between UHS and HIOW ICB and system partners 10 HIOW ICS 23/24 position, and NHSE view • ‘Re-submission’ (typically an amended submission) will be required from all NHS organisations / ICS at the start of May • NHSE has not accepted our current plan • We are being challenged, as part of HIOW ICS, to: • Justify the level of workforce growth since 19/20 • Set a sustainable (affordable) workforce and financial model, and trajectory as to how quickly we could reach this • Increase the scale of ambition in relation to follow-up activity reduction • There is substantial concern that HIOW ICS would, otherwise, be anticipating a large financial deficit in the year 23/24 11 Commentary • Our plan is extremely challenging, as a result of the combination of financial and non-financial objectives • Delivery of our plan in full is our intention, but is not guaranteed • UHS has reasons for positivity, including investments in physical capacity, our recruitment levels, our people, and record of efficiency / control / innovation • Aligning both the right physical capacity and staffing levels will be critical to delivering higher volumes of treatment and care whilst operating efficiently • The impact of ICS initiatives to better manage emergency demand and reduce discharge delays, that both impact on hospitals, is very important • Achieving further / more rapid financial improvements a part of plan re- submission is being considered by the Executive and Board currently 12 Implementation and Monitoring • We are in the process of communicating the detailed requirements by service / budget area, and securing agreement of these 23/24 plans • Transformation programmes (for inpatient ‘Flow’/Outpatient improvement/ Theatres) are established and resourced to support improvement • A Trust Savings Group was established in 22/23, chaired by the Chief Financial Officer, this oversees other financial recovery programmes of work • Additional financial controls have been implemented • Progress against our plan and national targets is reported and monitored monthly by both the Trust Executive Committee and by Trust Board • Supported by a range of other groups / meetings focused on the review of specific topics or areas e.g. Operational Performance, Value for Money 13 Council of Governors - Operating Plan for 23/24 Questions? Phil Bunting, Director of Operational Finance Andrew Asquith, Director of Planning and Productivity 26 April 2023 University Hospital Southampton NHS Foundation Trust Tremona Road, Southampton Hampshire, SO16 6YD www.uhs.nhs.uk 5.4 Non-NHS Activity 1 5.4 Non NHS Activity.doc Report to the Council of Governors Title: Agenda item: Sponsor: Author: Date: Purpose Non-NHS Activity 5.4 Ian Howard, Chief Financial Officer Peter Baker, Commercial & Enterprise Director 26 April 2023 Assurance or Approval reassurance Ratification Information Issue to be addressed: X One of the responsibilities of the Council of Governors is to determine whether the Trust’s non-NHS activity would significantly interfere with its principal purpose, which is to provide goods and services for the health service in England, or the performance of its other functions. This paper seeks to provide an update to the Council on the portfolios of activity within the Commercial Service. Response to the issue: Commercial Services undertake activity in a range of portfolios, delivering additional value through non-core income to the Trust. The below outlines activities that we will be focussed on for the financial year 2023-24. Private Patients: During the past financial year, the Trust will have supported clinicians to undertake activity in their own time. By supporting clinical staff to undertake this work, we can secure new income. The alternative to not undertaking this work is that the activity would be undertaken by another private provider such as Spire or Nuffield, and the profit would likely go to their shareholders rather than be ploughed back into the NHS. UHS has zero permanent beds for private patient activity. The plan for 2023/4 is to focus on key areas of service that can provide growth to generate income to support the services financial plans, areas such as neuro, paediatrics, and robotics. Overseas Visitors: All patients are able to access NHS services for emergency treatment, no matter what their nationality or permanent residence. However, for ongoing treatment, cost can be recovered for non-UK nationals and UK nationals not residing in the UK. New processes and investment into the overseas visitor’s team will see delivery of increased income 2023-24. Partnership: This area of the service focuses on how we can better interact with busi
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Governors/Papers-CoG-26.04.2023.pdf

Papers Council of Governors - 27 April 2022

Description: Date Time Location Chair Agenda Council of Governors 27/04/2022 14:00 - 16:00 Microsoft Teams Jane Bailey 1 Chair’s Welcome and Opening Comments 14:00 2 Declarations of Interest 14:01 3 Minutes of Previous Meeting 14:02 To approve the minutes of the previous meeting held on 26 January 2022 4 Matters Arising/Summary of Agreed Actions 14:03 5 Strategy, Quality and Performance 5.1 Operational Plan 2022/23 14:05 Sponsor: Ian Howard, Chief Financial Officer 5.2 Non-NHS Activity 14:20 Sponsor: Ian Howard, Chief Financial Officer Attendees: Na'el Clarke, Commercial Director 5.3 Chief Executive Officer's Performance Report 14:35 Sponsor: David French, Chief Executive Officer 5.4 Draft Quality Report and Annual Report Timetable 14:55 Sponsor: David French, Chief Executive Officer Attendee: Karen Flaherty, Associate Director of Corporate Affairs and Company Secretary 6 Governance 6.1 Non-Executive Director Reappointment 15:00 Sponsor: Jane Bailey, Interim Chair Attendee: Karen Flaherty, Associate Director of Corporate Affairs and Company Secretary 6.2 Review Terms of Reference - Council of Governors and Working Groups 15:10 Sponsor: Jane Bailey, Interim Chair Attendee: Karen Flaherty, Associate Director of Corporate Affairs and Company Secretary 6.3 Council of Governors' Election 2022 15:15 Sponsor: Jane Bailey, Interim Chair Attendee: Karen Russell, Council of Governors' Business Manager 6.4 Council of Governors' Expenses Reimbursement Protocol 15:19 Sponsor: Jane Bailey, Interim Chair Attendee: Karen Flaherty, Associate Director of Corporate Affairs and Company Secretary 6.5 Consultation Regarding Timings of Council of Governors' Meetings 15:24 Sponsor: Jane Bailey, Interim Chair Attendee: Karen Flaherty, Associate Director of Corporate Affairs and Company Secretary 7 Membership Engagement and Governor Activity 7.1 Membership Engagement 15:29 Sponsor: David French, Chief Executive Officer Attendee: Sam Dolton, Events and Membership Officer 7.2 Governors' Nomination Committee Feedback 15:39 Chair: Jane Bailey 7.3 Feedback from Strategy and Finance Working Group 15:43 Chair: Tim Waldron 7.4 Feedback from Patient and Staff Experience Working Group 15:47 Chair: Forkanul Quader 7.5 Feedback from Membership and Engagement Working Group 15:51 Chair: Bob Purkiss 8 Any other business 15:55 To raise any relevant or urgent matters that are not on the agenda 9 Date of next meeting: 19 July 2022 15:59 To note the date of the next meeting Page 2 Minutes - Council of Governors (CoG) Date Time Location Chair Present In attendance Apologies 26 January 2022 14.00-15.40 Microsoft Teams Peter Hollins Peter Hollins, Chair Theresa Airiemiokhale, Elected, Southampton City (until item 7.1) Katherine Barbour, Elected, Southampton City (until item 7.1) Colin Bulpett, Elected, Rest of England and Wales Dr Nigel Dickson, Elected, New Forest, Eastleigh and Test Valley Professor Mandy Fader, Appointed, University of Southampton (for items 6.2 to 6.4) Harry Hellier, Elected, New Forest, Eastleigh and Test Valley Kelly Lloyd, Elected, Health Professional and Health Scientist Staff Councillor Alexis McEvoy, Appointed, Hampshire County Council Robert Purkiss, Elected, Rest of England and Wales (until item 6.4) Forkanul Quader, Elected, Southampton City Catherine Rushworth, Elected, Isle of Wight Quintin van Wyk, Elected, Rest of England and Wales Tim Waldron, Elected, Southampton City (until item 7.1) Jane Bailey, Non-Executive Director (NED), Deputy Chair and Senior Independent Director Sam Dolton, Events and Membership Officer Karen Flaherty, Associate Director of Corporate Affairs David French, Chief Executive Officer (for item 5.1) Steve Harris, Chief People Officer (for item 6.2) Femi Macaulay, Associate NED Karen Russell, Council of Governors’ Business Manager James Woodward, Student Governor Representative (until item 4) Dr Diane Bray, Appointed, Solent University Helen Eggleton, Appointed, NHS Hampshire, Southampton and Isle of Wight CCG Rebecca Reynolds, Elected, Nursing and Midwifery Staff Councillor Rob Stead, Appointed, Southampton City Council Amanda Turner, Elected, Non-Clinical and Support Staff PTH TA KBa CB ND MF HH KL AM RP FQ CR QvW TW JB SD KF DAF SH FM KR JW DB HE RR RS AT 1 Chair’s Welcome and Opening Comments The Chair welcomed everyone to the meeting and in particular CR and FM who were attending a meeting of the CoG for the first time. DB and RR, who had recently joined the CoG, were also welcomed to the CoG, although they had sent apologies for the meeting. 2 Declarations of Interest There were no new declarations of interest relating to matters on the agenda. 1 3 Minutes of Previous Meeting The minutes of the meeting held on 27 October 2021 were approved as an accurate record of the meeting. 4 Matters Arising/Summary of Agreed Actions The updates on the actions in the paper were noted and further updates were provided on the following actions: • Review of the Council of Governors’ Composition This had been considered by the CoG Membership and Engagement Working Group and a progress update with proposals would be presented to the CoG later in the meeting. • Governor Forum The guidance had been shared with governors on 17 November 2021 and the Governor Forum was available for use. 5 Strategy, Quality and Performance 5.1 Chief Executive Officer’s Performance Report PTH welcomed DAF, who was attending to present the performance report. The report was noted and DAF provided an update since the period of September to November 2021 covered by the report. He highlighted that: • although the COVID-19 Omicron variant had proved to be much more transmissible than the Delta variant, its symptoms appeared to be less severe; • there were approximately 50 patients in the hospitals who had tested positive for COVID-19, two of whom were in critical care being treated for other medical conditions; • the number of patients with COVID-19 had been relatively stable over the previous two weeks and it was anticipated that numbers would steadily decline over the next few months; • there were 220 patients in the hospitals who were medically optimised for discharge (MOFD), however, levels of staff sickness absence in community care, domiciliary care and care homes were leading to delays in discharge where patients needed further support following discharge or had longerterm care needs; • the number of patients MOFD in hospital was impacting on the Trust’s capacity, particularly elective capacity as beds in surgical wards were being used to accommodate these patients; • sickness absence in the Trust, normally in the region of 3% of staff, had increased to 6% as staff were absent due to COVID-19; • University Hospitals Sussex NHS Foundation Trust and Oxford University Hospitals NHS Foundation Trust were assisting the Trust to reduce the number of patients awaiting cardiac surgery, which had arisen due to a shortage of specialist critical care capacity as the Trust had provided additional surge capacity in previous waves of the COVID-19 pandemic; • the Trust was continuing work to reinstate its full programme of elective activity as the number of patients with COVID-19 in the hospitals reduced; • the Trust was working to increase theatre and bed capacity for elective activity and submitting bids for external funding to support this, including a joint bid with the other acute trusts in Hampshire and the Isle of Wight for an elective hub at Winchester Hospital; • the number of staff at the Trust who were fully vaccinated against COVID-19 was more than 96%, one of the highest levels in the country; • the Trust was continuing to prioritise recruitment and retention of staff, including recruitment in areas where there were staff shortages such as critical care; 2 • Saul Faust, a consultant at the Trust, had led the COV-BOOST vaccine trial, which had been instrumental in informing national policy through identifying the level of protection offered by the booster vaccination; • work was commencing on the rooftop garden at the Princess Anne Hospital for use by staff, which was funded by Southampton Hospital Charity from the proceeds of the auction of the ‘Game Changer’ artwork by Banksy, and there were also plans for a wellbeing centre for staff and to upgrade staff rooms and changing areas across the Trust reflecting the donor’s wishes for a lasting legacy to support the wellbeing of staff; • the implementation of changes to the structure of integrated care systems, which were being introduced to improve coordination of health and social care services at a local level, had been delayed until 1 July 2022; • the Trust was expected to deliver its financial forecast and breakeven in 2021/22 due to additional elective recovery fund income, however, the position for 2022/23 was still uncertain as guidance continued to be released and a reduction in funding was expected; and • the Trust was also on track to deliver its capital programme for 2021/22, having spent £33.2 million up to the end of November 2021, including investment in four new theatres within the vertical extension building and an expanded ophthalmology outpatient facility. In response to a query raised by RP, DAF explained that where a complainant was not satisfied with the Trust’s response (identified as complaints returned dissatisfied in the report), the complaint would be reopened and issues that remain unresolved for the complainant would be investigated again. If the complainant remained dissatisfied following this they could contact the Parliamentary and Health Service Ombudsman. Following a question from FQ about whether other hospitals could assist in reducing waiting lists for elective activity in other areas, DAF explained that capacity and the length of waiting lists were a challenge throughout the NHS due to the COVID-19 pandemic and the Trust was focusing on increasing its capacity. AM queried whether the incidence of COVID-19 transmission within the hospital related to more vulnerable patients and if those who had antibodies due to previously contracting COVID-19 could still transmit the infection to others despite having some degree of protection themselves. DAF advised that the mortality rate for patients who contracted COVID-19 in hospital earlier in the pandemic had been approximately 40-50%, however, strict infection control procedures in place at the Trust had kept the rates of transmission in hospital (nosocomial transmission) low. Currently transmission to patients was tending to occur when patients were visiting non-clinical areas within the hospitals and from visitors. Actions: • DAF would provide a response to a query regarding one of the cookers in the Trust’s Feast restaurant which was reported to have been out of order for some time. • PTH would provide a more detailed response about the ability of those who had previously been infected with COVID-19 to transmit the virus. 6 Governance 6.1 Annual Business Plan 2022/23 KF presented the annual business plan for CoG for 2022/23, which would be reviewed and updated during the year as required. Action: It was requested that the annual CoG strategy event was added to the plan 3 for information. Decision: The CoG approved the Annual Business Plan for 2022/23. 6.2 Chair and Non-Executive Director Appraisal Process PTH advised that the contribution of the CoG to the NED appraisal process was critical as one of the key roles of governors was to hold the NEDs to account for the performance of the board of directors (Board). The NHS Foundation Trust Code of Governance required that the CoG should take the lead on agreeing the process for appraisal. The timeline for the appraisal process would ensure its completion before the tenure of the current Chair ended on 31 March 2022. The GNC had reviewed the proposed process at its meeting on 7 January 2022 and recommended that it should be approved by the CoG. Governors were encouraged to participate in the appraisal process by providing feedback to the Lead Governor by 4 February 2022. Although there had been fewer opportunities for governors to interact in person with NEDs due to restrictions on visiting the hospitals and meeting in person as a result of the COVID-19 pandemic, governors were invited to observe the NEDs at Board meetings and Board committee meetings, which were chaired and attended by NEDs, and to participate in the question and answer sessions with NEDs prior to the CoG meetings and in the discussions with governors following the open session of the Board meeting. Decision: The CoG approved the appraisal process as recommended by the GNC. 6.3 Governor attendance at Council of Governors’ Meetings Under the Trust’s constitution if a governor failed to attend two successive meetings of the CoG, his or her tenure of office was to be immediately terminated by the CoG unless the CoG was satisfied that: • the absences were due to reasonable cause; and • he/she would be able to attend meetings of the CoG within such a period as the CoG considers reasonable. Whilst it was recognised that governors may not be able to attend every meeting the expectation was that they would make every effort to attend meetings regularly. There were five governors who had failed to attend two successive meetings of the CoG, however, for three of these governors this had included the extraordinary meeting of the CoG held in December 2021. There were two governors who had failed to attend two consecutive ordinary meetings of the CoG, both of whom were clinical NHS staff who had not been able to attend due to work commitments. While the CoG was likely to consider that their absence was due to reasonable causes, the two governors concerned had subsequently resigned as they did not feel that they would be able to attend meetings regularly in the future due to work commitments and the timing of CoG meetings. Decision: The CoG confirmed that it was satisfied that the failure of the remaining three governors to attend two successive meetings of the CoG was due to reasonable causes and that they would be able to attend future meetings within a reasonable period so that no termination of a current governor’s tenure of office is required or occurs. 4 6.4 Composition of the Council of Governors At its meeting in July 2021 the CoG reviewed its current composition. The consideration of the composition of the CoG had subsequently been referred to the CoG Membership and Engagement Working Group for further review. The CoG Membership and Engagement Working Group commenced this review at its meeting in November 2021 and considered updated proposals at its meeting in January 2022. Following its review, the CoG Membership and Engagement Working Group recommended the following proposals: • to reduce the number of governors in the Rest of England and Wales public constituency by one governor and increase the number of governors in the New Forest, Eastleigh and Test Valley public constituency by one governor to ensure that the number of governors representing the public constituencies was more representative of the number of patients seen by the Trust from those areas; and • to include a student representative as a full member of the CoG as an appointed governor. The Trust’s constitution would need to be amended to reflect these changes and would require approval by the CoG and the Board. Decision: The CoG noted the progress of the review to date and supported the proposals recommended by the CoG Membership and Engagement Working Group. 6.5 Audit and Risk Committee Terms of Reference The terms of reference for all Board committees should be reviewed regularly, and at least once annually, to ensure that they reflected the purpose and activities of each committee. The NHS Foundation Trust Code of Governance required that the CoG was consulted on changes to the terms of reference for any audit committee given the CoG’s role in appointing, reappointing and removing external auditors, prior to their submission to the Board for approval. Only minor changes of a typographical nature were proposed to the terms of reference following a comprehensive review and update in 2021. Decision: The CoG agreed the proposed changes to the Audit and Risk Committee terms of reference. 6.6 Non-Executive Directors’ Additional Commitments The NHS Foundation Trust Code of Governance required that the CoG was informed of any changes to the significant commitments of NEDs following their appointment by the CoG. The Chair would discuss changes to their commitments with NEDs during their appraisals. There was no potential conflict of interest relating to the new commitments that had been declared. Decision: The CoG noted the additional commitments of the NEDs. 6.7 Decisions in Response to Recent Vacancies on the Council of Governors The CoG had been asked to consider a number of proposals to fill governor vacancies that had arisen in the public and staff constituencies in recent months. In addition, there had been a number of new appointed governors who had joined the CoG during that period. 5 Governors had previously been asked to approve each of the proposals in response to governor vacancies by written resolution. Decision: The CoG ratified and confirmed the decisions taken in response to vacancies on the CoG. 7 Membership Engagement and Governor Activity 7.1 Membership Engagement SD introduced the membership engagement report highlighting that: • engagement with the Trust’s members had continued and included the rebranding of the membership newsletter as Connect, making it more interactive in a page turner format rather than a standard PDF format; • targeted tailored emails had been issued to members including surveys relating to Patient Initiated Follow Up and the UHS discharge process; • in November 2021 members who had stated that they had a disability or were carers were invited to attend a virtual event to launch new access guides for the Trust; • the rescheduled annual members’ meeting took place in November 2021 and included highlights from the annual report and accounts for 2020/21 and the Trust’s five year strategic plan, an update on the membership strategy and an operational update on priorities for managing the surgical waiting list; • a virtual event was held in December 2021, which focused on the next steps for COVID-19 vaccination and included key findings from the Trust led COV-BOOST trial, latest updates on vaccine safety in pregnancy and the vaccination situation in the community from Southampton City Council; • social media activity included an emphasis on encouraging the public to have their COVID-19 booster vaccinations and a message to the community regarding pressures faced by the Trust’s emergency department; • in November 2021 the Trust attended a Health and Home Fair at the University of Southampton, which KBa had kindly supported; • the Trust’s COVID ZERO campaign had been shortlisted in PRWeek’s awards for best crisis communications and results would be announced in February 2022; • governors were thanked for their feedback prior to the issue of a survey to the Trust’s members regarding the membership programme; and • planned future activities included an event about the Trust’s new Green Plan and engagement with students, young people and underrepresented ethnic groups. 7.2 Governors’ Nomination Committee Feedback The GNC had concluded the appointment process for the associate NED role by appointing FM and had reviewed the appraisal process for the Chair and NEDs, approved earlier in the meeting. An update on the recruitment process for a new chair would be provided in the closed session of the meeting. 7.3 Feedback from Strategy and Finance Working Group Due to the operational pressures as a result of COVID-19 in January 2022, it had been agreed with the TW, the chair of the CoG Strategy and Finance Working Group, that the meeting due to have taken place would be rescheduled. 6 7.4 Feedback from Patient and Staff Experience Working Group (including confirmation of election of the Patient and Staff Experience Working Group Chair) A vacancy had arisen for the chair of the CoG Patient and Staff Experience Working Group following the death of Tony Havlin at the end of 2021. FQ had very kindly volunteered to take on the role and was elected as chair at the CoG Patient and Staff Experience Working Group meeting on 24 January 2022. The CoG was asked to confirm the appointment. Decision: The CoG confirmed the appointment of FQ as Chair of the CoG Patient and Staff Experience Working Group. FQ advised that Laura White, the Head of Involvement and Participation, had provided an update on the results of three patient surveys: Adult Inpatients, Children and Young People and Urgent and Emergency Care at the most recent meeting. Following the meeting KR had circulated the full survey results to governors. A question was raised at the meeting relating to the pain scores in the Children and Young People’s survey and the scoring/assessments used and this information would be provided to governors as soon as it was received. Emma Jane Squires had also attended the meeting to provide an update on the Patient Support Hub which had been very informative and well received. FQ was considering including feedback from junior doctors and trainee nurse at a future meeting of the working group. 7.5 Feedback from Membership and Engagement Working Group At the meeting of the CoG Membership and Engagement Working Group on 20 January 2022, the composition of the CoG had been considered followed by an update from SD relating to the membership strategy, feedback on previous events and plans for future events. 8 Any other business Following the discussion with staff governors who had been unable to attend meetings of the CoG, PTH suggested that a consultation exercise was undertaken to ask for governors’ views on varying the timing of CoG meetings to accommodate work schedules of staff and other governors. Action: KR would carry out a consultation to consider the timing of CoG meetings. PTH informed the CoG that this would be his last full meeting as Chair prior to the end of his tenure on 31 March 2022, and thanked governors for their help and support. 9 Date of Next Meeting - 23 February 2022 To note the date of the next meeting. 10 Resolution regarding the press, public and others Decision: The CoG 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 CoG, 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. 7 List of action items Agenda item Assigned to 14 April 2022 16:00 Deadline Status Council of Governors 31/03/2021 5.5 Amendment to the Trust's Constitution - CCG Merger 444. Review the Council of Governors' Composition Flaherty, Karen Russell, Karen 27/04/2022 Explanation action item A review of the Council of Governors' composition is to be carried out to check that it still remains appropriate. Pending The review was presented to the CoG at the meeting on 21 July 2021. The CoG agreed that volunteers for a task and finish group would be sought to consider the composition of the CoG in more detail. If no volunteers were forthcoming it would be referred to the Membership and Engagement Working Group for further review. Explanation Russell, Karen Following the discussion at the CoG meeting on 26 January 2022, feedback will be provided to the Membership and Engagement Working Group at its meeting on 26 April 2022. Council of Governors 26/01/2022 5.1 Chief Executive’s Performance Report 633. Query regarding a cooker in the Trust's Feast restaurant French, David 27/04/2022 Completed Explanation action item RP raised a concern regarding one of the cookers in the Trust’s Feast restaurant which was reported to have been out of order for some time. DF agreed to investigate. It was confirmed that the cooker had been replaced and was in operation. Governors were advised by email on 2 February 2022. 14 April 2022 16:00 634. COVID-19 transmission Hollins, Peter 27/04/2022 Completed Explanation action item AM queried whether the incidents of COVID-19 transmission within the hospital related to more vulnerable patients and if those who had antibodies due to previously having COVID-19 could still transmit to others despite having some degree of protection themselves. KR consulted Dr Eleri Dr Eleri Wilson-Davies who is the principal investigator for the Sarscov2 Immunity and Reinfection Evaluation (SIREN) study at the Trust. It was confirmed that transmission could still take place. A full explanation was provided to governors on 2 February 2022. Council of Governors 26/01/2022 6.1 Annual Business Plan 2022/23 635. Strategy Day to be added to the Annual Business Plan Flaherty, Karen Russell, Karen 27/04/2022 Completed Explanation action item PTH queried whether the CoG Strategy Day could be added to the Annual Business Plan. KF agreed this could be added. Explanation Russell, Karen Strategy Day has now been added to the Annual Business Plan Council of Governors 26/01/2022 8 Any other business 636. Consultation regarding timings of CoG meetings Russell, Karen 27/04/2022 Completed Explanation action item Two governors had resigned recently and had found difficulty attending CoG meetings due to work commitments. Governors would be consulted as to the most appropriate timings for CoG meetings. Explanation Russell, Karen The consultation has been held and feedback will be provided to the CoG at its meeting on 27 April 2022. Page 2 5.1 Operational Plan 2022/23 1 5.1i Report template UHS COG April 2022 Operating Plan.docx Report to the Council of Governors Title: Agenda item: Sponsor: Author: Date: Purpose Issue to be addressed: 2022/23 Operational Plan 5.1 Ian Howard, Chief Financial Officer Andrew Asquith, Director of Planning, Performance and Productivity 27 April 2022 Assurance Approval or reassurance Ratification Information Y Information about trust planning and budget setting supports the Council of Governors in their role. Response to the issue: This report is intended to inform the Council of Governors about aspects of the Trust’s operating environment and plan for 2022/23. A more detailed report is presented to Trust Board for their consideration and approval. Implications: This report provides information relating to a broad range of trust (Clinical, Organisational, services and activities, there are no specific implications. Governance, Legal?) Risks: (Top 3) of carrying This report is provided for the purpose of information. out the change / or not: Summary: Conclusion This report is provided for the purpose of information. and/or recommendation Page 1 of 1 Council of Governors Meeting April 2022 2022/23 Operational Plan 2022/23 Operational Plan Content of Presentation • Process / Expectations • Summary of plan – finance, workforce, activity and performance • Conclusion • Building on ‘Connect’ (Internal Presentation for Senior Leaders) • Questions Process / Expectations • Final plan submission to NHSE (via ICS) due on 28th April • Trust board briefed on draft submissions and the anticipated final submission • Strong influence from national ‘guidance’ / frameworks, issued between Dec 24th and late February, with subsequent clarifications too… • Planning for a ‘low COVID’ environment Summary of plan (see following slides) Summary of plan - Finance • Income broadly level with 2021/22, additional funding for inflation fully offset by reductions in funding / national efficiency requirements • Expectation that 104% elective activity will be delivered for this level of funding through increased efficiency • Planned UHS operating deficit - £19.5m – Driven by understandable factors where the reality is differing from planning assumptions / factors outside trust control e.g. COVID prevalence, energy prices, general inflation, drug cost increases in block contracts Summary of plan - Finance • Planned efficiency improvement valued at £33m / 2.7% (compared to 2021/22) – 2% / £20m Cost Improvement requirement as part of issued budgets – Further £13m improvement to be delivered centrally including through business cases and management of growth funding – Little opportunity to achieve additional financial contribution through growth in NHS activity due to the financial framework / contractual arrangements (75% of tariff) • Financial challenges in delivering the 22/23 plan are being consistently reported across the country Summary of plan - Workforce • Continued recruitment and retention to increase employed staff by a further 478 wte • Offset by planned reductions in the use of Bank and Agency hours • Minimal net increase in funded posts (establishment) - aligned with funding availability, cost improvements to offset additional investments, and significant increases during COVID-19 to date Summary of plan - Activity and Performance Planning to deliver activity as follows: • 104% of 19/20 levels for elective care • 100% of 19/20 outpatient follow-ups (doesn’t achieve national ambition for reduction, despite good UHS engagement with initiatives) • 100% of 19/20 levels for non-elective admissions • 20/21 numbers of A&E attendances (there are risks here, given the 21/22 growth rate) Summary of plan - Activity and Performance RTT • July 2022 - no patient waiting > 2 years • April 2023 - no patient waiting > 18 months Cancer • March 2023 - patients waiting > 62 days from referral returned to pre-pandemic levels Outpatients • Transform care, greater use of technology, improve both waiting times and experience of waiting Conclusion • Very challenging national expectation, when considering finances, workforce, and patient care in combination • Exacerbated by the current variance between planning assumptions and the real environment e.g. COVID, inflation • UHS is well positioned to respond, and aims to deliver for our patients, and people, operate efficiently, and achieve acceptable financial outcomes relative to the context and to our peers Conclusion – ‘Connect’ Slides Our World with and beyond COVID: •Pause to reflect as we come out of COVID •National messages •Reasons to be proud •Our collective leadership priorities  2025 vision guides us  Unite around the patient  Personal development, wellbeing, inclusion, recruitment  Operational sweet spot  Bringing back the hospital to normal footprint  Maximise elective activity  Transformation projects in theatres, outpatients and flow improvement  Always Improving, pathway/process innovation and squeaking wheels  Confidence in us and in our future Questions / Discussion Report to the Council of Governors Title: Agenda item: Sponsor: Author: Date: Purpose Issue to be addressed: Non-NHS Activity 5.2 Ian Howard, Chief Financial Officer Na’el Clarke, Commercial Director 27 April 2022 Assurance Approval or reassurance Y Ratification Information One of the responsibilities of the Council of Governors is to determine whether the Trust’s non-NHS activity would significantly interfere with its principal purpose, which is to provide goods and services for the health service in England, or the performance of its other functions. Response to the issue: The Council of Governors must then notify the directors of its decision. The Trust’s private patient income for 2021-22 is forecast to be approximately £6.4 million. This represents just under 0.7% of the Trust’s overall income. This year has seen a growth in activity due to the more complex patients being treated, whilst maintaining the prioritisation of clinically urgent procedures, noting the unprecedented pressure that core NHS services have faced. There has been growth in services delivered through an outpatient setting, whilst remaining mindful of the needs and constraints faced by our core services. Over the next six months at least, activity for private patient services is expected to remain at the same level as NHS activity is prioritised. Again, it is expected that only a limited number of patients that are deemed an emergency or clinically urgent will be treated privately as inpatients. Private cancer treatment is expected to continue in the Solent suite, which provides a dedicated nurse-led service. The income forecast for 2022-23 will be in line with the forecast total for 2021-22. There is also a growing income stream linked to the commercialisation of Trust-derived intellectual property, although this is forecast at just under £40,000 for 2021-22, we expect a forecast income of at least £140k in 2022-23. Another core area of non-core income is linked to the co-development of innovative medical technology, again income from this workstream is forecast at £150,000 for 2022-23, having been established through a series of strategic partnerships to co-develop products that meet unmet clinical needs during 2021-22. The range of commercial workstreams that deliver non-core income has been expanded. Implications: Risks: Summary: This ensures that the Trust meets its legal requirements that income received from its principal purpose is greater than its non-NHS income. It also enables the Council of Governors to monitor when it may need to specifically approve an increase in non-NHS income under other provisions of the National Health Service Act 2006. This would apply to proposals to increase by 5% or more the proportion of total income in any financial year attributable to activities other than the provision of goods and services for the purposes of the health service in England (including private work). 1. Non-compliance with the provisions of the National Health Service Act 2006 and the Trust’s constitution. 2. Monitoring the performance of the Trust against its principal purpose. 3. Ensuring NHS activity is not negatively impacted by non-NHS activity whilst recognising how income from additional activity supports NHS services and the activity itself supports innovation. Given the current and forecast levels of non-NHS income, the Council of Governors is requested to: • confirm that is satisfied that the Trust’s non-NHS activity would not significantly interfere with its principal purpose, which is to provide goods and services for the health service in England, or the performance of its other functions; and • authorise the Interim Chair or Associate Director of Corporate Affairs and Company Secretary to inform the directors of its decision. Non-Core Income –UHS HIGHLIGHTS: • Non-Core (Commercial Income) forecast at £8.5m for the 22/23 FY • Core areas of commercial activity are : the provision of private patient services, management of overseas visitors, commercialisation of UHS-derived innovations and strategic working with medical technology suppliers to create technology that addresses unmet clinical needs. • Third party commercial contracting with non-NHS bodies is also an important area of commercial activity that brings in around £1.5m of income per annum and which also has reduced third party contractual costs by at least £90k (21/22 FY) and mitigated commercial risks of > £1m • Miscellaneous schemes such as the commercial use of physical and digital space produce a useful income of around £100k p.a. • This income is re-invested back into development projects and core NHS services as part of our CIP PRIVATE PATIENT SERVICES –Summary • Private Patient Income (£6.4m forecast year end position) (21/22) represents a small % of our overall income ( 95.0% ≥ 90.0% Dec 2021 70.1% 79.7% Jan 2022 69.1% 79.5% Feb 2022 65.8% 77.9% A deterioration in UHS timeliness has continued and performance is now a significant distance from the national target, yet remains relatively good in comparison to many other acute trusts. In the period between December 2021 and February 2022 UHS ranked third best amongst eight major trauma centres that we benchmark with (Type 1 attendances). The Trust Board reviews emergency access performance every month and has reviewed the subject in detail at its meetings in September 2021, November 2021 and February 2022. The Trust has continued to invest in both the physical environment and workforce to respond to rapidly increasing levels of attendances. We are also seeking to progress other contributions to improvement including working with partners to improve discharge from hospital beds, an internal focus on improving treatment and reducing patients’ length of stay in hospital, and working with partners to reduce the numbers of patients attending the emergency department where there are alternative ways of meeting their clinical needs. Referral to Treatment (RTT) % incomplete pathways within 18 weeks in month Total patients on a waiting list Target => 92% Dec 2021 67.4% 44,737 Jan 2022 67.2% 44,551 Feb 2022 67.4% 45,857 The number of patients on our waiting lists has increased by approximately 30% compared to January 2020, although the size of the waiting list has been stable in recent months. Page 3 of 5 Many of our patients are also waiting very long periods to start their treatment: • There were 2,032 patients who had waited over 52 weeks at the end of February 2022 (down from a peak in 3,149 in March 2021) • We are confident that by July 2022 no patient (other than those who are choosing to wait longer) will have waited over 104 weeks (there were a total of 171 such patients waiting in December 2021). The Trust has increased its physical capacity and workforce, and is engaging with NHS partners to plan further expansions which would respond to both rising need for the types of treatment UHS can provide and the ‘backlog’ due to COVID-19. Reductions in the number of inpatients with COVID-19 infection, and the number of staff absent with COVID-19 infection, will also be critical to our rate of improvement. The Trust Board reviewed Referral to Treatment performance in detail through spotlight reports at its meetings in October 2021, November 2021 and January 2022. Cancer Urgent GP referrals seen in 2 weeks Breast symptomatic patients’ referral seen in 2 weeks Treatment started within 62 days of urgent GP referral Target => 93% => 93% => 85% Dec 2021 74.5% 7.0% 71.0% Jan 2022 80.4% 33.3% 66.8% Feb 2022 89.6% 36.4% 69.2% Our breast service is in the process of increasing capacity and improving performance following the challenges relating to demand and COVID-19 disruption described in the previous report. These difficulties, and the time required to implement solutions, account for the failure to achieve two week waiting time targets for urgent GP referrals (patients suspected of having cancer, including breast patients), and breast symptomatic patients (symptoms not considered suspicious for cancer). Improving performance trajectories can now be observed, and further improvement is expected. As a result of both referral and treatment challenges across the majority of specialities, our 62 day cancer treatment performance has been adversely impacted. Performance has deteriorated compared to the previous three month period when it ranged between 71.8% and 74.7%. Despite this, UHS performance remains very good compared to other hospitals, in February 2022 UHS was fourth best amongst our peer group of 19 teaching hospitals, and matched the average performance of 17 hospital trusts in the south east region despite the majority of these hospitals offering a significantly less complex range of treatments than UHS. Cancer performance was reviewed by the Trust Board in detail at the December 2021 meeting and a further detailed review is planned for the April 2022 meeting. 5. Finance At the end of March 2022, the Trust reported a breakeven position for the year. This was an improvement on a planned £3.4 million deficit position as a result of receipt of additional national elective recovery funding. Operational pressures related to staffing (COVID-19 related sickness absence), increased emergency demand and increased COVID-19 inpatient numbers have led to a challenging operational position; however the financial pressures have been supported by nonrecurrent national funding. The underlying position of the finances is however more challenging, with inflationary pressures in energy and drugs cost growth within block contracts, meaning the outlook for 2022/23 is one of significant financial as well as operational challenge. Page 4 of 5 The Trust also reported on plan with its capital investment programme for 2021/22 with expenditure of internally funded capital (£50 million) and additional national funding (£15 million). This included investment in four new theatres within the ‘vertical extension’ building, a refurbishment and expansion of emergency department ‘majors’, and an expanded ophthalmology outpatients facility, as well as investment in digital, equipment and backlog maintenance. 6. Human Resources Indicator Target 2020/21 UHS Comparison Q3 2021/22 Staff FFT - % of staff likely or extremely likely to recommend UHS as a place to work Staff recommending UHS as a place to receive care/treatment => 75.5% => 85.0% 77% 86.7% 71.9% 83.1% National Average (Acute/Acute + Community Trusts) 58.4% 66.9% The ‘advocacy’ scores above, measured through the NHS Staff Survey, have declined since the previous year but remain well above the benchmark averages which have declined further. UHS had a survey response rate of 56%, which is an increase of 6% from 2020, and the highest level of participation UHS has achieved since the survey began. The median response rate in our benchmark group was 46%. UHS: • • • rated “the best” for career progression opportunities, and for offering a range of challenging work scored above average on 106 of 126 questions and scored below average on only 7 of 127 questions Indicator Turnover (internal target) Sickness absence 12 month rolling (internal target) Nursing vacancies (registered nurse only in clinical wards) (internal target) Target <=12% <=3.4% <=15% Dec 2021 13.4% 4.1% 15.6% Jan 2022 13.6% 4.1% 14.9% Feb 2022 13.7% 4.2% 15.0% Staff ‘turnover’ continues to be high and is increasing (following a reduction in 2020/21). A wide range of actions are being progressed including to support wellbeing, internal career development, work-life balance, and to focus on specific improvement opportunities such as healthcare assistant roles, recent recruits and staff approaching retirement. Sickness absence has unfortunately increased further, with monthly levels reaching a peak of 5.7% in January 2022 associated with a peak of COVID-19 infection. Page 5 of 5 5.4 Draft Quality Report and Annual Report Timetable 1 5.4a Annual Report and Quality Accounts timetable cover sheet.doc Report to the Council of Governors Title: Agenda item: Sponsor: Author: Date: Purpose Issue to be addressed: Annual Report and Quality Accounts Timetable 5.4 David French, Chief Executive Officer Karen Flaherty, Associate Director of Corporate Affairs and Company Secretary 27 April 2022 Assurance Approval or reassurance Ratification Information Y NHS England and NHS Improvement (NHSE/I) has published the timetable for the 2021-22 annual report and accounts and associated guidance. This removes the requirements to produce a separate quality report, although the quality accounts requirements set out in The National Health Service (Quality Accounts) Regulations 2010 still apply requiring trusts to produce quality accounts, including circulation of the quality accounts to commissioners, local authorities, local Healthwatch and the Council of Governors by the end of April for comment. Some additional quality reporting will be required to be included in the performance report section of the annual report instead. There are also no external audit assurance requirements in respect of the quality accounts as a result of the changes to the NHSE/I guidance. Response to the issue: Implications: The quality accounts are required to be published by 30 June 2022, whereas the annual report and accounts cannot be published until after they have been laid before Parliament. This is expected to occur at the beginning of September 2022 to allow time for the external auditor to complete the value for money external audit work and finalise its audit report and certificate for inclusion in the published version of the annual report and accounts. The external auditor expects to complete this work by the end of July 2022 after Parliament begins its summer recess. The Trust has taken the decision to produce the annual report and accounts and the quality accounts on the same timetable as a single document by the submission deadline of 22 June 2022. However, due the additional work required to complete the value for money external audit, the quality accounts will be published as a separate document by 30 June 2022. The attached timetable sets out the process in greater detail. The Trust meets the requirements of the National Health Service Act 2006, The National Health Service (Quality Accounts) Regulations 2010 and the NHS foundation trust annual reporting manual 2021/22. The timing of the meeting of the Council of Governors at which the final annual report and accounts (including the quality accounts) and the external auditors’ report are presented will be later than usual to allow for these to be laid before Parliament as this would normally take place in July. An update will be provided to the Council of Governors in a closed session of its meeting in July 2022 to mitigate the impact of this Risks: Summary: Conclusion and/or recommendation delay. The date of the annual members’ meeting will be finalised at a later date or delayed slightly to ensure that the annual report and accounts have been laid before Parliament before the annual members’ meeting takes place. 1. Non-compliance with the National Health Service Act 2006, The National Health Service (Quality Accounts) Regulations 2010 and the NHS foundation trust annual reporting manual 2021/22. 2. Ensuring openness, transparency and accountability regarding the performance and activities of the Trust. 3. Pressure on staff to provide information for inclusion in the annual report and accounts and the quality accounts as the Trust emerges from the latest wave of the COVID-19 pandemic, deals with significant emergency pressures and deliver the elective recovery programme. The Council of Governors is asked to note the timetable. Annual Report and Accounts (including the Quality Accounts) 2021-22 Timetable NHS England and NHS Improvement (NHSE/I) has published the timetable for the 2021-22 annual report and accounts and guidance on producing the annual report and accounts. This takes into account the pressures of the latest wave of the COVID-19 pandemic and feedback in earlier years of the COVID-19 pandemic that the process went on too long. NHSE/I have been consulting on changes to the quality reporting requirements over the past year and it is anticipated that changes will be made to the requirements in future years. In 2021-22 the requirements to produce a separate quality report have been removed, although the quality accounts requirements set out in The National Health Service (Quality Accounts) Regulations 2010 still apply requiring trusts to produce quality accounts, including circulation of the quality accounts to commissioners, local authorities, local Healthwatch and the Council of Governors by the end of April for comment. Some additional quality reporting will be required to be included in the performance report section of the annual report instead. There are also no external audit assurance requirements in respect of the quality accounts as a result of the changes to the NHSE/I guidance. As a result the deadline for submission of the annual report and accounts to NHSE/I has been extended to 22 June 2022. Additional time has also been allowed for the completion of the external audit of value for money introduced in 2020-21. The main changes to the requirements this year are: • reintroduction of the requirement for a performance analysis, which includes information on sustainability incorporating progress against the Trust’s Green Plan and information about social, community, anti-bribery and human rights; • removal of the quality report requirements and a requirement to include performance against quality priorities and quality indicators in the performance report in the main body of the annual report instead; and • new and expanded ‘fair pay’ disclosure requirements. The proposed timetable is set out below Action Deadline for draft accounts submission to NHSE/NHSI through NHSI Portal Draft quality accounts circulated to governors and Quality Committee members Issue final draft quality accounts to CCG, Local Healthwatch, Overview and Scrutiny Committee and Council of Governors for one month consultation Early May Bank Holiday Circulation of first draft annual report to external auditor, Board of Directors and Council of Governors Draft annual report and accounts reviewed at Audit and Risk Committee meeting Draft annual report and accounts reviewed at Board of Directors meeting Spring Bank Holiday Platinum Jubilee Bank Holiday Final draft quality accounts reviewed at Quality Committee meeting Date Tuesday, 26 April 2022 (noon) Thursday, 21 April 2022 By Friday, 29 April 2022 Monday, 2 May 2022 w/c Monday, 9 May 2022 Monday, 23 May 2022 Thursday, 26 May 2022 Thursday, 2 June 2022 Friday, 3 June 2022 Monday, 13 June 2022 Page 1 of 2 Action Final draft annual report and accounts including quality accounts reviewed at Audit and Risk Committee meeting Final draft annual report and accounts including the quality accounts approved by Board of Directors Deadline for submission of signed annual report and accounts and supporting documentation to NHS England and NHS Improvement Add quality accounts to Trust website and forward th
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Papers Trust Board - 29 November 2022

Description: Date Time Location Chair Agenda Trust Board – Open Session 29/11/2022 9:00 - 13:20 Conference Room, Heartbeat/Microsoft Teams Jenni Douglas-Todd 1 Chair’s Welcome, Apologies and Declarations of Interest 9:00 Note apologies for absence, and to hear any declarations of interest relating to any item on the Agenda. 2 Staff Story The 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 29 September 2022 9:20 Approve the minutes of the previous meeting held on 29 September 2022 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) 9:30 Dave Bennett, Chair 5.2 Briefing from the Chair of the Finance and Investment Committee (Oral) 9:35 Jane Bailey, Chair 5.3 Briefing from the Chair of the Quality Committee (Oral) 9:40 Tim Peachey, Chair 5.4 Chief Executive Officer's Report 9:45 Receive and note the report Sponsor: David French, Chief Executive Officer 5.5 Integrated Performance Report for Month 7 10:05 Review and discuss the Trust's performance as reported in the Integrated Performance Report. Sponsor: David French, Chief Executive Officer 5.6 Finance Report for Month 7 10:35 Review and discuss the finance report Sponsor: Ian Howard, Chief Financial Officer 5.7 People Report for Month 7 10:45 Review and discuss the people report Sponsor: Steve Harris, Chief People Officer 6 Break 10:55 7 Infection Prevention and Control 2022-23 Q2 Report 11:05 Review and discuss the report Sponsor: Gail Byrne, Chief Nursing Officer Attendees: Julian Sutton, Interim Lead Infection Control Director/Julie Brooks, Head of Infection Prevention Unit 8 Medicines Management Annual Report 2021-22 11:15 Receive and discuss the report Sponsor: Paul Grundy, Chief Medical Officer Attendee: James Allen, Chief Pharmacist 9 Equality, Diversity and Inclusivity (EDI) Update including Workforce Race 11:25 Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) Results 2022 Receive and discuss the reports Sponsor: Steve Harris, Chief People Officer Attendee: Ceri Connor, Director of OD and Inclusion 10 Annual Ward Staffing Nursing Establishment Review 11:35 Discuss and approve the review Sponsor: Gail Byrne, Chief Nursing Officer Attendee: Rosemary Chable, Head of Nursing for Education, Practice and Staffing 11 Guardian of Safe Working Hours Quarterly Report 11:45 Receive and discuss the report Sponsor: Paul Grundy, Chief Medical Officer Attendee: Diana Hulbert, Guardian of Safe Working Hours and Emergency Department Consultant 12 Learning from Deaths 2022/23 Quarter 2 Report 11:55 Review and discuss the report Sponsor: Paul Grundy, Chief Medical Officer Attendee: Ellis Banfield, Associate Director of Patient Experience 13 Freedom to Speak Up Report 12:05 Review and discuss the report Sponsor: Gail Byrne, Chief Nursing Officer Attendee: Christine Mbabazi, Equality & Inclusion Adviser/Freedom to Speak Up Guardian Page 2 14 Annual Assurance Process and Self-assessment against the NHS 12:15 England Core Standards for Emergency Preparedness, Resilience and Response (EPRR) Review and discuss the report Sponsor: Joe Teape, Chief Operating Officer Attendee: John Mcgonigle, Emergency Planning & Resilience Manager 15 STRATEGY and BUSINESS PLANNING 15.1 Board Assurance Framework (BAF) Update 12:25 Review and discuss the update Sponsor: Gail Byrne, Chief Nursing Officer Attendee: Craig Machell, Associate Director of Corporate Affairs and Company Secretary 16 CORPORATE GOVERNANCE, RISK and INTERNAL CONTROL 16.1 Register of Seals and Chair's Actions Report 12:35 Receive and ratify In compliance with the Trust Standing Orders, Financial Instructions, and the Scheme of Reservation and Delegation. Sponsor: Jenni Douglas-Todd, Trust Chair 16.2 Review of Standing Financial Instructions 2022-23 12:40 Review and approve the SFIs Sponsor: Ian Howard, Chief Financial Officer Attendee: Phil Bunting, Director of Operational Finance 16.3 Corporate Governance Update 12:50 Receive and discuss the update Sponsor: Gail Byrne, Chief Nursing Officer Attendee: Craig Machell, Associate Director of Corporate Affairs and Company Secretary 17 Any other business 13:00 Raise any relevant or urgent matters that are not on the agenda 18 Note the date of the next meeting: 31 January 2023 19 Items circulated to the Board for reading 19.1 CRN: Wessex 2022-23 Q2 Performance Report Note the report Sponsor: Paul Grundy, Chief Medical Officer Page 3 20 Resolution regarding the Press, Public and Others Sponsor: Jenni Douglas-Todd, Trust 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. 21 Follow-up discussion with governors 13:05 Page 4 3 Minutes of Previous Meeting held on 29 September 2022 1 Draft Minutes TB 29 Sept 22 OS v2 Minutes Trust Board – Open Session Date Time Location Chair Present 29/09/2022 9:00 – 13:00 Microsoft Teams Jenni Douglas-Todd (JD-T) Jane Bailey (JB), Non-Executive Director (NED) Gail Byrne (GB), Chief Nursing Officer Cyrus Cooper (CC), NED (from item 5.4 part two) Jenni Douglas-Todd (JD-T), Chair Keith Evans (KE), NED David French (DAF), Chief Executive Officer Paul Grundy (PG), Chief Medical Officer Steve Harris (SH), Chief People Officer Jane Harwood (JH), NED Ian Howard (IH), Chief Financial Officer Tim Peachey (TP), NED Joe Teape (JT), Chief Operating Officer In attendance Jane Fisher, Head of Health and Safety Services (JF) (for item 7.3) Sarah Herbert, Deputy Chief Nursing Officer (SHe) (for item 5.7) Femi Macaulay (FM), Associate NED Corinne Miller, Named Nurse for Safeguarding Adults (CM) (for item 5.8) Karen McGarthy, Named Nurse for Safeguarding Children (KMcG) (for item 5.8) Christine McGrath (CMcG), Director of Strategy and Partnerships Helen Potton, Associate Director of Corporate Affairs and Company Secretary (Interim) (HP) Helen Ralph, Manager, Transformation Team (HR) (for item 6.1) Annabel Shawcroft, Clinical Programme Officer, Transformation Team (AS) (for item 6.1) Jason Teoh, Director of Data and Analytics (JTe) (for item 5.11) Diana Ward, Clinical Outcomes Manager (DW) (for item 5.10) One member of the public (observing) 3 governors (observing) 5 members of staff (observing) 1 members of the public (observing) Apologies Dave Bennett (DB), NED 1. Chair’s Welcome, Apologies and Declarations of Interest JD-T welcomed all those attending the meeting which was being held by Microsoft Teams. Apologies were received from DB. CC would be joining the meeting later. 2. Patient Story HP introduced the Patient Story which focused on the experience of a mother and daughter who had used the Trust’s services. Mum advised that during the pandemic, her daughter had been diagnosed with cancer in her abdomen at the age of nine years old. Page 1 Her daughter had surgery followed by nine rounds of chemotherapy at the Trust followed by radiotherapy in London. Whilst on maintenance chemotherapy her daughter had relapsed and sadly a decision was made that further treatment would not be beneficial. Her daughter’s response was to write a “bucket list”. Some of the items were for herself but some related to changes that she wanted for other people including wanting parents to be fed. Her daughter could not understand why, when she was asked what she wanted to eat, that this did not extend to her mum, when her mum was in the hospital supporting her. Her daughter had not wanted mum to leave to go and eat, and no one else could come to sit with her because of the COVID restrictions. Her daughter was scared and going through gruelling treatment and that made it very difficult for mum to leave her. In addition, her treatment had affected her smell, making her feel unwell which resulted in her mum eating in the ensuite toilet as there was nowhere else to sit and eat. After her daughter died, mum had been working on items from her daughter’s bucket list, with senior representatives of the NHS. Work focused on putting in place a national programme to feed parents, improve food for children and also the provision of play specialists. In terms of food, mum had been working with UHS’ Patient Support Hub since January. Initially snack and toiletry boxes were put into every parent room but now, every children’s ward across Portsmouth and Southampton, a total of 17 wards, received food and drink every week. A charity, Sophie’s Legacy, had been set up and a trial had started that provided parents with a £4 food voucher for the restaurant, which was in addition to the support provided by the Patient Support Hub. The initiative had been well received by parents. The hope is to roll this out across the Country as looking after parents was important to enable them to support the care of their children. JD-T thanked mum for sharing noting how devastating it must have been to lose her daughter and how amazing it was that she and her daughter had wanted to support others in this difficult time. GB also thanked mum for sharing the experience and the work that was being done in her daughter’s name, which was important to continue. DAF noted how extraordinary that at the age of nine her daughter was considering the future of others. DAF asked whether mum had good links with the hospital charity and SH confirmed that he would make contact to ensure that this happened. Action: SH JT noted the importance of good facilities being available including good quality, affordable food. It was important for the Board to look at this and also to look at the estate to ensure that there was appropriate spaces provided for parents. 3. Minutes of the Previous Meeting held on 28 July 2022 The minutes of the meeting held on 28 July 2022 were approved as an accurate record of the meeting save for the following amendments: Page 2 • Page 3 – Correct spelling of Beachcroft • Page 3 – 5.3 third bullet – should read compliant not complaint. 4. Maters Arising and Summary of Agreed Actions Actions that were due had been completed. Action 763 – The complaint data was being compiled and would be sent out shortly. The remaining actions were not yet due but were being taken forward. 5. QUALITY, PERFORMANCE and FINANCE 5.1 Briefing from the Chair of the Audit and Risk Committee KE provided a briefing following the meeting on 12 September. The External Auditors had signed off their opinion on the financial statements with a clean opinion being given. From the Internal Auditors three reviews had been completed. The incident management review had focused on smaller incidents, noting that major incidents would normally be highlighted quickly. A large number had been tested and the conclusion was that the Trust needed to work on turning the reports around within the ten-day period. The Cyber Security review was one of significant assurance. However, the report highlighted that the Trust did not have formal documentation in terms of a Cyber Security Strategy and that not much training was provided for staff. Finally, in terms of General Data Protection Regulation (GDPR) and personal information, the Trust was required to have a “record of processing activities” (ROPA). The Trust undertook hundreds of activities but did not have a ROPA for every activity and the recommendation was to review and put in place an appropriate policy to enable a more general approach for wider coverage. The final review was stage 2 of how the Trust managed and governed IT projects. The report had focused on three areas: • The initial assessment of the benefits of the IT project which had been found to be thorough and well thought out and documented. • More guidance was recommended on how to evaluate benefits particularly in terms of non financial benefits including safety benefits. • There were very few post benefit assessments being completed which would help with learning. Plans were in place to put additional controls in place by March 2023 and a review would take place as part of their follow up procedures. JT reminded members that he had arranged for Cyber training for the Board and had agreed to provide further assurance around some of the arrangements and the Internal Audit was aligned to this. JT noted that staffing arrangements would need to be reviewed as currently there was only one colleague within the digital team that worked on cyber security issues. HP informed the Board that work was already underway in terms of the work around ROPAs. Action: JT Page 3 5.2 Briefing from the Chair of the Finance and Investment Committee JB provided an update from the last meeting noting that discussions had taken place around the current financial position and the operational plan, both of which were due to be discussed in the closed board meeting. There was significant challenge particularly around the deficit position but overall there was a really good grip on exactly where the Trust currently was, with appropriate decisions being made to reflect the balance between managing the financial position, whilst continuing to support our people and activity. A number of ongoing actions around productivity were being addressed together with a clearer view of the future cash position of the Trust. Finally, JB noted that Model Hospital data had been reviewed to enable the Trust to drive efficiencies compared to other hospitals and to facilitate learning. 5.3 Chief Executive Officer’s Report DAF noted that this was the first time that the Board had met since the death of Her Majesty Queen Elisabeth II and wanted to formally recognise the fantastic public service that she had given. The state funeral, which gave an additional bank holiday, provided the Trust with some challenging operational issues, with little guidance being provided in terms of what the best approach should be. Where staff were not involved in urgent or emergency care, such as within outpatients, electives and day case procedures, they were given the choice that if they wanted to work that would be gratefully received, but similarly if they wanted to take the day off to pay their respects, they were able to. Some staff wanted to work and others wanted to take the day. More than two thirds of the scheduled activity had been undertaken. DAF thanked all staff for all of their hard work and dedication. He also noted that: • The pilot of the care village had been very successful and would be discussed further in the next item. • Junior doctor pay rates had been quite challenging and was symptomatic of where the Trust was with many members of the workforce. The Royal College of Nursing (RCN) had notified the Trust of an intended ballot for strike action. Also, the British Medical Association (BMA) had published a rate card that they wanted trusts to pay, which was in many cases, significantly above current ratees. DAF noted that there were groups of staff who had indicated that they would not work for the Trust unless paid the new rates. It was a period of instability and people were understandably wanting to protect their income which was manifesting in the behaviours that we were seeing. • The HR team had been recognised by the Chartered Institute of Professional Management (CIPD), for a National awards which was a testament to the good work that SH and his team did. • The number of COVID positive cases was increasing with around 70 currently in the hospital. Mask wearing had been re-introduced in clinical areas in an attempt to limit the number of nosocomial transmissions. Care homes were not willing to accept patients with COVID which would impact potential discharges. In terms of staff Page 4 absence from COVID this was also increasing and staff were being encouraged to have both COVID and influenza vaccinations. • UHS was in the process of finalising an IT contract which, at first glance looked like it could be a replacement for our Emergency Department (ED) IT system. The initial contract was small but included from a strategic perspective, as the Trust had recognised the potential for having a longer-term development partner. UHS remained committed to its “Best of Breed” strategy but had been struggling to recruit and retain the people needed to develop the systems and this could be a step to delivering this by working together in partnership. Ultimately this could result in UHS not only being able to bring to develop our systems but also had the potential to bring to the market a number of our IT products that we had developed. • At the previous month’s board, the Trust had been aware of its segmentation under the Single Oversight Framework (SOF) review, but had omitted to formally advise the board. The Trust remained in segment 2, with 1 being good and 4 being bad. Trusts in segments 3 and 4 received more dedicated support and oversight. This was a vote of confidence from the regulators in the Trust despite the challenges it was facing. TP noted that the BMA pay card had received much criticism and should be resisted unless there was a proper negotiation about the rates. In terms of the IT partnership this was excellent news. PG noted that the Trust had been very clear through the Local Medical Councils (LMC), and individual conversations with teams, that the Trust would not be entering into negotiations about the BMA rates. It was growing as an issue but was an untenable position to hold in front of the rest of the workforce. Meetings were taking place with teams noting that it was not just about money. PG had been clear with his medical consultant colleagues that he was not able to recommend that consultants were paid as much in one day for an overtime operating list, which was greater than the amount some staff received in a month. In a cost-of-living crisis this was wrong. Many colleagues had understood this approach but there was still many who were very unhappy. JH congratulated SH for the award noting that this was a very difficult award to achieve, with tough competition, and that to achieve it during the pandemic was outstanding. Decision: The Board noted the report. 5.4 Integrated Performance Report for Month 5 (part one) JT noted the challenges that the Trust was currently under and in particular highlighted: • The previous day had been particularly tough with every space in the hospital full and lots of patients in the ED waiting for beds. This was replicated nationally with many organisations had declared critical incidents due to the pressures being faced. It was caused by increased numbers of COVID positive patients and a big spike in the number of delayed patients in the hospital which had hit 245 patients at the start of the week, with almost a quarter of the bed base who could be treated elsewhere. Page 5 • There was a record number of cancer referrals with the waiting list being the highest it had ever been. The Trust continued to deliver more diagnostic capacity than it had ever delivered but continued to struggle with capacity in view of the increased demand. This was a very difficult position alongside a time where staff morale was low and staff were tired due to the pressures over the last couple of years. • One of the two spotlights related to cancer and the Board had a study session the following week with a deep dive. Referrals had grown by about 25% per month from around 1600 two-week referrals to consistently above 2000 per month. The backlog of patients who had breached 62 days had gone up three-fold in the last two years from around 100 to 370 patients. The overall number of patients on the cancer pathway had also doubled in this period. This was challenging for a group of patients that the Trust wanted to prioritise in terms of access to services and care. • Across the Wessex Alliance footprint the backlog remained better than the rest of the Country but it was not where we would want to be in terms of cancer services. It was likely that our performance would dip as we started to treat those patients which would impact the 62 day target, despite the levels of activity and delivering relatively well in terms of our peer groups. • There were some excellent new pathways being developed including the dermatology dream pathway which would make a significant impact on the skin pathway once implemented. Work was also being done with the cancer allowance to map what we had, against what we needed to understand better the gaps. DAF noted that the cancer performance metrics were a measure of the patients that had been treated. Once you had a number of patients above the 62 days, if you did not treat them and let them remain on the waiting list. your measure would remain strong. However, this was not the right thing to do but once you had treated them this would impact that metric which was likely to be poor over the coming months. TP noted that the waiting had continued to get bigger which would suggest that either the Trust was not coping with the numbers coming through and people were therefore waiting longer and longer or that there was a higher rate of cancer in the population. Was this as a result of COVID reducing the body’s ability to fight small cancers that would normally disappear. JD-T also noted the highest number of referrals happening in August and wondered whether there was any national modelling being done around this. JT informed members that Professor Peter Johnson would be one of the presenters at the board study session and this would be a good opportunity to explore this. Anecdotally we appeared to be seeing more sicker patients who had a number of co-morbidities presenting as more complex patients and work was underway to investigate this further particularly from an inequality lens in terms of the demographics that were being referred on the two week wait referrals. PG noted that during COVID people tended to not present which was part of the reason for a backlog of presentations but that diagnosis appeared to also be increasing. Understanding why was not yet known and a discussion in the study session would be helpful to understand that particularly better. In terms of the appraisals spotlight SH noted: Page 6 • That a key element from the People Strategy was the Trust’s ability to provide meaningful progression for our staff. From the feedback given in the staff survey many staff believed that during the pandemic they had not received the development, training or the appraisal focus that they would have wanted. • Work to address that included a multi disciplinary team who had focused on refreshing the appraisal paperwork which had been well received. The team had a wide breadth of staff including clinical, operational and trade union representatives. Previously the number of appraisals carried out had been good but the quality had been low so training for appraisals had been reviewed to improve the quality of the appraisal discussion. Whilst the Trust was better than its peers, this simply highlighted that the NHS was not particularly good at appraisals. • A pilot had been implemented to better align appraisals with objective setting to enable them to cascade down to staff better which would conclude shortly and would feed into the process. JD-T noted that Division D consistently outperformed the other Divisions in terms of completed appraisals. In addition the staff survey showed that they were the only division that achieved a green in terms of an appraisal helping staff to undertake their job. This showed a correlation between the two and wondered what was the learning was. SH noted that Division D had historically had good rates of completion and had been involved in the refresh and had highlighted the need to focus at every level of the team. JH asked whether those within Division D had better promotion and development opportunities which could link back into the value of conducting a good appraisal. SH advised that there was nothing obvious but Division D had some good engagement scores overall but this could be looked at further. GB noted that the new appraisal paperwork had removed the need to consider how an individual contributed to the values of the organisation, and although the values were still referenced, questioned how through appraisal the behaviours and values continued to sit within the process. SH noted that the review of the values work was important and it would be good to look at how that could be brought back into the appraisal process to add value. Decision: The Board noted the report. 5.5 Finance Report for Month 5 IH presented the report and highlighted: • The Trust continued to focus on the underlying deficit, which for months 1 – 4 had been around £3m which had slightly worsened to £3,5m as energy costs started to grow. A deep dive had taken place at the Finance & Investment (F&I) Committee looking at some of the actions being undertaken and some of the future forecasts before the energy cap would come in and whether this would help or otherwise. There would still be a small increase in run rate into the latter half of the year which would deteriorate the Trust’s underlying position as we entered the winter months. • The key drivers were consistent. As well as energy prices, there were some drug costs pressures as we were on a block contract, cost associated with COVID including backfill of staff together with all of the operational pressures that had already been discussed. Page 7 • Cost Improvement Programme (CIP) performance had improved following the introduction of the Cost Savings Group. The Trust was currently achieving more than 80% identified which should increase going forward. In month delivery had also been strong. Everything was being done to try and improve the financial position but there were a number of pressures that were outside our control that would impact this. • Elective recovery framework performance had dipped in line with the operational pressures discussed, but UHS continued to achieve 106%, above the required 104%. UHS was in the top Trusts both in the region and nationally in terms of activity levels compared to 2019/20 levels. However, this was not resolving the waiting list issue that continued to grow. UHS continued to do well in terms of 2019/20 levels compared to other Trusts but this did create a financial pressure. • The Trust had reported a £12m deficit. The Hampshire and Isle of Wight deficit was £53m. This was an outlier within the region, and the region was an outlier nationally. This had resulted in the system becoming an outlier in terms of financial performance which might have adverse consequences going forward including upon the SOF rating. • The underlying deficit reduced the Trust’s cash balance and that may put pressure on our future capital investment programme. KE referred to the financial risks table and asked what the difference was between the original worst case of £57m and the forecast assessments which showed, best, intermediate and worst case? IH noted that the original worstcase scenario had been presented to the Board as part of the planning submissions, to show the range of possible financial outcomes with everything that was known at the time. The current best, intermediate and worst case were the current assessments. KE noted that UHS could not control COVID costs, energy costs and inflationary measures and that this would need Treasury to provide support. IH reminded members that nationally there was a drive to find efficiencies. It was likely that many Trusts would go into deficit this year but it was not clear what the response would be to that. KE commended the work on the CIP which was a fantastic achievement. He questioned whether the position could improve further with more CIP savings. IH advised that a target date of Month 6 had been agreed in terms of everything being identified 100% and the position might improve next month. IH noted that UHS was at 106% activity levels with the national average being around 94%. The 12% from the Elective Recovery Fund (ERF) would be worth about £20m to the Trust. If the Trust had undertaken less activity the Trust’s financial position would be a lot less stark but UHS continued to put patients first and try and balance performance, money and quality. In response to a question from JD-T IH confirmed that as of today and what was currently known, UHS could still achieve the best-case scenario. DAF suggested that in view of what had happened in markets over the recent days it was unlikely that the NHS would want to approach the Treasury. UHS should proceed on the basis that there would be no financial support being provided. In those circumstances the Board would need to consider at what point more significant interventions would need to be made. Page 8 5.6 People Report for Month 5 JD-T noted that this was a new report for the board. Previously the report had been presented to the Trust Executive Committee (TEC) and following discussion in that forum a decision was made that it should be presented to the open board for discussion. SH presented the report and noted that the version before the Board was the detailed report presented to TEC. Going forward a more streamlined report, with key highlights, would be developed for the Board discussion. SH highlighted: • Some of the key actions that had been taken in relation to recruitment and retention and also the cost-of-living crisis. There had been discussions at a previous closed board meeting around concerns in relation to the recruitment and retention of certain staff groups and some actions had been put in place to mitigate those concerns. • SH highlighted the challenges around Advanced Clinical Practitioners (ACPs) and pay rates. A few local organisations including GP practices were providing a differential rate of pay with a higher pay band. In the short term this was being addressed by a recruitment and retention premium to bridge the gap, together with conducting a workforce review that would seek to understand the banding and whether there was a need for a permanent band change. However, it would be important to consider the possible impact on the change to other bands across the Trust and manage that appropriately. • UHS continued to undertake Health Care Assistant (HCA) recruitment well, but the challenge was retention. There were good pathways in place but work was needed to strengthen landing boards and increase the support available in the hubs and implement some band 2 to band 3 progression roles for those who did not want to utilise the nursing apprenticeship route. • Demand on the recruitment team had significantly increased with a 25% increase of requested support. Some additional resource had been agreed to support them both within the organisation but also to increase engagement outside of the organisation. • In terms of cost of living, SH had been undertaking a lot of work with partners across the Trust including trade unions and listening to staff voices. There were a number of elements that were not under the Trust’s control including the national pay award and the rising energy crisis so the approach being taking was to take a balanced and fair approach. A number of things would be implemented which would be highlighted to all staff. A substantial discount was being negotiated in the restaurant to help people to eat a broad range of foods at competitive prices. The cycle to work scheme was being expanded, and there was some targeted support for those with high mileage within the organisation. For the 200 or so families who used the nursery the price was being rolled back to April this year. • The Trust already has a range of general support which would be expanded to make sure that we were targeting the right people. Through a partnership with the ICS we were linking up with the Citizens Advice Bureau to provide really high quality financial advice to our staff. We were focusing on crisis, and working with the Charity, had set up a hardship fund of £20,000 which would be distributed to the most challenging cases where staff had been identified as a particular Page 9 hardship case they would be able to eat free at the restaurant. Arrangements had also been made with a local charity to provide vouchers and food parcels. Discussion had taken place as to whether a food bank should be set up on site which logistically would have been difficult, so the decision to work with the charity was agreed to be the best approach to deliver that service for us. • Discussions had taken place at the Trust Executive Committee (TEC) who had fully supported the measures noting the impact on the nonrecurrent spend. KE suggested that this was a very sensible, targeted group of things to support our people. However, asked if the cost of £2.3m was currently included in the financial reports. IH advised that it was not included although some of the nonrecurrent elements had a funding source so would not hit the underlying position. In terms of annual leave buy out there were accruals from previous years. However, there were some recurrent costs. The measures were targeted, proportionate and in line with the Trust’s values for the current pressures being faced and if the Trust did not do anything it would likely increase costs or consequences elsewhere. DAF noted that the report was the same as presented to the TEC at which there had been a more detailed conversation. It would be helpful to understand which areas of the report were more relevant and appropriate for the Board conversation which could be discussed at the next People and OD POD) Committee meeting. Action: SH. JH supported the proposals within the paper and noted that they had also been presented to the People and OD Committee (POD). POD would be tracking the progress of each of the initiatives to ensure that they were delivering as anticipated. JH asked if the Trust had looked at what others were doing to ensure that we were doing everything possible for our staff. SH confirmed that discussions had taken place locally and that the Trust was one of the first to implement the range of measures which were similar to those of others. Nationally, there had been a push to have a collective response, noting that the NHS employed 1.5m people and that there would be national support that would be available shortly. TP noted the importance of having a people report at the Board and whilst the contents were good suggested that they could be presented in a more accessible way. FM also noted the importance of the report and discussion but wondered what staff morale was. If the finance, performance and people report were considered as a whole it was clear that staff were facing a lot of pressure and there was insufficient staff due to high turnover. The volume of patients was increasing which meant that the staff that the Trust did have, had to work harder and longer with pay that was not great and a cost-of-living crisis to deal with. This must have an impact on staff morale and was there also an impact on patient care? SH noted that morale was challenged which was recognised in the executive updates. The Trust undertook a quarterly staff survey alongside the current national annual staff survey and those results have been included within the report. The recent results discussed motivation, engagement and advocacy in Page 10 the organisation and UHS scores were still consistently in the top 10 of the NHS. However, the entirety of that engagement score was deteriorating. Morale was challenged and how that impacted on care was discussed in other forums. GB chaired the Quality Governance Steering Group (QGSG) which fed into the Quality Committee and focused on quality whether that be from the engagement of our staff or other challenges. GB suggested that it was a mixed picture. People enjoyed working as a team and we can see them pull together and work as a team through the challenges. There were a number of different pockets in the organisation who believed that they were in a worst situation following the pandemic and it was important to move out of that space and recognise this as a whole. In terms of quality, it was important to retain a close focus on quality and in some other Trusts they were starting to experience a significant challenge with regards to their quality indicators. At UHS there were some potential early indications that were being closely monitored. Without a doubt staffing levels, and the way in which we looked at the wards, impacted on patient experience and outcome. JD-T noted that one of the proposals was for staff to be able to sell back annual leave and being able to easily access the bank but if this was considered in the wider context, we had staff who were tired and not able to take leave as they had sold it, and were looking to work extra hours on the bank. How did the Trust manage and balance this? How should we look at the overarching risks for the workforce, and consequently patient care and performance, and what were the things that we needed to do to balance that. It would be helpful if the report could address some of those challenges to help the Board’s understanding. In addition JD-T asked NEDs to feedback what they would want to see within the report to enable an effective discussion. Action: SH and All NEDs JH asked about exit surveys and wondered if there was any information from them that could support our approach. SH advised that approximately 30% of staff completed exit surveys which needed to be increased. Pay for the lower paid staff had become an issue. SH reminded members that he chaired the ICS people officers group and that group had been looking at how collectively they could support retention and were looking to purchase better exit surveys for the system pulling together their collective buying power. Decision: The Board noted the report. 5.4 Integrated Performance Report for Month 5 (part two) Having noted the previous discussions under items 5.5 and 5.6 JD-T suggested that a discussion on the remaining of the IPR would be helpful and the following questions and comments were made: • JB noted that on pages 31 and 35, F1 – F5 this suggested that in terms of digital we believed that this was going to transform our efficiencies but it was not clear what the metrics indicated nor were some of them very high. PG suggested that there was an amazing resource in my medical record which we were not really making the most of. Work was needed to raise awareness with both patients and clinicians. Having used it as a patient it had been really helpful and enabled him to go paperless. JT noted that there was a business case that was overdue Page 11 for my medical record around how we industrialised it across the Trust which should provide some huge benefits and would bring a timeline back as to when this would happen. Action: JT JT noted that there was some big digital change happening with the rolling out of speech recognition and some E tools. In addition it would be helpful to look at the indicators to understand whether they were the right ones and review them as part of the digital updates which could be discussed at F&I. Action: JT The Board discussed the importance of giving people an overwhelming reason to access my medical record noting that the NHS App had initially been used for COVID vaccinations but could now enable people to order prescriptions and book appointments. JD-T noted the Serious Incident reports and the number of harm falls which looked higher than previously and wondered in terms of the pressures we were seeing and the issues around workforce should the Board be concerned about this? GB advised that it had recently been falls awareness week. There had been a number of successful programmes in the Trust including bay watch, but with reduced staffing numbers that had became a challenge and some more deliberate high impact actions were needed to reduce those falls. A deep dive into this would be brought to a future meeting. Action: GB GB confirmed that COVID numbers were rising. There were 66 patients with COVID some of whom were both asymptomatic and symptomatic. 5.7 Break The break took place prior to the Safeguarding Annual Report. 5.8 Safeguarding Annual Report 2021-22 and Strategy 2022-25 JDT suggested that the strategy should be discussed first noting that both had been discussed at the Quality Committee. KMcG presented the strategy which had previously been presented to the Trust Board two years ago before Covid. The strategy had been reviewed and updated in line with new legislation and aligned to UHS values and now included maternity services. Some of the strategy linked to children and adult reviews and making safeguarding personal together with our partners and developing stronger links within maternity, the emergency department and the wider hospital. Joining this up with the domestic abuse strategy and ensuring that we were always improving particularly around training and education including level 3 requirements. In terms of the Annual Report from a children’s perspective there were three main highlights: Page 12 • A significant increase, from 3700 to 6004, in the number of information sharing forms (ICF) which come through the ED where a child may possibly be at risk. In particular numbers had increased in the number of children presenting with mental health problems, particularly the 0 – 4 age group. This had been discussed at the Health Safeguarding Looked After Children Partnership who were looking at the 0 – 19 service provision which had changed significantly with COVID and a possible pattern of children of parents accessing through ED rather than going via their GP. • In terms of mental health, for any child who presented in the ED with a mental health condition an ICF would be completed. The number of presentations remained high. Alongside this the number of deliberate harm incidents had risen from 676 to 898, drugs and alcohol referrals had risen as had assaults over the preceding year. • Level 3 safeguarding training was at about 61%. There were two main reasons for this which was capacity and demand for the service and also a change of reporting requirements impacting just over 2000 staff. Training was on the Integrated Care Board (ICB) Risk Register as it was a wider system issue. In terms of the Annual Report for adults CM highlighted the following: • A 31% increase in safeguarding activity from the previous year with a 162% increase in Section 42 inquiries. This was due to a number of reasons including the impact of COVID including the removal of social distancing rules. • A 35% increase in the number of allegations made against people in a position of trust which was something that was being seen across other local provider organisations. These were highly sensitive cases and required significant safeguarding oversight and management alongside collaboration with HR colleagues and the relevant clinical areas, which had a significant impact on the team. • The creation of a new Mental Capacity Act (MCA), Deprivation of Liberty (DoL) and Liberty Protection Safeguards (LPS) team who supported people over the age of 16. Both locally and nationally this was one of the first teams that had been established. The team had worked to embed MCA as every day business which was key to the preparation for when LPS become law later next year or early the following year. • In terms of Learning Disability and Autism there was a lack of local provision which had been acknowledged by the ICS and work was underway in relation to service review and what this needed to look like going forward. GB thanked the team noting how hard they worked to safeguard vulnerable adults and children. GB referenced the Panorama programme that had aired the previous night in terms of a number of safeguarding issues against a Mental Health Trust. Whilst often allegations against staff were not grounded they were taken very seriously and investigated thoroughly. JB noted the 35% increase against staff and wanted to understand what the outcomes of the investigations were and whether they were justified and whether allegations were being made against different groups. CM advised that one of the key areas of allegations focused on restraint and that the level Page 13 of restraint applied was disproportionate. These would always be reviewed. Security staff worked in pairs and wore body cameras which would always be reviewed. There had not been any cases recently where that had proved to be an issue. Although there had been a big increase the total number of cases was 38 so not large numbers. The previous year there had been 23 cases. CC questioned what element of this sat within the Trust and what sat with the ICS? SH noted the importance of remembering the broader picture. Nationally there had been a rise of safeguarding incidents, but it was important to remember that our workforce formed part of that population and had struggled with lockdown and were experiencing hardship. JD-T noted the need for a system approach to manage the increased mental health demand. However, safeguarding was a key focus for the Care Quality Commission (CQC) inspections post COVID, and a local provider had recently been deemed to be inadequate due to safeguarding issues and was an issue for UHS to pay particular attention to. KMcG noted that through legislation children had the Local Area Designated Officer (LADO) which was lacking in adults, which provided a really strong link with that external partner. TP noted that there had been a detailed presentation on this in the Quality Committee. This was a national trend in increased safeguarding problems. Whatever pressure we are put under it was important not to let our safeguarding procedures slip and it needed to be protected to ensure that it worked well. Decision: The Board received the report. 5.9 Medical Appraisal and Revalidation Annual Report including Board Statement of Compliance PG presented the report which was a statement of compliance with the medical regulations and had a robust and strong process in place. PG noted that a new appraisal system had been introduced which had been well received and enabled the ability for medical staff to collect all of their appraisal information within one system instead of the previous three systems. This was beneficial for not only staff but also for those managing the process as it provided real time feedback and information both from a quality assurance perspective but also would enable better management of the process and improve appraisal rates in the future. JD-T asked whether the doctor appraisal information was included within the IPR information that the Board received and SH confirmed that it was reported separately but included in the report and currently stood at 76.7%. CC suggested that the system was good but asked whether everyone was using it. PG confirmed that the system was a mandatory one and would be the only system going forward in the future. In terms of how many staff had undertaken the process this was a little ahead of the rest of the staff. However, the system enabled us to keep better track as people would need to have completed four appraisals within the previous five years to go forward with revalidation which provided a good incentive to keep on top of this. Page 14 JD-T asked for Board members to confirm that they approved the statement of compliance. Decision: The Board noted the report and approved the statement of compliance. 5.10 Clinical Outcomes Summary PG introduced the comprehensive summary noting that the clinical lead who had ran the service for a number of years, had now left UHS and a process of recruitment was currently underway which would provide an opportunity to refresh and review. DW presented the paper and focused on the outcome programme which was unique to UHS, with 64 services out of 86 reporting their outcomes. A total of 484 outcomes had been reported all of which had been reviewed by TP via the Quality Committee. There was a thriving clinical audit programme in place. The outcomes reported per care group covered a large proportion of patients and dealt with both national and international work. In particular DW highlighted: • The Research and Development (R&D) team and the work that they had undertaken internationally on the COVID booster trial. • The Bone Marrow Transparent unit. • Maternity and the nest support teams who focused on women who may need additional support because of serious mental illness, or they were from socially challenging situations, or were non-English speaking, addiction, were homeless or were suffering from domestic abuse and other difficult situations. 12% of patients that were being seen in maternity required nest care. KE asked why 18 services were not reported and DW advised that it was because they did not have the mechanisms in place to know what their outcomes were and work was underway to support them to develop those processes. KE asked whether any of the reds within the report were really poor and JD-T noted that the data used was for 2020 and did not understand why it was so out of date. TP advised that data was provided from national audits was often two years behind, because there was a year of collection, a year of analysis and then it would be published. Within his experience he had never come across a hospital that had measured nearly 500 clinical outcomes let alone p
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